Comparing the diagnostic accuracy of radiologists with that of other specialities is increasingly difficult. Autopsy results suggest that the final working diagnosis may be inaccurate in up to one in five patients, however, it is not possible to quantify how much of the physician’s final working diagnosis is influenced by the radiology report. Since discrepancies in final working diagnoses cannot always be attributable to either the radiologist or the clinician, accountability should be shared by both. A patient-centric approach, which sees radiologists embedding themselves deeply into the clinical team, will help with this.
The Kim-Mansfield radiological error classification system analysed 1,269 radiological errors and split them into 12 categories. The three most common errors were ‘missed findings’ (42%), ‘satisfaction of search’ (22%) and ‘misinterpretation of findings’ (9%).
A much simpler approach is to broadly separate errors into two categories: perceptual (missed findings) and cognitive (misinterpretation of findings). Although discrepancies in both categories are due to a combination of system and human errors, it is clear the radiologist is as dependent on the clinician to provide accurate clinical information as the clinician is on the accuracy of the final radiological report.
There is a well-documented example of procedural error whereby two paediatric radiologists missed a coin lodged within a child’s oesophagus on a chest X-ray despite no clinical history to suggest this. The process of interpreting a study requires a complex thought process, which is tailored to the clinical history and index of suspicion of a particular pathology as a cause for the patient’s symptoms. In the case of the missed coin, had the suspicion of a swallowed foreign body been raised by the clinical team, at least one of the radiologists would have searched for it.
Although perceptual errors account for a larger proportion of errors, cognitive errors might benefit most from better clinical input. More often than not, radiological findings can represent wide differential diagnoses of limited clinical value. In these situations, the initiative is on the radiologist to actively seek additional clinical information to produce a clinically relevant report.
Radiology departments should ensure that strategies are in place to reduce errors where possible, whether through the use of computer-aided detection or the imminent arrival of AI systems to help identify and eliminate avoidable errors. For example, structured or synoptic reporting has been shown to provide clearer reports while also reducing typographic errors.
Despite the increased exposure to discrepancies that come with the work’s volume and complexity, it is important that radiologists do not allow the fear of an error to alter their practice, as this can lead to non-committal and defensive reports that are often of little clinical value. It is in fact the radiologist’s courage of his or her convictions that has added so much clinical value in the past and will allow them to thrive in the future.
This article was co-written by Dr. Shah Islam