Comparing new radiographs with those obtained previously.

T he Case A 57-year-old woman with a recent onset of cough and lowgrade fever was referred by her family physician to the radiology department of a hospital for chest radiography. A radiologist interpreted the posteroanterior and lateral chest radiographs as disclosing a “subtle ill-defined infiltration in the left mid-lung field, seen only on the PA view, consistent with pneumonia” (Figs. IA and 1B). The physician treated the patient with antibiotics, and her symptoms resolved. No immediate follow-up radiographs were obtained. Three months later, the patient again consuited her family physician because of recurrence of cough and fever. After establishing a tentative diagnosis of pneumonia, the physician referred the woman for another radiographic examination. On this occasion, a radiologist who was associated in practice with the radiologist who had interpreted the study 3 months earlierreported seeing a “fairly well-circumscribed infiltrationin the leftlower lobe, most likely representing pneumonia” (Fig. 1C). The radiologist made no mention in his radiographic report of a comparison with the previous radiographs. The patient was again treated with antibiotics by her family physician, and her symptoms improved. The woman did not return to her family physician until 9 months later, at which time she was experiencing hemoptysis and weight loss. She again underwent radiography of the chest. The same radiologist who had interpreted the second set of radiographs now reported that the left lower lobe infiltration had increased in size and, because of its “well-circumscribed appearance” and the fact that the left hilum appeared enlarged, concluded that the “findings are suspicious for tumor” (Figs. lD and 1E). Additional diagnostic testing revealed primary lung carcinoma with metastases to the mediastinum and brain. Chemotherapy was begun, but the patient died 4 months later. Just before her death, the woman filed a malpractice suit against the family physician and the radiologist who had interpreted the second and third sets of radiographs, claiming that her chance for cure was lost because both physicians had negligently delayed the diagnosis of lung cancer.