Radiologists should always review CT scout images, and not doing so could have legal ramifications down the line, according to a recent commentary published in the American Journal of Roentgenology.

Richard H. Daffner, MD, of the department of diagnostic radiology at Allegheny General Hospital, wrote the article, drawing from his experience as both a radiologist and a medical witness in cases involving spinal and skeletal injuries.

“Scout images are an integral part of any CT examination and should be carefully reviewed for findings that may or may not be included in the FOV of the study,” Daffner wrote. “As a longtime radiologic educator, I have emphasized to my students, residents, and fellows the importance of looking at all of the images of a CT or MRI examination and at every portion of radiographs. We are responsible for everything on those images.”

Daffner has found that many radiologists ignore scout images aside from using them to correlate the levels of axial images. But, he wrote, scout images often include crucial information that the other images don’t display, and this is something legal teams know to look for when filing malpractice suits.

“The crux of any malpractice suit is whether the defendant-physician violated the standard of practice,” Daffner wrote. “In many instances the standard has been established by professional organizations (e.g., ACR practice parameters and technical standards). Legally, the standard is defined as what the typical practitioner would do under similar circumstances.”

Daffner explained that, over the years, he has seen many cases where the radiologist clearly missed a finding, but it was still something the lawyer could defend. That radiologist made a mistake, yes, but others would have likely made the same mistake as well.

However, this usually does not hold true if the finding in question was visible on an ignored scout image.

“Plaintiffs' attorneys frequently use this smoking gun in pointing out that the scout image was included in the study given to the defendant-radiologist,” Daffner wrote. “This becomes critical in any case in which there is a bad result (permanent neurologic deficits or death, particularly of a child). Such cases are usually adjudicated in the plaintiff's favor.”

Daffner’s full analysis, including specific case studies, can be found here.