85% of radiologists’ head and neck cancer misses are ‘failure to see’ errors
More than 85% of radiologists’ misses on head and neck imaging are perceptual, “failure to see” errors, according to a new analysis published Friday.
They were also often detected incidentally on MR and CT scans meant for other purposes, based on an analysis of more than 283,000 exams performed at a single center. Clinically significant errors were found most often in the aerodigestive tract (21%), orbits (17.7%), masticator space, and parotid gland (both 14.5%), researchers detailed in the journal of Clinical Radiology.
Experts believe their findings could assist radiologists in creating checklists to help them focus on anatomical areas with commonly overlooked concerns.
“In conclusion, the present study found that a majority of [head and neck] misses were perceptual and were detected on examinations not performed for H&N indication,” A. Ferguson, MD, with the Department of Radiology at UC Davis Medical Center in Sacramento, and colleagues wrote July 23. “Misses in H&N pathology could be minimized if search patterns were changed to include the sites of the most frequent missed pathologies,” they advised.
To reach their conclusions, Ferguson et al. queried a neuroradiology quality assurance database, searching for attending physician errors between 2014-2020. They were limited only to computed tomography and magnetic resonance imaging data, and grouped misses by the lateral neck (where they found 25.7% of errors), central neck (36.5%) and face/orbits (37.8%). Altogether, the analysis unearthed 283,248 CT and MR scans that met the criteria, with 74 head and neck misses.
About 85.1% were defined as “perceptual,” with the radiologist overlooking the concern, while 14.9% were “interruptive,” spotted by a physician who reached the incorrect conclusion. The majority of misses were detected incidentally (67.6%) on imaging exams not performed for a primary head and neck indication. Brain MRI was the most common test found in the analysis (at 27%), while clearly or potentially malignant masses accounted for almost half (48.6%) of all misses, Ferguson et al. noted.
You can read more about the analysis in the Royal College of Radiologists’ journal here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.