Radiology Lookback Review – Frequently Asked Questions

1.) How did the Trust become aware that there might be a problem?

As a direct result of concerns raised by the General Medical Council (GMC), an internal audit of one particular locum Consultant Radiologist’s work considered a sample of the images which that consultant had reported on. This preliminary review identified more errors than would be clinically expected.

2.) How long was the locum Consultant Radiologist engaged by the Trust?

They were employed from July 2019 until February 2020.

3.) Did he/she work in any other hospitals in Northern Ireland?

There is no evidence that the person concerned has worked in any other Trust in Northern Ireland.

4.) How many images were considered in the internal audit?

30 CT scans were reviewed initially.

5.) How many of the images reviewed in the internal audit were considered to be ‘unsatisfactory’?

Eight (26.7%) of the 30 of the CT scan reports that were reviewed were ‘unsatisfactory’ and two (6.7%) of the 30 had significant errors, which could have had an adverse impact on clinical outcome.

6.) What does ‘unsatisfactory’ mean?

‘Unsatisfactory’ can range from a simple typographical error to missing a significant finding on an image.

7.) What has happened so far?

Following the internal audit, the Trust then had to identify the total number and types of images which had been reported on by the radiologist concerned. Given the number of images involved, options were then explored as to how to complete a timely review of these images. To ensure that the review could be progressed as quickly as possible without impeding internal capacity, the Trust approached a suitably qualified and experienced external provider, that is already contracted to do this work within the HSC, to consider if they could support Trust consultants in the completion of the review.

In line with regional guidance, the Trust has set up a Lookback Team which is overseen by a Steering Group. Membership of the Lookback Team includes clinicians with the skills to oversee the lookback process and the Steering Group membership includes HSC professionals with the knowledge and experience to ensure the process is followed within Regional Guidance.

8.) How many images will be reviewed?

The total number of images to be reviewed is 13,030.

9.) When did the formal review process begin?

The formal review began in the week beginning 21 June 2021.

10.) How long will the review take?

It is expected that the review will be completed by the end of October 2021.

11.) How many people are potentially impacted by this?

We have written to 9,091 patients or parents/guardians, where appropriate. Although the review is still in the early stages, based on the initial sample audit, we expect that less than seven percent of these patients may have an inaccurate report that could potentially have impacted on their clinical outcome. The images for all 9,091 patients will be reviewed, and we anticipate that there will be a number of patients for whom further clinical assessment will be required.

12.) Have all 9,091 patients been told?

Each of the 9,091 patients will have received a letter informing them that they may be affected and providing them with a helpline telephone number to call if they have any concerns. Information about a remote sign language interpreting service was included in the letter for any members of the Deaf Community unable to call the helpline. The helpline staff also have access to a foreign language telephone interpreting service to support anyone calling whose first language is not English. Patients who are very anxious as a result of receiving the letter will have access to a psychological support service.

13.) If I need to be called back when will I find out?

If you need to be recalled you will be told as soon as your image(s) has/have been reviewed and a decision has been made that further assessment is required. The Trust is mindful that this will be an anxious time for those who have received a letter and we will make sure that if you need to be called back this will be done as quickly as possible.

14.) How will I be told that I am being called back?

Patients will either be telephoned to offer an appointment or contacted in writing. Telephone calls will also be followed up in writing. All patients requiring recall will be seen as soon as possible.

15.) What will happen if I am called back?

You may require further imaging, be asked to attend an outpatient appointment or be placed on an appropriate clinical pathway. Of course, that would all be subject to your agreement.

16.) Should people be concerned?

The vast majority of patients should have no cause for concern but there may be a small number of patients where a delay in diagnosis as a result of inaccurate image reporting may have had an impact for them.

17.) Is a radiologist a doctor?

Yes, a radiologist is a doctor who is specially trained to interpret diagnostic images such as X-rays, MRI and CT scans.

When a patient has a radiology examination, a radiologist will report on the images. This report is sent to the doctor/health care professional who asked for the image to be carried out so that they can act on any findings.

18.) Why did the Trust need to employ a locum radiologist?

There is a global shortage of radiologists with an increasing demand for their service. In the UK, for example, a recent census by the Royal College of Radiologists comments that the NHS is now short-staffed by 33%. Despite proactively and continually trying to recruit additional radiologists, the Northern Trust normally has around 7 to 8 vacancies for Consultant Radiologists. The position is similar in other Trusts in Northern Ireland.

19.) What are the different types of radiology images?

Radiology is a service that plays a role in diagnosing and monitoring a range of conditions. Types of radiology examination include plain film X-rays, MRI (magnetic resonance imaging) and CT (computed tomography) scans, ultrasound scans, nuclear medicine scans, fluoroscopy (medical imaging that shows a continuous x-ray image on a monitor e.g. barium studies) and bone density (DEXA) scans.

20.) What types of images will be included in this review?

X-Rays, MRI and CT scans, ultrasound scans and fluoroscopy.

21.) How many radiology images are requested and reported upon in the Northern Trust each year?

Over 300,000. For example, in the 2019/20 year, 329,584 diagnostic radiology tests were completed in the NHSCT.

22.) Who would request a CT scan or other image and why?

All radiology images are requested by doctors and other clinical staff who are approved to do so. CT scans and MRIs would normally be requested by a senior doctor who has clinical responsibility for the patient.

23.) What is the normal process for image requests?

In the main, radiology images are requested through an electronic referral system but in the case of specialised or emergency tests, the referrer may in addition speak directly to the radiologist so that there is no delay in the scan taking place.

24.) Would a doctor making the request for an image normally provide the radiologist with some indication of what to look for?

The doctor making a request would be expected to include relevant clinical details and to provide the radiologist with an indication as to the potential clinical diagnosis.