Common Missed Imaging Findings in Musculoskeletal Radiology: A Retrospective Analysis

Purpose: To describe commonly missed imaging findings in musculoskeletal (MSK) imaging and their frequency, as well as mitigation methods, in a high-volume subspecialty-based radiology practice. The consistently rising volume of medical imaging performed in the United States has placed increasing demand on radiologists to increase interpretation speed. A retrospective analysis of commonly missed imaging findings stratified by body part and pathology was performed utilizing data from our subspecialty-based radiology practice.

Methods/Materials: A total of 534 imaging exams labeled “learning opportunity present” as decided during a monthly interdisciplinary radiology peer learning meeting were extracted from our PACS with internally reported missed findings from January 2023 – June 2025. The exams reviewed included 98 CT, 46 MR, 386 XR, and 4 US. Cases were then separated into subcategories, including trauma, infection/inflammation, neoplasm, hardware, degenerative, congenital, metabolic, vascular, body misses, and miscellaneous. Trauma cases were further subcategorized by body part region.

Results: The majority of missed findings (64%) occurred in the trauma setting, with 88% of these findings missed on radiographs. The most prevalent sites of missed findings occurred in the pelvis/hip (31.1%), knee (21.6%), and foot (19%). Within these subcategories, the most frequently missed findings included fractures of the femoral neck, pubic rami, tibial plateau, metatarsals/phalanges, calcaneus, and Lisfranc joint. Missed infectious/inflammatory findings such as erosions comprised 8.6% of the total cases, missed neoplasms comprised 6%, and incidental body misses comprised 5%. The remaining subcategories comprised a small minority of the total missed findings.

Conclusions: Increased awareness of the commonly missed imaging findings in MSK radiology is imperative to maintain diagnostic accuracy despite consistently growing volume demands. The data from our high volume, subspecialty-based radiology practice provides valuable insight into common radiologist blind spots, and will help increase diagnostic attention to these regions and pathologies to improve overall patient care.