Cognitive and System Factors Contributing to Diagnostic Errors in Radiology

Abstract

Every radiologist worries about missing a diagnosis or giving a false-positive reading. The retrospective error rate among radiologic examinations is approximately 30%, with real-time errors in daily radiology practice averaging 3-5%. Nearly 75% of all medical malpractice claims against radiologists are related to diagnostic errors. As medical reimbursement trends downward, radiologists attempt to compensate by undertaking additional responsibilities to increase productivity. The increased workload, rising quality expectations, cognitive biases, and poor system factors all contribute to diagnostic errors in radiology. Diagnostic errors are underrecognized and underappreciated in radiology practice. This is due to the inability to obtain reliable national estimates of the impact, the difficulty in evaluating effectiveness of potential interventions, and the poor response to systemwide solutions. Most of our clinical work is executed through type 1 processes to minimize cost, anxiety, and delay; however, type 1 processes are also vulnerable to errors. Instead of trying to completely eliminate cognitive shortcuts that serve us well most of the time, becoming aware of common biases and using metacognitive strategies to mitigate the effects have the potential to create sustainable improvement in diagnostic errors.

What is the relation between number of sessions worked and productivity of radiologists—a pilot study?

“…A possible deterrent to increasing the number of PAs worked by radiologists is reporting fatigue. It has been shown that problems such as visual fatigue and cognitive overload can result from reporting high volume and high-complexity images [22,23]. This can reduce productivity and increase stress levels in radiologists.…”

Perceptual errors in pediatric radiology

“…Fatigue can also result in a decrease in the radiologist's working memory, particularly after several hours of continuous and prolonged decision making. The increased amount of effort (cognitive load) required to make an accurate diagnosis when tired can result in the radiologist taking short-cuts and subsequent diagnostic errors [31,32].…”

“…A second, more focused and detailed search is performed after a specific clinical concern is articulated. This approach is thought to effectively utilize both systems of decision-making [32].…”

“…Structured reports act as a checklist to promote consistency in visual approach, and help avoid predictable biases. This approach can be helpful in considering common and serious "do-not-miss" diagnoses [32]. Self-prompting verbalization of the focus of attention has also been shown to be an effective strategy in reducing search satisfaction errors.…”

Pitfalls in Imaging of Female Pelvic Masses

“…According to the European Society of Genitourinary Radiology (ESUR) guidelines, pelvic MR imaging should be performed to further characterize any sonographically indeterminate mass [ Clinical questions are always asked before the exam (including age, questions regarding clinical symptoms, hormonal status, hormonal medication, recent surgeries and recent deliveries).Cognitive biases such as anchoring and framing are reduced when the radiologist seeks more clinical information from patients, especially disconfirming information that disproves the initial clinical diagnosis [4] (Fig. 1).…”