Opportunities for Targeted Education: Critical Neuroradiologic Findings Missed or Misinterpreted by Residents and Fellows

AJR Am J Roentgenol. 2015 Dec;205(6):1155-9. doi: 10.2214/AJR.15.14905.


Objective: We reviewed neuroradiology cases in which a resident or fellow missed a significant finding, to identify potential areas of deficiency that could be strengthened through targeted education.

Materials and methods: Included in the study were all neuroradiology reports from 2011 through 2013 that were marked with an electronic flag to indicate a significant modification between the preliminary and final versions. The reports were examined to determine whether a critical finding (CF) or a non-CF was missed, with the use of a hospital-approved list of 17 neuroradiology CFs. Results were analyzed for all trainees.

Results: A total of 978 modified reports were found among reports from 225,628 neuroradiology examinations. Of these modified reports, 891 (91.1%) contained an addendum that identified the discrepancy: 658 (73.8%) contained a CF,192 (21.7%) contained a non-CF, and 41 (4.6%) were changed from containing a CF to not containing a CF. A total of 725 missed CFs were found in the 658 modified reports. The CF miss rate for all trainees was 6.0% (95% CI, 5.6-6.4%), whereas that for residents was 8.6% and that for fellows was 4.8%. Residents missed hydrocephalus, intracranial pressure or edema, new hemorrhage, and new infarction more frequently than did fellows. The five most frequently missed CFs were congenital variation, infection, misplaced hardware, a new or enlarging mass, and vascular abnormality.

Conclusion: Our trainees' overall CF miss rate was 6.0%. Five CFs had miss rates of approximately 10% or more, and residents missed four of the CFs more frequently than did fellows. With the use of these data, our curriculum could potentially be strengthened and our trainee error rates decreased, leading to improved patient care.

Keywords: critical findings; interpretation; neuroradiology; quality improvement; radiology education.

MeSH terms

  • Clinical Competence
  • Diagnostic Errors / statistics & numerical data*
  • Education, Medical, Graduate*
  • Humans
  • Internship and Residency*
  • Magnetic Resonance Imaging
  • Neuroimaging / standards*
  • Retrospective Studies
  • Tomography, X-Ray Computed