|Gorovitz & Borten, P.C.
Attorneys at Law
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Tel: (781) 890-9095
Diagnostic error in medicine is a major cause of patient harm, with the rate of
missed, incorrect, or delayed diagnoses estimated to be as high as 10%–15%.
Because medical imaging constitutes such a large component of modern clinical
diagnosis, the high prevalence of diagnostic unreliability, including both incorrect
and delayed diagnoses, in medical practice is partly attributable to the errors of
radiologists. In fact, the radiologic contribution to diagnostic error overall is likely to
Errors in diagnostic radiology occur for a variety of reasons related to human error,
technical factors and system faults. The most widely accepted classification of
radiologic errors includes the following categories:
• type 1: complacency
o finding identified, but attributed to wrong cause
• type 2: faulty reasoning
o finding identified as abnormal, but attributed to wrong cause
• type 3: lack of knowledge
o finding identified, but attributed to wrong cause due to lack of knowledge
• type 4: under-reading
o missed abnormality that was appreciable in retrospect
• type 5: poor communication
o finding identified as abnormal, but poor communication to relevant clinician
• type 6: technique
o abnormality was not identifiable (even in retrospect) secondary to poor
• type 7: prior examination
o failure to review previous imaging results in missed finding
• type 8: history
o finding missed due to incomplete clinical information
• type 9: location
o finding missed because it was outside of region of interest
• type 10: satisfaction of search
o failure to find a subsequent abnormality after the initial abnormality was
• type 11: complication
o most often related to interventional procedures
• type 12: satisfaction of report
o over-reliance on the prior report
From the medicolegal point of view, any discrepancy in interpretation that differs
substantially from the consensus of the reasonable and prudent radiologist’s peers
would be an appropriate definition of an interpretive error. Even skilled and
experienced radiologists failed to note important findings on 30% of chest
radiographs that were positive for disease.
Perceptual errors occur during the initial detection phase of an image interpretation.
A perceptual error is deemed to have occurred when an abnormality is
retrospectively determined to have been present on a diagnostic image, but was not
seen by the interpreting radiologist at the time of primary interpretation. In most
instances, perceptual errors can be attributed to specific risk factors such as poor
conspicuity of the target lesion on the image; reader fatigue; an overly rapid pace of
performing interpretations; distractions, such as phone calls, e-mails, and other
Internet-based distractions or interruptions; and a phenomenon known as
satisfaction of search, whereby the finding of one abnormality on an image results in
a second abnormality being overlooked, ostensibly because the radiologist is
satisfied with the results of his or her initial finding. Most perceptual errors, however,
lack any obvious cause and too often, a finding that is readily apparent in retrospect
is inexplicably missed by the initial interpretive radiologist.
To properly interpret an imaging study and arrive to a meaningful interpretation, a
radiologist uses: a) visual detection; b) pattern recognition; c) working memory
functions; and d) cognitive reasoning. Each individual radiologist brings to the
interpretative process their knowledge base, past experience and cognitive biases.
Cognitive or interpretive errors occur when an abnormality is identified on an image
but its importance is incorrectly understood, resulting in an incorrect final diagnosis.
This type of error may be secondary to a lack of knowledge, a cognitive bias on the
part of the radiologist interpreting the study, or misleading clinical information
distorting the apparent pretest probability of disease. In many instances, it is simply
the result of a radiologist inadvertently propagating an error made by a colleague in
a previous radiology report, also referred to as a satisfaction of report. This is
usually reported as ‘no significant changes from previous exam(s)’ when indeed the
disease has progressed and changes are clearly present.
A large portion of radiologic errors are due to the failure of a radiologist to report
what is known as incidental findings. An incidental finding is described as ‘a finding
detected that is unrelated to the primary objective of the examination ordered’.
Commonly included in radiology specialist’s interpretation of these scans are
findings unrelated to the chief complaint or in an adjacent area, and not pertinent to
the immediate patient care. The typical example is the appearance of a fractured
vertebra in a chest x-ray ordered to rule out pneumonia.
If you believe that you or your loved one have been injured as a result of a
radiologist’s misinterpretation of an imaging study (radiography, ultrasonographic
study, CT scan, MRI, etc.) that was diagnosable, avoidable and/or preventable, you
may have a valid cause of action. The injury may be the result of a radiologist’s
mistake in interpreting your imaging study and the result of medical negligence. Dr.
Borten has over 35 years of experience as a physician/surgeon to fully evaluate the
merits of your potential case. Allow the medical malpractice attorneys at Gorovitz &
Borten help you assert your rights and get the compensation you deserve.
For a free confidential consultation and receive a response within 24 hours (when
possible), please contact us by phone, fax or e-mail with your question or concern.
Telephone: 781-890-9095 - Fax: 781-890-9098
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