The Expert: Dr. Thomas Oliver, a radiology expert in Georgia, concludes that the defendant radiologist met the standard of care in his review of imaging.
Giving testimony in a 2017 Georgia state court medical malpractice trial, Dr. Thomas Oliver, a vascular and interventional as well as neuroradiologist, opines about the standard of care of the radiologist in a case involving the patient’s eventual death from kidney cancer.
In this clip, the expert utilizes an expanded view of the patient’s actual CT scan to demonstrate his thought processes and interpretations regarding the lesion that was noted in the left kidney. He describes this lesion as a benign cyst. A cyst by definition contains fluid, and as it secretes more fluid, it becomes larger. This can take months or years and as it occurs, the cyst wall balloons out, seeking the path of least resistance and escaping into the irregular spaces that exist within the confined structures of the retroperitoneum. The kidney itself can be distorted by the pressure from this fluid containing cyst, and as it maneuvers through the potential spaces, the cyst can have the appearance of being lobulated when it is really not. This look can be within the normally expected appearance of a benign cyst and does not automatically require the investigation of a contrast study in addition to the regular CT scan. The expert testifies that he emphasizes more the sharp, smooth, and thin appearance of the borders of the cyst and its homogenous interior when deciding whether the lesion is suspicious for malignancy or not. When he measured the CT density of the interior of the cyst or its lobulations, the radiologist confirmed that this was a water density as one would expect from a benign cyst.
When he was challenged, the expert steadfastly denied that lobulations within a cyst were outside of the realm of a normal, benign cyst and insisted that this did not represent the early development of malignancy. As such, he asserted that it was not imperative to investigate this further from a radiologic standpoint. There is no evidence of septation, nodularity, or soft tissue contained within the cyst. These things might very well call for further investigation.
Oliver describes how the technology for CT scans has changed since this was originally investigated, allowing now for the examination of greater detail in looking at the lesion. Incidentally, he allows that this has been a blessing as well as a curse, since it frequently exposes tiny lesions that are of little significance, but now require follow up or even biopsy once noted.
Within his testimony, the doctor points out that the patient’s CT scan exposed several simple cysts, including within the patient’s other kidney. There was also some minor lobulation of the left kidney itself. This is a variant frequently noted by radiologists that may be related to fetal lobulation, a benign congenital irregularity or to a previous renal infarction which had been asymptomatic and inconsequential.
The expert concludes that there was no breach in the standard of care by the defendant when interpreting this CT scan. The jury concurred by granting a verdict for the defense.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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