Gloucestershire Hospitals NHS Foundation Trust

3. Mrs H complains about aspects of treatment Mr H had from the Trust. She says on 23 March 2021, the radiologist consultant failed to identify the epidural thoracic disease in his seventh thoracic vertebra.

4. Mrs H says Mr H experienced nine weeks of extreme pain in his legs and back due to compression on his spinal cord. She says he experienced permanent nerve damage to his legs, and found it difficult to walk, sit down and put on shoes, trousers and socks. Mrs H says she found it distressing and upsetting watching him go through this.

5. As an outcome, she would like an apology, for the radiology department to take learning from her complaint and to make sure future patients will get better care.

6. In February 2021, Mr H told the Trust he was in pain and wanted to know whether it was associated with his cancer. The Trust arranged for Mr H to have a CT scan. On 23 March Mr H went for a CT scan of his thorax abdomen and pelvis to check whether his pain was linked with advanced prostate cancer.

7. On 31 March the results of the CT scan were communicated to Mr H. They showed widespread cancer and non-regional lymph nodes. The consultant arranged for Mr H to have a course of radiotherapy and also referred him to a hospital to be considered for a personalised therapeutic approach in the form of clinical trials.

8. On 14 May, Mr H attended went to an appointment at the hospital. The consultant reviewed the CT scan taken on 23 March and commented that Mr H had epidural thoracic disease at seventh thoracic vertebra level (T7) and spinal cord compression. The consultant arranged for Mr H to have an MRI scan, and this took place on 24 May. The results of the MRI scan showed significant spinal cord compression. Mr H was admitted for emergency decompression surgery.

11. When we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

12. Mrs H complains the Trust had failed to identify a problem from the scan taken on 23 March 2021.

13. The Trust say the radiologist reviewed the scans and confirmed the spinal canal soft tissue detected in the scan of 24 May could not be seen on the CT scan of 23 March. The Trust further stated ‘with the benefit of hindsight [Dr Z] wonders whether a component of chest wall pain was related to the now known about nerve root compression from the vertebral body disease at the T7 level. However, there were radiologically overt and progressive skeletal lesions (within the sixth rib) which clearly were a prima facie explanation for his symptoms’.

14. There are no specific clinical guidelines on how a scan should be reported. A scan is reported using the clinical details given. Our adviser explained a whole-body CT imaging should be reviewed as more than one plane (looking at scan from more than one direction to show different sections of the body). Soft tissue abnormalities should be assessed with soft tissue windows (used to view most organs). Dedicated lung windows (view lung parenchyma) should be assessed for lung metastases. The images need to be compared to previous imaging. It is best practice to assess the study on a dedicated radiology workstation at which the present and previous study can be linked to assess for any change.

15. Mr H had a whole-body CT scan on 23 March. The scan was compared to the previous CT scan on 19 August 2020. The images were viewed on soft tissue and bony windows in axial (top to bottom), coronal (front to back), and sagittal (side to side) planes.

16. Our adviser said on the left side at the level of T7 there is extensive metastases (cancer) from the pedicle (a stem or stalk of tissue that connects parts of the body to each other) towards the canal (spine) with subtle left sided epidural disease, but the canal appeared to have a lot of space with no suggestion of cord compression. In the absence of clinical history of symptoms, it would have been extremely difficult to identify the epidural thoracic disease from the 23 March scan.

17. CT imaging is less sensitive than an MRI in identification of tumour into the canal or cord compression. When Mr H was seen in hospital, it arranged for him to have an MRI. He complained of symptoms related to the area which made identification of the subtle abnormalities easier.

18. We recognise Mr H was in pain for several weeks after the scan taken on 23 March. Mrs H believes this pain could have been avoided had the radiologist read the scans correctly. We understand how upsetting it was to see Mr H in pain. Having considered the medical records and clinical advice, in the absence of specific symptoms related to T7, we would not have expected the radiologist at the Trust to identify the subtle epidural soft tissue from the CT scan done on 23 March. We therefore do not think the Trust missed the opportunity to do more.

19. We recognise how important Mrs H’s complaint is to her and thank her for bringing it to us to consider.

1. We have carefully considered Mrs H’s complaint about the care and treatment her husband, Mr H, had from Gloucestershire Hospitals NHS Foundation Trust (the Trust). We realise that complaining about Mr H’s care has been difficult for Mrs H.

2. We have seen no evidence that anything went seriously wrong when the Trust reported on the results of the CT scan taken on 23 March 2021.