Family nurse practitioners have a wide range of clinical expertise and responsibilities, including the interpretation of diagnostic images. Mistakes can be common, especially when practitioners are less experienced, overworked, burnt out, or short on time. In this article, we will cover the major pitfalls for interpreting diagnostic images, so nurse practitioners can avoid easy mistakes and save time.
Common technical errors on diagnostic image evaluation
First, it is important to keep in mind that nurse practitioners can be given an invalid or incomprehensible diagnostic image. When nurse practitioners can identify problems with the diagnostic images themselves, they will be better able to tell the difference between an abnormal result and an unusable image.
It is possible for technical errors to occur in imaging. In X-ray imaging, for example, insufficient exposure can cause underexposed results, leading to a grainy and unreadable image. Excessive X-ray exposure can lead to an overexposed result, which will show up as overly dark or burnt out. Both of these outcomes can make abnormalities very difficult to see, so a nurse practitioner would have to request a second round of imaging.
Finally, technical errors can occur if the patient’s positioning is off, if the patient moves in the middle of an imaging procedure, or if the patient is inadequately prepared for the examination. For example, if patients do not adhere to dietary restrictions or other imaging preparation needs (or if they are not properly trained in the importance of this preparation), this could negatively impact the quality of the resulting images.
Related: Sharpen Your Sherlock Skills: Mastering the Art of the Differential Diagnosis
Perceptual errors in interpretation
Next, nurse practitioners must be aware of the common errors of diagnosis so they can work to mitigate them. In interpreting diagnostic images, nurse practitioners might miss an important finding due to:
- Stopping their search after finding one abnormality and missing others, in what is known as “satisfaction of search”
- Focusing their attention on the wrong area due to expectation, bias, or overreliance on previous clinical reports
- Confirmation bias, where nurse practitioners only look for a finding to confirm their hypothesis and miss any findings that might be contradictory
- Scanning the images and not spending the required time to thoroughly review all the results
Related: Chest X-ray Interpretation: A systematic approach
What are common mistakes in interpreting X-ray images?
When interpreting X-ray images, there are certainly a number of “can’t miss” fractures, such as a compound fracture with bone displacement or complete fractures that present with obvious dark lines bisecting bones on the X-ray.
It can be harder to see smaller fractures, such as stress fractures, and fractures in unexpected places. Therefore, nurse practitioners should look out for:
- Fractures on small bones like those in the hands, wrists, feet, and ankles
- Radial head fractures in the elbow
- Compression fractures of the spine
- Posterior rib fractures
- Avulsion fractures of the pelvis
Additionally, nurse practitioners interpreting X-ray images must be cautious before misinterpreting abnormalities as old injuries, even if the findings do not align perfectly with the patient’s clinical presentation.
What are the most common diagnostic errors in chest X-ray analysis?
Chest X-rays are particularly difficult imaging for new nurse practitioners to get right. There are many subtle but important abnormalities, such as small lung nodules, pneumothorax, and pleural effusions. Nurse practitioners also commonly miss mediastinal masses due to misinterpreting the cardiac silhouette or the hilar regions. Finally, it can be easy to miss bone fractures as they may not be the nurse’s main point of focus. Therefore, nurse practitioners looking at chest X-rays must always remember to review the sternum and rib cage.
What are common errors in interpreting CT scans?
The most common error in CT scan interpretation is failure to detect a lesion. This could be because it is near another lesion, less obvious than a larger lesion, or on a commonly overlooked part of the body. Other errors include overlooking abnormalities and thinking an anatomical structure looks normal, or on the other hand, misidentifying a normal body structure as abnormal. Finally, it is important for nurse practitioners to remember to consider the clinical context of the images in order to better understand what might be normal for that patient or what should be further reviewed.
What are common mistakes made in ultrasound interpretation?
Ultrasound interpretation can be especially difficult for nurse practitioners with minimal experience due to natural variations of anatomy. It can be hard for newer nurses to tell the difference and avoid either misdiagnosing normal anatomy as pathology or, on the other hand, dismissing pathology and ascribing it to normal variation or an imaging artifact. It is essential, therefore, that nurse practitioners conduct proper evaluation before delivering their test results.
How can nurse practitioners mitigate common errors in diagnostic images?
- Have more than one nurse practitioner review the images: While nurses could request a second opinion on difficult cases, it is even better to have a standard protocol where all images are analyzed by more than one clinician.
- Use advanced imaging technologies: Staying current on the available medical technologies will help nurse practitioners to get a better look at any abnormalities and utilize artificial intelligence technologies that can flag potential areas of concern.
- Utilize a checklist to ensure you review all important sections of a diagnostic image, especially more complex ones like those involving multiple organs.
- Clearly document findings and communicate them to all involved parties: This will help nurse practitioners ensure colleagues also have the chance to review the imaging.
- Stay updated on medical trends via continued education: Nurse practitioners should utilize continued education credits to keep sharpening their areas of expertise. As nurses become more experienced, confirmation bias becomes more prevalent. This can happen when nurses think they know what to expect from a certain clinical presentation. Refreshing knowledge of rare abnormalities helps nurse practitioners remember to check for the once-in-a-career but potentially life-threatening diagnoses that can come up.
Related: Earn CE hours with our Imaging Skills Fundamental Package (free with a Passport Membership)!
