• Title/Summary/Keyword: Diagnostic errors

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Basal cell carcinoma misdiagnosed as trichoepithelioma

  • Wee, Sung Jae;Park, Myong Chul;Chung, Chan Min
    • Archives of Craniofacial Surgery
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    • v.21 no.3
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    • pp.202-205
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    • 2020
  • Trichoepithelioma is a benign hair follicle tumor that can undergo malignant transformation into basal cell carcinoma in rare cases. Due to the similar clinical and histological features of trichoepithelioma and basal cell carcinoma, distinguishing between these types of tumors can be a diagnostic challenge. Punch biopsy obtains only a small sample of the entire lesion, and thus inherently involves a risk of misdiagnosis between histologically similar diseases. Therefore, if the possibility of misdiagnosis can reasonably be suspected, clinicians should conduct an excisional biopsy or immunohistochemical staining (e.g., CD10 and Bcl-2) to ensure an exact diagnosis. Although trichoepithelioma is benign, the surgical excision of solitary trichoepithelioma should be considered in order to avoid the possibility of malignant transformation, which has occasionally been documented for multiple familial trichoepitheliomas. Herein, we report a case that was initially misdiagnosed as trichoepithelioma before ultimately being diagnosed as basal cell carcinoma through excision and immunohistochemical staining.

Influence of Harmonics in Power System Voltage on Arrester Deterioration Diagnostics by Leakage Current Measurement (누설전류측정에 의한 피뢰기 열화진단에 있어 전원고조파의 영향)

  • 길경석;한주섭;주문노
    • The Transactions of the Korean Institute of Electrical Engineers C
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    • v.52 no.1
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    • pp.42-46
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    • 2003
  • Arresters are deteriorated by overvoltages or impulse currents, and the resistive leakage current of arresters increases as the deterioration of the arrester progresses, showing an increase in the 3$^{rd}$ harmonic component of the leakage current. In this reason, arrester diagnostic techniques based on the 3$^{rd}$ harmonic leakage current as a reference parameter of deterioration are widely used. The technique, however, includes an error due to the harmonics of power system voltage. Therefore, the influence of the harmonics on arrester diagnostics should be considered. In this paper, we designed a PSpice ZnO arrester model to simulate the influence of the voltage harmonics described above. A pure sinusoidal voltage and its the 3r harmonic voltage were applied to the model, and the leakage current components were analyzed. From the simulation results, it is confirmed that the peak value of resistive leakage current depends not only on the phase of the 3$^{rd}$ harmonic voltage but also on the magnitude of it. Consequently, the errors caused 1)y the harmonic voltage could be minimized by correcting the magnitude of leakage current upon analyzing the harmonics.cs.

Concept of an intelligent operator support system for initial emergency responses in nuclear power plants

  • Kang, Jung Sung;Lee, Seung Jun
    • Nuclear Engineering and Technology
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    • v.54 no.7
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    • pp.2453-2466
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    • 2022
  • Nuclear power plant operators in the main control room are exposed to stressful conditions in emergency situations as immediate and appropriate mitigations are required. While emergency operating procedures (EOPs) provide operators with the appropriate tasks and diagnostic guidelines, EOPs have static properties that make it difficult to reflect the dynamic changes of the plant. Due to this static nature, operator workloads increase because unrelated information must be screened out and numerous displays must be checked to obtain the plant status. Generally, excessive workloads should be reduced because they can lead to human errors that may adversely affect nuclear power plant safety. This paper presents a framework for an operator support system that can substitute the initial responses of the EOPs, or in other words the immediate actions and diagnostic procedures, in the early stages of an emergency. The system assists operators in emergency operations as follows: performing the monitoring tasks in parallel, identifying current risk and latent risk causality, diagnosing the accident, and displaying all information intuitively with a master logic diagram. The risk causalities are analyzed with a functional modeling methodology called multilevel flow modeling. This system is expected to reduce workloads and the time for performing initial emergency response procedures.

Metabolic evaluation of children with global developmental delay

  • Eun, So-Hee;Hahn, Si Houn
    • Clinical and Experimental Pediatrics
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    • v.58 no.4
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    • pp.117-122
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    • 2015
  • Global developmental delay (GDD) is a relatively common early-onset chronic neurological condition, which may have prenatal, perinatal, postnatal, or undetermined causes. Family history, physical and neurological examinations, and detailed history of environmental risk factors might suggest a specific disease. However, diagnostic laboratory tests, brain imaging, and other evidence-based evaluations are necessary in most cases to elucidate the causes. Diagnosis of GDD has recently improved because of remarkable advances in genetic technology, but this is an exhaustive and expensive evaluation that may not lead to therapeutic benefits in the majority of GDD patients. Inborn metabolic errors are one of the main targets for the treatment of GDD, although only a small proportion of GDD patients have this type of error. Nevertheless, diagnosis is often challenging because the phenotypes of many genetic or metabolic diseases often overlap, and their clinical spectra are much broader than currently known. Appropriate and cost-effective strategies including up-to-date information for the early identification of the "treatable" causes of GDD are needed for the development of well-timed therapeutic applications with the potential to improve neurodevelopmental outcomes.

Intra-Operative Frozen Sections: Experience at A Tertiary Care Centre

  • Preeti, Agarwal;Sameer, Gupta;Kulranjan, Singh;Abhinav, Sonkar Arun;Preeti, Rani;Sunita, Yadav;Mati, Goel Madhu
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.12
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    • pp.5057-5061
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    • 2016
  • The present study was conducted to assess error rates with diagnosis using intra-operative frozen sections, and to indicate ways to increase overall performance. Over a period of two years, 227 cases were biopsied intra-operatively. Errors were observed in 14 cases. Four of these were sampling errors, one by a pathologist and three by surgeons. In seven cases incorrect interpretations were made. Epithelial dysplasia was observed on definitive histology in two cases which was not reported intra-operatively. One case was of ectopic thyroid. In cases of oral cancer where sentinel lymph nodes were sampled, immunohistochemistry for cytokeratin was performed to facilitate identification of micrometastasis. Only single case displayed tumor deposits which was not evident morphologically. Resection margins were reported in seventy eight cases. Some 18% (14/50) benefited from revision of margins; overall sensitivity of intra-operative frozen sections for marginal status was 71.4%, with a specificity of 90.3%. Overall sensitivity was 75% and specificity was 97.5%. Careful observation, pathologist experience and knowledge of limitations help in improving the overall diagnostic outcome.

Development of P-5 Transducer or Detection of the Pulse Wave (맥파검출용 트랜스듀서의 개발)

  • Han, S.H.;Kwon, O.S.;Park, S.H.;Hong, S.H.
    • Proceedings of the KOSOMBE Conference
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    • v.1997 no.11
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    • pp.395-398
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    • 1997
  • Human pulse represents the physical characteristics of heart and cardiovascular system. Therefore, malfunctions and errors of heart and cardiovascular system can be determined by using an automatic diagnosis system that can detect the pulse signal. Not only will the computerised system preclude the possibilities of observational errors by giving an accurate measurement with great stability, but minimize the possibilities of misinterpretation by using an automated diagnostic logic. A new combinational fiber-optic sensor, which has a detecting part and a transmitting part was used to acquire radial pulse signal noninvasively. The development of P-5 transducer makes it possible to obtain more effective detection and obvious display of pulse signals in the aspect of reliability. Using P-5 transducer in the field of plethysomography and MAC- JIN, one of our diagnoses in Korean traditional medicine, it is expected that we can ontain quantitative and valuable information or the diagnosis of human pulses.

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Peer Review of Teleradiology at a Teleradiology Clinic: Comparison of Unacceptable Diagnosis and Clinically Significant Discrepancy between Radiology Sections and Imaging Modalities (원격판독 의료기관에서 시행한 원격판독의 동료평가: 세부전공분야와 촬영장비에 따른 판독 불일치 정도와 불일치 판독의 임상적 의의 비교)

  • Hyung Suk Seo;Jai Soung Park;Yu-Whan Oh;Dongwook Sung;A Leum Lee
    • Journal of the Korean Society of Radiology
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    • v.82 no.6
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    • pp.1545-1555
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    • 2021
  • Purpose The purpose of this study was to evaluate the rates of unacceptable diagnosis and clinically significant diagnostic discrepancy in radiology sections and imaging modalities through a peer review of teleradiology. Materials and Methods Teleradiology peer reviews in a Korean teleradiology clinic in 2018 and 2019 were included. The peer review scores were classified as acceptable and unacceptable diagnoses and clinically insignificant and significant diagnostic discrepancy. The diagnostic discrepancy rates and clinical significance were compared among radiology sections and imaging modalities using the chi-square test. Results Of 1312 peer reviews, 117 (8.9%) cases had unacceptable diagnoses. Of 462 diagnostic discrepancies, the clinically significant discrepancy was observed in 104 (21.6%) cases. In radiology sections, the unacceptable diagnosis was highest in the musculoskeletal section (21.4%) (p < 0.05), followed by the abdominal section (7.3%) and neuro section (1.3%) (p < 0.05). The proportion of significant discrepancy was higher in the chest section (32.7%) than in the musculoskeletal (19.5%) and abdominal sections (17.1%) (p < 0.05). Regarding modalities, the number of unacceptable diagnoses was higher with MRI (16.2%) than plain radiology (7.8%) (p < 0.05). There was no significant difference in significant discrepancy. Conclusion Peer review provides the rates of unacceptable diagnosis and clinically significant discrepancy in teleradiology. These rates also differ with subspecialty and modality.

The effects of various exposure times in the detectability on the tips of the endodontic files in Digora$\textregistered$ (Digora$\textregistered$에서 노출시간의 변화가 근관치료용 file의 첨부식별에 미치는 영향)

  • Ko Jee-Young;Park Chang-Seo
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.27 no.1
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    • pp.55-71
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    • 1997
  • Digora/sup (R)/ an intraoral digital radiography system utilizing image plate (IP) - has a dynamic range of exposure time which allows it to decrease the patient's exposure time and to increase diagnostic ability through image processing, transmission and storage. The purpose of this study was to evaluate the Digora/sup (R)/ system by assessing the effects of various exposure times on the detectability on the tip of the endodontic file. Examining the root canals of 45 extracted sound premolars, K -files No. 10, 15, and 20 were placed at slightly varying distances from the apex. The teeth were glued onto resin-plaster blocks. Five exposure times varying between 0.01 seconds and 0.25 seconds were used. Four observers were asked to measure the distance between the tip of the file and a reduction of crown portion, and obtained mean errors (subtracting true file length from the measured file length), comparing Digora/sup (R)/ monitors with E-plus films, which were both obtained under the same geometrical positions. The results were as follows : 1. Comparing E-plus film with Digora/sup (R)/ at 0.01 seconds, the mean errors in E-plus film showed -4.453 nun, -4.497 nun, and -3.857 nun, while the mean errors in Digora/sup (R)/ showed 0.065 nun, 0.607 nun, and 0.719 mm according to the file groups. Therefore there was a significant difference between E-plus film and Digora/sup (R)/(p<0.05). 2. By comparison of mean errors according to the various exposure times in the Digora/sup (R)/ system, the mean error at 0.01 seconds was significantly lower than that at 0.12 and 0.25 seconds in the No. 10 file group(p<0.05). And the standard deviation was the highest at 0.01 seconds. 3. Comparing E-plus film at 0.25 seconds with the Digora/sup (R)/ system, the mean errors showed a significant difference between E-plus film at 0.25 seconds and the Digora/sup (R)/ system at 0.25 seconds in No. 10 and 20 file groups(p<0.05). 4. Comparing E -plus film at 0.25 seconds with other exposure times, the mean errors showed a significant difference between E-plus film at 0.25 seconds and E-plus film at 0 .. 01 and 0.03 seconds in 10 file group(p<0.05). In the No. 15 and 20 file groups, there was a significant difference between E-plus film at 0.25 seconds and E-plus film at 0.01 seconds(p<0.05). In conclusion, Digora/sup (R)/ was better than E-plus film in detectability on the tip of the file at the exposure time of 0.01 seconds in all file groups. And we concluded that Digora/sup (R)/ can shorten exposure times up to 4% of 0.25 seconds (0.01 sec), which is adequate exposure time for premolar in E-plus film using No. 15 and 20 files.

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Diagnostic Correlation and Accuracy Between Fine Needle Aspiration Cytology and Histopathologic Examination (세침흡인 세포검사와 조직검사의 진단 일치율 및 정확도에 대한 조사)

  • Sohn, Jin-Hee;Chae, Seoung-Wan;Cho, Eun-Yoon;Kim, Eo-Jin
    • The Korean Journal of Cytopathology
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    • v.14 no.2
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    • pp.53-59
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    • 2003
  • Fine needle aspiration cytology (FNAC) has been known as a very sensitive and effective method for preoperative diagnosis. We studied cases preoperatively diagnosed by FNAC and confirmed by the histopathologic examination to define the effectiveness of FNAC. A total of 567 cases including breast, thyroid gland, lymph node, and soft tissue confirmed histologically after FNAC were enrolled, among 2,844 FNAC cases from January 1996 to March 2000. Overall sensitivity and specificity of FNAC were 93% and 100%, respectively. Sensitivity and specificity of FNAC by sites or organs were 91% and 100% in breast, 100% and 100% in thyroid, 97% and 100% in lymph node, and 71% and 100% in soft tissue, respectively. Nine cases showed diagnostic discrepancy; eight cases of sampling error and one case of interpretation error. Five cases, diagnosed as fibrocystic change at FNAC but invasive ductal carcinoma after the histopathologic examination, were categorized as sampling error due to the presence of diffuse fibrosis or deep seated location. One case of breast, diagnosed descriptively as atypical ductal and stromal cells suggesting invasive ductal carcinoma at FNAC but malignant phyllodes tumor histologically, was categorized as interpretation error. Other cases of sampling errors were two cases of soft tissue, a case of lymph node, and a case of salivary gland.

Multi-Component Relaxation Study of Human Brain Using Relaxographic Analysis (Relaxographic 분석법을 이용한 뇌의 다중 자기이완특성에 관한 연구)

  • Yongmin Chang;Bong Soo Han;Bong Seok Kang;Kyungnyeo Jeon;Kyungsoo Bae;Yong-Sun Kim;Duk-Sik Kang
    • Investigative Magnetic Resonance Imaging
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    • v.6 no.2
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    • pp.120-128
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    • 2002
  • Purpose : To demonstrate that the relaxographic method provides additional information such as the distribution of relaxation times and water content which are poentially applicable to clinical medicine. Materials and Methods : First, the computer simulation was performed with the generated relaxation data to verify the accuracy and reliabilility of the relaxographic method (CONTINI). Secondly, in or der to see how well the CONTIN quantifies and resolves the two different ${T_1}$ environments, we calculated the oil to water peak area ratios and identified peak positions of ${T_1}-distribution$ curve of the phantom solutions, which consist of four centrifugal tubes (10 ml) filled with the compounds of 0, 10, 20, 30% of corn oil and distilled water, using CONTIN. Finally, inversion recovery MR images for a volunteer are acquired for each TI ranged from 40 to 1160 msec with TR/TE=2200/20 msec. From the 3 different ROIs (GM, WM, CSF), CONTIN analysis was performed to obtain the ${T_1}$-distribution curves, which gave peak positions and peak area of each ROI location. Results : The simulation result shows that the errors of peak positions were less in the higher peak (centered ${T_1}=600$ msec) than in the lower peak (centered ${T_1}=150$ msec) for all SNR but the errors of peak areas were larger in the higher peak than in the lower peak. The CONTIN analysis of the measured relaxation data of phantoms revealed two peaks between 20 and 60 msec and between 500 and 700 msec. The analysis gives the peak area ratio as oil 10%: oil 20%: oil 30% = 1:1.3:1.9, which is different from the exact ratio, 1:2:3. For human brain, in ROI 3 (CSF), only one component of -distributions was observed whereas in ROI 1(GM) and in ROI 2 (WM) we observed two components of ${T_1}-distribution$. For the WM and CSF there was great agreement between the observed ${T_1}-relaxation$ times and the reported values. Conclusion : we demonstrated that the relaxographic method provided additional information such as the distribution of relaxation times and water content, which were not available in the routine relaxometry and ${T_1}/{T_2}$ mapping techniques. In addition, these additional information provided by relaxographic analysis may have clinical importance.

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