E2002. Lessons from Great Calls and Near-Misses in Neuroradiology Identified by a 4-Year Quality Improvement Initiative
  1. Julian Sison; Yale School of Medicine
  2. Long Tu; Yale School of Medicine
  3. Jay Pahade; Yale School of Medicine
  4. Sandra Fadel; Yale School of Medicine
  5. Victor Becerra; Yale School of Medicine
  6. Mehmet Adin; Yale School of Medicine
Maintaining high diagnostic accuracy is one of the most fundamental goals in clinical radiology, and much attention has fittingly been put towards this topic. Previous studies have reviewed missed findings, such as on noncontrast head CT, to understand common blind spots and revise search patterns to address these shortcomings. Institutional "great calls", where clinicians detect subtle pathology or demonstrate keen clinical judgment by synthesizing salient elements of a case, can likewise act as great learning opportunities. From 2015 to 2018, 122 neuroradiology cases were submitted as learning opportunities to our quality improvement initiative, 88 of which were designated as learning opportunities and 34 of which were designated as "great calls". In our presentation, we share highlighted cases obtained from these 4 years' worth of peer-learning data within the neuroradiology section at our institution. We expect that our findings are generalizable to a broad audience and can identify common areas of challenge to facilitate self-improvement.

Educational Goals / Teaching Points
We will briefly review common challenges in neuroradiology studies based on our institutional quality improvement data. We will then present selected cases that were identified as either 1) learning opportunities or 2) great calls. We will use these cases to illustrate common challenges and pitfalls. Each case will be followed by a discussion of how these challenges can be navigated. By the end of our presentation, the viewer should be able to apply these lessons to commonly ordered neuroradiology studies in everyday practice.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will present sample radiography, CT, and MRI cases.

As the volume of imaging ordered continues to climb, the concern of missing critical pathology becomes more relevant. Although some proportion of missed findings is inevitable, we can learn valuable lessons from our misses as well as "great calls" where subtle findings were detected. Our presentation is a case-based approach to this topic based on 4 years of institutional quality improvement data submitted within our neuroradiology section. These cases offer insights regarding blind spots and misinterpretations on neuroimaging. By sharing these cases, we hope to provide a broad audience with tangible lessons about how to navigate these potential pitfalls.