Common patterns in 558 diagnostic radiology errors

Abstract

Introduction: As a Quality Improvement initiative our department has held regular discrepancy meetings since 2003. We performed a retrospective analysis of the cases presented and identified the most common pattern of error. Methods: A total of 558 cases were referred for discussion over 92 months, and errors were classified as perceptual or interpretative. The most common patterns of error for each imaging modality were analysed, and the misses were scored by consensus as subtle or non-subtle. Results: Of 558 diagnostic errors, 447 (80%) were perceptual and 111 (20%) were interpretative errors. Plain radiography and computed tomography (CT) scans were the most frequent imaging modalities accounting for 246 (44%) and 241 (43%) of the total number of errors, respectively. In the plain radiography group 120 (49%) of the errors occurred in chest X-ray reports with perceptual miss of a lung nodule occurring in 40% of this subgroup. In the axial and appendicular skeleton missed fractures occurred most frequently, and metastatic bone disease was overlooked in 12 of 50 plain X-rays of the pelvis or spine. The majority of errors within the CT group were in reports of body scans with the commonest perceptual errors identified including 16 missed significant bone lesions, 14 cases of thromboembolic disease and 14 gastrointestinal tumours. Of the 558 errors, 312 (56%) were considered subtle and 246 (44%) non-subtle. Conclusion: Diagnostic errors are not uncommon and are most frequently perceptual in nature. Identification of the most common patterns of error has the potential to improve the quality of reporting by improving the search behaviour of radiologists.

Characteristics of Chest Lesions Missed on Neck CT Interpretations

“…Occasionally, as in cases of neck or abdominal computed tomography (CT) scans, additional specific sites (i.e., a part of the chest) may inevitably be included and also need to be interpreted correctly. Incidental but potentially important findings outside the area of interest may be present but missed in any radiologic studies (2)(3)(4)(5)(6). We have occasionally found chest lesions that were not reported on neck CT interpretations when follow-up neck or chest CT studies were performed and compared with a previous neck CT study.…”

“…Other studies have reported that if the first radiologist misses a finding, the next radiologist will likely miss it as well (8,12). There are only a few studies which investigated common errors in the interpretation of head and neck CT scans, none of which focused on missed chest lesions (2,13,14). One study showed that vascular lesions, such as aneurysm, were most commonly missed on head and neck CT angiography, and neck mass, sellar mass, and nasogastric tube malposition were also missed as well (13).…”

The Effect of Teaching Search Strategies on Perceptual Performance

“…P erceptual errors account for a substantial part of misdiagnoses in radiology (1) and can be related to the search behavior of the observer (2). For educational purposes, it is important to identify which visual search patterns are most effective and to investigate if teaching search strategies improves perception.…”

Perceptual errors in pediatric radiology

“…Perceptual errors account for 48%-80% of all diagnostic radiology errors reported in the literature [1,2]. While the underlying reasons for perceptual errors are not well understood, there is considerable evidence that argues strongly against the concept that visual errors are the result of carelessness, sloppiness or negligence on the part of radiologists [3].…”