Which of the following is a type of cognitive bias?

1. Edge of the film error
2. Alliterative error*
3. Communication error
4. Perceptual error

• Alliterative error is one of many cognitive biases and represents the influence that one radiologist’s judgment can exert on the diagnostic thinking of another radiologist.  An example is when a radiologist interprets a liver lesion on MRI as focal nodular hyperplasia (FNH) because the prior radiologist called it FNH, even though it has imaging features characteristic of hepatocellular carcinoma.
• Edge of the film error occurs when an important finding is missed because it is at the edge of a study, such as in the periphery of an x-ray or on the top or bottom images of aCT of the abdomen and pelvis. This is a form of blind spot error.
• Communication errors represent a type of error related to communication of important findings to other providers and are unrelated to cognitive biases. Examples include unclear and ambiguous reports, as well as instances in which important findings are not communicated directly to ordering providers with documentation in the radiology report that communication occurred.
• Perceptual errors are a general category of errors in which an important finding is missed by a radiologist, but visible in retrospect. Perceptual errors can happen for many reasons, including systematic factors like fatigue and cognitive biases such as satisfaction of search.

Type 1 thinking can be described as:

1. Rule-based
2. Deductive
3. Analytical
4. Reflexive*

• Type 1 thinking, also known as fast thinking, is described as intuitive, heuristic, unconscious, and reflexive.
• Type 2 thinking, also known as slow thinking, is described as analytical, deductive, deliberate, and rule-based.

Anchoring bias:

1. Reflects the undue influence that an initial interpretation has on the evaluation of subsequently collected information*
2. Results from a tendency to be influenced by how a question is asked or how a problem is presented 
3. Refers to the tendency for diagnostic assessments to be unduly influenced by easily recalled experiences
4. Represents the influence that one radiologist’s judgment can exert on the diagnostic thinking of another radiologist.

• Anchoring bias reflects the undue influence that an initial interpretation has on the evaluation of subsequently collected information
• Framing bias results from a tendency to be influenced by how a question is asked or how a problem is presented
• Availability bias refers to the tendency for diagnostic assessments to be unduly influenced by easily recalled experiences
• Alliterative bias represents the influence that one radiologist’s judgment can exert on the diagnostic thinking of another radiologist.

Which of the following theories helps us understand why cognitive errors occur?

1. Cognitive miser theory
2. Dual process theory*
3. Analytical processing theory
4. Cognitive error theory

• The dual process theory has recently emerged as the dominant model for cognitive operations and suggest causal reasons for diagnostic errors. This theory outlines two distinct types of thinking, termed fast and slow.
• The cognitive miser theory states that to conserve energy, we try to use type 1 (fast) thinking as much as possible.This is a corollary to the dual process theory.
• The other answers are not accepted theories.

A 71 year old man with hematuria has an enhanced CT scan (see images below), which demonstrates a calcified mesenteric mass with desmoplastic reaction and a hypoenhancing liver lesion. What is the most likely diagnosis?

1. Metastatic testicular cancer
2. Desmoid
3. Small bowel carcinoid*
4. Lymphoma

• A calcified  mass with desmoplastic reaction is the classic description of small bowel carcinoid, and actually represents nodal metastasis from a primary tumor in the small bowel.
• Metastatic testicular cancer typically involves retroperitoneal lymph nodes, not mesenteric lymph nodes.
• Desmoid tumors and lymphoma are not typically calcified