The daily practice of radiologists has evolved and radiologists are increasingly being directly involved with patient care and treatment. Consequently, radiologists have become a part of the ...therapeutic team available to patients. This active role, in hospital based or out-patient practices, does not only have an impact on the radiologist's professional activities. New liabilities related to interventional procedures or treatments are now added to already existing professional liability from diagnostic activities. Therefore, musculoskeletal radiologists performing interventional procedures must be aware and familiar with their obligations towards patients, including the requirement to provide adequate information to patients and documenting that informed consent was obtained.
Concerns about legal implications affect many decisions of the average radiologist, and physicians do not always appreciate the validity of these concerns. However, such concerns often influence ...radiologists' decisions more than is warranted. An improved understanding of the law and its ramifications may serve to prevent adverse legal effects found in the everyday practice of radiology. Legal issues influence radiology in many ways. Two important ways the law affects the practice of radiology relate to the business affairs of radiologists and to the radiologist's duty to perform to a standard of care. Legal issues relate to the business aspects of radiology through radiologists' relationship to their group practice and the radiology group's relation to the outside world. Radiology groups use legal services for issues such as employment contracts, hospital privileges, group relations, and bylaws. They make decisions with major legal implications when they establish their standard business practices. These decisions range from business procedures that ensure a timely delivery of service to the choice and implementation of quality assurance systems to how to ensure that patients are informed of the results of a radiologic examination. Legal matters affect many business decisions radiology groups make. Antitrust law is concerned about issues such as cost sharing, price sharing, mergers, acquisitions, and practice patterns. Laws limit the right to practice radiology. Billing practices, conflicts of interest, self-referral, right to refuse care, employment practices--all have substantial legal implications. These issues are a concern of every practicing radiologist. Changes in our health care system may cause new legal obligations. An appreciation of the relationship radiologists must have with payors and patients is increasingly important in preventing medical-legal problems. These additional duties and responsibilities occur when many physicians and the public at large seem to feel they are already overburdened with legal duties and responsibilities. A lack of familiarity with the legitimate relationship of the law to everyday life may greatly affect radiologists' job satisfaction. Many acts physicians perform in the practice of radiology have legal implications not often recognized by the practicing radiologist. This monograph seeks to enhance radiologists' understanding of some common and important legal issues related to their practice of medicine. We hope that this monograph will help radiologists appreciate the legal implications of their behavior. The opinions expressed in this monograph are those of the authors and should not be inferred to represent the official views of any government agency.
Medical risk management has one main purpose: to ensure the safety of care. The law of March 2002 has generated a true cultural revolution. The radiologist is involved with new and difficult areas of ...medical liability due to technical advances, the increasing number of imaging techniques, the increasing complexity of imaging techniques, their efficiency and the need for multidisciplinary approach. Imaging recommendations requiring increasing levels of technical and clinical skills. The radiologist is liable with regards to the indications of imaging studies, and also with regards to informed consent. The prevention of medicolegal problems is achieved by competency, which must be combined to good liability insurance and ongoing vigilance supported by appropriate continuous medical education.
It is to be feared that the expansion of interventional radiology could lead to the reappearance of chronic radiodermatitis. Only a few studies mention the doses received by the hands, however these ...radiation doses are always high. Whereas clinical examinations lead to a belated diagnosis, capillary microscopy, a quick and non invasive test, enables to detect vascular injuries at the subclinical stage. Radiological protection is currently based on leaded gloves and on the reduction of exposure duration. Compensation for chronic radiodermatitis depends on the practitioner's status. In spite of a better evaluation of the overall irradiation, hand exposure remains a cause for concern. Capillary microscopy can provide appropriate medical surveillance.
Whatever the aim of the procedure, puncture of a vessel can lead to local complications. Access to the artery carries a risk of hemorrhage, occlusion, stenosis, arteriovenous fistulization or ...pseudo-aneurysm. The same types of complications can occur in veins. Other complications include skin necrosis due to extravasation of the contrast medium, perforation of the superior vena cava after insertion of an infusion catheter and the risk of pericardial effusion. General complications occur immediately, usually caused by contrast media, or late. There are different examples of secondary legal procedures following punctures involving, with the exception of radiology cases, intraarterial injection at the elbow, perforation of the right atrium by a jugular catheter and acute ischemia of the foot after catheterization of the pedial artery. Legal procedures after radiological procedures were discussed in more detail. The personal experience of the authors and others concerns accidents occurring after arteriography, angioplasty or embolization. Finally, two legal cases after treatment for impotency are analyzed. We focus on a certain number of rules on patient information, preangiography consultation, participation of an anesthetist, careful post-operative follow-up and operation report. Finally, the possibility of radiation-induced arteriopathy is demonstrated by one case reported here.
