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Smith JT. It's not about the errors, it's about the learning: How the Royal College of Radiologists has developed a Radiology Events and Learning process in the United Kingdom. J Med Imaging Radiat Oncol 2022; 66:185-192. [PMID: 35243780 DOI: 10.1111/1754-9485.13355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
The Royal College of Radiologists (RCR) is based in the United Kingdom but is a global organisation with members and fellows worldwide. In this invited article, the chair of the RCR Radiology Events and Learning (REAL) panel recounts his experience in looking at radiological errors. He starts with his personal work auditing his own mistakes as a junior consultant, describes what he learned in his departmental role in a large teaching hospital running a Radiology Events and Learning Meeting (REALM) and gives an overview of some of the work done over the last two decades by the RCR. This includes publishing national guidelines which set standards for running a REALM, setting up the REAL panel which produces a quarterly newsletter of cases from RCR members, and running an annual conference to share information with local radiology departments around the country. A review of the literature describing the drivers for this work and looking at the parallels with industry lies alongside the practical tips he found useful which he hopes would be helpful to anyone setting up their own departmental errors or discrepancy meeting.
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Yokoo T, Singal AG, Diaz de Leon A, Ananthakrishnan L, Fetzer DT, Pedrosa I, Khatri G. Prevalence and clinical significance of discordant LI-RADS ® observations on multiphase contrast-enhanced MRI in patients with cirrhosis. Abdom Radiol (NY) 2020; 45:177-187. [PMID: 31342103 DOI: 10.1007/s00261-019-02133-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the prevalence and clinical significance of discordant LI-RADS® (Liver Imaging Reporting and Data System) liver observations on multiphase contrast-enhanced (MCE) magnetic resonance imaging (MRI) in patients with cirrhosis. METHODS This cross-sectional study included 93 cirrhosis patients who underwent 1.5 or 3 T MCE MRI for evaluation of hepatocellular carcinoma (HCC). Two abdominal radiologists independently reviewed T1-, T2-, diffusion-weighted unenhanced images as well as MCE T1-weighted fat-suppressed images and reported liver observations using LI-RADS®. Concordance were recorded for detection (co-detected by both radiologists or not), size category (< 10; 10-19; ≥ 20 mm), and LI-RADS® category assignment as reportable (LR-3/4/5/M) and actionable (LR-4/5/M). The overall concordance (i.e., concordant in detection, size, and LR-category) was calculated with 95% confidence interval [CI], and separately for detection, size, and LR-category. Clinical significance of discordance was assessed as impact on follow-up imaging, referral for biopsy, liver transplant eligibility, or treatment modality. RESULTS Reportable and actionable observations were overall concordant between two radiologists only in 32.3% [24.6, 41.0] and 40.1% [29.5, 51.5] of cases, respectively. Poor overall concordance was related to detection concordance of 52.0% [44.3, 59.5] and 62.5% [52.3, 71.8], as well as LR-category concordance of 73.7% [61.6, 83.1] and 70.9% [57.3, 81.6], for reportable and actionable observations, respectively. Discordant LI-RADS® observations would have impacted clinical management in 30 subjects (43.5%), most (66.7%) of whom were due to discordant detection. CONCLUSION Discordant MRI LI-RADS® observations are common in patients with cirrhosis and may have potential implications for patient management.
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Affiliation(s)
- Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alberto Diaz de Leon
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - Lakshmi Ananthakrishnan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - David T Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
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Koo A, Smith JT. Does learning from mistakes have to be painful? Analysis of 5 years' experience from the Leeds radiology educational cases meetings identifies common repetitive reporting errors and suggests acknowledging and celebrating excellence (ACE) as a more positive way of teaching the same lessons. Insights Imaging 2019; 10:68. [PMID: 31312978 PMCID: PMC6635510 DOI: 10.1186/s13244-019-0751-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Royal College of Radiologists (RCR) and General Medical Council (GMC) encourage learning from mistakes. But negative feedback can be a demoralising process with adverse implications for staff morale, clinical engagement, team working and perhaps even patient outcomes. We first reviewed the literature regarding positive feedback and teamworking. We wanted to see if we could reconcile our guidance to review and learn from mistakes with evidence that positive interactions had a better effect on teamworking and outcomes than negative interactions. We then aimed to review and categorise the over 600 (mainly discrepancy) cases discussed in our educational cases meeting into educational 'themes'. Finally, we explored whether we could use these educational themes to deliver the same teaching points in a more positive way. METHODS AND RESULTS The attendance records, programmes and educational cases from 30 consecutive bimonthly meetings between 2011 and 2017 were prospectively collated and retrospectively analysed. Six hundred and thirty-two cases were collated over the study period where 76% of the cases submitted were discrepancies, or perceived errors. Eight percent were 'good spots' where examples of good calls, excellent reporting, exemplary practice or subtle findings that were successfully reported. Eight percent were educational cases in which no mistake had been made. The remaining 7% included procedural complications or system errors. CONCLUSION By analysing the pattern of discrepancies in a department and delivering the teaching in a less negative way, the 'lead' of clinical errors can be turned in to the 'gold' of useful educational tools. Interrogating the whole database periodically can enable a more constructive, wider view of the meeting itself, highlight recurrent deficiencies in practice, and point to where the need for continuing medical training is greatest. Three ways in which our department have utilised this material are outlined: the use of 'good spots', arrangement of targeted teaching and production of specialist educational material. These techniques can all contribute to a more positive learning experience with the emphasis on acknowledging and celebrating excellence (ACE).
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Affiliation(s)
- Andrew Koo
- Leeds Teaching Hospitals NHS Trust, St James University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
| | - Jonathan T Smith
- Leeds Teaching Hospitals NHS Trust, St James University Hospital, Beckett Street, Leeds, LS9 7TF, UK
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Degnan AJ, Ghobadi EH, Hardy P, Krupinski E, Scali EP, Stratchko L, Ulano A, Walker E, Wasnik AP, Auffermann WF. Perceptual and Interpretive Error in Diagnostic Radiology-Causes and Potential Solutions. Acad Radiol 2019; 26:833-845. [PMID: 30559033 DOI: 10.1016/j.acra.2018.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
Interpretation of increasingly complex imaging studies involves multiple intricate tasks requiring visual evaluation, cognitive processing, and decision-making. At each stage of this process, there are opportunities for error due to human factors including perceptual and ergonomic conditions. Investigation into the root causes of interpretive error in radiology first began over a century ago. In more recent work, there has been increasing recognition of the limits of human image perception and other human factors and greater acknowledgement of the role of the radiologist's environment in increasing the risk of error. This article reviews the state of research on perceptual and interpretive error in radiology. This article focuses on avenues for further error examination, and strategies for mitigating these errors are discussed. The relationship between artificial intelligence and interpretive error is also considered.
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Affiliation(s)
- Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily H Ghobadi
- Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Peter Hardy
- Department of Radiology, University of Kentucky Medical Center, Lexington, Kentucky
| | - Elizabeth Krupinski
- Department of Radiology & Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Elena P Scali
- Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Lindsay Stratchko
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adam Ulano
- Department of Radiology, University of Vermont Medical Center, The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, Vermont
| | - Eric Walker
- Department of Radiology, Penn State Health, Milton S. Hershey Medical Center & Penn State College of Medicine, H066, Hershey, Pennsylvania; Department of Radiology and Nuclear Medicine, Uniformed University of the Health Sciences, Bethesda, Maryland
| | - Ashish P Wasnik
- Department of Radiology, University of Michigan Health System-Michigan Medicine, University Hospital B1D502D, Ann Arbor, Michigan
| | - William F Auffermann
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East, Rm # 1A71, Salt Lake City, UT 84132, USA.
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Ivan CV, Mullineux JH, Shah V, Verma R, Rajesh A, Stephenson JA. Peripheral vision: abdominal pathology missed outside the centre of gaze. Br J Radiol 2018; 91:20180142. [PMID: 29927632 PMCID: PMC6475938 DOI: 10.1259/bjr.20180142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Radiology misses have been the subject of much debate on both sides of the Atlantic in recent years. There is now greater focus in trying to reduce radiology errors by continuous education and changing the working environment to try and protect the radiologist, and ultimately the patient from potential harm. Duty of candour is a relevant and sensitive area. Developing robust validated reporting pathways within the healthcare structure is very important so as to encourage a "learning from discrepancies" culture and to put the patient and their families at the center of reporting and acknowledging errors in radiology. Having reflected in our daily practice and while writing this pictorial review, we have concluded that during reporting MRI scans, routine assessment of the localizer images, focusing outside the area of interest and having a more structured approach to image interrogation are key actions which may help reduce the number of omissions. We present a myriad of cases where pathology was "missed" outside the center of gaze in relation to the abdomen or outside the abdomen on abdominal MRI, and suggest key high yield sequence related review areas to minimize the chance of missing potentially significant pathology.
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Affiliation(s)
- Catalin Vasile Ivan
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - Joseph H Mullineux
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - Vikas Shah
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - Ratan Verma
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - Arumugam Rajesh
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
| | - James A Stephenson
- 1 Department of Radiology, Gastrointestinal Imaging Group, University Hospitals of Leicester, Leicester General Hospital , Leicester , UK
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Hudson SR, Little D, Mathew A, Rosof-Williams D, Pathiraja F, Varghese K, Stephenson J. Multidisciplinary team and clinical meeting data: JRF national survey of trainees 2015. Br J Radiol 2017; 90:20170156. [PMID: 28937264 DOI: 10.1259/bjr.20170156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To collect radiology trainees' views on training for clinic-multidisciplinary team meetings (MDTMs), identify aspects requiring improvement and develop a guide to aid training. This is central to quality assurance and is within the core RCR curriculum. METHODS The Junior Radiology Forum National Training Survey 2015 was emailed to 1222 UK trainees. Questions related to role in MDTMs, training, use of the MDTM eportfolio tool and experience of leading meetings. RESULTS 611 radiology trainees responded. 22% received teaching in MDTM preparation. 29% of trainees use the eportfolio MDT assessment tool. 76% of trainees who run MDTMs have adequate preparation time. 18% always review cases with a consultant prior to a meeting. 7% of trainees always debrief with a consultant. 9.7% have been asked to lead an MDTM which they did not feel comfortable with. Most trainees think trainees should be running MDTMs post FRCR2B. CONCLUSION There are currently deficits in teaching and consultant supervision when trainees are learning to participate in MDTMs. Formal teaching sessions and timetabled preparation/debrief time with a consultant should be available. Trainees should not be asked to lead meetings without adequate support. This also ensures a safe MDTM environment for the patient. The eportfolio assessment tool can be used to sign off competence levels before independently leading an MDTM. Advances in knowledge: These results suggest shortfalls in the current model for preparing radiology trainees for their central role in clinico-MDT meetings. Using this data, a guide for trainees has been written to address these deficits.
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Affiliation(s)
- Sarah R Hudson
- 1 Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester , Leicester , UK
| | - David Little
- 2 Department of Radiology, Consultant Radiologist, Royal United Hospitals Bath NHS Foundation Trust , Bath , UK
| | - Anup Mathew
- 3 Department of Radiology, Consultant Interventional Radiologist, Royal Preston Hospital , Preston , UK
| | - Diana Rosof-Williams
- 4 Department of Radiology, Consultant Radionuclide Radiologist, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust , Chorley , UK
| | - Fiona Pathiraja
- 5 Department of Radiology, University College London Hospitals , London , UK
| | - Kabir Varghese
- 6 Department of Radiology, Chelsea and Westminster Hospital , London , UK
| | - James Stephenson
- 7 Gastrointestinal Imaging Group, Department of Radiology, Consultant Radiologist, University Hospitals of Leicester , Leicester , UK
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