Radiologic errors, past, present and future

During the 10-year period beginning in 1949 with publication of five articles in two radiology journals and UKs The Lancet, a California radiologist named L.H. Garland almost single-handedly shocked the entire medical and especially the radiologic community. He focused their attention on the fact now known and accepted by all, but at that time not previously recognized and acknowledged only with great reluctance, that a substantial degree of observer error was prevalent in radiologic interpretation. In the more than half-century that followed, Garland's pioneering work has been affirmed and reaffirmed by numerous researchers. Retrospective studies disclosed then and still disclose today that diagnostic errors in radiologic interpretations of plain radiographic (as well as CT, MR, ultrasound, and radionuclide) images hover in the 30% range, not too dissimilar to the error rates in clinical medicine. Seventy percent of these errors are perceptual in nature, i.e., the radiologist does not "see" the abnormality on the imaging exam, perhaps due to poor conspicuity, satisfaction of search, or simply the "inexplicable psycho-visual phenomena of human perception." The remainder are cognitive errors: the radiologist sees an abnormality but fails to render a correct diagnoses by attaching the wrong significance to what is seen, perhaps due to inadequate knowledge, or an alliterative or judgmental error. Computer-assisted detection (CAD), a technology that for the past two decades has been utilized primarily in mammographic interpretation, increases sensitivity but at the same time decreases specificity; whether it reduces errors is debatable. Efforts to reduce diagnostic radiological errors continue, but the degree to which they will be successful remains to be determined.