Pediatric Abdominal Radiographs: Common and Less Common Errors

OBJECTIVE. Interpretation of abdominal radiographs of children benefits from a firm knowledge of the congenital anomalies and pathologies unique to this patient population, leveraged by a systematic approach. Interpretive errors place the patients and their families at risk for a delay in diagnosis, unnecessary additional imaging, a potential increase in the radiation burden, and possible psychologic trauma.

CONCLUSION. In this article, we describe the common and uncommon potential pitfalls in pediatric abdominal radiography, using several of our own interpretive errors as a framework while providing teaching points to help avoid these mistakes.

Keywords: abdominal radiographs, errors, pediatric

The concept that medical errors contribute to patient morbidity and mortality was widely substantiated by the Institute of Medicine in 1999, when its report To Err Is Human: Building a Safer Health System was published [1]. The numbers quoted at the time seemed staggering, but they have continued to increase, with medical errors most recently reported as the third leading cause of death in the United States [2].

As in all fields of medicine, errors in radiology are often multifactorial, may be perceptual (i.e., the finding was not seen), may be caused by insufficient characterization (i.e., the finding was identified but its significance was not appropriately recognized), or may represent a failure in communication (i.e., the finding was accurately reported but the appropriate channels of communication for notifying the provider were not used), among many other causes [3, 4]. Growing awareness of imaging errors has led to an increased focus on identifying, understanding, and avoiding these mistakes, not only in the radiology literature as a whole but, more recently, in pediatric radiology as well [3, 46].

At our institution, as part of a rigorous quality assurance program, we use various peer review strategies to identify such errors and promote ongoing continuous education and feedback [7, 8]. These strategies include monthly peer review conferences and peer review scorecards that assist in closing the feedback loop to interpreting radiologists. Although peer review methods or scorecards are critically important as educational tools, a more extended discussion of these tools is beyond the intended scope of this article. Instead, using a case-based approach, we offer examples of some of our own “missed” cases to illustrate common and less common errors that may occur, specifically when interpreting abdominal radiographs of pediatric patients.

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