Diagnostic Errors in US of the Pancreas: A Comprehensive Case-based Review of Lessons Learned from Quality Assurance Rounds

US is an important diagnostic tool in evaluation of the pancreas, as it is noninvasive, does not require irradiation, and offers real-time imaging capability and broad accessibility. Despite the utility of pancreatic US, it often has limited effectiveness due to the complex anatomy of the pancreas and peripancreatic structures, which inevitably leads to diagnostic errors. The authors summarize the lessons learned from quality assurance rounds at a high-volume tertiary care center. The errors are systematically categorized as perceptual, interpretive, information transfer, and process errors. Each error type is discussed with detailed case studies from clinical practice to underscore common pitfalls and their impact on patient management. Perceptual errors occur when the operators overlook subtle pathologic signs due to the complex anatomy. Interpretive errors arise from misjudgments regarding the clinical significance of visible abnormalities, while information transfer errors stem from inadequate communication of patient history or suboptimal review of previous imaging findings. Process errors reflect systemic issues related to US protocol and scanning techniques. The authors advocate having a thorough understanding of the US appearances of normal and variant pancreatic anatomy and emphasize the importance of correlating US findings with findings of complementary imaging modalities to improve diagnostic accuracy. They also highlight the need to use high-resolution US transducers, embrace new technologies, and adopt meticulous scanning techniques as valuable practical strategies to mitigate diagnostic errors. By providing a detailed analysis of cases, this review demonstrates how structured quality assurance measures and continuous education can significantly reduce diagnostic errors. These efforts are crucial in ensuring accurate diagnoses and optimizing patient outcomes. ^©RSNA, 2025 Supplemental material is available for this article.