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Review
. 2016;89(1061):20150914.
doi: 10.1259/bjr.20150914. Epub 2016 Feb 3.

Errors in imaging patients in the emergency setting

Antonio Pinto  1 , Alfonso Reginelli  2 , Fabio Pinto  3 , Giuseppe Lo Re  4 , Federico Midiri  4 , Carlo Muzj  1 , Luigia Romano  1 , Luca Brunese  5
Affiliations
Review

Errors in imaging patients in the emergency setting

Antonio Pinto et al. Br J Radiol. 2016.

Abstract

Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.

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Figures

Figure 1.
Figure 1.
Anteroposterior radiograph of the pelvis (a): the absence of fracture. The radiologist recommends the need of a CT examination. Subsequent CT (axial section, b) reveals an anterior left-column acetabular fracture (arrow).
Figure 2.
Figure 2.
Plain abdominal radiograph: missed diagnosis of ingested foreign body (arrow). The clinician did not report an adequate history.
Figure 3.
Figure 3.
Cross-table lateral radiograph of the abdomen (a). Evidence of a translucent image (arrow) not correctly interpreted as pneumoperitoneum. Subsequent multidetector CT examination (sagittal reconstruction, b) shows the presence of a faecal impaction and the absence of free intraperitoneal air. Fracture of T12 body.
Figure 4.
Figure 4.
Missed fracture of the lateral plateau on the anteroposterior view of the knee radiograph (arrow).
Figure 5.
Figure 5.
Lateral radiograph: missed diagnosis of subtle depression of the superior endplate of L1 (arrow).
Figure 6.
Figure 6.
Missed lung cancer (arrow) on chest radiograph (a). Corresponding axial CT examination of the same patient outlining the missed lesion (b).
Figure 7.
Figure 7.
CT examination of the brain. Missed diagnosis of fracture of C2 body on CT scout view (arrow).
See this image and copyright information in PMC

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