Significant on-call misses by radiology residents interpreting computed tomographic studies: Perception versus cognition

Abstract

The purpose of this study was to evaluate the etiology of significant false-negative computed tomographic (CT) interpretations by radiology residents on-call. Over a 1-year period, significant on-call false-negative CT interpretations were analyzed to determine whether errors were perceptual (i.e., the resident did not see the finding or findings) or cognitive (i.e., the resident did not recognize the implications or misinterpreted a finding or findings). Significant “misses” were defined as errors that delayed surgical treatment or misdirected management in a potentially life-threatening manner.

A total of 12 significant false-negative interpretations occurred over a 1-year period. All head CT misses (extraaxial hemorrhage, pneumocephalus, contusion, subarachnoid hemorrhage due to ruptured aneurysm) were perceptual errors. Misses on thoracic, abdominal, and pelvic CT scans (2 abscesses, abdominal aortic aneurysm rupture, superior vena cava perforation due to catheter placement, ischemic bowel, liver laceration, hypoperfusion syndrome, appendicitis) were mixed (4 cognitive and 4 perceptual errors).

Since the diagnostic possibilities of emergency head CT scans are limited, residents missed only subtle, perceptual manifestations and had little difficulty interpreting findings when they were correctly recognized. The gamut of diagnostic possibilities in the thorax, abdomen, and pelvis was more challenging to residents on-call; errors in both perception and interpretation arose with equal frequency, and the significant error rate was higher than that for head CT interpretation. Junior residents, who make most of the significant on-call errors, commonly feel overwhelmed in attempting to assimilate the knowledge required to take call. Prepartion needs to be extensive, yet it should be focused on areas that will engender optimal impact on after-hours performance. When preparing residents to interpret on-call CT studies, perceptual manifestations of neuroradiology should be emphasized, whereas a more comprehensive approach to thoracic, abdominal, and pelvic disorders needs to be stressed.