Diagnostic Radiologist Fails To Recognize Advanced Spinal Cancer


Diagnostic Radiology Expert

This case involves a physically active middle-aged female patient who injured her back while exercising and began seeing an orthopedist for treatment. She underwent an MRI which revealed an abnormal signal in her vertebral body and a follow-up bone scan was recommended. Upon receiving the follow-up bone scan, the impression was rib and vertebral body activity. In spite of these impressions, the orthopedist continued to treat the patient for musculoskeletal complaints without further investigation. In the subsequent months, the patient suffered worsening back pain. She required an MRI of the lumbar spine which revealed advanced osteosarcoma. The patient passed away within the year. An expert in diagnostic radiology was sought to opine on whether or not the imaging impressions merited different treatment.

Question(s) For Expert Witness

  • 1. Do you routinely review imaging for patients like the one described in this case?
  • 2. Have you lectured/published on this subject?

Expert Witness Response E-025681

I graduated from Hopkins Medical School in 1984. I completed a residency in diagnostic radiology and nuclear medicine and have been board certified since 1988. I formerly served as faculty at Duke and clinical faculty at Yale.  As a former full-time faculty member at Duke and more recently clinical faculty at Yale, I have lectured and directly teach on oncologic staging and diagnosis across modalities, and this included prostate cancer. I have reviewed many hundreds of imaging studies evaluating and staging patients with prostate cancer, and at least a few dozens with extremely similar bone scan findings and MRI and/or X-ray correlations.

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