Perceptual errors in pediatric radiology.

Perceptual errors are common contributors to missed diagnoses in the clinical practice of radiology. While the physical attributes of an image such as image resolution, signal-to-noise characteristics, and anatomic complexity are major causes of poor conspicuity of pathologic lesions, there are major interrelated cognitive contributors to visual errors. The first is satisfaction of search (SOS), where the detection of an abnormality results in premature termination of further search. Another form of incomplete search pattern is visual isolation, where a radiologist's search pattern is truncated to the main areas of an image, while little or no attention is given to peripheral areas. A second cognitive error is inattentional blindness, defined as the failure to notice a fully visible, but unexpected object because attention was otherwise engaged. Strategies for error mitigation have centered around the use of check lists, self prompting routines, and structured reporting within an institutional culture of safety and vigilance.