In the 2013 retrospective study by Kim and Mansfield about types of diagnostic error, the percentage of errors attributed to not reviewing prior imaging studies was:

1. 5%*
2. 22%
3. 0.9%
4. 2%

• 5% of errors were attributed to not reviewing prior imaging studies.
• 0.9% of errors were attributed to an error of overreading and misinterpretation, in which a finding is appreciated but is attributed to the wrong cause.
• 2% of errors were attributed to 1)limitations of examination or technique, and 2) inaccurate or incomplete clinical history.
• 22% of errors were attribute to failure to continue to search for additional abnormalities after the first abnormality was found (e.g. satisfaction of search).

Which of the following is NOT a contributing factor to radiologists failing to review relevant prior studies?

1. Prior examination was performed at an outside institution
2. Lack of evidence that reviewing prior studies reduces errors*
3. Failure of a PACS server to retrieve prior exams at the time of interpretation
4. PACS automatically selects prior studies for comparison

• Lack of evidence that reviewing prior studies reduced errors does not contribute to radiologists failing to review prior studies.
• The remaining options are all contributing factors to radiologists failing to review prior studies.

Which of the following types of cognitive bias can occur when a radiologist reads the prior imaging report before reviewing an imaging study?

1. Hindsight bias
2. Availability bias
3. Alliterative bias*
4. Anchoring bias

• Alliterative bias represents the influence that one radiologist’s judgment can exert on the diagnostic thinking of another radiologist, for example when he/she reads the report for a prior imaging study before reviewing the current imaging study.
• Hindsight bias refers to the tendency to overestimate the predictability of an event after the event is known.
• Availability bias refers to the tendency for diagnostic assessments to be unduly influenced by easily recalled experiences
• Anchoring bias reflects the undue influence that an initial interpretation has on the evaluation of subsequently collected information

According to the ACR’s practice parameter for the performance of chest radiography, a radiologist should:

1. Review the most recent prior chest x-ray
2. Review all recent chest x-rays
3. Review all prior chest x-rays
4. Review all pertinent imaging studies*

• Review all pertinent imaging studies is the correct answer. The remaining answers are not as comprehensive and do not accurately reflect the ACR’s practice parameter.

Among the following options, the most common type of error is when:

1. The finding is identified and interpreted correctly, but the message fails to reach the ordering provider
2. The finding is identified but attributed to the wrong cause
3. The finding is missed because of failure to continue to search for additional abnormalities after the first abnormality was found*
4. The finding is missed because of failure to consult prior radiologic studies or reports

• Satisfaction of search accounted for22% of errors, which is when a finding is missed because of failure to continue to search for additional abnormalities after the first abnormality was found.
• Poor communication accounted for less than 1% of errors.
• Failure to consult prior radiologic studies or reports accounted for 5% of errors.
• Finding is identified but attributed to the wrong cause is a combination of type 1, 2 and 3 errors, accounting for0.9%, 9%, and 3% of errors, respectively.