La radiologia medica

, Volume 120, Issue 9, pp 785–794 | Cite as

Errors in multidetector row computed tomography

  • M. A. Mazzei
  • L. Volterrani


Multidetector row computed tomography (MDCT) represents the technique of choice for the majority of pathologies today and is responsible for the majority of diagnoses. However, despite the low number of studies dedicated to errors in MDCT, CT reporting seems especially prone to generating errors and errors are an inevitable part of MDCT practice. Most of these arise during image interpretation but, differently from other radiological techniques, the awareness of radiologists regarding technical CT aspects and pathologies substantially contribute in generating errors, in particular because CT technology expands rapidly and radiologists do not routinely receive specific and appropriate training for its use and because CT examinations are not the same for each patient and each pathology and the choice of the most appropriate CT examination (including the dose exposure to the patient) presumes a very large awareness from radiologists. This review is aimed at increasing awareness regarding the type of errors in MDCT and in particular to also highlight technical and procedural errors.


Multidetector row computed tomography Medical error Diagnostic error Dose CT 



The Authors thank Ms. Julia Hassall for reviewing the English language and Dr. Susanna Guerrini for editorial assistance in the manuscript and images preparation.

Conflict of interest

The authors declare that they have no conflict of interest. The submission of this manuscript for publication has been approved by all the authors and by the appropriate authority at the Institution where the work was carried out.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Pescarini L, Inches I (2006) Systematic approach to human error in radiology. Radiol Med 111:252–267CrossRefPubMedGoogle Scholar
  2. 2.
    West OC, Anderson J, Lee JS, Finnel CW, Raval BK (2002) Patterns of diagnostic error in trauma abdominal CT. Emerg Radiol 9:195–200PubMedGoogle Scholar
  3. 3.
    Pinto A, Brunese L (2010) Spectrum of diagnostic errors in radiology. World J Radiol 2:377–383. doi: 10.4329/wjr.v2.i10.377 PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    AHRQ (2003) AHRQ’s Patient safety initiative building foundations, reducting risk. Interim report to the senate Committee on appropriateness. Rockville, AHRQ Publications, 04-RG005. Accessed 28 Jan 2015
  5. 5.
    Pinto A, Brunese L, Pinto F, Reali R, Daniele S, Romano L (2012) The concept of error and malpractice in radiology. Semin Ultrasound CT MRI 33:275–279. doi: 10.1053/j.sult.2012.01.009 CrossRefGoogle Scholar
  6. 6.
    Donald JJ, Barnard SA (2012) Common patterns in 558 diagnostic radiology errors. J Med Imag Rad Oncol 56:173–178. doi: 10.1111/j.1754-9485.2012.02348.x CrossRefGoogle Scholar
  7. 7.
    McCreadie G, Oliver TB (2009) Eight CT lessons that we learned the hard way: an analysis of current patterns of radiological error and discrepancy with particular emphasis on CT. Clin Radiol 64:491–499. doi: 10.1016/j.crad.2008.12.010 CrossRefPubMedGoogle Scholar
  8. 8.
    Iaselli F, Mazzei MA, Firetto C, D’Elia D, Squitieri NC, Biondetti PR, Danza FM, Scaglione M (2015) Bowel and mesenteric injuries from blunt abdominal trauma: a review. Radiol Med 120(1):21–32. doi: 10.1007/s11547-014-0487-8 CrossRefPubMedGoogle Scholar
  9. 9.
    Jacob J, Hansell DM (2015) HRCT of fibrosing lung disease. Respirology. doi: 10.1111/resp.12531 PubMedGoogle Scholar
  10. 10.
    Colagrande S, Origgi D, Zatelli G, Giovagnoni A, Salerno S (2014) CT exposure in adult and paediatric patients: a review of the mechanisms of damage, relative dose and consequent possible risks. Radiol med 119:803–810. doi: 10.1007/s11547-014-0393-0 CrossRefPubMedGoogle Scholar
  11. 11.
    Allen BC, Hosseinzadeh K, Qasem SA, Varner A, Leyendecker JR (2014) Practical approach to MRI of female pelvic masses. Am J Roentgenol 202:1366–1375. doi: 10.2214/AJR.13.12023 CrossRefGoogle Scholar
  12. 12.
    Siegelman ES, Chauhan A (2014) MR characterization of focal liver lesions: pearls and pitfalls. Magn Reson Imaging Clin N Am 22:295–313. doi: 10.1016/j.mric.2014.04.005 CrossRefPubMedGoogle Scholar
  13. 13.
    Mazzei MA, Khader L, Cirigliano A, Cioffi Squitieri N, Guerrini S, Forzoni B, Marrelli D, Roviello F, Mazzei FG, Volterrani L (2013) Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC). Abdom Imaging 38:1422–1430. doi: 10.1007/s00261-013-0013-9 CrossRefPubMedGoogle Scholar
  14. 14.
    Walsh SL, Hansell DM (2014) High-resolution CT of interstitial lung disease: a continuous evolution. Semin Respir Crit Care Med 35:129–144. doi: 10.1055/s-0033-1363458 CrossRefPubMedGoogle Scholar
  15. 15.
    Mazzei MA, Scialpi M, Mazzei FG, Giacobone G, Volterrani L (2010) Three-dimensional volumetric assessment with thoracic CT: a reliable approach for non calcified lung nodules? Radiology 254:634; author reply 635. doi:  10.1148/radiol.091655
  16. 16.
    Marrelli D, Mazzei MA, Pedrazzani C, Di Martino M, Vindigni C, Corso G, Morelli E, Volterrani L, Roviello F (2011) High accuracy of multislices computed tomography (MSCT) for para-aortic lymph node metastases from gastric cancer: a prospective single-center study. Ann Surg Oncol 18:2265–2272. doi: 10.1245/s10434-010-1541-y CrossRefPubMedGoogle Scholar
  17. 17.
    Wakeley CJ, Jones AM, Kabala JE, Prince D, Goddard PR (1995) Audit of the value of double reading magnetic resonance imaging films. Br J Radiol 68:358–360CrossRefPubMedGoogle Scholar
  18. 18.
    Kundel HL, Nodine CF, Carmody D (1978) Visual scanning, pattern recognition and decision-making in pulmonary nodule detection. Invest Radiol 13:175–181CrossRefPubMedGoogle Scholar
  19. 19.
    Yerushalmy J (1969) The statistical assessment of the variability in observer perception and description of roentgenographic pulmonary shadows. Radiol Clin North Am 7:381–392PubMedGoogle Scholar
  20. 20.
    Pitmna AG (2006) Perceptual error and the culture of open disclosure in Australina radiology. Australas Radiol 50:206–211CrossRefGoogle Scholar
  21. 21.
    Berlin L (2000) Malpractice issues in radiology: alliterative errors. Am J Roentgenol 174:925–931CrossRefGoogle Scholar
  22. 22.
    Pinto A, Pinto F, Faggian A, Rubini G, Caranci F, Macarini L, Genovese EA, Brunese L (2013) Sources of error in emergency ultrasonography. Crit Ultrasound J 5(Suppl 1):S1. doi: 10.1186/2036-7902-5-S1-S1 PubMedCentralPubMedGoogle Scholar
  23. 23.
    Mazzei MA, Guerrini S, Cioffi Squitieri N, Genovese EA, Mazzei FG, Volterrani L (2012) Diagnosis of acute mesenteric ischemia/infarction in the era of multislice CT. Recenti Prog Med 103:435–437. doi: 10.1701/1166.12884 PubMedGoogle Scholar
  24. 24.
    Mazzei MA, Mazzei FG, Marrelli D, Imbriaco G, Guerrini S, Vindigni C, Civitelli S, Roviello F, Grassi R, Volterrani L (2012) Computed tomographic evaluation of mesentery: diagnostic value in acute mesenteric ischemia. J Comput Assist Tomogr 36:1–7. doi: 10.1097/RCT.0b013e31823b4465 CrossRefPubMedGoogle Scholar
  25. 25.
    Mazzei MA, Volterrani L (2015) Nonocclusive mesenteric ischaemia: think about it. Radiol Med 120:85–95. doi: 10.1007/s11547-014-0460-6 CrossRefPubMedGoogle Scholar
  26. 26.
    Loy CT, Irwig L (2004) Accuracy of diagnostic tests read with and without clinical information. JAMA 292:1602–1609CrossRefPubMedGoogle Scholar
  27. 27.
    Leslie A, Jones AJ, Goddard PR (2000) The influence of clinical information on the reporting of CT by radiologists. Br J Radiol 73:1052–1055CrossRefPubMedGoogle Scholar
  28. 28.
    Fillippone A, Cianci R, Iezzi R, Legnini M, Storto ML (2009) Effect of clinical history in focal liver lesion detection and classification on 4-detector row computed tomography and gadoxetic acid enhanced MR imaging in oncologic patients. J Comput Assist Tomogr 33:851–857. doi: 10.1097/RCT.0b013e3181a63e1e CrossRefGoogle Scholar
  29. 29.
    Eldevik OP, Dugstad G, Orrison WW, Haughton VM (1982) The effect of clinical bias on the interpretation of myelography and spinal computed tomography. Radiology 145:85–89CrossRefPubMedGoogle Scholar
  30. 30.
    Berbaum KS, Franken EA Jr, Dorfman DD, Barloon T, Ell SR, Lu CH, Smith W, Abu-Yousef MM (1986) Tentative diagnosis facilitates the detection of diverse lesions in chest radiographs. Invest Radiol 21:532–539CrossRefPubMedGoogle Scholar
  31. 31.
    Leblanc VR, Brooks LR, Norman GR (2002) Believing is seeing: the influence of a diagnostic hypothesis on the interpretation of clinical features. Acad Med 77:S67–S69CrossRefPubMedGoogle Scholar
  32. 32.
    Hatala R, Norman GR, Brooks LR (1999) Impact of a clinical scenario on accuracy of electrocardiogram interpretation. J Gen Intern Med 14:126–129CrossRefPubMedGoogle Scholar
  33. 33.
    Suzuki S, Ikusaka M, Ohira Y, Miyahara M, Noda K, Kajiwara H, Shikino K, Kondo T (2013) Effect of diagnostic predictions combined with clinical information on avoiding perceptual errors of computed tomography. Jpn J Radiol 31:731–736. doi: 10.1007/s11604-013-0244-2 CrossRefPubMedGoogle Scholar
  34. 34.
    American College of Radiology (2010) ACR practice guideline for communication of diagnostic imaging findings. In: 2010 ACR practice guideline for communication of diagnostic imaging findings. American College of Radiology, Reston, VA, p 6Google Scholar
  35. 35.
    Berlin L (2005) Errors of omission. Am J Roentgenol 185:1416–1421CrossRefGoogle Scholar
  36. 36.
    Harrigal CL, Erly WK (2007) On-call radiology: community standars and current trends. Semin Ultrasound CT MR 28:85–93CrossRefPubMedGoogle Scholar
  37. 37.
    Raskin MM (2006) Survival strategies for radiology: some practical tips on how to reduce the risk of being sued and losing. J Am Coll Radiol 3:689–693CrossRefPubMedGoogle Scholar
  38. 38.
    Fardanesh M, White C (2012) Missed lung cancer on chest radiograpy and computed tomography. Semin Ultrasound CT MR 33:280–287. doi: 10.1053/j.sult.2012.01.006 CrossRefPubMedGoogle Scholar
  39. 39.
    Pickhardt PJ (2013) Missed lesions at CT colonography: lessons learned. Abdom Imaging 38:82–97. doi: 10.1007/s00261-012-9897-z CrossRefPubMedGoogle Scholar
  40. 40.
    Pinto A, Caranci F, Romano L, Carrafiello G, Fonio P, Brunese L (2012) Learning from errors in radiology: a comprehensive review. Semin Ultrasound CT MR 33:379–382. doi: 10.1053/j.sult.2012.01.015 CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2015

Authors and Affiliations

  1. 1.Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, Azienda Ospedaliera Universitaria SeneseUniversity of SienaSienaItaly

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