SF 12a - My most scary head and neck mistakes
1. To become familiar with the most common mistakes in head and neck imaging and their causes.
2. To learn strategies to avoid mistakes.
3. To learn how to deal with different types of mistakes.
At the same time imaging became a major player in the diagnostic process it has also become a major source of diagnostic error. Although errors in radiology are multifold, most are attributable to image interpretation errors by radiologists which can grossly be subdivided into perceptual and cognitive. Radiologists are put under a great amount of pressure by the urgency of the diagnosis requiring rapid reporting, on top of increasing workload, increasing complexity of imaging techniques and increasing complexity of clinical cases. While the number of images and post-processing requirements have increased dramatically in the past decades the reporting time has decreased at the same pace, leaving more room for error. This session will cover misses, perceptual errors defined as important imaging findings that are not seen by the radiologist and mistakes, cognitive errors defined as visually detected findings which are misinterpreted by the radiologist, in head and neck imaging using illustrative clinical cases. We will also provide strategies both at the individual and departmental level to prevent these mistakes in a solution-oriented approach and to cope with mistakes once they eventually occur.
1. To become familiar with different types of missed findings.
2. To appreciate common radiologist’s bias.
3. To learn strategies to avoid different categories of misses.
This lecture will give you an overview of diagnosis which can be missed easily. The reason for missed diagnosis can be variable and includes the following: the radiologists know only common disease; radiologists are only able to diagnose lesions, which they have seen before; radiologist did not get the full clinical Information; lack of time; radiologists can have the "hammer-and-nail" bias; radiologists want to save money by not doing an additional examination (e.g. with another modality); radiologists have different skill levels.
1. To appreciate different causes of misinterpretation of imaging findings in the head and neck.
2. To review common misinterpreted findings in the head and neck.
3. To learn how to avoid misinterpretations.
Head and neck cancer imaging is fraught with opportunity for error. These errors include but are not limited to failure to observe, failure to synthesize and integrate findings into the correct interpretation and various types of knowledge gaps that can produce an incomplete, inaccurate or otherwise inadequate reading. This presentation will reflect on my own personal shortcomings in several cases, serving as a cautionary tale to others.
1. To learn how to deal with mistakes: your own and other’s.
2. To understand the value of clinical audits.
3. To become familiar with different steps of clinical action.
Errors always occur in radiology, as a result of the nature of the subject, clinical circumstances and the complexity of human individuality. Individuals and departments must have a strategy for dealing with these incidents. The initial question to address is whether an error has actually occurred and whether it is clinically significant. Radiological reporting is open to discrepancies (a better description than “errors”) in medical opinion and each discrepancy should be graded in a system which allows for justifiable variation in opinion and judges the potential clinical impact. Where a significant discrepancy is found the appropriate action potentially involves the radiologist, the referring clinician and the patient. It also depends on the grade of discrepancy. Any actions taken should be documented at the time: retrospective alteration of medical records should be avoided. Departments should have methods of recording discrepancies that change the impact of previously issued reports, whether or not these have impact extending to duty of disclosure to the patient. Where an individual radiologist is found to generate an excessive number of discrepancies the grading system can be used to evaluate their competence objectively, but must be statistically robust, i.e. it employs a sufficient number of blinded viewers who independently grade an adequate number of the same reports, randomly selected. Regular evaluation of all radiologists in this way could be used to demonstrate the overall clinical performance of individual departments. Where substandard performance is found departments must have arrangements for retraining or altering the content of that radiologist’s practice.