Inside access By James R. Duncan, MD, PhD, FSIR JVIR spotlight Tell us about you, your team and your institution.
Improving Performance during Image-Guided Procedures: A Human Factors Perspective
Duncan J., et al. J Vasc Interv Radiol. 2025;36(11):1637–1647.
Read the full article on JVIR.
Authors: James R. Duncan, MD, PhD, FSIR, is Professor of Radiology who rejoined the faculty at the Mallinckrodt Institute of Radiology (MIR) in 2000 and became interested in data-driven process improvement. From his background in cellular and molecular biology, he appreciated how fundamental ideas around most topics have typically been thoroughly explored by investigators in other fields. This led him to review prior work in human factors and ergonomics (HFE).
Jake Berg is currently a third-year medical student at the University of Minnesota. He learned about HFE during his participation in the 2024 MIR Summer Research Program and received a SIR 2025 Medical Student Scholar Program award.
Caroline Cao, PhD, is Professor and Dean of the Faculty of Engineering at the University of Ottawa. She has extensive experience in HFE, medical simulation and healthcare technology
The MIR is a large institution that includes a robust IR section. MIR has long supported quality and safety improvement as evidenced by creation of a departmental Quality and Safety Office in 2008. That office has grown over the years and now includes four full-time staff.
Why did you pursue this topic? James R. Duncan, MD, PhD, FSIR: When studying the fundamentals of improving performance during image- guided procedures, we repeatedly encountered insights from HFE but felt that much of that knowledge hasn’t been applied or taught in IR.
What are the key takeaways from your research? Dr. Duncan: A key takeaway is the need to leverage Information Theory if we want to better understand communication, data gathering and decision-making during IR procedures. This includes the crucial difference between data and information. Improving patient care requires both systems thinking and a growth mindset. The predictive power of our mental models only improves when we critically assess the causes behind our failed predictions.
Planning is more important than execution. Good plans anticipate problems with execution and include strategies for detecting errors, correcting them and when necessary, switching to contingency plans.
Illustration of the interactions between uncertainty, planning and execution during image- guided procedures. Note that the “Assess Outcome” step also includes uncertainty that is addressed by acquiring and interpreting images.
How might this research influence treatment, practice or clinical processes in interventional radiology? Dr. Duncan: By improving teamwork before, during and after procedures; recognizing that organizational learning
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