This paper uses novel qualitative research methods (phenomenology, ethnography and enactivism) to understand the cognitive processes through which radiologists interpret medical images to arrive at a diagnosis. From this perspective, diagnosis is not simply a matching of findings to retrieved mental images, but more properly an act of embodied or situated cognition, one that involves perception along with the actualization of professional memory and imagination and an expert-level understanding of the involved technology. Image interpretation involves a diverse set of factors, each of which is critical to arriving at the correct diagnostic interpretations, and conversely, may be the source of mis-interpretations and diagnostic error. Interpretation depends on the radiologist's understanding of the imaging modality that was used, a deep appreciation of anatomy and comprehensive knowledge of relevant diseases and how they manifest in medical imaging. A range of personal and inter-personal factors may also come into play, including understanding the actions, values and goals of the patient, the imaging technicians and the clinicians and other medical professionals involved in the patient's care. This multi-dimensional perspective provides novel insights regarding the cognitive aspects of diagnostic radiology and a novel framework for understanding how diagnostic errors arise in this process. Some of the findings of this research may have applications for diagnostic praxis in general, that is, beyond radiology diagnostics.
Keywords: diagnostic errors; image-based diagnosis; phenomenological ethnography; radiology; situated cognition.