Unbiased review of digital diagnostic images in practice: informatics prototype and pilot study

[Quality of findings, interpretation, and self-assessment of readers of chest x-rays acquired in one plane depending on the use of an anatomical viewing scheme and reader expertise]

PURPOSE

To objectify effects of an anatomical viewing scheme on the respective correctness of (a) findings, (b) interpretations, and (c) self-assessments of readers in chest radiographs acquired in one plane and the assessment of other influencing factors.

MATERIALS AND METHODS

In all, 20 radiologists with 3-60 months of full-time radiography experience evaluated 12 chest radiographs of varying difficulty: once with and once without using an anatomical viewing scheme with at least 1 month in between (n = 480). In consensus of 3 radiological experts (a) and (b) were determined by means of a current computed tomography. The self-assessment (c) of readers was queried.

RESULTS

(a) Findings were either missed or not described in 21%. Another 20% were recognized, but incorrectly described, (b) 62% of interpretations and 31% of derived clinical consequences were wrong and (c) in 39% of items the readers overestimated themselves. Experts were faster and better than novices, but for the scheme usage no further significant differences were detected (p > 0.5, respectively). The most pronounced effect was found in comparison with the routine report produced by the joint evaluation of novices and experts being clearly superior even to the expert study results (a), (b) and (c) alone (p < 0.001, respectively).

CONCLUSION

Reporting of chest X‑rays acquired in one plane was often incomplete or even wrong, and the evaluators overestimated themselves, which was not influenced by the use of the anatomical viewing scheme. Since errors between the evaluators sometimes differed greatly, duplicate evaluation of the radiographs by two different radiologists, which is already the case in many training facilities, may possibly be advisable in general.

Expert witness blinding strategies to mitigate bias in radiology malpractice cases: a comprehensive review of the literature

Like all physicians, radiologists in the United States are subject to frequent and costly medical malpractice claims. Legal scholars and physicians concur that the US civil justice system is neither precise nor accurate in determining whether malpractice has truly occurred in cases in which claims are made. Sometimes, this inaccuracy is driven by biases inherent in medical expert-witness opinions. For example, expert-witness testimony involving "missed" radiology findings can be negatively affected by several cognitive biases, such as contextual bias, hindsight bias, and outcome bias. Biases inherent in the US legal system, such as selection bias, compensation bias, and affiliation bias, also play important roles. Fortunately, many of these biases can be significantly mitigated or eliminated through the use of appropriate blinding techniques. This paper reviews the major works on expert-witness blinding in the legal scholarship and the radiology professional literature. Its purpose is to acquaint the reader with the evidence that unblinded expert-witness testimony is tainted by multiple sources of bias and to examine proposed strategies for addressing these biases through blinding.