A review of medical literature reveals a consistent pattern of misdiagnosis related to the perception and decision-making process of radiologist. Better training is needed.
?The judge found statistics presented by the witnesses that radiologists? ?miss? rates can be as high as 30%, and admissions by all of the witnesses that they, too, on occasion had missed radiologic findings, to be 'unsettling' and ?clearly disturbing?, but he did not question their authenticity.?
Wisconsin Case on Missed Radiographic Diagnoses
ACR Bulletin - Dec. 95
?The generally accepted error rate for the detection of early lung cancer is between 20% and 50%, and little improvement has been noted over the last few decades.?
Pitfalls in the Radiologic Diagnosis of Lung Cancer
A review article by John H. Woodring, MD,
Department of Diagnostic Radiology
University of Kentucky Medical Center
American Journal of Radiology - June 1990
?Surprisingly, the average error rate among radiologists is 30%... Non-radiologists and even some radiologists may be astonished to learn that the error rate among radiologists hovers around 30%, a percentage consistently documented in almost every report dating from Garland?s classic article in 1949 to a report by Renfrew et al of the University of Iowa in 1992. In 1976, Lehr et al of the University of Missouri elucidated and classified errors and omissions more fully. They found that the error rate was similar among all radiologic modalities. ?
Missed Radiologic Diagnosis: Medico-Legal and Ethical Considerations.
Leonard Berlin, MD, FACR
Department of Radiology
Rush North Shore Medical Center, Skokie, IL
American Journal of Radiology - July 1994
?Radiologic misses continue to occur at an average rate of 30%, with little hope of improvement... In an exhaustive study of error rates in 2000 cases, Lehr et al found that experience had little to do with accuracy. The error rate among staff radiologists was 30%, among third- and fourth-year residents, 33%, and among second-year residents, 31%.?
Malpractice and Radiologists, Updated 1986: An 11.5-Year Perspective.
Leonard Berlin, MD, FACR
Department of Radiology
Skokie Valley Hospital, Skokie, IL
and University of Illinois College of Medicine, Chicago, IL
American Journal of Radiology - December 1986
?Malpractice cases filed against the US. government were reviewed. The most common claim was misdiagnosis of malignancy (30% of the cases); in these cases the claimants received relatively high compensation.?
Medical Malpractice in Diagnostic Radiology: Claims Compensation, and Patient Injury
Mary M. Hamer, MD
Department of Diagnostic Radiology
William Beaumont Hospital, Royal Oak, MI
Radiology - July 1987
?In diagnostic radiology, the error rate is presently around 30% for subtle visual signals.? (Jaffe 1982).
Engineering Research in Visual Perception
A report prepared for the National Science Foundation
by the American College of Radiology - November 1986
?Approximately 30% of nodules are missed during the initial reading of chest radiographs. Eye-position recordings have shown that most nodules that are missed receive prolonged visual attention.?
Computer-Displayed Eye Position as a Visual Aid to Pulmonary Nodule Interpretation
Harold L. Kundel, MD, et al
Department of Radiology
University of Pennsylvania, Philadelphia, PA
Investigative Radiology - August 1990
?With several colleagues, I investigated this problem some years ago and was amazed to find that three experienced radiologists, charged only with indicating the presence of abnormal shadows in a collection of chest films, ?overlooked? 20 to 30 percent of the findings which they as a group later judged to have been reportable.?
Visual Search, Image Organization and Reader Error in Roentgen Diagnosis
Studies of the Psychophysiology of Roentgen Image Perception.
William I. Tuddenham, MD
Department of Radiology
Hospital of the University of Pennsylvania, Philadelphia, PA
Memorial Fund Lecture
Presented at 47th Annual RSNA, Chicago, IL - 1961.
?....Garland...reported on the accuracy of diagnostic procedures and showed that the x-ray report was indeed subject to errors in technique and interpretation, with experienced roentgenologists overlooking as many as 30% of a series of abnormal chest films while overreading about 20% of the normal ones. He emphasized that realization of observer error in diagnostic roentgenology should provide a stimulus to greater care in examination, increased use of consultation, and continued attempts to minimize technical error.?
Accuracy of the X-ray Report
Clyde A. Stevenson, MD
Department of Radiology
Sacred Heart Hospital, Spokane, WA
JAMA - February, 1969
?The peripheral cancers grew slowly. 90 % were visible in retrospect for months or even years. Despite this, 70% of the peripheral cancers were classified as post-surgical AJC Stage.?
Lung Cancer Detected During a Screening Program Using Four-Month Chest Radiographs
John R. Muhm, MD, et al
Departments of Diagnostic Radiology, Division of Thoracic Diseases and Internal Medicine, and of Internal Medicine
Mayo Clinic and Mayo Foundation, Rochester Minnesota
Radiology - September 1983
?20% to 40% of statements in diagnostic radiology reports have been found to contain significant or potentially significant errors. During a quality assessment audit of the emergency radiographic area at Massachusetts General Hospital, the staff radiologists indicated they had changed the resident?s initial reports in a significant or potentially significant way in 11% of these reports. An analysis of the errors was made to determine the influence of initial errors and the revised interpretation on the patients? care and to investigate the characteristics of the errors.... there will always be a base line or inherent error rate due to the limitations of the human processes of perception and interpretation...?
Errors of Interpretation as Elicited by a Quality Audit of an Emergency Radiology Facility
James T. Rhea et al
Department of Radiology
Massachusetts General Hospital and Harvard Medical School
Boston, MA
?... as many as 90% of lung cancers can be seen on previous chest radiographs once the diagnosis is established. If the resipsa loquitor standard was applied for each of these cases, radiologists would be liable for damages in 90% of lung cancer cases.?
When is it Malpractice to Miss Lung Cancer on Chest Radiographs?
E. James Potchen, MD, JD et al
Department of Radiology
Michigan State University, East Lansing, MI
Radiology - April 1990
