EDiR common mistakes
EDiR · Understand the traps and how to avoid them.
Reading a chest radiograph by jumping straight to the obvious abnormality without a fixed sequence (airway, lungs, pleura, mediastinum, bones, lines/tubes), so a subtle pneumothorax or misplaced line is missed.
Time pressure and satisfaction of search make candidates stop once they find one finding; unstructured review is faster but unreliable.
What to do instead
Use a verbalised checklist on every chest radiograph and deliberately re-scan the pleura, apices, costophrenic angles and all support devices after identifying the main finding.
Calling a mediastinal or aortic contour abnormal on a non-contrast chest CT without checking density, margin and continuity on adjacent slices, leading to false-positive aortic dissection or missed intramural haematoma.
Single-slice interpretation and failure to use multiplanar reformats cause misclassification of motion artefact, atheroma and artefactual lines.
What to do instead
Review the aorta in axial, coronal and sagittal planes, measure attenuation, and correlate with clinical acuity; if a dissection flap is suspected, confirm true/false lumen and branch involvement before committing.
On abdominal CT, diagnosing bowel obstruction without assessing for closed-loop configuration, strangulation signs, reduced wall enhancement, pneumatosis or portomesenteric gas.
Candidates focus on dilated loops and transition point but omit vascular and wall signs that change management.
What to do instead
For every dilated-bowel case, state loop calibre, transition point, closed-loop features, wall enhancement, mesenteric vessels, pneumatosis and free gas in a structured report.
Characterising a renal mass by size alone on a single phase, without assessing enhancement, fat, calcification, capsule and venous invasion.
The common reflex is to call lesions 'cystic' or 'solid' without measuring attenuation pre- and post-contrast or checking the appropriate phase.
What to do instead
Use a dedicated renal mass protocol: compare unenhanced and contrast-enhanced attenuation, assess enhancement quantitatively, and describe fat, calcification, margins, collecting system and venous involvement.
Missing a subtle non-displaced fracture on MSK radiographs because only the obvious cortex is inspected and no second orthogonal view or joint above/below is reviewed.
Search is dominated by the clinical side and the most visible line; subtle trabecular or articular fractures are overlooked.
What to do instead
Trace every cortex on both orthogonal views, inspect common blind spots (femoral neck, scaphoid, posterior malleolus, radial head, base of fifth metatarsal), and request CT/MRI when clinical suspicion persists despite a normal radiograph.
On head CT, missing early infarction or subarachnoid haemorrhage because only the ventricles and obvious haematoma are checked, without reviewing grey-white differentiation, insular ribbon, basal cisterns and sulcal blood.
Early ischaemic change is subtle and candidates anchor on mass effect or obvious blood.
What to do instead
Use a fixed stroke/SAH window review: basal ganglia, insular ribbon, MCA territory, grey-white junction, basal cisterns, sulci and posterior fossa; correlate with vessel imaging and window adjustments.
On breast imaging, dismissing a focal asymmetry or architectural distortion because no discrete mass is seen, and not correlating with prior films or ultrasound.
Candidates search for a mass and underweight distortion, especially in dense tissue.
What to do instead
Treat focal asymmetry and architectural distortion as actionable: compare priors, obtain additional mammographic views and targeted ultrasound, and recommend biopsy when suspicious despite negative ultrasound.
In paediatric imaging, attributing unexplained fractures or intracranial injury to accidental trauma without checking for inconsistent history, different ages of injury, or classic metaphyseal lesions.
Candidates focus on the acute finding and do not systematically evaluate injury patterns or developmental stage.
What to do instead
Use a skeletal survey when indicated, assess fracture age and pattern, review the whole skeleton and neuroimaging, and involve safeguarding pathways when findings are inconsistent with the mechanism.
In interventional radiology, proceeding with a procedure without checking coagulation, renal function, contrast allergy, anticoagulants and infected skin at the puncture site.
Technical enthusiasm and case flow distract from pre-procedure safety checks.
What to do instead
Complete a structured pre-procedure checklist and document modifiable risks, consent, site marking, and a plan for reversal or alternative access before skin puncture.
In nuclear medicine, interpreting uptake without confirming patient preparation, injected activity, timing, attenuation correction and physiologic biodistribution.
Candidates read the images as if they were anatomical studies and ignore protocol-dependent artefacts.
What to do instead
Before interpretation, verify the protocol, preparation, timing and acquisition; compare with expected biodistribution and, when needed, review raw data, attenuation maps and prior studies.