The document discusses various types of errors that can occur in diagnostic radiology, including perceptual errors, interpretative errors, and biases. It notes that perceptual errors, where an abnormality is simply missed on images, account for around 60-80% of errors. Common missed findings on chest X-rays include small pulmonary nodules. Cognitive and interpretative errors involve seeing an abnormality but misunderstanding its meaning, leading to an incorrect diagnosis. The most frequent types of errors identified in studies include under-reading/missed findings, satisfaction of search errors, and faulty reasoning errors. Human biases like anchoring bias can also influence diagnoses.
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This document summarizes key points from a presentation on radiologic errors given at a conference. It discusses defining medical errors and differentiating them from complications. Error rates from retrospective studies of radiology are presented, ranging from 25-90% for missed cancers depending on the imaging modality and body area. Prospective "real-time" error rates are estimated to be 3-4%. Causes of errors including perceptual and cognitive factors are reviewed. Standards of care, hindsight bias, outcome bias and efforts to reduce errors are also discussed. An anecdote is shared about lawyers and doctors continuing adversarial relationship on flights.
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2) Both patients and providers reacted positively to the use of live remote expert supervision during telecolposcopy exams.
3) Preliminary results suggest telecolposcopy is a feasible approach when integrated into a mobile colposcopy system and may help address lack of in-person colposcopy services, especially for underserved populations.
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This document summarizes key points from a presentation on radiologic errors given at a conference. It discusses defining medical errors and differentiating them from complications. Error rates from retrospective studies of radiology are presented, ranging from 25-90% for missed cancers depending on the imaging modality and body area. Prospective "real-time" error rates are estimated to be 3-4%. Causes of errors including perceptual and cognitive factors are reviewed. Standards of care, hindsight bias, outcome bias and efforts to reduce errors are also discussed. An anecdote is shared about lawyers and doctors continuing adversarial relationship on flights.
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Initial findings from a study on implementing a telecolposcopy program on a high-risk population in California showed that:
1) Experts were able to assist junior providers remotely and provide guidance in real-time during colposcopy procedures through a mobile telecolposcopy system.
2) Both patients and providers reacted positively to the use of live remote expert supervision during telecolposcopy exams.
3) Preliminary results suggest telecolposcopy is a feasible approach when integrated into a mobile colposcopy system and may help address lack of in-person colposcopy services, especially for underserved populations.
Access to treatment, care and clinical trials by patients with rare cancers...patvocates
"Access to treatment, care and clinical trials by patients with rare cancers", presented by Jan Geissler (Twitter @jangeissler) at ESMO congress in Vienna, 30 Sept 2012
This document summarizes a study examining biases that could affect the diagnostic accuracy of CT scans and MRI for detecting appendicitis in pediatric patients. It notes several potential biases including: selection bias from only enrolling patients over 12 years old; information bias from differences in protocols for oral contrast and radiologist experience levels; and confounding biases from longer interpretation times for MRI and differences in experience between abdominal and pediatric radiologists. The study included 48 patients ages 12-20 years old who received CT scans and MRI reads by both abdominal and pediatric radiologists to evaluate differences in diagnostic performance between imaging modalities and reader specialties.
This document discusses medical errors and misdiagnosis. It notes that one in five medical errors are potentially serious or fatal, and that the most common reasons for medical malpractice claims are surgery errors and diagnostic errors. Diagnostic errors account for many preventable deaths annually in the US. Some of the leading causes of misdiagnosis discussed include lack of healthcare professionals, poor teamwork and follow up, human cognitive factors, and too much focus on one exam finding. The document also provides strategies to reduce errors such as thorough history taking, physical exams, using diagnostic aids, and always following up on concerning symptoms.
The document discusses the probabilistic nature of medical diagnosis and risk in clinical decision making. Some key points made include:
1. Physicians make probability assessments rather than definitive diagnoses and must accept some level of risk in their practice.
2. Even when a diagnosis is missed, harm does not always result as it depends on a sequence of subsequent events, and patients may improve on their own or be correctly diagnosed in the future.
3. Both sensitivity and specificity are important considerations for screening tests, but sensitivity is most important for ruling out a diagnosis while specificity prevents overdiagnosis of false positives.
4. There are risks and benefits to patients from diagnostic testing and treatment decisions, and physicians must weigh
Medication errors are a significant problem in healthcare that can harm patients. They occur commonly at various stages of the medication process including prescribing, transcribing, preparing, dispensing, and administering medications. Several studies over decades have found high rates of medication errors and preventable adverse drug events in hospitals. James Reason developed a widely used model for classifying errors as either active failures by frontline staff or latent failures due to upstream organizational or management issues. Understanding the causes of errors through models like Reason's can help pharmacists and other healthcare providers develop effective strategies to improve medication safety.
Radiology is a dynamic medical specialty that uses various imaging technologies to diagnose and treat diseases. While radiologists are often thought to work alone interpreting images in dark rooms, the reality is that radiology involves direct patient care, communication with other physicians, and teaching residents. The field also has many subspecialties and opportunities to specialize further in areas like interventional radiology that perform medical procedures. There are several pathways to become a radiologist, including integrated programs, with demand expected to remain steady due to advancing technologies.
Radiology is a dynamic specialty that uses various imaging modalities like X-rays, CT, MRI, ultrasound, and nuclear medicine to diagnose and treat diseases. Radiologists communicate results to other doctors and patients. While radiologists spend time interpreting images, they also perform procedures, see and talk to patients, and are involved in multi-disciplinary teams. There are many radiology subspecialties focused on different body systems and imaging modalities. Radiology residents train for 4 years including call duties and take their board exams in their third year before pursuing optional fellowship training in a subspecialty.
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Dr. Zabinski discusses how Artificial Intelligence (AI) and Real-World Datasets (RWD) can work in synergy to address many of the challenges facing rare disease researchers, including better describing real-world epidemiology; identifying meaningful patterns in rare disease patient journeys; and assisting in finding patients, plus those not yet diagnosed. This presentation will briefly explore the ways AI and RWD together can enhance visibility into patient trajectories, improve rare disease patient identification for clinical trial recruitment and observational research, and shorten time to diagnosis.
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Cancer Rose is a French non-profit organization of health professionals.
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By decoding and popularizing the most recent research findings published in the most important international medical journals, analyzing the controversy and providing a social and feminine analysis, our objective is to inform women concerned by breast cancer mass screening in order to help them making their choice and to provide independent information resources to interested physicians.
Cancer Rose has no sponsorships, honoraria, monetary support or conflict of interest from any commercial sources.
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At least one in every 20 adults who seeks medical care in a U.S. emergency room or community health clinic may walk away with the wrong diagnosis, according to a new analysis that estimates that 12 million Americans a year could be affected by such errors.
Experts have often downplayed the scope of diagnostic errors not because they were unaware of the problem, but “because they were afraid to open up a can of worms they couldn't close.
Medical errors represent a serious public health problem and occur frequently in various healthcare settings. They can involve medicines, surgery, diagnosis, equipment, or lab reports. Studies estimate medical errors may be the third leading cause of death in the US, resulting in between 200,000 to 400,000 deaths per year. Many common types of errors like misdiagnosis, unnecessary treatment, medication mistakes, and uncoordinated care have been reduced through standardized protocols and safety practices, but medical errors still frequently harm and kill patients.
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This document discusses best practices for patient care in radiology departments. It emphasizes that patients should be treated with safety, quality care, comfort and minimal radiation exposure. It also stresses the importance of clear communication between radiology staff and patients to avoid errors. The document provides recommendations for optimizing various aspects of the patient experience, including minimizing wait times, increasing communication, and making the environment more welcoming. It suggests radiologists take a more active role in interacting with patients. Finally, it discusses various protocols to ensure patient privacy, safety and informed consent are maintained during examinations.
MedicReS Winter School 2017 Vienna - Advanced Clinical Practice in Oncology -...MedicReS
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Experts decision making schemes slide shareImad Hassan
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1. Gather information through history and physical
2. Summarize the case using technical language
3. Propose a diagnosis using pattern recognition, heuristics, or differential diagnosis
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7. Determine therapeutic interventions using a 5S scheme addressing site of care, symptoms, support, specific treatments, and specialty referral
8. Prepare for discharge by assessing response to treatment, discharge criteria, and follow-up timing
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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Diagnostic radiology errors and discrepancies (2).pptx
1. Diagnostic radiology errors and
discrepancies
• Dr. Vincent Batista Lemaire
• Locum Consultant Radiologist
• St. Richards Hospital ,University Hospital Sussex Hospitals Trust, NHS .
• Chichester , England , UK .
2. Dedicado a Mi padre Dr. Guarocuya Batista del Villar y mi
hermano Dr. Erasmo Vasquez Henriquez.
3. Diagnostic radiology errors and
discrepancies
• Dr. Vincent Batista Lemaire
• Locum Consultant Radiologist
• St. Richards Hospital ,University Hospital Sussex Hospitals Trust, NHS .
• Chichester , England , UK .
6. Human Error
• Bad publicity from an assumption that perfection is
achievable.
• Any error or discrepancy must be punished .
• The public expects the correct answer all the time .
• Tv dramas, media reports describing the error or discrepancy
as a scandal .
• Unfavourable remarks by politician and lawyers alike.
• Medical malpractice claims have been initiated alleging the
radiologist’s failure to detect os acromial and os trigonum
• Societal and government trend of placing increasing
expectation and legal obligation on radiologist. Jury would
expect general radiologist to have the same skills as
subspecialty radiologist .
7. Grading or scoring Error
• 2014, Royal College of Radiologist (RCR):
“grading or scoring errors…was unreliable or
subjective…of questionable value, with poor
agreement .”
• Could fuel a blaming culture; there is danger
od deliberate or malicious misuse of error
scoring system in the pursuit of personal
grievance.
9. Is there a problem ?
• - Humans will always make errors and radiologist are not different. (RCR )
• - Errors occur in the absence of negligence , hence in the absence of breach of
standard of care.
• - - Diagnostic errors in medicine causes patient harm , with the rate of missed ,
incorrect, or delayed diagnoses estimated to be as high as 10-15%. Autopsy have
identified major diagnostic discrepancies up to 20% of cases , hence 1 in every 5
patients overall .
• Overconfidence …appears to be endemic in medicine. Compared results of
diagnosis of ICU patient and autopsy showed that “clinicians who were
“completely certain” of the diagnosis antemorten were wrong 40% of the time.”
• “errors”: more appropriate to concentrate on “discrepancies” between a report an
a retrospective review of a film or outcome .
.
10. Is there a problem ?
• Worldwide radiologic examination approximately 1
billion . With a low error rate of 4% this would translate
in 40 million radiologist errors per year .
• - Some studies showed error rate of 10-15% with 2-20%
significant errors.
• - Unlike any other medical specialties, apart from
pathology, not only do we make errors but we store
images to allow retrospective review of our misses.
11. Is there a problem ?
• -Radiologist Leo Henry Garland (1903-1966) pioneer in the study of
radiologist error discovered that even skilled and experienced
radiologist failed to note important findings on 30% of CXR that
were positive for disease and also had 2% of false positive .
• - Second reading interpretation performed by experienced
abdominal imaging radiologist from Massachusetts General
Hospital compared to previous CT abdominopelvic report
interpreted by either themselves or colleagues , they disagreed
which each other more than 30% of the time –intra-observer- and
disagreed with themselves more than 25% of the time –inter
observer.
• A cancer diagnosis (false-positive) rate of up to 61%has been
quoted in screening mammography (Nelson HD et al.)
• “…humans are incorrigibly inconsistent in making summary
judgments of complex information “. Daniel Kahneman.
12. Sample of published studies of
radiological error: Adrian P Brady
• 1.) 1993 , Harvey et al. : Mammography : ca identified on previous studies
in 41% when blindly reinterpreted , and 75 % when reviewers were aware
subsequence findings.
• 2.) 1990,1994, Markus et al. : Barium enema : average observer missed
30% of visible lesions .
• 3.)2008, Siewert et al. : Oncologic CT : discordant interpretation in 31-37%,
with resultant change in radiological staging in 19%, and change in patient
treatment in up to 23%.
• 4.) 2007, Briggs et al . : Neuro Ct & MRI: 13% major and 21% minor
discrepancy rates (undercalls, overcalls & misinterpretations) when
specialist neuroradiologist second reading of studies initially interpreted
by general radiologist.
14. Missed breast cancer
• 35% of both interval cancers and screen-
detected cancers could be classified as missed.
• “missed”: detectable at retrospective review
of a previous obtained mammogram that was
prospectively reported as showing negative,
benign, or probably benign findings d as
missed
• Leslie R Lamb et al . ; Missed Breast Cancer : Effects of Subconscious Bias and lesion characteristic .
RadioGraphics Vol.40 , No 4,Jun 12 2020
15. Stages in imaging cycle
• 1. clinical question ; request of imaging
modality ; patient preparation and
cooperation .
• 2. imaging acquisition and processing .
• 3. Radiologist reporting and communication of
results.
17. Perceptual errors
• - All too often , a finding that is readily apparent in retrospect
is inexplicably missed.
• The consistency of experimental results on radiologist
perceptual errors reported worldwide, involving radiologist at
all levels of training and experience working in a wide variety
of clinical setting and across all imaging modalities , argues
convincingly against the idea that radiologist who make errors
are simply to blame for being careless , sloppy , or negligent
or for underperforming in some way; rather, the phenomenon
or radiologist underperception and misperception appears to
be an unvarying feature of the extremely complex system in
which radiologist operate. (Michael A Bruno et al.)
18. Perceptual errors
• 1. combined sensation in a historic frame of experience
and knowledge form a perception of normal or
abnormal structure .
• 2. perceptual error : those in which and important
abnormality is simply not seen on the images ,
• To be considered a perceptual error, the finding would
need to be deemed sufficiently conspicuous and
detectable in retrospect by the interpreting radiologist
or in the consensus of his or her peers. 60-80% false
negative . A few false positive , seen but no present .
19. CXR most common Perceptual errors
Jennifer J Donald and Stuart A Barnard: Common patterns in 558 diagnostic radiology errors
20. CXR most common Perceptual errors
Distribution of missed nodules. Median 16 mm
Jennifer J Donald and Stuart A Barnard: Common patterns in 558 diagnostic radiology errors
21. Cranial imaging most common
Perceptual errors
Jennifer J Donald and Stuart A Barnard: Common patterns in 558 diagnostic radiology errors
22. Body CT most common Perceptual
errors
Jennifer J Donald and Stuart A Barnard: Common patterns in 558 diagnostic radiology errors
23. Cognitive and interpretative errors
• 1. Cognitive : distinguish pathology from non-
pathology, and provides either a single
differential diagnosis .
• 2.Interpretative : 20%-40%
• 3.Radiologist may see an abnormality or a normal
variant , but they misunderstand its meaning or
importance , resulting in an incorrect diagnosis .
• 4. False positive : overcalling ; false negative :
undercalling
24. Radiologic Error Classification System 12-category
system developed by Kim and Mansfield
• Kim and Classification Scheme for Errors in Diagnostic Radiology
• Cause of Error Explanation Occurrence (%)
• 1.Complacency : An unimportant finding is appreciated but attributed to the wrong
• cause –a more serious cause (false-positive finding) 0,9
• 2.Faulty reasoning : A finding is appreciated and interpreted as abnormal
• but is attributed to the wrong cause (true-positive finding misclassified) 9.0
• 3.Lack of knowledge : A finding is seen but is attributed to the wrong cause
• because of a lack of knowledge on the part of the interpreter 3.0
• 4.Under-reading (missed finding) : A finding is present on the image but is missed 42.0
25. Radiologic Error Classification System 12-category
system developed by Kim and Mansfield
• 5.Poor communication : An abnormality is identified and interpreted correctly
• but the message does not reach the clinician 0.0
• 6.Technique : A finding is missed because of the limitations of the
• examination or technique 2.0
• 7.Prior examination : A finding is missed because of failure to consult prior
• radiologic studies or reports 5.0
• 8.History : A finding is missed because of inaccurate or incomplete clinical history 2.0
• 9.Location A : finding is missed because of the location of a lesion outside
• the area of interest on an image “tunnel vision”, “scrolling error”,
• “innattentional blindness” ,”gorilla in the midst syndrome”. 7.0
26. Radiologic Error Classification System 12-category
system developed by Kim and Mansfield
• 10.Satisfaction of search : A finding is missed because of failure to continue to
• search for additional abnormalities after the first
• abnormality was found , Premature termination 22.0
• 11.Complication : A complication from a procedure 0.5
• 12.Satisfaction of report (alliterative error: “I saw a saw that could out saw any other saw I ever
saw”; aliteracion : “tres tristes tigres “)
• A finding was missed because of overreliance on the radiology report from a
previous examination ; error in one report followed by error in next report” 6
• CONCLUSION:
• Delayed diagnoses were not recognized on subsequent radiologic examinations in about one
third of the cases. The most common types of error were underreading , satisfaction of
search, faulty reasoning, and location of the finding.
• Kim YW, Mansfield LT. Fool me twice: delayed diagnoses in radiology with emphasis on perpetuated errors. AJR Am J
Roentgenol 2014;202(3):465–470.
27. Most common biases
• A) anchoring bias: locks onto some salient feature too early in the diagnostic
process and discounts conflicting or new information gained subsequently .
• B) availability bias : recent experience with a disease may inflate the future
likehood of its being diagnosed again (conversely, if a disease has not been see for
a long time, it may be underdiagnosed).
• C) confirmation bias : look for confirmatory evidence to support a diagnostic
hypothesis and to ignore evidence that refutes the hypothesis .
• D) outcome bias, preference to opt for diagnosis decision that will lead the patient
to a better final outcome
• E) zebra retreat , self doubt about a remote or unusual diagnosis even though the
patient ‘s history and imaging finding support it .
• F) frame bias: initially viewing the images prior to reading the clinical details
28. Human brain
• The human brain is a network of about 20 billion
neurons – nerve cells – linked by several trillion
connections. Not to mention glial cells, which
scientists used to think were inactive scaffolding,
but increasingly view as an essential part of how
the brain works. Our brains give us movement,
language, senses, memories, consciousness and
personality. We know a lot more about the brain
than we used to, but it still seems far too
complicated for human understanding.
29. Human brain
• Many of these simple networks occur in the visual system. We used to
think that the eye was like a camera, taking a “snapshot” of the outside
world that was stored in the brain like a photo stuck in an album. It uses a
lens to focus an image on to the retina at the back of the eye, which
functions a bit like a roll of film – or, in today’s digital cameras, a charge-
coupled device, storing an image pixel by pixel. But we now know that
when the retina sends information to the brain’s visual cortex, the
similarity to a camera ends.
• Although we get a strong impression that what we are seeing is “out
there” in front of us, what determines that perception resides inside our
own heads. The brain decomposes images into simple pieces, works out
what they are, “labels” them with that information, and reassembles
them.
• An effective way to infer how something functions is to see what it does
when it goes wrong. It may be hard to understand a bridge while it stays
up, but you can learn a lot about strength of materials when it collapses.
34. Selective looking
• It is a well-known phenomenon that we do not
notice anything happening in our surroundings
while being absorbed in the inspection of
something; focusing our attention on a certain
object may happen to such an extent that we
cannot perceive other objects placed in the
peripheral parts of our visual field, although the
light rays they emit arrive completely at the visual
sphere of the cerebral cortex.'' Rezso« Ba¨lint
1907 (translated in Husain and Stein 1988, page
91)
35. Gorilla in the mist syndrome
• https://www.youtube.com/watch?v=wdVXco6
YDgg
• 48 times the size of the nodules.
• 83% of radiologist did not see the gorilla.
73. FAULTY REASONING
Focal lesion in L1 with subtle low T1 signal and high signal on T2/STIR: H/O thyroid ca ;
Possible atypical haemangioma but f/u to r/o met : is a fat poor haemangioma .
86. SATISFACTION OF
REPORT:ALLITERATIVE REASONING
Patient with breast cancer : looks for mets: missed small meningioma , satisfaction
of search and alliaterative reasoning : 2013, 2014, 2016, 2016, 2017, 2019 bingo 2020!
87. INACCURATE OR INCOMPLETE CLINICAL HISTORY
Breast mets: I did not check previous CT
4 years before : sarcoid
88. CORRECT REPORT FAILING TO REACH
REFERRING CLINICIAN
2016 2016 2017
Inspissated bile Wall-thickened Tumour vs.
abscess
Significant finding overlooked
because was no in the conclusion
Referred for GB polyp
89. History
82 y/o F : epigastric pain , weight loss , dysphagia : recent OGD normal, US normal.
CT: no sinister but has oesophageal cancer at OGJ : normal OGD !!
91. Individual performance
• No follow Gaussian (normal) distribution but Paretian (power) distribution
where most performers are below “average”, and thus less productive and
more likely to make mistakes than the super-performers.
92. Factors/causes of errors
• Technique or Image acquisitions errors : the
lesion is hidden due to limited or suboptimal
scanning .
• Perceptual /cognitive /interpretative
• External causes and communications
93. Perceptual /cognitive /interpretative
• Training , Experience, Intellect
• Concentration ,Perceptual skill
• Fatigue, illness , mood
• Shortcuts: viewing one place
• Failing to optimized tools : window setting
• Attempting to interpret grossly poor quality
images.
• Failure to compare to all previous images or
pertinent studies available
94. Improvement 1
• Look at the image as it belong to your best friend.
• Training
• Attending courses
• Peer review
• Discrepancy ,MDT and morbimortality meetings .
• Share diagnostic mistakes
• Perform our own interpretation before reading the
previous radiology report to avoid alliterative errors
• Pay attention to the first and last image , to the scout
view or localizer , at the corners .
95. External causes and communications.
• Heavy workloads : ER , large volume of cases , fast turnaround ,
many study in short period, numerous body part.
• Distractions : noise, chat , phone calls (increased 12% like hood of
error).Internet , whatsapp , mails .
• Overly rapid pace.
• Failure to review the voice recognition ; copy-paste errors ,
template.
• Failure to communicate regarding unexpected important finding.
• Failure of PACS server to retrieve prior exam .
• Lack of immediate online diagnostic references resources.
• Tele radiology services
96. More improvements
• Quality management (QI: Quality Improvement
)activities: Events and Learning meetings , audits,
continuing education, appraisal .
• Check-list : reduce errors of omission in a wide
variety of fields including aviation, critical care
medicine and presumably radiology. Widely used
on PET-CT; remind radiologist to take a second
look at certain aspects , areas , and features of
the images.
97. More improvements
• Structured report; standardizing, for cancer,
measurements . Thyroid US , mammography BI-RADS
, Prostate PI-RADS , CT colonography Classification ;
etc improving communication .
• Double reading : widely used in mammography
reading .
• PET-CT, computer-aided detection and Artificial
intelligence (AI): highlight neglected areas in
mamography, lung nodule detection , Ct
colonography .
• Improving individual physician factors.
102. Learning from discrepancy meeting
• 1. A reporting discrepancy occurs when a
retrospective review, or subsequent information
about patient outcome, leads to an opinion
different from that expressed in the original
report.
• Acceptance of the concept of necessary fallibility
needs to be encourage; public education can help
. Fortunately , many errors identified by
retrospective reviews are of little or no
significance to patient ; conversely , some
significant errors are never discovered (A.Brady)
103. Hindsight bias
• “Tendency for people with knowledge of the
actual outcome of an event to believe falsely
that they would have predicted the outcome
“(Berlin , L)
105. Experts
• One who knows more and more about less
and less until he knows absolutely everything
about nothing .
106. CUOTE
• IT IS SAID, THE WISE LEARN
FROM THE MISTAKES OF OTHERS,
THE SMART LEARN FROM THEIR
OWN MISTAKES, AND THE
FOOLISH LEARN FROM NEITHER.
107. REFERENCES
•
• Daniel Kahneman. Thinking, Fast and Slow. Farrar, Straus and Giroux , ISBN 978-0-347-27563-1;
2013.
• Michael A Bruno et al . Understanding and Confronting Our Mistakes: The Epidemiology of Error in
Radiology and Strategies for Error reduction .RadioGraphics 2015; 35:1668-1676.
• Common patterns in 558 diagnostic radiology errors. Jennifer J Donald and Stuart A Barnard.
Journal of Medical Imaging and Radiation Oncology 56 (2012)173-178
• Adrian P Brady .Error and discrepancy in radiology: inevitable or avoidable?. Insights Imaging
(2017)8: 171-182
• Stuart E Mirvis. Toward decreasing diagnostic errors. The Journal of Practical Medical Imaging and
Management .
• Young W Kim and Liem T Mansfield. Fool Me Twice: Delayed Diagnoses in Radiology With Emphasis
on Perpetual Errors. AJR 2014; 202: 465-470
• Adrian Brady et al. Discrepancy and Error in Radiology: Concepts, Causes and Consequences .
Ulster Med J 2012; 81(1): 3-9
• The RCR : REAL , Radiology Events and Learning . real@rcr.ac.uk
• Clinical radiology. The RCR : Standards for Learning from Discrepancy Meetings. www.rcr.ac.uk
• Christopher E. Bickle et al . Now You see It , Now you Don’t: Visual Illusions in Radiology .
RadioGraphics 2013; 33:2087-2102.
•
109. Swirl sign
85 y/o woman :Lobar haemorrhage . Almost no surrounding
edema. The basal ganglia are spared. Low density in the core
In keeping with active bleeding . Severe edema effacing
the sulci and sylvian fissure.