Dept of Radiology, George Washington University Hospital, 900 23rd St NW First Floor, Washington, DC, 20037, USA.
George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
Emerg Radiol. 2023 Aug;30(4):525-537. doi: 10.1007/s10140-023-02143-8. Epub 2023 Jun 9.
Computed tomography angiography (CTA) of the head and neck is central in emergency department (ED) evaluation of clinically suspected acute stroke and intracranial hemorrhage. Timely and accurate detection of acute findings is crucial for best clinical outcomes; missed or delayed diagnosis can be devastating. Our pictorial essay presents twelve CTA cases that provided significant diagnostic dilemmas to on-call trainees while reviewing current bias and error classifications in radiology. Among others, we discuss anchoring, automation, framing, satisfaction of search, scout neglect and zebra-retreat bias. Each imaging vignette depicts a potential diagnostic "pitfall" while introducing types of cognitive bias/error before concluding with a concrete "pearl" for CTA interpretation. We believe that familiarity with bias and error is particularly important in the ED setting where high case volume, high acuity and radiologist fatigue intersect. Particular attention to personal cognitive biases and these potential CTA pitfalls may help emergency radiologists transition from habit-driven pattern recognition to analytical thinking, ultimately improving diagnostic decision making.
头部和颈部的计算机断层血管造影 (CTA) 是急诊科临床疑似急性中风和颅内出血评估的核心。及时准确地发现急性发现对于获得最佳临床结果至关重要；漏诊或延迟诊断可能是毁灭性的。我们的图片文章介绍了 12 个 CTA 病例，这些病例在审查当前放射科中的偏倚和错误分类时，为值班学员提供了重大的诊断难题。其中，我们讨论了锚定、自动化、框架、搜索满足、忽视侦察和斑马退缩偏倚。每个成像小插图都描绘了一个潜在的诊断“陷阱”，同时在介绍认知偏倚/错误类型之前，以 CTA 解释的具体“亮点”结尾。我们认为，在急诊科环境中，熟悉偏倚和错误尤为重要，因为急诊科的病例量高、病情急、放射科医生疲劳。特别注意个人认知偏差和这些潜在的 CTA 陷阱可能有助于急诊放射科医生从习惯驱动的模式识别过渡到分析思维，最终提高诊断决策能力。
