Skip to main content
  • 874 Accesses

Abstract

Missed lung lesions are one of the most frequent causes of malpractice issues [13]. Chest radiography plays an important role in detecting and managing lung cancer, chronic airways disease, pneumonia and interstitial lung disease. Among all diagnostic tests, chest radiography is essential for confirming or excluding the diagnosis of most chest diseases. However, numerous lesions of a wide variety of disease processes affecting the thorax may be missed on a chest radiograph. For example, the frequency of missed lung carcinoma on chest radiographs can vary from 12% to 90%, depending on study design [4]. Despite the lack of convincing evidence that screening for lung cancer with the chest radiograph improves mortality rates, chest radiography is still requested for this purpose [5, 6]. The chest radiograph also helps narrow a differential diagnosis, helps direct additional diagnostic measures, and serves during follow-up. The diagnostic usefulness of the radiograph is maximized by the integrating radiological findings with clinical features of the individual patient [7]. In this chapter, we review the more important radiological principles regarding missed lung lesions in a variety of common chest diseases, with a special focus on how correlation with multidetector computed tomography (MDCT) of missed lung lesions can help improve interpretation of the plain chest radiograph.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Berlin L (1986) Malpractice and radiologists: an 11.5-year perspective. AJR Am J Roentgenol 147:1291–1298

    Article  PubMed  CAS  Google Scholar 

  2. Berlin L (1995) Malpractice and radiologists in Cook County, IL: trends in 20 years of litigation. AJR Am J Roentgenol 165:781–788

    Article  PubMed  CAS  Google Scholar 

  3. Potchen EJ, Bisesi MA (1990) When is it malpractice to miss lung cancer on chest radiographs? Radiology 175:29–32

    PubMed  CAS  Google Scholar 

  4. Quekel LG, Kessels AG, Goei R et al (1999) Miss rate of lung cancer on the chest radiograph in clinical practice. Chest 115:720–724

    Article  PubMed  CAS  Google Scholar 

  5. Marcus PM (2001) Lung cancer screening: an update. J Clin Oncol 19:83S–86S

    PubMed  CAS  Google Scholar 

  6. Melamed MR (2000) Lung cancer screening results in the National Cancer Institute New York study. Cancer 89:2356–2362

    Article  PubMed  CAS  Google Scholar 

  7. Aideyan UO, Berbaum K, Smith WL (1995) Influence of prior radiologic information on the interpretation of radiographic examinations. Acad Radiol 2:205–208

    Article  PubMed  CAS  Google Scholar 

  8. Carmody DP, Nodine CF, Kundel HL (1980) An analysis of perceptual and cognitive factors in radiographic interpretation. Perception 9:339–344

    Article  PubMed  CAS  Google Scholar 

  9. Austin JH, Romney BM, Goldsmisth LS (1992) Missed bronchogenic carcinoma: radiographic findings in 27 patients with a potentially resectable lesion evident in retrospect. Radiology 182:115–122

    PubMed  CAS  Google Scholar 

  10. Turkington PM, Kennan N, Greenstone MA (2002) Misinterpretation of the chest X-ray as a factor in the delayed diagnosis of lung cancer. Postgrad Med J 78:158–160

    Article  PubMed  CAS  Google Scholar 

  11. Woodring JH (1990) Pitfalls in the radiologic diagnosis of lung cancer. AJR Am J Roentgenol 154:1165–1175

    Article  PubMed  CAS  Google Scholar 

  12. Monnier-Cholley L, Arrive L, Porcel A et al (2001) Characteristics of missed lung cancer on chest radiographs: a French experience. Eur Radiol 11:597–605

    Article  PubMed  CAS  Google Scholar 

  13. Krupinski EA, Berger WG, Dallas WJ et al (2003) Searching for nodules: what features attract attention and influence detection? Acad Radiol 10:861–868

    Article  PubMed  Google Scholar 

  14. Samei E, Flynn MJ, Eyler WR (1999) Detection of subtle lung nodules: relative influence of quantum and anatomic noise on chest radiographs. Radiology 213:727–734

    PubMed  CAS  Google Scholar 

  15. Kundel HL, Nodine CF, Krupinski EA (1989) Searching for lung nodules. Visual dwell indicates locations of false-positive and false-negative decisions. Invest Radiol 24:472–478

    Article  PubMed  CAS  Google Scholar 

  16. Samuel S, Kundel HL, Nodine CF et al (1995) Mechanism of satisfaction of search: eye position recordings in the reading of chest radiographs. Radiology 194:895–902

    PubMed  CAS  Google Scholar 

  17. Quekel LG, Goei R, Kessels AG et al (2001) Detection of lung cancer on the chest radiograph: impact of previous films, clinical information, double reading, and dual reading. J Clin Epidemiol 54:1146–1150

    Article  PubMed  CAS  Google Scholar 

  18. Kelsey CA, Moseley RD, Brogdon BG et al (1977) Effect of size and position on chest lesion detection. AJR Am J Roentgenol 129:205–208

    Article  PubMed  CAS  Google Scholar 

  19. Kundel HL, Revesz G, Toto L (1979) Contrast gradient and the detection of lung nodules. Invest Radiol 14:18–22

    Article  PubMed  CAS  Google Scholar 

  20. Kundel HL (1975) Peripheral vision, structured noise and film reader error. Radiology 114:269–273

    PubMed  CAS  Google Scholar 

  21. Kundel HL, Revesz G (1976) Lesion conspicuity, structured noise, and film reader error. AJR Am J Roentgenol 126:233–238

    Article  Google Scholar 

  22. Wu M-H, Gotway MB, Lee TJ et al (2008) Features of non-small cell lung carcinomas overlooked at digital chest radiography. Clin Radiol 63:518–528

    Article  PubMed  Google Scholar 

  23. Berbaum KS (1995) Difficulty of judging retrospectively whether a diagnosis has been “missed”. Radiology 194:582–583

    PubMed  CAS  Google Scholar 

  24. Berlin L (2000) Hindsight bias. AJR Am J Roentgenol 175:597–601

    Article  PubMed  CAS  Google Scholar 

  25. Berlin L (2001) Defending the “missed” radiographic diagnosis. AJR Am J Roentgenol 176:317–322

    Article  PubMed  CAS  Google Scholar 

  26. Berlin L, Hendrix RW (1998) Perceptual errors and negligence. AJR Am J Roentgenol 170:863–867

    Article  PubMed  CAS  Google Scholar 

  27. Jung JI, Kim H, Park SH et al (2001) Differentiation of pneumonic-type bronchioloalveolar cell carcinoma and infectious pneumonia. Br J Radiol 74:490–494

    PubMed  CAS  Google Scholar 

  28. Melbye H, Dale K (1992) Interobserver variability in the radiographic diagnosis of adult outpatient pneumonia. Acta Radiol 33:79–83

    PubMed  CAS  Google Scholar 

  29. Woodhead M, Gialdroni Grassi G, Huchon GJ et al (1996) Use of investigations in lower respiratory tract infection in the community: a European survey. Eur Respir J 9:1596–1600

    Article  PubMed  CAS  Google Scholar 

  30. Heussel CP, Kauczor HU, Ullmann AJ (2004) Pneumonia in neutropenic patients. Eur Radiol 14:256–271

    Article  PubMed  CAS  Google Scholar 

  31. Webb WR, Müller NL, Naidich DP (2001) High-resolution CT of the lung, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, PA

    Google Scholar 

  32. Epler GR, McLoud TC, Gaensler EA et al (1978) Normal chest roentgenograms in chronic diffuse infiltrative lung disease. N Engl J Med 298:934–939

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Italia

About this chapter

Cite this chapter

Howarth, N., Tack, D. (2011). Missed Lung Lesions. In: Hodler, J., von Schulthess, G.K., Zollikofer, C.L. (eds) Diseases of the Heart and Chest, Including Breast 2011–2014. Springer, Milano. https://doi.org/10.1007/978-88-470-1938-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-1938-6_12

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-1937-9

  • Online ISBN: 978-88-470-1938-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics