Cleareview Blog

Affiliation Bias

March 1, 2018 | Authored by: Neerav Mehta

affiliation bias

We have already discussed Framing bias, as one of the major sources of a non-objective review of radiology cases, the second major source of bias is Affiliation bias.

Affiliation bias occurs when an expert witness radiologist knows they are reviewing the case for a plaintiff attorney or for the defense. By affiliating with a plaintiff, the expert witness is influenced to emphasize the alleged missed finding and its importance. The expert has been hired by a plaintiff attorney, and a successful outcome for the plaintiff attorney is for there to be a verdict in their favor. Given multiple potential radiology expert witnesses, all of whom are charging the attorney money for their reviews, the radiologist who consistently provides a favorable review will be the preferred expert witness for that attorney. It is basic business practice.

Conversely, when reviewing the case for the defense, the expert witness is influenced to minimize and de-emphasize the alleged missed finding and its importance. The radiology expert who consistently produces more favorable reports that the alleged miss was easily missed, will have a repeat customer from the defense attorney. 

Cleareview’s blind review services help to remove the affiliation bias from the case, leading to a more objective result.

Framing Bias

February 1, 2018 | Authored by: Neerav Mehta

framing bias

Framing bias occurs when a radiologist is aware that a malpractice case is being presented. When provided a case from an attorney, the radiologist is automatically biased by the context of the review as well as the presumed adverse outcome which led to the litigation.

Normally, a clinical radiologist working a routine day will not know whether a case is normal, abnormal with minor findings, or abnormal with major findings. Healthy patients and sick patients get scans, and not every case is an abnormal one. In a recent review of patients getting CT scans of the head with a symptom of headache, only 6.2% had clinically significant findings (Gupta, 2015).

However, when presented with a malpractice case, the expert witness radiologist’s assumption is that the case is one that is 100% abnormal and 100% with clinically significant findings. The context of the review is what contributes to the framing bias, which leads the expert witness radiologist to scrutinize the study to a higher degree than a typical clinical radiologist. A radiologist given a scan with a 100% chance of there being a clinically significant finding looks at the scan more carefully than they would if there were only a 6.2% chance.   Playing the game of “Where’s Waldo,” a person will look at a picture more carefully until they find Waldo if they KNOW IN ADVANCE that there is a 100% chance of Waldo being in the picture, as opposed to the scenario where they know that there is only a 6.2% chance of Waldo even being in the picture.

Cleareview’s blind review services removes the inherent Framing bias the expert witness has in reviewing malpractice cases, leading to a more credible opinion.



Gupta et al. “Prevalence of normal head CT and positive CT findings in a large cohort of patients with chronic headaches.” Neuroradiol J. 2015 Aug; 28(4): 421–425.


January 1, 2018 | Authored by: Neerav Mehta

credibility trustworthiness

Credibility of an expert witness is a critical factor at trial. Constructs of credibility are complex, and the Witness Credibility Model (Brodsky, 2010) breaks credibility down into the following components: Trustworthiness, Knowledge, Confidence, Likability.

Confidence has received a lot of attention in the expert witness world, with higher degrees of expert witness confidence originally thought to result in higher degrees of expert witness credibility. However, this turns out to be not quite true. It has been shown that while a low degree of expert witness confidence correlated with lower credibility, and a medium degree of expert witness confidence correlated with higher credibility... a high degree of expert witness confidence then led to a lower degree of credibility (Cramer, 2009). So higher and higher degrees of confidence go from the credible expert witness to the cocky expert witness.

On the other hand, trustworthiness and knowledge have been shown to be positively correlated to credibility. Majority of expert witnesses are knowledgeable... they are the experts. This cannot be changed by the attorney. Trustworthiness, however, is a different animal than knowledge. The trustworthy expert is the one who is most objective. An expert that comes across as the most objective will win the trustworthiness battle.

Cleareview provides your expert witness with the platform (Blind Expert Review) or data (Blind Panel Review) to provide an objective, and hence trustworthy, opinion.



Brodsky SL, Griffin MP, Cramer RJ: The Witness Credibility Scale: an outcome measure for expert witness research. Behav Sci & L 28:892–907, 2010.

Cramer RJ, Brodsky SL, and Jamie DeCoster J: Expert Witness Confidence and Juror Personality: Their Impact on Credibility and Persuasion in the Courtroom. Journal of the American Academy of Psychiatry and the Law Online 37 (1) 63-74, March 2009.


ACR Expert Witness Practice Parameter 2017

December 1, 2017 | Authored by: Neerav Mehta

ACR blind

When an expert is given a radiology case by an attorney, they have lost their objectivity. The battle is already lost. What’s the chance that the attorney is giving them a normal case? What’s the chance that the attorney is giving them a case with only minor findings? Common sense dictates that the case being provided by an attorney is a bad one... the finding was a major one and the outcome was bad. Bad enough to warrant a lawsuit.

So can an attorney provide a case to an expert witness radiologist without losing the trustworthiness battle? The solution lies in a blind review. The radiologist needs to be blinded to the fact that the case was provided by an attorney. This radiologist will review the case more objectively than the expert who is not blinded. In 2017, the American College of Radiology acknowledged this and even codified it into their expert witness practice parameter:


“Images and other relevant material presented in a blinded fashion to the expert in a malpractice lawsuit strengthens the credibility of the opinion rendered by the expert.”


Cleareview offers the platform necessary to achieve this blinded review, and bolster the expert witness’s objectivity. Your own expert witness, or one of ours, will review the case free of bias on our unique web based platform with Blind Expert Review. The objective review of your client’s radiology case will tip the scales of trustworthiness in your direction. Even in the pre-trial phase, our Blind Panel Review will provide additional objective data that can be used as a branch point in the decision tree... whether to settle, how much to settle for, or whether to continue the fight at trial. A combination of Blind Panel Review and Blind Expert Review can give you the complete package of objective guidance pre-trial, and objective expert witness testimony at trial.