Photos in X-rays reduce 'wrong patient' mistakes

Embedding patients' photo in their X-ray studies can result in a five-fold reduction in "wrong-patient" mistakes, according to a study presented last week at the American Roentgen Ray Society meeting in Washington, D.C.

"X-rays can look alike, and if one patient's images are confused with another before the radiologist sees them, it can be difficult for the radiologist to determine there is a mismatch," Srini Tridandapani, M.D., of Emory University and an author of the study, said according to an announcement.

For the study, 10 radiologists interpreted 20 pairs of X-ray images with and without photographs. Two to four mismatched images were included in each set of 20 pairs of images. Without the photographs, radiologists detected the mismatched pair just 13 percent of the time, but with the photographs, that percentage increased to 64 percent.

Interestingly, some of the radiologists--unaware they could use the photographs to identify mismatched pairs--chose to ignore the photos because they thought they were put there to distract them. To that end, a smaller second study of five radiologists was held in which the radiologists were told to use the photos. This time, the error detection rate shot up to 94 percent.

Part of the problem with imaging, Tridandapani said, is that radiologists don't expect to get mismatched X-rays; instead of recognizing that a mistake has been made, many may try, instead, to explain away a discrepancy.

Tridandapani estimated that these kinds of identification errors occur in roughly one out of every 10,000 patients. He added that while such a figure seems small, it still should be considered unacceptable when, by comparison, electronics companies like Motorola want to see computer chips fail no more than one out of every million.

"I think human beings are more precious than chips, so I don't accept a rate of one in 10,000," Tridandapani said, according to NBCnews.com.

To learn more:
- see the article on NBCnews.com
- read the announcement