The 5-hour CT scan

A woman was forgotten in a CT scanner. Scary thing is, this wasn’t the first time this happened:

A physician who works at the practice and knew of the incident said it’s not the first time such a thing has happened. “People have been left in the office after hours, when something like that happens “” it’s the same sort of thing,” said Dr. Steven Ketchel. “My guess is she was lying on the table, waiting and waiting and nobody told her she could go home.”

Comments

Anonymous
Sometimes the radiology staff forgets that attached to those black and white images are real flesh and blood patients.
Anonymous
There’s really no excuse for this happening, especially when it apparently has happened more than once.
After the first time, they should have reviewed their procedures. How hard is it for a tech to inform the patient that the procedure is done and to ensure the patient is signed out? And it just seems like a common-sense security measure that you would do a final sweep of the building before locking up and going home for the day.
This is just sloppy… and totally avoidable.
Toni Brayer MD
This takes patient DISsatisfaction to a new level. Talk about a non-patient centered clinic. The astonishing lack of caring and professional behavior this practice manifests is a shock. I hope they lose their imaging license.
Anonymous
To Anonymous #1: Before you give other readers the false impression that this was a radiology facility, please visit the facility’s web site (www.arizonaoncology.com). You’ll notice there isn’t a single radiologist on staff. These are all medical and radiation oncologists — self-referrers — who regard imaging as a profitable side venture. Their handling of this patient is telling.
And Dr. Brayer: There is no such thing as an imaging license. Anyone who can afford to plunk down several million dollars can buy one of these, open up shop, and start cranking patients through. A facility like this has none of the checks and balances inherent in a radiologist-operated facility. Instead, there’s the temptation to scan everyone who walks through the door, and no one looking over their shoulder to check whether what they’re doing is indicated or even done properly. The end result is a facility doing high-ticket imaging but treating it as a hobby that pays.
Maybe they should stick to eBay.
Anonymous
anon 10:00
re: “You’ll notice there isn’t a single radiologist on staff. These are all medical and radiation oncologists — self-referrers — who regard imaging as a profitable side venture. Their handling of this patient is telling.”
1: The scans are read by radiologists whether or not they are staff.
2: No argument it it was a screw up, indefensible, and possibly a job ending mistake by the rad tech. But are you saying the rad onc/heme onc docs should walk through the rad facility every night? Are you saying that these professionals who deal with cancer everyday with HUMAN BEING’s (not reading CT scans all day) are somehow less caring than you? Those are mighty damning words for someone who isn’t in direct primary patient care (if you are a radiologist). Additionally, the primary heme/onc rad/onc doc who is actually giving chemotherapy/radiation therapy probably has a better idea “when” a f/u scan is or is not indicated than a radiologist who has never even seen the patient.
2:
Anonymous
To anonymous 9:16 AM:
Oh, where to begin?
“The scans are read by radiologists whether or not they are staff.” First, that’s (sadly) not necessarily true. These guys could be reading their own scans [shudder]. Second, even if it is true, I’ll bet those radiologists are not on site — the images are most likely sent electronically elsewhere — and therefore radiologists don’t have supervisory role in the operation of that facility. I don’t have firsthand knowledge of the facility, but with my experience in the field, that’s the typical arrangement.
“But are you saying the rad onc/heme onc docs should walk through the rad facility every night?” You bet. That’s what I do. Imaging is my profession, and my responsibilities include everything from training techs, educating our schedulers, monitoring our receptionists, providing feedback to our transcriptionists, gathering and preparing accreditation material, and, yes, walking around the place to make sure everything is in order — in addition to reading the imaging studies, talking to patients and their families, and consulting with referring physicians. These are the responsibilities of a radiologist running a full-service imaging center. When a patient comes in to such a center, he or she is getting the full-time attention of a group of professionals who are dedicated solely to imaging, not treating it as a side venture.
“Are you saying that these professionals who deal with cancer everyday with HUMAN BEING’s (not reading CT scans all day) are somehow less caring than you? Those are mighty damning words for someone who isn’t in direct primary patient care (if you are a radiologist).” How naive. Let’s take today, a typical day, as an example. What about the seven biopsy patients with whom I spent roughly 30-40 minutes each discussing the procedure, performing the procedure, and counseling afterwards? How about the time I spent with their family members afterwards telling them how the procedures went and what to expect next? How about the time I spent reviewing a chest CT scan with a worried smoker whose 4 mm nodule we’ve been monitoring periodically? How about the 11 year old gymnast whose distal radial epiphysis looked a little wide but who had absolutely no point tenderness there on my directed physical exam which permitted me to conclude that it was a normal anatomic variant? What about the three different women, each of whose pelvic sonogram revealed what was likely to be a hemorrhagic ovarian cyst, with whom I spent time talking about the findings, reassuring each about the high likelihood of a benign outcome, and discussing what the possible next steps were likely to be? Or the patient who had a breast biopsy last week, noticed redness near the biopsy site over the last few days, and came in to be evaluated, revealing an obvious simple hypersensitivity reaction to the bandage rather than a post-procedure infection?
These are the typical events in my day at our full-service imaging center. If self-dealers like these guys are allowed to propagate and thereby cherry-pick all the high-end imaging studies, then full-service imaging centers will cease to exist. It is impossible to make a living on plain films, barium studies, and mammography. At that point, radiologists will have no choice but to relegate themselves to reading studies for these self-dealers, and your currently unrealistic view of radiologists will become reality — we’ll all be sitting in isolation in dark rooms, reading CT scans. And all of medicine will be the poorer for it. Isn’t the conflict of interest inherent in having the person ordering a test also profiting from it obvious to everyone?
“Additionally, the primary heme/onc rad/onc doc who is actually giving chemotherapy/radiation therapy probably has a better idea ‘when’ a f/u scan is or is not indicated than a radiologist who has never even seen the patient.” I don’t disagree at all. But to jump from that premise to the notion that the oncologist ought to derive a financial benefit from ordering the scan defies logic. To anticipate your rebuttal, the convenience argument is a smokescreen. These are horrendously expensive machines with considerable ongoing expenses for lease payments, maintenance contracts, software upgrades, site upgrades such as chillers and shielding, and at least two highly reimbursed technologists to run the equipment. These are not stethoscopes or blood pressure cuffs. These can’t be sitting idle, waiting for Mrs. Smith’s checkup to conclude so that she can stride into the scanner with no waiting. One cannot begin each day with an empty scanner schedule, waiting for the day’s office visits to generate enough business to justify the existence of the scanner.
Tell me that that’s not a recipe for inappropriate use of imaging equipment.
Anonymous
Oh where to begin:
“”The scans are read by radiologists whether or not they are staff.” First, that’s (sadly) not necessarily true. These guys could be reading their own scans [shudder]. Second, even if it is true, I’ll bet those radiologists are not on site”
The simple fact is these scans are read by radiologist for the simple reason of liability if nothing else. You know it and spewing a smokescreen otherwise.
“”But are you saying the rad onc/heme onc docs should walk through the rad facility every night?” You bet. That’s what I do. Imaging is my profession, and my responsibilities include everything from training techs”
Then you are a rare duck. Most radiologists I have seen are usually long gone before the techs close up shop. If they have late reading to do it is via a pacs screen at home.
“Are you saying that these professionals who deal with cancer everyday with HUMAN BEING’s (not reading CT scans all day) are somehow less caring than you? Those are mighty damning words for someone who isn’t in direct primary patient care (if you are a radiologist).” How naive”
How incredibly naive and arrogant on your part. Are you truly equating a short term biopsy, checking pt’s with post procedure complications, or talking with families after procedures with patient care and management? I know it has been many years since you have done your internship but clearly you can’t be that stupid or uninformed about time committments when you are really taking care of patients. What you show is that you have totally forgotten what clinical medicine involves. Do me a favor and talk with a heme/onc doc about hwat really managing an oncology pt involves. It would take way to much time for me to.
“These are the typical events in my day at our full-service imaging center. If self-dealers like these guys are allowed to propagate and thereby cherry-pick all the high-end imaging studies, then full-service imaging centers will cease to exist”
Ahh so it comes down to $$$. One of the main frustrations many oncology practices face is timely scans. Begging the radiologist’s to move up scans was a daily hassle. Doesn’t happen when there are on site scanners. I don’t disagree with the conflict of issue. However, I do argue that the patients’ shouldn’t suffer because your local outpt “full service” radiology center can’t have scans done in a timely matter which commonly happens. In the perfect world you are right about the conflict of interest. But in real world I can’t get scans in a timely basis which I find all the more insulting as I start the day long before my local “full service” outpt radiology center opens and end the day long after it closes. My patient’s shouldn’t (and won’t) suffer for you and your staff’s lifestyle.
Do me a favor, spend a little tie in a local hospital/clinic. you haven’t done any clinical medicine in a long time and based on your statements it shows.
Anonymous
I spend up to half of each day in the most direct type of contact with a patient that one can have, my face not two feet from hers, talking to her, distracting her, and reassuring her the whole time. But somehow that’s not good enough — to you, that’s not the right type of patient contact.
Sheesh.
These folks could very well be competent and compassionate within their specialty of oncology. I’m not sure that that’s a given, though. From the original article in the Arizona Daily Star: “A physician who works at the practice and knew of the incident said it’s not the first time such a thing has happened. ‘People have been left in the office after hours, when something like that happens — it’s the same sort of thing,’ said Dr. Steven Ketchel. ‘My guess is she was lying on the table, waiting and waiting and nobody told her she could go home.’”
For someone who sings the praises of full-time patient contact, you are surprisingly ignorant of one fundamental truth of human nature. For this practice, imaging is a paying hobby, and as such it will never command their undivided attention the way oncology does for them or the way imaging does for me and other radiologists.
It shows in the way they handled this patient.
Anonymous
A: Thanks for never addressing the issue with timely scans at “full service” outpt rad centers. I will tell you MY PT’s will never ever suffer for your “lifestyle” …..period.
B: Distractin/reassuring a patient is not treating a patient. I am not minimalizing what you do, however it is clearly it has been a long long time since you did your transitional year in clinical medicine based on you unknowledgeable statement
C: From the arizona oncology website :
”
Our Response to Patient Incident and Resulting Media Coverage
Last week we had an unfortunate incident in which a patient was accidentally locked in our facility at the end of the day. We are very sorry this happened and our physician and involved staff member personally apologized to the patient. Within 24 hours of the incident, we conducted a thorough analysis, revised our processes and implemented the new procedures to make sure nothing like this happens again.
While we can’t address the specifics of the case without permission of the patient, we can tell you that the CT scan had been successfully completed and the patient was in absolutely no danger of overexposure.
Media coverage has implied that the patient was somehow “trapped” or confined in the equipment. This is not the case. When a patient is lying on the equipment couch or table, their mobility is not confined by the equipment or restraints. We do place a warm blanket over the patient that is tucked in on the sides for comfort. With that said, the room had been darkened and we can appreciate that being alone in an unfamiliar environment was very disorienting. We offer the patient and family our heartfelt apology for that unsettling experience. Our processes let the patient down and we took swift, decisive action to correct our procedures.
The new procedure calls for a complete facility sweep and a series of checks and balances before we lock down every day. We have communicated the new procedure to all employees and developed a written check list to assure compliance.
One other point that’s important to note. Nothing like this has ever happened before at our facility. When we talk of other incidents, we are referring to similar incidents in other health care facilities. We looked at those incidents to evaluate our process and make the necessary changes in protocol.
We want to extend our sincere apology and reinforce our commitment to high quality, compassionate care….every day and every patient.
So it never happened before (and I am not justifying it, somebody should lose their job over this). That is what happens when you trust the lay press reporters. The AZ Daily Star is infamous for getting half of it’s story wrong.
D: Please don’t talk to me about “undivided attention” with radiologists. I have been to enough codes in the CT suite where no one was paying attention to the patient. Ever run a code in a CT suite…..can you say screw up.
Anonymous
We “add patients on” all the time. I didn’t address it because it’s such a non-event. We do plenty of mammograms on the same day when a referring doctor discovers a lump on a routine physical exam. We do add-on urgent “rule out P.E.” chest CTs, “rule out diverticulitis” or “rule out appendicitis” or “rule out kidney stone with hydronephrosis” abdominal/pelvic CTs. We do urgent pelvic sonograms for suspected ectopic pregnancy. We do countless wrist, ankle, and shoulder radiographs for playground or soccer injuries. This list goes on and on. Maybe you’re not sending your patients to the right place.
The one study we don’t do on an add-on basis is PET/CT. Nobody does, and that’s because the radioisotope has to be tailored to the patient, has no shelf life, is monumentally expensive, and has to be used on the day it’s delivered (the dose is even calculated down to the hour of anticipated administration). Arizona Oncology can’t do these PET/CT scans on an add-on basis, either, which is why the “we do scanning here for the convenience of the patient” argument is completely empty here.
As to their ex post facto spin control, it’s interesting that the initial comment was made by a physician, while the spin control was delivered by their office manager. I know whose word I find more convincing.
Restraints are used all the time in CT scans — a Velcro band across the forehead during an MR of the IACs, for instance. Furthermore, Arizona Oncology is a group that includes radiation oncologists. It is quite routine to use a special type of restraint during CT scanning — they’re not called restraints, they’re called fiducials, and they ensure that the patient is in the same position for IMRT as they were in when the scan was performed to plan that complex therapy. Whether Velcro or thermoplastic, the average lay person would call it a restraint, and it’s quite conceivable that one would find it difficult to extract oneself without assistance. For them to imply they never use restraints is laughable.
It’s interesting that you imply great familiarity with the Arizona Daily Star. You’re not, like, from Arizona Oncology, are you?

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