Fig. 4.

a–c Postoperative changes in esophageal cancer in a 67-year-old man. a, b Axial CT showed the postoperative changes in esophageal cancer. However, because the clinical request form did not provide a reminder, radiologists only described postoperative changes and failed to mention tracheoesophageal fistula. Multiplanar reformation (MPR) can better display the fistula (arrow). According to the administration of oral contrast agent, radiologists should understand that the doctor wants to observe if a fistula occurs. (d-g) A 56-year-old man with right oropharyngeal carcinoma after radiotherapy. Four MRIs at different times showed abnormal signals in the right mandible. The first two reports (d, e) did not mention abnormal signals, illustrating a perceptual error. In the third exam (f), the radiologist found but mistook it as bone metastasis, illustrating a cognitive error. The patient’s frequent swollen gums since 2018 were omitted, and this syndrome improved substantially after anti-inflammatory therapy. The diagnosis should be right mandibular osteoradionecrosis with osteomyelitis, but radiologists misdiagnosed it because they were not familiar with radiotherapy complications and diagnostic bias