“Blind spots” in the analysis of computed tomography of the head and neck area

Abstract

BACKGROUND: Diagnostic errors in radiology occur in 2–5% of cases and most of them are due to perception errors, when a pathological change is not detected during the initial analysis, although its presence is very obvious during a retrospective analysis. In some cases, the errors appear due to the presence of «blind spots» — anatomical areas that most often go unnoticed when interpreted by a radiologist. It is extremely important to know their features when analyzing the CT study of the head and neck area for a targeted and systematic search for pathology. AIM: To determine the most common anatomical areas in which radiologists frequently miss pathological changes when analyzing computed tomograms of the head and neck area. METHODS: We have retrospectively analyzed 62 computed tomography scans of the head and neck region in cancer patients, in which there was no description of additional clinically significant pathological changes at the initial assessment. All the cases of missed pathology were identified after the repeat radiological examination or after the retrospective analysis of the CT study. RESULTS: Several anatomical zones were identified in which most frequently the pathological findings were not described in the initial analysis of computed tomography studies of the head and neck area: brachiocephalic vessels (n=15; 24,2%), parotid salivary glands (n=10; 16,1%), paranasal sinuses (n=8; 12,9%), lungs and mediastinum (n=9; 14,6%), brain and temporal bones (n=5; 8,1%), soft tissues of the neck (n=4; 6,5%), thyroid gland and cervical spine (n=3; 4,8%). CONCLUSION: The most common «blind spots» in the analysis of computed tomography scans of the head and neck region have been identified. The knowledge about such regions may potentially lead to the reduced incidence of missed pathology when interpreting a computed tomography study of those anatomical locations.