Error And Uncertainty In Diagnostic Radiology

Over the past decade, radiological imaging tests - including CT scanning, MRI, PET, X-rays, ultrasound, fluoroscopy and other modalities - have become essential to the routine diagnostic process. While these modern advanced medical images and their striking anatomic detail have discovered underlying issues, they have also contributed to a false impression of infallibility. Unlike other straightforward diagnostic tests, such as the EKG or blood chemistry panel, radiological imaging tests are highly variable and complex, often yielding uncertain results, as well as frequent false-negatives and false-positives. The experts who interpret the images (the diagnostic radiologists) sometimes make mistakes: the practice of diagnostic radiology is a fallible, human endeavour, one involving complex perceptual, neuro-physiological and cognitive processes employed under a wide range of circumstances, and with a great deal of variability. Error and Uncertainty in Diagnostic Radiology opens the 'black box,' of medical imaging, exposing the remarkable inner workings of the process of diagnostic radiology-including how and why it can sometimes go tragically wrong. The occurrence of radiological error is shown to be fundamentally intertwined with the underlying high level of uncertainty known to be present in the diagnostic process. As a foremost expert on radiology quality and safety, Dr. Bruno provides insight into the various types of radiologist error, along with a conceptual framework for understanding error and uncertainty in radiology, leading to practical strategies for error prevention and for reducing the risk of harm to patients when errors inevitably occur. This book is essential for radiologists, members of the Society to Improve Diagnosis in Medicine, emergency physicians, medical educators, medical and hospice administrators, especially quality and safety officers, as well as malpractice insurance carriers.

Diagnostic errors are important in all branches of medicine because they are an indication of poor patient care. As the number of malpractice cases continues to grow, radiologists will become increasingly involved in litigation. The aetiology of radiological error is multi-factorial. This book focuses on (1) some medico-legal aspects inherent to radiology (radiation exposure related to imaging procedures and malpractice issues related to contrast media administration are discussed in detail) and on (2) the spectrum of diagnostic errors in radiology. Communication issues between the radiologists and physicians and between the radiologists and patients are also presented. Every radiologist should understand the sources of error in diagnostic radiology as well as the elements of negligence that form the basis of malpractice litigation.

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.

This book describes and illustrates the gamut of errors that may arise during the performance and interpretation of imaging of both nontraumatic and traumatic emergencies, using a head-to-toe approach. The coverage encompasses mistakes related to suboptimal imaging protocols, failure to review a portion of the examination, satisfaction of search error, and misinterpretation of imaging findings. The book opens with an overview of an evidence-based approach to errors in imaging interpretation in patients in the emergency setting. Subsequent chapters describe errors in radiographic, US, multidetector CT, dual-energy CT, and MR imaging of common as well as less common acute conditions, including disorders in the pediatric population, and the unique mistakes in the imaging evaluation of pregnant patients. The book is written by a group of leading North American and European Emergency and Trauma Radiology experts. It will be of value to emergency and general radiologists, to emergency department physicians and related personnel, to general and trauma surgeons, and to trainees in all of these specialties.

This is the first book to explore the epistemology and ethics of advanced imaging tests, in order to improve the critical understanding of the nature of knowledge they provide and the practical consequences of their utilization in healthcare. Advanced medical imaging tests, such as PET and MRI, have gained center stage in medical research and in patients’ care. They also increasingly raise questions that pertain to philosophy: What is required to be an expert in reading images? How are standards for interpretation to be fixed? Is there a problem of overutilization of such tests? How should uncertainty be communicated to patients? How to cope with incidental findings? This book is of interest and importance to scholars of philosophy of medicine at all levels, from undergraduates to researchers, to medical researchers and practitioners (radiologists and nuclear physicians) interested in a critical appraisal of the methodology of their discipline and in the ethical principles and consequences of their work.

This book offers a thorough, clear and practical guide to identifying, preventing and correcting any error or bias that may arise during the interpretation and reporting of medical images. It combines information and insights from the fields of radiology, expertise theory, cognitive psychology, and advanced learning practices with the author's considerable clinical (radiologic) experience. In addition, the book features an extensive "Teaching Cases Section" that simulates real-world situations, giving readers an opportunity to practice what they have just learned. The purpose of the book is to provide readers with essential information and strategies, and to point out the deficiencies of the current radiology education system, in order to minimize the occurrence and the clinical impact of errors in imaging by offering the proper education and training for imaging professionals. It offers a valuable guide for diagnostic radiologists and all other imaging professionals, whether in training or in practice. Though the main emphasis is on computed tomography and magnetic resonance, the general principles are applicable to all conventional imaging modalities.