Errors and fallibility in radiology: X-ray readings and expert radiologists, 1947–1960

Abstract

This article traces the historical emergence of a new understanding of radiologists as fallible expert observers from the late 1940s, a conception that was shaped by new technologies and techniques, but also prepared the ground for promises of automation and artificial intelligence in the field of medical imaging. Reports of radiologists’ unreliable performance prompted investigations in many countries into ‘observer variability’ and ‘observer error’. Towards the end of the 1950s, scientists could conceive of radiologists as imperfect medical decision makers, while they concurrently developed a new model for ‘logical analysis’ of the diagnostic process that would limit errors. As well as technological solutions to flawed X-ray readers, researchers proposed ‘double-reading’ practices (a second independent reading) as a way to mitigate the ‘human factor’. Yet these ideas did not find widespread resonance due to concerns about feasibility and debates about radiological expertise, and also because of a discrepancy between experimental models and real-world practices. A genealogy of the fallible trained observer helps us understand persistent worries about – and solutions to – radiologists’ ‘error problem’ and contributes to a better understanding of current discourses on AI in medical imaging.