Abstracts

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E2074. Avoiding Common On-Call Errors: A Guided Tutorial for Radiology Residents
Authors
  1. Ashley Etchison; Baylor College of Medicine
  2. Joshua Carlton; Baylor College of Medicine
  3. Pedro Diaz-Marchan; Baylor College of Medicine
  4. Vincent Mellnick; Mallinckrodt Institute of Radiology
  5. Douglas Katz; NYU Langone Health
  6. Suzanne Chong; Indiana University School of Medicine
  7. Khaled Elsayes; MD Anderson Cancer Center
Background
Errors are inevitable in medical training, and radiology residents are not excluded from diagnostic blunders. Within the practice of radiology, errors are generally divided into perceptive and cognitive errors. Perceptive errors comprise the majority of radiology errors and result from simply overlooking a finding. Colloquially referred to as an “eye test,” a perceptive error may result from a distractive phone call, sleep deprivation, or perhaps organically without an inciting event. Cognitive errors, on the other hand, stem from incorrect interpretations of identified findings. This error type is often attributed to knowledge gaps and cognitive biases. Although radiology residents fall victim to both error types, repeated cognitive errors become frustrating roadblocks if not appropriately addressed early in training.

Educational Goals / Teaching Points
This educational exhibit is a compact and practical guide for junior radiology residents that illustrates common interpretation errors encountered during on-call shifts. Both perceptive and cognitive errors are addressed in this exhibit due to their interwoven relationship during early residency training. However, this exhibit emphasizes why findings are misinterpreted versus simply reviewing where findings are located. If trainees possess a deeper understanding of why findings are misinterpreted, they begin to develop a robust and invaluable diagnostic skill set early in training.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will highlight various pathologies that trainees commonly misinterpret during on-call shifts. Disease presentations were selected based on common trainee mistakes observed by the co-authors, who are all academic radiologists. For example, pulmonary emboli are frequently cited as both missed and overcalled findings. Within neuroradiology, cognitive errors commonly occur during interpretations of acute cerebral infarcts, intracranial hemorrhage, and cervical spine fractures. Cognitive errors within abdominal imaging involve diagnosing appendicitis, diverticulitis, hepatic lacerations, and small bowel obstruction. On-call musculoskeletal mistakes often stem from missing osteomyelitis and pelvic fractures on plain film radiographs.

Conclusion
This exhibit serves as an illustrated guide for radiology residents in preparation for on-call shifts in the Emergency Department. Relevant anatomy and pathophysiology, suggested search patterns, and explanations of common trainee mistakes are described for each selected disease process. Examples of real cases from the authors’ institutions will accompany each pathology. After reviewing this exhibit, junior radiology trainees should feel more confident in avoiding commonly made errors during on-call shifts.