Mali W P Th M
Universitair Medisch Centrum Utrecht, afd. Radiologie, Postbus 85.500, 3508 GA Utrecht.
Ned Tijdschr Geneeskd. 2002 Apr 27;146(17):792-3.
The interpretation of imaging studies is associated with missed diagnoses. These are due to the inherent limitations of the technique, which are quantified in the sensitivity and specificity of the test and can be caused by normal variation in the interpretation. This can be studied in the reproducibility. Another source of missed diagnoses is related to the observer and is the result of an inadequate technique, mistakes in perception and judgement, and a lack of knowledge. Here, perception error is probably the most important category. A reproachable error is made when a group of experts states that the error should not have been made. Some basic questions that can be posed to reach a judgement in such cases are: was the work conducted in accordance with a protocol, how were the films read and what was the clinical context? The missing of an abnormality on a film can only be judged against the background of the diagnostic handling around such a clinical problem and the quality of the observer.
影像学检查结果的解读与漏诊相关。这些漏诊是由于该技术固有的局限性所致,这些局限性通过检查的敏感性和特异性来量化,并且可能由解读中的正常变异引起。这可以在可重复性方面进行研究。漏诊的另一个原因与观察者有关,是技术不熟练、感知和判断错误以及知识不足的结果。在此,感知错误可能是最重要的类别。当一组专家表示该错误本不应发生时,就会出现应受指责的错误。在这种情况下,为做出判断可以提出的一些基本问题是:工作是否按照方案进行、如何阅读影像以及临床背景是什么?只有在围绕此类临床问题的诊断处理背景以及观察者的素质背景下,才能判断影像上是否遗漏了异常情况。