Teaching Point: Awareness in radiology reporting of cognitive errors such as the alliterative bias can help minimize the delay to diagnosis and accelerate adequate patient care

Denis Tack

Hanna Salame

Laura Haddad

Journal of the Belgian Society of Radiology

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IMAGES IN CLINICAL RADIOLOGYABSTRACTTeaching Point: Awareness in radiology reporting of cognitive errors such as the alliterative bias can help minimize the delay to diagnosis and accelerate adequate patient care.CORRESPONDING AUTHOR:Laura HaddadUniversité libre de Bruxelles, Belgiumlaurahaddad02@gmail.comKEYWORDS:interpretation error; chest radiography; missed foreign body; training; diagnostic accuracyTO CITE THIS ARTICLE:Haddad L, Salame H, Tack D. An Avoidable Cognitive Error in Chest Radiography. Journal of the Belgian Society of Radiology. 2023; 107(1): 101, 1–3. DOI: https://doi.org/10.5334/jbsr.3353LAURA HADDAD HANNA SALAME DENIS TACK *Author affiliations can be found in the back matter of this articleAn Avoidable Cognitive Error in Chest Radiography2Haddad et al. Journal of the Belgian Society of Radiology DOI: 10.5334/jbsr.3353CASE HISTORYA 79-year-old male patient on hemodialysis for chronic renal failaure, presented with persistent cough and reccurrent pneumonias over the last few months. A chest radiograph (Figure 1a) showed blunting of both costophrenic angles as well as bibasilar infiltrates and atelectasis, predominant in the right lower lung field, and associated with bilateral volume loss. A hemodialysis catheter in adequate position and an electronic device overlying the heart were seen. A rounded opaque structure is noted at the level of the main right bronchus. This last element was not mentioned in the initial report by the radiologist. The clinician observed this and the radiologist reviewed all available images. This opaque structure was present on chest radiographs performed one month (not shown) and two months earlier (Figure 1b). Chest computed tomography (CT) (Figure 2) showed a round dense structure located within the right main bronchus, probably aspirated by the patient. A bronchospy was performed and a metal dental crown was removed.COMMENTSMost malpractice issues in radiology are related to diagsnotic errors [1]. The majority of these errors are perceptual errors when the radiologist fails to detect an abnormality. Less commonly, diagnostic errors are interpretative errors. A mental shortcut or a systemic error in reasoning are the main causes of diagnotic errors [1]. This case of successive chest radiographs with the same error draws the attention to the importance of awarness of the mechanisms of errors. This round structure is obviously clearly visible on the radiographs. Thus, it was probably seen, yet considered as not relevant, making it an interpretative error. If on the first radiograph it was a simple error of judgement, on the second and third radiograph, it is more likely to be related to the alliterative bias. This cognitive bias occurs when the radiologist is largely influenced by prior reports with a greater likelihood of repeating the same error [1]. This error could have been easily avoided if the radiologists were just aware or reminded of this specific interpretative cognitive bias known as the alliterative bias, as illustrated in this simple case. Figure 1.Figure 2.3Haddad et al. Journal of the Belgian Society of Radiology DOI: 10.5334/jbsr.3353TO CITE THIS ARTICLE:Haddad L, Salame H, Tack D. An Avoidable Cognitive Error in Chest Radiography. Journal of the Belgian Society of Radiology. 2023; 107(1): 101, 1–3. DOI: https://doi.org/10.5334/jbsr.3353Submitted: 01 September 2023          Accepted: 27 October 2023          Published: 28 December 2023COPYRIGHT:© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.Journal of the Belgian Society of Radiology is a peer-reviewed open access journal published by Ubiquity Press.COMPETING INTERESTSThe authors have no competing interests to declare.AUTHOR AFFILIATIONSLaura Haddad  orcid.org/0000-0002-6190-1991 Université libre de Bruxelles, BelgiumHanna Salame  orcid.org/0009-0009-4885-4332 Department of Radiology, Epidura La Madeleine, Rue Maria Thomée, 1, 7800 Ath, BelgiumDenis Tack  orcid.org/0000-0002-1509-1983 Department of Radiology, Epidura La Madeleine, Rue Maria Thomée, 1, 7800 Ath, BelgiumREFERENCE1. Itri JN, Patel SH. Heuristics and cognitive error in medical imaging. AJR Am J Roentgenol. 2018; 210(5): 1097–1105. Epub 2018 Mar 12. PMID: 29528716. DOI: https://doi.org/10.2214/AJR.17.18907

An Avoidable Cognitive Error in Chest Radiography

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An Avoidable Cognitive Error in Chest Radiography

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