AJR in Brief continues on p. 20
safely eliminate the need for C T in patients who—after C T—end
up with a diagnosis of NSAP,” said study coauthor Jonathan D.
Eisenberg, Yale University, New Haven, C T. “We also found that
emergency department (ED) physicians’ initial diagnoses of
NSAP changed after C T in more than one-third of the patients.”
The results suggest that further related research should be
directed toward the development of a predictive model that is
capable of incorporating an even broader range of variables than
those included in this or other studies to date.
The research was supported by a grant from the National
Electrical Manufacturers Association.
Interpretive Error in Radiology
Errors in diagnostic interpretations
are common occurrences exacerbated
by increasing demands on radiologists.
Unfortunately, although imaging technology has significantly advanced, interpretive error rates have remained
unchanged. A literature review from radiologists at the State University of New
York Downstate, Brooklyn, highlights
mechanics involved in searching an image, categorizing omission errors, and
discusses both intrinsic and extrinsic factors influencing diagnostic accuracy. The review then discusses technical and nontechnical solutions to reduce these errors.
Radiologists use visual detection, pattern recognition, memory, and cognitive reasoning to synthesize final interpretations of
radiologic studies. This synthesis is performed in an environment in which there are numerous extrinsic distractors increasing workloads and fatigue, and intrinsic sources of errors such as
cognitive biases. Given the ultimately human task of perception,
some degree of error is likely inevitable even with experienced
observers; however, an understanding of the causes of interpretive errors can help in the development of tools to mitigate errors
and improve patient safety.
CT Colonographic Screening of
Patients With a Family History
of Colorectal Cancer:
Comparison With Adults at
Average Risk and Implications
CT colonographic (CTC) screening can be safely used as a front-line
screening strategy for adults with a
family history of colorectal cancer
(CRC), according to a study conduct-
ed by researchers and radiologists at
the department of radiology, University of Wisconsin School of
Medicine and Public Health, Madison.
“Although the overall C TC-positive and colonoscopy referral
rates were higher in our American Cancer Society (ACS)–de-
fined family history cohort, we found no statistically significant
increase in actual rates of neoplasia, including advanced neopla-
sia and cancer,” said study coauthor Perry J. Pickhardt, a radiolo-
gist with the university.
Regardless of family history, CRC screening of adults without
symptoms by use of preventive tests that can reveal both cancers and
nondiminutive benign neoplastic polyps is clearly of benefit.
Accordingly, the 2008 landmark ACS guidelines for CRC screening of
adults at average risk strongly emphasized the use of preventive mo-
dalities, such as optical colonoscopy and CTC, over stool-based tests.
In 2016, the U.S. Preventive Services Task Force updated its
recommendation for CRC screening of adults at average risk.
Although CTC was included as a grade A screening option for
adults 50–75 years old, the task force did not consider cohorts at
higher risk, including those with a family history of CTC. As
such, screening options for the family history cohort have not
been updated in more than a decade.
Although most new CRC cases arise in patients without any
family history of CRC, as many as 15–25% of cases occur in indi-
viduals who have a first-degree relative with a history of CRC—
in the absence of any defined genetic syndrome (so-called
familial CRC). Another 5–10% of diagnoses of CRC are a conse-
quence of recognized hereditary conditions, most commonly he-
reditary nonpolyposis colorectal cancer (Lynch syndrome) and
familial adenomatous polyposis.
The study is based on a presentation at the ARRS 2016 Annual
Meeting, Los Angeles, CA. It was supported in part by the
Unfortunately, although imaging technology has
significantly advanced, interpretive error rates
have remained unchanged.—Stephen Waite
Perry J. Pickhardt
Regardless of family history, CRC screening of adults without symptoms by use of preventive tests
that can reveal both cancers and nondiminutive benign neoplastic polyps is clearly of benefit.
—Perry J. Pickhardt