From “satisfaction of search” to “subsequent search misses”: a review of multiple-target search errors across radiology and cognitive science

For over 50 years, the satisfaction of search effect has been studied within the field of radiology. Defined as a decrease in detection rates for a subsequent target when an initial target is found within the image, these multiple target errors are known to underlie errors of omission (e.g., a radiologist is more likely to miss an abnormality if another abnormality is identified). More recently, they have also been found to underlie lab-based search errors in cognitive science experiments (e.g., an observer is more likely to miss a target ‘T’ if a different target ‘T’ was detected). This phenomenon was renamed the subsequent search miss (SSM) effect in cognitive science. Here we review the SSM literature in both radiology and cognitive science and discuss: (1) the current SSM theories (i.e., satisfaction, perceptual set, and resource depletion theories), (2) the eye movement errors that underlie the SSM effect, (3) the existing efforts tested to alleviate SSM errors, and (4) the evolution of methodologies and analyses used when calculating the SSM effect. Finally, we present the attentional template theory, a novel mechanistic explanation for SSM errors, which ties together our current understanding of SSM errors and the attentional template literature.

The Importance of Avoiding Satisfaction of Search Bias in a Case of Concurrent Calcaneonavicular Coalition and Osteoid Osteoma

We report a rare case of concurrent calcaneonavicular osseous coalition and osteoid osteoma of the navicular. While each pathology is relatively common, the combination of the two in one foot is rare and as such can present a unique challenge to imaging interpretation. This case reinforces the importance of the concept of “satisfaction of search.”

The Role of Cognitive Bias in Breast Radiology Diagnostic and Judgment Errors

Cognitive bias is an unavoidable aspect of human decision-making. In breast radiology, these biases contribute to missed or erroneous diagnoses and mistaken judgments. This article introduces breast radiologists to eight cognitive biases commonly encountered in breast radiology: anchoring, availability, commission, confirmation, gambler’s fallacy, omission, satisfaction of search, and outcome. In addition to illustrative cases, this article offers suggestions for radiologists to better recognize and counteract these biases at the individual level and at the organizational level.

Satisfaction of Search: Recurrent Wilms Tumor Mimicking Chest Port Granuloma on Chest Film

Wilms tumor (nephroblastoma) is the most common renal malignancy of childhood and typically presents as a painless abdominal mass. The high success rates of surgery and chemotherapy make recurrence of Wilms tumor uncommon. We report the case of a 5-year-old girl who underwent radical nephrectomy and chemotherapy for a Wilms tumor, but suffered a relapse of the tumor to the lung. The metastasis was initially detected as a density on chest radiograph that was, coincidentally, in the same location as a recently explanted chest port. The diagnosis of recurrent malignancy was thus obscured by the patient’s history as well as a correlating physical examination finding of a palpable mass at the site of the previously placed chest port. Moreover, the mass was not seen on lateral view, all of which suggested an alternative diagnosis of granulation tissue versus seroma rather than recurrent Wilms tumor. A high degree of clinical suspicion was necessary on the part of the clinician and radiologist to diagnose the relapse.

A national study of the causes, consequences and amelioration of adverse events in the use of MRI, CT, and conventional radiography in Norway

Background Rapid technological developments, increased complexity, and increased demand have made patient safety a challenge in radiology. Purpose To uncover the causes and consequences behind patient injury compensation claims in the use of MRI, CT, and conventional X-ray examinations, and to determine the system factors that need to be focused on in order to prevent these events. Material and Methods This descriptive cross-sectional study uses data acquired from The Norwegian System of Patient Injury Compensation. A total of 240 cases from 2012–2016 were included. Results According to our study, the main factors contributing to patient injury compensation claims in radiology were false-negative findings (48.7%), misinterpretation (13.1%), and “satisfaction of search” (12%). Another source of error was routines (8.7%), mainly where the patient should have been (further) examined using another modality. Other causes were related to communication (7.6%), procedures (2.9%), technical factors (2.5%), organizational and management factors (1.5%), competence (0.7%), location of the lesion (0.7%), patient factors (0.7%), false-positive findings (0.4%), and work environment (0.4%). These events led to delayed diagnosis and/or treatment in the range of 0–3650 days. Conclusion Errors of perception (false negative and “satisfaction of search”) and cognitive errors (misinterpretation) were the main reasons behind patient injury compensation claims in radiology. We suggest that a combination of double-reading, specialization, increased collaboration between professionals, as well as a reduction of unnecessary examinations should be considered to reduce adverse events in radiology.