Systemic Error in Radiology

Waite, Stephen; Scott, Jinel; Legasto, Alan C.; Kolla, Srinivas; Gale, Brian; Krupiński, Elizabeth A.

doi:10.2214/ajr.16.17719

Cited by 40 publications

(16 citation statements)

References 70 publications

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“…Cognitive errors are considered to occur when a correct positive finding is followed by misclassification due to faulty reasoning or lack of knowledge (Renfrew et al, 1992). Communication errors are an additional important cause of error, outside of interpretive or perceptual categorization (Waite et al, 2017c, 2018).…”

Section: Error Rates In Radiologymentioning

confidence: 99%

Analysis of Perceptual Expertise in Radiology – Current Knowledge and a New Perspective

Waite

Grigorian

Alexander

et al. 2019

Front. Hum. Neurosci.

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Radiologists rely principally on visual inspection to detect, describe, and classify findings in medical images. As most interpretive errors in radiology are perceptual in nature, understanding the path to radiologic expertise during image analysis is essential to educate future generations of radiologists. We review the perceptual tasks and challenges in radiologic diagnosis, discuss models of radiologic image perception, consider the application of perceptual learning methods in medical training, and suggest a new approach to understanding perceptional expertise. Specific principled enhancements to educational practices in radiology promise to deepen perceptual expertise among radiologists with the goal of improving training and reducing medical error.

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Section: Error Rates In Radiologymentioning

confidence: 99%

Analysis of Perceptual Expertise in Radiology – Current Knowledge and a New Perspective

Waite

Grigorian

Alexander

et al. 2019

Front. Hum. Neurosci.

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“…Finally, accuracy in diagnostic imaging depends on the appropriateness of the imaging modality, technical quality/parameters, radiologist perception, and interpretation 27,42 . Though our analysis accounted for differences in modality, technical parameters were heterogeneous due to incremental technical improvements during the study period.…”

Section: Discussionmentioning

confidence: 99%

The use of imaging to identify immunocompromised children requiring biopsy for invasive fungal rhinosinusitis

Harreld

Kaufman

Kang

et al. 2020

Pediatric Blood & Cancer

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Background and purpose: Children with severe immunocompromise due to cancer therapy or hematopoietic cell transplant are at risk both for potentially lethal invasive fungal rhinosinusitis (IFRS), and for complications associated with gold-standard biopsy diagnosis. We investigated whether early imaging could reliably identify or exclude IFRS in this population, thereby reducing unnecessary biopsy. Methods: We reviewed clinical/laboratory data and cross-sectional imaging from 31 pediatric patients evaluated for suspicion of IFRS, 19 without (age 11.8 ± 5.4 years) and 12 with proven IFRS (age 11.9 ± 4.6 years). Imaging examinations were graded for mucosal thickening (Lund score), for fungal-specific signs (FSS) of bone destruction, extra-sinus inflammation, and nasal mucosal ulceration. Loss of contrast enhancement (LoCE) was assessed separately where possible. Clinical and imaging findings were compared with parametric or nonparametric tests as appropriate. Diagnostic accuracy was assessed by receiver operating characteristic (ROC) analysis. Positive (+LR) and negative likelihood ratios (−LR) and probabilities were calculated. Results: Ten of 12 patients with IFRS and one of 19 without IFRS had at least one FSS on early imaging (83% sensitive, 95% specific, +LR = 15.83, −LR = 0.18; P < .001). Absolute neutrophil count (ANC) ≤ 200/mm 3 was 100% sensitive and 58% specific for IFRS (+LR = 2.38, −LR = 0; P = .001). Facial pain was the only discriminating symptom of IFRS (P < .001). In a symptomatic child with ANC ≤ 200/m 3 , the presence of at least one FSS indicated high (79%) probability of IFRS; absence of FSS suggested low (<4%) probability. Conclusion: In symptomatic, severely immunocompromised children, the presence or absence of fungal-specific imaging findings may effectively rule in or rule out early IFRS, potentially sparing some patients the risks associated with biopsy.

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“…There is a significant need, and indeed an urgent call, to address fatigue and errors caused by fatigue in radiology. [18][19][20][21][22][23] Clearly fatigue can be addressed in a variety of ways, and optimizing the reading environment and the tools used to interpret images is a fundamental and very direct way to do so. With film, the "bright light" was used only when necessary to increase the visibility of subtle structures and potential lesions.…”

Section: Summary and Discussionmentioning

confidence: 99%

Increasing display luminance as a means to enhance interpretation accuracy and efficiency when reducing full-field digital mammography dose

Krupiński

2018

J. Med. Imag.

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Reducing dose increases noise impacting image quality but can be offset by increasing display luminance. Two contrast detail mammography images were obtained at 26 kV and the same distance between detectors, at 45 and 50 mAs resulting in entrance surface doses of 7.09 and 7.88 mGy, respectively. They were processed to make average gray level of the background independent of the dose level while maintaining original SNR. Eight radiologists viewed the images at 420, , and SpotView™ a tool that resulted in an average display luminance of . Percent correct (PC) for all three luminances was higher for high versus low dose. Performance was always higher with high dose no matter what the luminance. For low dose, PC was highest with SpotView™, and SpotView™ and were significantly higher than . At high dose, SpotView™ PC was significantly higher than both lower luminances. Average time per image was lower in high dose, and, at both doses, time decreased as luminance increased, with SpotView™ having significantly shorter times. Increasing luminance from 420 to significantly increases target detection by and with SpotView™ by . Increasing display luminance with SpotView™ significantly decreases reading time by 16.0%.

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Systemic Error in Radiology

Cited by 40 publications

References 70 publications

Analysis of Perceptual Expertise in Radiology – Current Knowledge and a New Perspective

Analysis of Perceptual Expertise in Radiology – Current Knowledge and a New Perspective

The use of imaging to identify immunocompromised children requiring biopsy for invasive fungal rhinosinusitis

Increasing display luminance as a means to enhance interpretation accuracy and efficiency when reducing full-field digital mammography dose

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