Neuroradiologists tend to make more mistakes when facing three key situations, according to new research published Wednesday.

These can include taking on a higher volume of shifts, interpreting scans over the weekend, and tackling exams that take a longer time to discern, experts wrote in the American Journal of Roentgenology [1]. Researchers hope their findings offer guidance to radiology leaders as they seek to limit patient harm, minimize malpractice claims and put providers in the best position to succeed.

“These findings should be considered when designing workflow-related and other interventions seeking to reduce errors in neuroimaging interpretation,” Vladimir Ivanovic, MD, with the Department of Radiology at the Medical College of Wisconsin in Milwaukee at the time of the study, and co-authors wrote March 29.

Reported major errors can occur at a clip as high as 6% in radiology, according to previous research, with increasing workloads and corresponding burnout likely only adding to this number. Neuroradiology is one particular pain point, given median plaintiff settlements of nearly $2.9 million and common blind spots/error patterns when imaging the neurovasculature, head and neck, and skull base, the study authors noted.

To explore these issues further, Ivanovic and co-authors gathered data from a large academic medical center’s quality assurance program, spanning 2014-2020. They pinpointed CT and MRI examinations of the brain, spine, head and neck that had assigned scores from RadPeer—a clinical tool that allows radiologists to review one another’s work.

The final study sample included 564 instances of error among the same number of patients, alongside a control group of 1,019 more without a mistake. Diagnostic errors were independently associated with longer interpretation times, higher shift volumes and weekend work. Other factors such as emergency or inpatient setting, along with trainee participation, did not have an influence. Longer interpretation times and a higher volume of shifts only increased the number of errors on weekdays, rather than weekends, Ivanovic et al. reported.

“This disparity may in part relate to the larger sample size (and thus greater statistical power) for weekday than for weekend examinations,” the authors noted. “In addition, interpretation times were shorter, and shift volumes were higher, on weekends than on weekdays in both the study and control groups,” they added later. “It is possible that diagnostic error rates are sensitive to changes in interpretation time and shift volume only within specific ranges for those variables, and that the variables were outside of such ranges on weekends.”