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Congress: ECR25
Poster Number: C-16054
Type: Poster: EPOS Radiologist (educational)
Authorblock: R. V. Cardoso, M. J. Ferreira, M. S. Gomes, L. B. D. C. Ferreira, P. C. D. M. Pereira; Vila Nova de Gaia/PT
Disclosures:
Rafael Vieira Cardoso: Nothing to disclose
Mª João Ferreira: Nothing to disclose
Manuela Silva Gomes: Nothing to disclose
Luciana Brás Da Cunha Ferreira: Nothing to disclose
Pedro Cabral De Melo Pereira: Nothing to disclose
Keywords: Lung, Mediastinum, Thorax, Conventional radiography, CT, Education, Education and training, Pathology
Learning objectives To identify commonly missed areas on posteroanterior (PA) and lateral chest radiographs.To highlight techniques for systematic evaluation of chest X-rays that can help radiologists reduce diagnostic errors.To improve recognition of subtle but clinically significant findings.
Read more Background Chest radiography is one of the most commonly performed imaging studies in clinical practice. However, its diagnostic utility can be compromised by subtle findings that are easily overlooked, leading to missed or delayed diagnoses. Certain anatomical regions are particularly challenging to assess, necessitating a systematic approach to ensure comprehensive evaluation. A structured review process can help mitigate diagnostic errors, particularly in high-risk areas where subtle pathology can be missed. Radiologists must remain vigilant in detecting abnormalities, as even minor missed...
Read more Findings and procedure details Commonly Missed Areas on Chest Radiographs1. Lung ApicesThe lung apices are often obscured by overlying structures such as the clavicles and ribs. They are best assessed in the PA view, as there is less overlay with other structures compared to the lateral view.Studies have shown that the majority of missed lung cancers on chest radiographs have an upper lobe predominance [1, 2].A careful comparison of both lung apices may reveal subtle difference in opacities, which may be the only clue...
Read more Conclusion Missed diagnoses on chest radiographs frequently occur in predictable locations. A structured approach emphasizing high-risk areas - such as the lung apices, lung bases, retrosternal and retrocardiac spaces, the hilum, the mediastinum and the bones - reduces the likelihood of errors. By employing a systematic review process, radiologists can enhance diagnostic accuracy and improve patient outcomes. Encouraging a culture of double-checking overlooked zones and seeking correlation with clinical history or additional imaging when necessary is essential.
Read more References [1] - Missed bronchogenic carcinoma: radiographic findings in 27 patients with a potentially resectable lesion evident in retrospect, J H Austin, B M Romney, and L S Goldsmith, Radiology 1992 182:1, 115-122 [2] - Missed Non–Small Cell Lung Cancer: Radiographic Findings of Potentially Resectable Lesions Evident Only in Retrospect, Priya Kumar Shah, John H. M. Austin, Charles S. White, Pavni Patel, Linda B. Haramati, Gregory D. N. Pearson, Maria C. Shiau, and Yahya M. Berkmen, Radiology 2003 226:1, 235-241 [3] -...
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