Errors in Imaging

"This book offers a thorough, clear and practical guide to identifying, preventing and correcting any error or bias that may arise during the interpretation and reporting of medical images. It combines information and insights from the fields of radiology, expertise theory, cognitive psychology, and advanced learning practices with the author's considerable clinical (radiologic) experience. In addition, the book features an extensive "Teaching Cases Section" that simulates real-world situations, giving readers an opportunity to practice what they have just learned. The purpose of the book is to provide readers with essential information and strategies, and to point out the deficiencies of the current radiology education system, in order to minimize the occurrence and the clinical impact of errors in imaging by offering the proper education and training for imaging professionals. It offers a valuable guide for diagnostic radiologists and all other imaging professionals, whether in training or in practice. Though the main emphasis is on computed tomography and magnetic resonance, the general principles are applicable to all conventional imaging modalities. ." -- Prové de l'editor Foreword 1 Foreword 2 Acknowledgements Contents Introduction Errors in Imaging 1: Perception and Cognition in Medical Imaging 1.1 Overview 1.2 Research Studies: Results 1.3 Research Studies vs. Real Life 1.4 Inattentional Blindness References 2: Definition of Errors in Imaging 2.1 Errors and Discrepancies: Definition 2.2 Error and Discrepancy Rates 2.3 Potential Impact of Errors on Patients and Imaging Professionals References 3: Categories of Errors in Imaging 3.1 Introduction 3.2 Detection Errors 3.3 Interpretation or Judgment Errors 3.4 Blind Spots 3.5 Omission Errors 3.6 Errors Formulating the Report 3.7 Errors Communicating with the Referring Physician References 4: The Radiology Report 4.1 General Remarks 4.1.1 Identification 4.1.2 Clinical Referral or Clinical History 4.1.3 Technique 4.1.4 Findings 4.1.5 Conclusion or Impression 4.1.6 Advice or Recommendations 4.2 Incidental Findings (Incidentalomas) 4.3 Dismissing “Insignificant” Findings 4.4 Handling Findings Unreported in Prior Imaging 4.5 Radiologic Language 4.6 Distinguishing Uncertainty from Vagueness 4.6.1 Uncertainty 4.6.2 Vagueness 4.7 Quantifying and Managing Uncertainty 4.8 Errors Communicating with the Referring Physician 4.9 Factors Affecting Follow Through of Our Recommendations 4.10 Personal Thoughts 4.11 The Human Face of the Radiology Report References 5: Mechanisms of Errors 5.1 Extrinsic Sources of Errors 5.2 Internal Sources of Errors 5.2.1 Mechanical 5.2.1.1 Knowledge Base 5.2.1.2 Report-Related Mechanical Faults 5.2.2 Cognitive 5.2.2.1 General Remarks 5.2.2.2 Sensitivity Versus Specificity 5.2.2.3 Biases 5.3 Interpretation Errors and Biases: Bringing It All Together References 6: Expertise and Competence 6.1 General Remarks 6.2 How Do We Achieve Expertise in Radiology? 6.2.1 Medical Decision Making (MDM) 6.2.2 Accelerated Learning 6.2.3 The Author’s Proposals to Radiology Residents for Accelerated Learning 6.2.3.1 Initial Steps 6.2.3.2 Intermediate Steps 6.2.3.3 Final Steps (Fellowship or Last Year of Residency) References 7: Error Reducing Strategies 7.1 General Remarks 7.2 Error Reducing Strategies for Individual Radiologists 7.2.1 Diagnostic Algorithms and Methods for Neutralizing Biases 7.2.1.1 Bypassing the Request, the Patient’s History, and Prior Imaging Reports [63, 67, 70] 7.2.1.2 Bypassing Statistical Limitations 7.2.1.3 Satisfaction of Searching the Entire Image and the Entire Study 7.2.1.4 “What Can I Not Afford to Miss?” 7.2.1.5 What Else Could It Be? Or What Could It Be? 7.2.1.6 Looking Behind the Scenes for Causes and Complications 7.2.1.7 Time Factors 7.2.1.8 Pause and Reboot 7.2.2 Special Considerations for Oncology Patients 7.2.2.1 General Remarks 7.2.2.2 Posttreatment Considerations 7.2.2.3 Conclusion 7.2.2.4 Screening for Cancer 7.2.3 Special Considerations for Medical Devices/Instruments and Foreign Bodies 7.3 Error Management in Nonteaching Radiologic Centers and Departments 7.3.1 Quality Control 7.3.2 Error Discussion 7.3.3 Safeguarding the Patient’s Identity in Examinations, Reports, and Files 7.3.4 Allocation of Resources 7.3.4.1 Subspecialists 7.3.4.2 Double Reading 7.3.4.3 Official Second Interpretation 7.3.4.4 Arresting Propagation of Errors 7.3.4.5 Teleradiology 7.3.4.6 Safeguarding the Radiology Report 7.4 The Role of Teaching Institutions References Epilogue: Conclusions and Personal Thoughts About Our Education General Remarks The Author’s Key Proposals About Reshaping Our Education Teaching Cases Case 1 Discussion Teaching Points Case 2 Discussion Teaching Point Case 3 Discussion Teaching Point Case 4 Discussion Teaching Point Case 5 Discussion Teaching Points Case 6 Discussion Teaching Points Case 7 Discussion Teaching Points Case 8 Discussion Teaching Points Case 9 Discussion Teaching Points Case 10 Discussion Teaching Points Case 11 Discussion Teaching Points Case 12 Discussion Teaching Point Case 13 Discussion Teaching Points Case 14 Teaching Point Discussion Case 15 Discussion Teaching Point Case 16 Discussion Teaching Point Case 17 Discussion Teaching Point Case 18 Discussion Teaching Point Case 19 Discussion Teaching Point Case 20 Discussion Teaching Point Case 21 Discussion Teaching Point Case 22 Discussion Teaching Point Glossary References Suggested Reading