Errors in diagnostic radiology occur for a variety of reasons related to human error, technical factors and system faults. It is important to recognize that various cognitive biases contribute to these errors.
Classification
Renfrew classification
This classification was proposed by Renfrew et al. 5 in 1992, revised by Kim and Mansfield in 2014 1, and remains the most widely accepted classification 5-9.
The Kim-Mansfield modification of the Renfrew classification system 1,2,4:
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type 1: complacency
overreading and misinterpretation
finding identified but attributed to the wrong cause
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type 2: faulty reasoning
overreading and misinterpretation
finding identified as abnormal but attributed to the wrong cause
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type 3: lack of knowledge
finding identified but attributed to the wrong cause due to a lack of knowledge
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type 4: under-reading
missed abnormality that was appreciable in retrospect
most common error 1
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type 5: poor communication
finding identified as abnormal but poor communication to relevant clinician
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type 6: technique
abnormality was not identifiable (even in retrospect) secondary to poor technique
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type 7: prior examination
failure to review previous imaging results in missed finding
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type 8: history
finding missed due to incomplete clinical information
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type 9: location
finding missed because it was outside of region of interest
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type 10: satisfaction of search
failure to find a subsequent abnormality after the initial abnormality was detected
second most common error 1
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type 11: complication
most often of interventional procedures
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type 12: satisfaction of report
over-reliance on the prior report
Brook classification
Brook et al. proposed the following classification as an alternative to the Renfrew classification which takes more than human error into account 3:
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latent errors
'in-built' system or technical faults that predispose to errors
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active failures or human error
diagnostic errors and misinterpretation
complications from procedures
can involve more than one person or be secondary to latent errors
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external causes
beyond the control of the radiologist (e.g. power failures, quenches, etc.)
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customer causes
related to the patient and non-radiology staff (e.g. complying with instructions, unfamiliarity with procedure)