medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-2020-3-123-145medvis-956Research ArticleМЕДИЦИНСКИЕ ТЕХНОЛОГИИMEDICAL TECHNOLOGIESОттенки серого: как и почему мы ошибаемсяShades of grey: how and why we make mistakeshttps://orcid.org/0000-0002-0310-0889УчеваткинА. А.UchevatkinA. A.

Учеваткин Андрей Алексеевич – генеральный директор, врач-рентгенолог

111123 Москва, шоссе Энтузиастов, 62, Российская Федерация;

109029 Москва, ул. Средняя Калитниковская, д. 28, стр. 1, Российская Федерация

Andrey A. Uchevatkin – CEO, Radiologist

62, Shosse Entuziastov, Moscow, 111123, Russian Federation;

28-1, Srednyaya Kalitnikovskaya str., Moscow, 109029, Russian Federation

https://orcid.org/0000-0001-7284-4737ЮдинА. Л.YudinA. L.

Юдин Андрей Леонидович – доктор мед. наук, профессор, заведующий кафедрой лучевой диагностики и терапии МБФ

117997 Москва, ул. Островитянова, д. 1, Российская Федерация

Andrey L. Yudin – Doct. of Sci. (Med.), professor, head of radiology department

house 1, Ostrivityanova str., Moscow, 117997, Russian Federation

https://orcid.org/0000-0003-2203-989XАфанасьеваН. И.Afanas'yevaN. I.

Афанасьева Наталья Иосифовна – канд. мед. наук, доцент кафедры лучевой диагностики и терапии МБФ

117997 Москва, ул. Островитянова, д. 1, Российская Федерация

Natal’ya I. Afanas'yeva – Cand. of Sci. (Med.), associate professor, radiology department

house 1, Ostrivityanova str., Moscow, 117997, Russian Federation

https://orcid.org/0000-0002-6020-9434ЮматоваЕ. А.YumatovaE. A.

Юматова Елена Анатольевна – канд. мед. наук, доцент кафедры лучевой диагностики и терапии МБФ

117997 Москва, ул. Островитянова, д. 1, Российская Федерация

Elena A. Yumatova – Cand. of Sci. (Med.), associate professor, radiology department

house 1, Ostrivityanova str., Moscow, 117997, Russian Federation

yumatova_ea@mail.ruАО “Центр эндохирургии и литотрипсии”; ГБУЗ “Научно-практический клинический центр диагностики и телемедицинских технологий Департамента здравоохранения города Москвы”РоссияCenter of Endosurgery and Lithotripsy; Diagnostics and Telemedicine CenterRussian FederationФГАОУ ВО “РНИМУ имени Н.И. Пирогова” Минздрава РоссииРоссияPirogov Russian National Research Medical University of the Ministry of Health of RussiaRussian Federation202009102020243123145Copyright © Учеваткин А.А., Юдин А.Л., Афанасьева Н.И., Юматова Е.А., 20202020Учеваткин А.А., Юдин А.Л., Афанасьева Н.И., Юматова Е.А.Uchevatkin A.A., Yudin A.L., Afanas'yeva N.I., Yumatova E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/956Цель исследования

Цель исследования: рассмотреть эпидемиологию и классификацию ошибок в лучевой диагностике.

Материал и методы

Материал и методы. Проведен анализ статей, посвященных выяснению возможных причин диагностических ошибок, опубликованных до 2019 г. Ретроспективный анализ результатов исследований выявил наиболее частые когнитивные искажения, влияющие на принятие клинических решений. Выработаны стратегии по борьбе с данными искажениями, позволяющие минимизировать вероятность возникновения ошибок.

Обсуждение

Обсуждение. Анализ изображений врачами – это сложная работа, основанная на совокупности психофизиологических и когнитивных процессов, которая сама по себе подвержена широкому разнообразию ошибок, включая ошибки восприятия (когда патологические изменения просто пропускаются) и когнитивные ошибки (те случаи, когда патологические изменения обнаружены визуально, но неправильно интерпретированы). Хотя часть изменений на лучевых изображениях может быть пропущена из-за технических или физических ограничений модальности (разрешение, отношение сигнал / шум, артефакты и пр.), большинство диагностических расхождений связано с неверной интерпретацией выявленных находок рентгенологами.

Заключение

Заключение. Когнитивные искажения могут существенно влиять на процесс принятия диагностических решений и приводить к медицинским ошибкам и негативным последствиям для пациентов. Различные стратегии когнитивного воздействия и метакогнитивные практики могут помочь минимизировать влияние искажений на принятие решений и снизить частоту диагностических ошибок. Знание своих ограничений и возможностей при интерпретации лучевого исследования, а также понимание роли рентгенолога в формировании окончательного диагноза и соответственно в дальнейшей судьбе пациента может привести к более вдумчивому анализу изображений и клинической информации и повышению качества процесса принятия диагностического решения.

Purpose

Purpose: to consider the epidemiology and classification of errors in radiologic diagnostics.

Materials and methods

Materials and methods. The analysis of articles devoted to elucidating the possible causes of diagnostic errors published before 2019 is carried out. A retrospective analysis of the research results revealed the most frequent cognitive biases affecting clinical decision making. Strategies have been developed to combat these distortions, which minimize the likelihood of errors.

Discussion

Discussion. Image analysis by doctors is a complex work based on a combination of psychophysiological and cognitive processes, which in itself is subject to a wide variety of errors, including perception errors (when pathological changes are simply skipped) and cognitive errors (those cases when pathological changes are detected visually but incorrectly interpreted). Although some of the changes in the radiation images may be skipped due to technical or physical limitations of the modality (resolution, signal-to-noise ratio, artifacts, etc.), most diagnostic discrepancies are associated with an incorrect interpretation of the findings by radiologists.

Conclusions

Conclusions. Cognitive distortions can significantly affect the process of making diagnostic decisions, and lead to medical errors and negative consequences for patients. Various cognitive strategies and metacognitive practices can help minimize the impact of bias on decision making and reduce the frequency of diagnostic errors. Knowing one’s limitations and possibilities in interpreting radiation research, as well as understanding the role of the radiologist in the formation of the final diagnosis and, accordingly, in the fate of the patient, can lead to a more thoughtful analysis of images and clinical information and improve the quality of the diagnostic decision-making process.

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The authors declare that there are no conflicts of interest present.