0:00

This next section is on the duty of radiologists specifically

0:05

to MRI safety. Now,

0:08

MRI in the US is a prescription study,

0:12

meaning there has to be a prescribing physician,

0:15

the referring physician, whether they're an orthopod, a GI,

0:20

neuro,

0:22

the referring physician is not the prescribing physician.

0:27

Prescribing physician for a radiologic exam is typically the radiologist,

0:32

the supervising physician for the radiologic exam.

0:38

We are really good about communicating the radiologist's obligation

0:43

to accuracy of the interpretation and the timeliness of

0:48

producing an interpretive report.

0:51

What we are not very good about communicating to radiologists is

0:56

their duty to the safe execution of the MR Study itself.

1:02

Radiologists are familiar with one of the more frequent

1:07

demands of their time and attention,

1:10

and that is clearing patients who have complications

1:15

or contraindications.

1:18

This is a sticking point for many radiologists because if I can

1:22

turn it into a verb, patient clearance is not RVU ued.

1:27

It's not a mechanism by which radiologists receive

1:32

compensation,

1:33

and so there tends to be a tendency

1:38

to try and avoid any significant amount of time associated

1:43

with clearing patients and contraindications.

1:46

That one piece may be recognized by radiologist as being

1:51

within their domain,

1:53

within their sphere of influence or sphere of responsibility.

1:58

But patient clearance is not the only duty of

2:03

the radiologist to MRI safety or the safe execution

2:08

of an MRI study.

2:11

So there is a legal doctrine in the United States called the Captain of the SHIP

2:16

Doctrine, and it was originally developed for surgeons.

2:21

The idea being that in the operating room,

2:24

the surgeon is responsible for everything that takes place,

2:29

whether that's an error or an inappropriate action

2:33

by the anesthesiologist, by one of the nurses, by a supporting physician,

2:38

that the surgeon is the captain of the ship,

2:43

that is the or.

2:45

That legal doctrine holds up and is conveyed

2:50

to all physicians essentially saying,

2:54

whatever your ship is, you are the captain of it and

2:58

You are responsible for everyone else on the ship and their

3:03

wellbeing. So for radiologists,

3:07

this means the radiology suite,

3:10

the point of care for the MRI study,

3:15

the CT study, whatever it is you are reading for,

3:19

you are the captain of that particular ship for that particular

3:24

voyage or patient interaction.

3:27

What this means is that the radiologist is or can be held by

3:32

vicariously liable for the actions of people under your charge.

3:37

This means MRI technologist.

3:40

Even if you as a radiologist work for a radiology group that's

3:45

under contract to the hospital and the hospital employs the MR Technologist,

3:50

you are still the captain. Even if you,

3:53

the captain or your radiology group doesn't pay the salaries of the

3:58

MR technologists, you still have a responsibility to that.

4:04

Now, I have received pushback in presenting this information to radiologists

4:09

previously who informed me that radiology

4:13

interpretation is an asynchronous service.

4:17

It doesn't happen in real time as the patient is getting imaged.

4:22

We're not doing the quote unquote wet reads over the shoulder of the

4:26

technologist. It goes into the packs, it goes into a work list queue,

4:30

and somebody pulls it up minutes, hours,

4:33

sometimes days after the study has been completed.

4:38

So temporarily we're dissociated from when the event,

4:42

when the study actually happens. Add to that,

4:45

the fact that you know, remote reading,

4:48

oftentimes the radiologist is not at the same hospital that the study was

4:53

performed in.

4:54

They may not even be in the same state or the same country as the exam

5:00

was performed. Neither of these things,

5:03

neither the physical separation or the temporal shift absolve

5:08

the radiologist of their legal responsibility,

5:11

their captain of the ship duty to the wellbeing

5:16

of the patient.

5:17

All that does is it puts the additional burden on the radiologist to make sure

5:22

that even with temporal and spatial

5:26

separation from the execution of the imaging study,

5:30

that the radiologist circles around and makes sure that

5:35

policies and procedures are in place, that the staff training is up to par,

5:41

that actions at the point of care actually follow

5:45

the policies and procedures,

5:47

which replicate or reproduce industry best practices.

5:52

Each of those things remains the responsibility of the radiologist,

5:57

despite separations in both time and distance.