ARRS 2022 Abstracts

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E1023. Peer Learning: ED Radiology Cases of Inattention Blindness
Authors
  1. Willie McClure; David Grant USAF Medical Center
  2. Scott Myers; David Grant USAF Medical Center
  3. Rena Jesinger; University of California, Davis
  4. Robert Jesinger; David Grant USAF Medical Center; Uniformed Services University of the Health Sciences
Background
The purpose of this exhibit is to share cases (seen in our peer learning framework) that involved misidentification and/or misinterpretations of the significance of imaging findings in the chest, abdomen, or pelvis on ED exams, as seen with a variety of imaging modalities (x-ray, fluoroscopy, CT, US, and MRI). Our goal is not to show subtle "missed" cases; rather, we wanted to share cases where the finding was obvious when recognized but not reported due to inattention blindness bias -- a bias known as "missing a finding hiding in plain sight due to its unexpected nature."

Educational Goals / Teaching Points
Inattention blindness bias, also known as “tunnel vision,” refers to missing findings that are “hiding” in plain sight, owing to their unexpected location or nature. This bias is related to the notion that humans cannot process everything in their visual field at one time. Some objects, given their specific characteristics, including orientation, size, motion, and color, are noticed rapidly without any conscious effort. Learning, memory, attention, and expectation shape this perceptual process. Expert radiologists have learned where and how to look for clinically significant findings, sometimes focusing their attention to many seemingly irrelevant areas. Awareness of a patient’s focal clinical finding may elevate the significance of a subthreshold imaging finding or prompt additional imaging.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Five cases are presented in this exhibit. A round white ball in the spleen should be considered to represent a pseudoaneurym until proven otherwise (case 1). Missing bone margins should be assessed to not miss malignant bony destruction or fracture (case 2). What is thought to be thoracic aortic tortuosity might actually be a mediastinal mass (case 3). Missing vertebral bodies may not be the result of poor imaging technique (framing bias); rather, the vertebral body may be destroyed by an infectious or malignant process (case 4). Numerous locules of gas adjacent to the colon that could be diverticulosis might be the result of perforation (case 5).e 5)

Conclusion
Significant imaging findings (cancer, infection, pseudoaneurysm, fracture, bowel perforation) can occur in ED patients undergoing imaging. Astute radiologists can "wander" by these diagnoses due to inattention blindness. The cases in this exhibit can be of benefit in peer learning to teach places to perform a "second look" during interpretation.