Think horse be prepared for zebra: image reading and cognitive bias

In diagnostic imaging, mental shortcuts are commonly used while reading and interpreting images. These mental shortcuts are used automatically in order to reduce cognitive load in decision making. Cognitive bias is a distortion occurring during cognitive treatment of an information and its consequence results in wrong mental shortcuts. Therefore, in radiology final interpretation can be influenced by cognitive bias, lead to diagnostic errors or bring the clinician to embrace unneeded further diagnostic assessments. While reading images, two types of errors can be the result of cognitive biases: perceptual and interpretative errors. Perceptual errors occur when an abnormal finding is missed. Interpretative errors occur when the abnormal finding is identified but it is not correctly interpreted. Increasing knowledge about types and conditions of occurrence of cognitive biases and increasing self-awareness and metacognitive abilities of the reader are essential to depict potential sources of errors. Relying on a strong hypotetico-deductive and evaluation strategies, including cognitive biases assessment, is the key of a critical and comprehensive image reading in difficult cases and complex clinical situations. Examples of cognitive biases potentially affecting image reading are: availability bias (influence by past experiences), alliterative bias (one reader’s reading influences the second reader), anchoring bias (building hypothesis based on previously gathered information), framing bias (influence by how the question is asked or the problem is presented), regret bias (overestimating the likelihood of diagnostic hypothesis because of the adverse outcome in a previous case due to failure of recognizing the disease), satisfaction of search (stopping the visual search of abnormalities after the first significant finding), hindsight bias (overestimating predictability of an event after the event is known). [...]