Errors in diagnostic radiology

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Errors in diagnostic radiology occur for a variety of reasons related to human error, technical factors and system faults. It is important to recognise 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 20141, and at the time of writing (September 2021) remains the most widely accepted classification 5-8-9.

Renfrew et al. proposedThe Kim-Mansfield modification of the followingRenfrew classification system 1,2,4:

  • type 1: complacency

    • overreading and misinterpretation

    • finding identified but attributed to the wrong cause

  • type 2: faulty reasoning

    • overreading and misinterpretation

    • finding identified as abnormal but attributed to the wrong cause

  • type 3: lack of knowledge

    • finding identified but attributed to the wrong cause due to a lack of knowledge

  • type 4: under-reading

    • missed abnormality that was appreciable in retrospect

    • most common error 1

      •

  • type 5: poor communication

    • finding identified as abnormal but poor communication to relevant clinician

  • type 6: technique

    • abnormality was not identifiable (even in retrospect) secondary to poor technique

  • type 7: prior examination

    • failure to review previous imaging results in missed finding

  • type 8: history

    • finding missed due to incomplete clinical information

  • type 9: location

    • finding missed because it was outside of region of interest

  • type 10: satisfaction of search

    • failure to find a subsequent abnormality after the initial abnormality was detected

    • second most common error 1

      •

  • type 11: complication

    • most often of interventional procedures

  • 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:

  • latent errors

    • 'in-built' system or technical faults that predispose to errors

  • active failures or human error

    • diagnostic errors and misinterpretation

    • complications from procedures

    • can involve more than one person or be secondary to latent errors

  • external causes

    • beyond the control of the radiologist (e.g. power failures, quenches, etc.)

  • customer causes

    • related to the patient and non-radiology staff (e.g. complying with instructions, unfamiliarity with procedure)

See also

  • -<p><strong>Errors in diagnostic radiology</strong> occur for a variety of reasons related to human error, technical factors and system faults. It is important to recognise that various <a href="/articles/cognitive-bias-in-diagnostic-radiology">cognitive biases</a> contribute to these errors.</p><h4>Classification</h4><h5>Renfrew classification</h5><p>This classification was proposed by Renfrew et al. <sup>5</sup> in 1992, revised by Kim and Mansfield in 2014, and at the time of writing (September 2021) remains the most widely accepted classification <sup>5-8</sup>.</p><p>Renfrew et al. proposed the following classification system <sup>1,2,4</sup>:</p><ul>
  • -<li>type 1: complacency<ul><li>finding identified but attributed to wrong cause</li></ul>
  • -</li>
  • -<li>type 2: faulty reasoning<ul><li>finding identified as abnormal but attributed to wrong cause</li></ul>
  • -</li>
  • -<li>type 3: lack of knowledge<ul><li>finding identified but attributed to wrong cause due to lack of knowledge</li></ul>
  • -</li>
  • -<li>type 4: under-reading<ul><li>missed abnormality that was appreciable in retrospect</li></ul>
  • -</li>
  • -<li>type 5: poor communication<ul><li>finding identified as abnormal but poor communication to relevant clinician</li></ul>
  • -</li>
  • -<li>type 6: technique<ul><li>abnormality was not identifiable (even in retrospect) secondary to poor technique</li></ul>
  • -</li>
  • -<li>type 7: prior examination<ul><li>failure to review previous imaging results in missed finding</li></ul>
  • -</li>
  • -<li>type 8: history<ul><li>finding missed due to incomplete clinical information</li></ul>
  • +<p><strong>Errors in diagnostic radiology</strong> occur for a variety of reasons related to human error, technical factors and system faults. It is important to recognise that various <a href="/articles/cognitive-bias-in-diagnostic-radiology">cognitive biases</a> contribute to these errors.</p><h4>Classification</h4><h5>Renfrew classification</h5><p>This classification was proposed by Renfrew et al.&nbsp;<sup>5</sup> in 1992, revised by Kim and Mansfield in 2014 <sup>1</sup>, and remains the most widely accepted classification <sup>5-9</sup>.</p><p>The Kim-Mansfield modification of the Renfrew classification system <sup>1,2,4</sup>:</p><ul>
  • +<li>
  • +<p>type 1: complacency</p>
  • +<ul>
  • +<li><p>overreading and misinterpretation</p></li>
  • +<li><p>finding identified but attributed to the wrong cause</p></li>
  • +</ul>
  • -<li>type 9: location<ul><li>finding missed because it was outside of region of interest</li></ul>
  • +<li>
  • +<p>type 2: faulty reasoning</p>
  • +<ul>
  • +<li><p>overreading and misinterpretation</p></li>
  • +<li><p>finding identified as abnormal but attributed to the wrong cause</p></li>
  • +</ul>
  • -<li>type 10: <a href="/articles/satisfaction-of-search-error">satisfaction of search</a><ul><li>failure to find a subsequent abnormality after the initial abnormality was detected</li></ul>
  • +<li>
  • +<p>type 3: lack of knowledge</p>
  • +<ul><li><p>finding identified but attributed to the wrong cause due to a lack of knowledge</p></li></ul>
  • +</li>
  • +<li>
  • +<p>type 4: under-reading</p>
  • +<ul>
  • +<li><p>missed abnormality that was appreciable in retrospect</p></li>
  • +<li><p>most common error<sup> 1</sup></p></li>
  • +</ul>
  • -<li>type 11: complication<ul><li>most often of interventional procedures</li></ul>
  • +<li>
  • +<p>type 5: poor communication</p>
  • +<ul><li><p>finding identified as abnormal but poor communication to relevant clinician</p></li></ul>
  • +</li>
  • +<li>
  • +<p>type 6: technique</p>
  • +<ul><li><p>abnormality was not identifiable (even in retrospect) secondary to poor technique</p></li></ul>
  • +</li>
  • +<li>
  • +<p>type 7: prior examination</p>
  • +<ul><li><p>failure to review previous imaging results in missed finding</p></li></ul>
  • +</li>
  • +<li>
  • +<p>type 8: history</p>
  • +<ul><li><p>finding missed due to incomplete clinical information</p></li></ul>
  • +</li>
  • +<li>
  • +<p>type 9: location</p>
  • +<ul><li><p>finding missed because it was outside of region of interest</p></li></ul>
  • +</li>
  • +<li>
  • +<p>type 10: <a href="/articles/satisfaction-of-search-error">satisfaction of search</a></p>
  • +<ul>
  • +<li><p>failure to find a subsequent abnormality after the initial abnormality was detected</p></li>
  • +<li><p>second most common error <sup>1</sup></p></li>
  • +</ul>
  • -<li>type 12: satisfaction of report<ul><li>over-reliance on the prior report</li></ul>
  • +<li>
  • +<p>type 11: complication</p>
  • +<ul><li><p>most often of interventional procedures</p></li></ul>
  • +</li>
  • +<li>
  • +<p>type 12: satisfaction of report</p>
  • +<ul><li><p>over-reliance on the prior report</p></li></ul>
  • -<li>latent errors<ul><li>'in-built' system or technical faults that predispose to errors</li></ul>
  • -</li>
  • -<li>active failures or human error<ul>
  • -<li>diagnostic errors and misinterpretation</li>
  • -<li>complications from procedures</li>
  • -<li>can involve more than one person or be secondary to latent errors</li>
  • +<li>
  • +<p>latent errors</p>
  • +<ul><li><p>'in-built' system or technical faults that predispose to errors</p></li></ul>
  • +</li>
  • +<li>
  • +<p>active failures or human error</p>
  • +<ul>
  • +<li><p>diagnostic errors and misinterpretation</p></li>
  • +<li><p>complications from procedures</p></li>
  • +<li><p>can involve more than one person or be secondary to latent errors</p></li>
  • -<li>external causes<ul><li>beyond the control of the radiologist (e.g. power failures, <a href="/articles/quench">quenches</a>, etc.)</li></ul>
  • -</li>
  • -<li>customer causes<ul><li>related to the patient and non-radiology staff (e.g. complying with instructions, unfamiliarity with procedure)</li></ul>
  • +<li>
  • +<p>external causes</p>
  • +<ul><li><p>beyond the control of the radiologist (e.g. power failures, <a href="/articles/quench">quenches</a>, etc.)</p></li></ul>
  • +</li>
  • +<li>
  • +<p>customer causes</p>
  • +<ul><li><p>related to the patient and non-radiology staff (e.g. complying with instructions, unfamiliarity with procedure)</p></li></ul>
  • -</ul><h4>See also</h4><ul><li><a href="/articles/cognitive-bias-in-diagnostic-radiology">cognitive bias</a></li></ul>
  • +</ul><h4>See also</h4><ul><li><p><a href="/articles/cognitive-bias-in-diagnostic-radiology">cognitive bias</a></p></li></ul>

References changed:

  • 9. Zhang L, Wen X, Li J, Jiang X, Yang X, Li M. Diagnostic Error and Bias in the Department of Radiology: A Pictorial Essay. Insights Imaging. 2023;14(1):163. <a href="https://doi.org/10.1186/s13244-023-01521-7">doi:10.1186/s13244-023-01521-7</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/37782396">Pubmed</a>

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