The prevalence of diagnostic error rates in radiology illustrates the need for research that traces the cognitive and perceptual factors that lead to errors in radiology. With methods used in previous research and Fineberg's hierarchy, this study breaks down the diagnostic process to determine whether different technical systems and multiple underlying causes of a disease lead to errors in radiographic interpretation. Two experienced radiologists served as arbiters for the cases used in the study, and 3 radiologists and 3 radiology residents participated. Radiologists showed consistently lower error rates than the resident group. However, error rates were still high, being above 28%. The use of the X-ray images yielded lower error rates than did MRI images. Despite the high error rates in identifying and interpreting radiographic findings, referral ability did not differ between the two participant groups or imaging modalities.