title: Missed lesions at abdominal oncologic CT: lessons learned from quality assurance.
abstract: The evaluation of oncology patients represents a substantial volume of the workload in many radiology departments. Interpreting the results of oncologic examinations is often challenging and time-consuming because many abnormalities are identified in the same examination and must be compared with the findings in previous studies. However, errors in the interpretation of oncologic computed tomographic (CT) scans can have significant effects on patient care. These effects may range from withdrawal from a clinical trial or cessation of therapy to repeat CT examination because of a technically inadequate study, CT-guided biopsy of newly identified lesions, or initiation of therapy for previously unrecognized lesions. A root cause analysis of reported errors in the interpretation of abdominal and pelvic CT scans led to the identification of potential pitfalls that may be encountered when interpreting oncologic CT scans and factors that contribute to these errors. Awareness of the spectrum of factors that contribute to misinterpretation of CT scans in oncology patients may improve the performance of the individual radiologist and ultimately translate into improved patient care.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA. bsiewert@bidmc.harvard.edu
authors.forename: Bettina
authors.initials: B
authors.lastname: Siewert
authors.forename: Jacob
authors.initials: J
authors.lastname: Sosna
authors.forename: Ann
authors.initials: A
authors.lastname: McNamara
authors.forename: Vassilios
authors.initials: V
authors.lastname: Raptopoulos
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Kruskal
mesh_terms: D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging*; D003951:Diagnostic Errors / Q000517:prevention & control*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D011785:Quality Assurance, Health Care / Q000592:standards*; D011860:Radiography, Abdominal / Q000379:methods / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards*; D014481:United States