PET Scan

PET Scans and the Nexus of Diagnosis and Medical Malpractice

Positron Emission Tomography (PET) scans represent one of the most sophisticated and powerful diagnostic tools in modern medicine. It offers an unparalleled view into the metabolic function of the human body. Unlike traditional imaging that captures anatomy, PET captures activity. As a result, it is invaluable for detecting disease at its earliest, most active stages. However, like any advanced technology, PET scan’s complex nature introduces unique risks for misinterpretation and procedural errors. Pet scans are directly at the heart of medical malpractice litigation.

The History of Functional Imaging

The conceptual foundation for PET scanning dates back over a century, long before the technology was practical. The notion that blood flow and brain function are intrinsically linked was first appreciated in the late 1800s. However, the true development of PET began with the discoveries of the atomic age.

Key milestones include:

• 1931-1932: The invention of the Cyclotron by Ernest Lawrence, which allowed the creation of short-lived radioactive isotopes (radionuclides), and the theoretical and experimental discovery of the Positron by Paul Dirac and Carl Anderson, respectively.
• 1950s: Michael Ter-Pogossian is the “father of PET” for his early experiments at Washington University, which pioneered the use of these radiotracers as a practical diagnostic tool.
• 1970s: The development of the first true positron detection tomograph and the synthesis of fluorodeoxyglucose—a glucose analog that remains the most common radiotracer today—revolutionized the field. Since cancer cells consume glucose at a higher rate (the Warburg effect), FDG essentially acts as a chemical beacon for tumors.
• Early 2000s: The integration of the PET scanner with the Computed Tomography (CT) scanner to create the PET/CT hybrid machine. This development provided both metabolic data (PET) and high-resolution anatomical context (CT) in a single session, vastly improving diagnostic accuracy. More recently, PET/MRI hybrid machines offer superior soft-tissue detail.

Indications and Ordering of PET Scans

A doctor orders a PET scan when they need to observe the physiological activity or metabolism of tissues and organs, rather than just their structure.

Medical Conditions and Circumstances

PET scans are primarily in three major medical fields: Oncology, Cardiology, and Neurology.

Ordering Providers and Facilities

PET scans are specialized procedures ordered by doctors who manage complex diseases.

• Ordering Medical Providers: The primary ordering specialists are Oncologists (Medical, Radiation, and Surgical), Cardiologists, and Neurologists or Neurosurgeons. Primary care physicians (PCPs) or general surgeons may also order them based on initial findings from other tests.
• Interpreting Provider: A Radiologist or a Nuclear Medicine Physician, who is specially trained in reading these functional images, interprets and reports the scan.
• Facilities: PET scans are performed in facilities capable of handling both the advanced scanner and the radioactive tracers. These include:
  • Major Hospitals and Academic Medical Centers.
  • Dedicated Outpatient Imaging Centers (often run by hospital systems or large private radiology groups).
  • Mobile PET Scan Units (particularly for cardiac services in rural or smaller areas). The radiotracer, which has a short half-life, is produced in a specialized machine called a Cyclotron and transported to the scanning facility.

PET vs. CT and MRI: What They Show (and Don’t Show)

Often, doctors use PET scans in conjunction with, and compared to, Computed Tomography (CT Scan) and Magnetic Resonance Imaging (MRI), as the three modalities offer different, yet complementary, information.

A PET scan’s strength lies in its ability to detect physiological changes before they result in visible anatomical changes on a CT or MRI. Conversely, PET scans can have false positives (high metabolic activity in benign conditions like inflammation or infection) or false negatives (cancers that are slow-growing or use a non-glucose metabolic pathway).

PET Scans and Medical Malpractice

PET scans can be involved in a medical malpractice claim in two distinct ways: by being the source of the alleged negligence or by serving as critical evidence to prove negligence.

Committing Medical Malpractice

Negligence related to PET scans typically falls into one of three categories:

1. Failure to Order a Timely Scan: If a patient presents with clear red flag symptoms (e.g., unexplained weight loss, specific neurological deficits, or a suspicious finding on a preliminary CT or X-ray), the standard of care may require the ordering provider (e.g., the oncologist or PCP) to order a PET scan for proper staging or diagnosis. Failure to order the scan, leading to a misdiagnosis or diagnostic delay and worse prognosis, constitutes a claim of negligence.
2. Misinterpretation of the Scan: This is an interpreting doctor’s most common source of error (the Radiologist or Nuclear Medicine Physician).
   • False Negative Malpractice: The physician fails to note or report an area of high uptake (a “hot spot”) that was indicative of cancer or disease, which results in a delayed diagnosis (e.g., misreading a small lung nodule or a faint liver lesion).
   • Failure to Recommend Follow-Up: Even if a finding is ambiguous, the standard of care requires the radiologist to recommend further testing or biopsy. A doctor’s failure to make this critical recommendation can be a breach of duty.
3. Communication Failures: Negligence can occur when a radiologist correctly identifies a critical, time-sensitive finding but fails to effectively communicate that finding to the ordering or treating physician. If the treating physician is unaware of the critical finding, the patient’s cancer may progress untreated.

Using PET Scans in Malpractice Cases (Proof)

In litigation, the PET scan is often the most important piece of evidence.

1. Establishing Breach of Standard of Care: The lawyer shows the PET images themselves to a jury alongside testimony from expert witnesses (other Radiologists). The expert can point directly to the original scan. They can demonstrate that a reasonably prudent radiologist should have seen the abnormality (the bright spot) that was missed in the initial report.
2. Proving Causation (Diagnostic Delay): PET scans are powerful in proving how a delay harmed the patient.
   • Original Scan (PET 1): Taken at the time of the alleged mistake, it shows a localized, treatable tumor.
   • Follow-up Scan (PET 2): Taken months or a year later after the delayed diagnosis, it shows the disease has metastasized (spread widely, indicated by multiple distant hot spots). This visual evidence links the failure to read PET 1 correctly directly to the patient’s worsened stage and prognosis, satisfying the causation element of a malpractice claim.

In summary, the PET scan, while a powerful life-saving technology, introduces layers of complexity where diagnostic judgment and inter-specialty communication are paramount. Interpreting and acting upon these functional images requires high standards of care. When breached, the result is often a costly and medically damaging diagnostic delay that forms the basis of a medical malpractice lawsuit.

If you have concerns about PET scans and medical malpractice, visit our free consultation page or video. Then contact the Kopec Law Firm at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore medical malpractice lawyer. The Kopec Law Firm is in Baltimore and pursues cases throughout Maryland and Washington, D.C.