A new analysis published in Academic Radiology explored some of the many causes of error in diagnostic radiology and what could be done to prevent those issues moving forward.
“Diagnostic imaging requires complex perceptual and cognitive tasks wherein the radiologist perceives, identifies, evaluates, and interprets multiple imaging findings to arrive at a diagnosis,” wrote author Andrew J. Degnan, MD, department of radiology at Children’s Hospital of Philadelphia, and colleagues. “Each stage of the process has the potential for error to take place.”
These are five of the strategies suggested by Degnan and colleagues in their analysis:
1. Cognitive psychology approaches
One way to reduce diagnostic errors, the authors noted, is taking a closer look at why radiologists make the decisions they make. Psychological interventions can cut down on errors by increasing a specialist’s awareness of how a mistake was made and how they are limited by their own intuition.
“One of these approaches includes metacognition, also referred to as reflective reasoning, in which individuals think about how a thought process occurred and led to a conclusion,” the authors wrote. “In reflective reasoning, one applies healthy skepticism while examining a case and reflects on the thought processes behind the interpretation.”
2. Structured reporting and checklists
Structured reports help ensure a radiologist is fully reporting the findings and not missing any small details. Checklists that list commonly missed findings, Degnan et al. added, “may be helpful reminders to review areas that are often overlooked.”
3. Working to obtain better, more complete information
“As many radiology requisitions still require user input, it is of utmost importance that providers submit accurate clinical information,” the authors wrote. “Future efforts to efficiently provide more and better clinical information for radiology studies should attempt to harness computing systems to mine the electronic medical record for only relevant information to provide for each examination.”
4. Timed breaks in the reading room
Reader fatigue is a significant problem, and studies have found that accuracy decreases as a radiologist has been in the reading room after eight hours. By making radiologists take timed breaks, however, it can help them clear their minds for a moment and actually improve overall efficiency. Taking timed breaks can also help radiologists feel more comfortable, keeping them from hurting their necks, backs and chests due to a heavy workload.
5. Shared quality improvement
Departmental meetings focused on quality improvement are one way to help an entire team cut down on diagnostic errors.
“The discussion focuses not on the error itself but relevant learning points, providing an educational venue to discuss pitfalls, mimics, and mitigation strategies for commonly missed findings,” Degnan and colleagues wrote.
The Royal College of Radiologists has shared guidelines for how these meetings should be conducted, the authors added, but no equivalent exists yet in the United States.