Error and discrepancy in radiology: inevitable or avoidable?

Abstract

Errors and discrepancies in radiology practice are uncomfortably common, with an estimated day-to-day rate of 3-5% of studies reported, and much higher rates reported in many targeted studies. Nonetheless, the meaning of the terms "error" and "discrepancy" and the relationship to medical negligence are frequently misunderstood. This review outlines the incidence of such events, the ways they can be categorized to aid understanding, and potential contributing factors, both human- and system-based. Possible strategies to minimise error are considered, along with the means of dealing with perceived underperformance when it is identified. The inevitability of imperfection is explained, while the importance of striving to minimise such imperfection is emphasised.

Teaching points: • Discrepancies between radiology reports and subsequent patient outcomes are not inevitably errors. • Radiologist reporting performance cannot be perfect, and some errors are inevitable. • Error or discrepancy in radiology reporting does not equate negligence. • Radiologist errors occur for many reasons, both human- and system-derived. • Strategies exist to minimise error causes and to learn from errors made.

Keywords: Error sources; Error, diagnostic; Misdiagnosis; Quality improvement; Radiology.

Fig. 1

a Gaussian (normal) distribution. b Paretian (power) distribution

Fig. 2

Left upper lobe lung carcinoma (arrow), not reported on CXR (under-reading error)

Fig. 3

Hypervascular pancreatic metastasis from renal cell carcinoma (arrow), not reported on CT; lung and mediastinal nodal metastases identified and reported (satisfaction of search error)

Fig. 4

Metastasis from prostate carcinoma (arrow), missed on top slice of T1W axial MR sequence (error due to abnormality outside area of interest)