In the “legal section” of my presentation I always discussed that at some point I was convinced that someone, somewhere was going to be sued for making a mistake by post collimating pathology off without ever knowing that they had done this. A couple of years ago a very credible radiographer who works in a good size city in the U.S. (with over a million residents and 5+ large hospitals) came up to me and told me the following story. Because of the legal implications I had to promise to keep their name and city a secret, but in a 2-3 year period he/she was privy to 2 “lawsuits” that occurred in their city because of post collimation (shuttering).
Both of the “lawsuits” were for different exams but let me give you a perfect example of what happened. Let’s say one of your staff took this lateral C-spine image and then post collimated the anterior mandible off but left the marker (this is how we know it was post collimated and usually this style of shuttering is done with CR, not DR). Months later there is a bone tumor located in the mandible and the patient needs to have major reconstructive surgery. Afterwards the patient’s attorney requests all of the radiographs the patient has had and they discover that if the mandible had not been post collimated, the tumor would have been discovered half a year earlier and the mandible surgery would very well have been unnecessary.
Both cases were similar to this story. The reason I wrote “lawsuits” is that neither case went to court, as the imaging department was completely at fault. Both hospitals gave millions of dollars to the plaintiff, but were able to have everyone involved sign a gag order so that they were unable to tell anyone about the hospitals negligence or how and from where they got the money. Handing over that money was well worth not having the public find out that the imaging department/hospital made this kind of mistake.
Who knows how many times this has now happened all over the country, but it’s hard to believe it’s only occurred twice and both were in that city. I firmly believe it’s happened countless times, but every hospital has been able to shut down the bad publicity with lots of money and signed gag orders. I believe we won’t actually read about this happening until a patient finally decides that they not only believe they can win the case in court and get the money, but want to totally nail the hospital with the horrible publicity at the same time. Don’t let that hospital be yours!!
Legally your radiologist is responsible to read every bit of anatomy that is radiated and ends up on the Image Receptor (IR). This means if a chest x-ray is not collimated well and gall stones can be seen and the radiologist misses the stones, they can be liable even though gall stones should not normally show up on a chest image. This law (like most laws) has not changed one bit from film/screen to digital.
In closing, to use post collimation properly, you must show some pure black or white inside of your post collimated field to prove that you have not cut off any anatomy, whether you believe it’s pertinent or not.