Diagnostic errors in clinical FDG-PET/CT

Abstract

Purpose: To determine the frequency, types, and determinants of diagnostic errors in clinical FDG-PET/CT, based on addenda to the original report.

Materials and methods: This retrospective study included 4,099 consecutive clinical FDG-PET/CT scans with corresponding reports that were made at a tertiary care center in an 18-month period. FDG-PET/CT reports were scrutinized for the presence of an addendum enclosing a diagnostic error.

Results: 90 of 4,099 FDG-PET/CT reports (2.2%) contained an addendum enclosing a diagnostic error. The distribution of perceptual and cognitive errors among these 90 diagnostic errors was 54 (60.0%)/36 (40.0%). On multivariate logistic regression analysis, only low-dose FDG-PET/CT combined with concomitantly acquired and interpreted full-dose contrast-enhanced CT remained as significantly and independently associated with the presence of a diagnostic error, relative to low-dose FDG-PET/CT without concomitantly acquired and interpreted full-dose contrast-enhanced CT (odds ratio: 2.79 [95% confidence interval: 1.61-4.85], P < 0.001). Patient age, gender, hospital status, indication for FDG-PET/CT scanning, single vs. double reading (i.e. two medical imaging specialists), reader experience, and reading by a nuclear medicine physician only vs. reading by both a nuclear medicine physician and a radiologist, were not significantly and independently associated with the presence of a diagnostic error.

Conclusion: Diagnostic errors in clinical FDG-PET/CT based on addenda to the original report are relatively infrequent, though certainly non-negligible. Perceptual errors are slightly more frequent than cognitive errors. The availability of a concomitantly acquired and interpreted full-dose contrast-enhanced CT seems to increase diagnostic error rate. These data can be used for quality improvement and benchmarking purposes.

Keywords: 18F-FDG; Diagnostic errors; Malpractice; PET-CT.