Autopsies Can Help Radiologists Sharpen Skills

Radiologists can sharpen their interpretation skills by reviewing autopsies and learning from missed diagnoses, said researchers in a study published this month in the American Journal of Roentgenology.

Autopsies are not done as frequently now as they were in the past. The CDC estimates that the autopsy rate is only about 8 percent now, compared with 19 percent in the 1970s, but doctors, including radiologists, can still learn a lot from post-mortem examinations.

Researchers from the University of Pittsburgh School of Medicine reviewed 179 cases from 2008 and compared the diagnoses with the autopsy findings. To be included in the study, the subjects had to have undergone a radiological examination within one month prior to death.

There were 333 discrepancies found between the diagnoses from imaging exams and autopsy findings. Of these discrepancies, 201 were thought to have been present at the time of examination and that 119 resulted from various limitations of the imaging.

As advanced as the technology is, CT scans, MR images, ultrasounds and nuclear studies cannot provide the natural full-color, 3D, and microscopic level examinations provided by autopsy, the authors wrote. As a result, they found several situations where comorbidities obscured the diagnostic imaging study so other processes could not be seen.

“For example, a pericardial effusion that might soon cause cardiac tamponade can be obscured by adjacent consolidation on an anteroposterior chest radiograph,” explained the authors. They added that motion, fat, or metal artifacts can also hide important information.

Although most of the discrepancies were not significant, there was a 3.3 percent radiologic error rate: 11 missed diagnoses and seven misinterpretations. The missed diagnoses included pneumonia, hepatocellular carcinoma, a gastrointestinal bleed, and bladder carcinoma, among others.

The authors concluded that although fewer autopsies are being done and despite the advanced technology available, radiologists could use autopsy findings to refine their interpretation skills and to use as a quality control, learning from missed diagnoses and misinterpretations, some of which could be as simple as mistaking the right side from the left when examining the images.