PurposePerceptual errors account for a significant percent of errors in radiology. Reasons for failure to identify significant lesions are partially due to suboptimal differences in image contrast. The goal of this study is to determine if teaching trainees how to adjust image contrast, window, and level helps trainees identify pulmonary nodules on chest radiographs (CXRs).ApproachFourteen medical students voluntarily participated. Subjects were asked to identify pulmonary nodules on CXRs before and after being taught how to adjust image contrast, window, and level. At the end of the study, subjects were given a survey assessing their perceptions about their training.ResultsThe experimental group was more confident in their ability to localize nodules relative to the control group (P-value = 0.003). Subjects demonstrated statistically significant improvement in their ability to identify and localize nodules, with the experimental group performing better than the control group, though there was no statistically significant difference between groups. Participant survey indicated that they felt this training was beneficial, P-values for all survey responses were significant (P-values all <0.02).ConclusionsTeaching subjects how to window and level medical images may be a useful adjunct to current training for medical image interpretation.
KEYWORDS: Visualization, Eye, Radiography, Eye tracking, Information visualization, Radiology, Education and training, Windows, Medical imaging, Design and modelling
PurposeOne of the dominant behavioral markers of visual-expert search strategy, holistic visual processing (HVP), suggests that experts process information from a larger region of space in conjunction with a more focused gaze pattern to improve search speed and accuracy. To date, extant literature suggests that visual search expertise is domain specific, including HVP and its associated behaviors.ApproachThe current study is the first to use eye tracking to directly measure the HVP strategies of two expert groups, radiologists and architects, in comparison to one another and a novice control.ResultsIn doing so, we replicated and extended this prior research: visual expertise is domain specific. However, our eye-tracking data indicate that contrary to this prior work, HVP strategies are transferable across domains. Yet, despite the transfer of HVP strategies, there is neither reduced search time nor greater accuracy in visual search outside of an expert’s domain.ConclusionsTherefore, our data suggest that HVP behaviors are a particular form of visual search mechanism that, outside of an expert’s native search-ecology, are not necessarily conducive to more general visual search success. It is in addition to explicit knowledge of an expert’s domain, how to search, and where to search, that HVP strategies are their most effective for visual search success.
One of the benefits of expertise is thought to be the ability to reduce complex data to the information that is most relevant to the task at hand. In radiology, this ability manifests as fewer fixations and shorter dwell time in anatomical regions that are considered irrelevant to the observer’s task. Although these findings are generally viewed as an advantage of expertise, this study explored the potential negative effects of top-down guidance when cases had abnormalities that were inconsistent with the observer’s expectations (i.e., incidental findings). 37 radiologists evaluated abdominal CT scans. One group was told the patients were living liver donor candidates and the other group was told they were living kidney donor candidates. Critically, two of the cases had liver abnormalities and two had kidney abnormalities. Overall, abnormalities in the uncued organ were missed ~6% more than in the cued organ, but this difference was not significant and Bayes Factors were inconclusive. Using eyetracking measures, which provide a more sensitive measure of search behavior, we found the uncued organ was searched less thoroughly than the cued organ. There was no significant difference in scanning/drilling behavior between groups. There was no relationship between experience and missed incidental finding rates. Furthermore, radiologists across all levels of experience were equally likely to focus less attention on the uncued organ. Although previous research has found group-level differences between experts and naïve observers on incidentalfinding rates1, these findings add to growing evidence that expertise does not protect experts from missing incidentalfindings2.
Physicians interpreting medical images are expected to adjust display parameters on a routine basis, a skill which is generally not explicitly taught. This study examines the effects of perceptual training (PT) on windowing and leveling images and subject ability to identify pulmonary nodules on chest radiographs. Subjects were also given surveys on the perceived value of the PT. There was a statistically significant improvement in nodule identification for both control and experimental groups. Survey results were significantly positive for all questions. These results suggest there is a role for PT on windowing and leveling medical images.
Purpose: Experienced radiologists have enhanced global processing ability relative to novices, allowing experts to rapidly detect medical abnormalities without performing an exhaustive search. However, evidence for global processing models is primarily limited to two-dimensional image interpretation, and it is unclear whether these findings generalize to volumetric images, which are widely used in clinical practice. We examined whether radiologists searching volumetric images use methods consistent with global processing models of expertise. In addition, we investigated whether search strategy (scanning/drilling) differs with experience level.
Approach: Fifty radiologists with a wide range of experience evaluated chest computed-tomography scans for lung nodules while their eye movements and scrolling behaviors were tracked. Multiple linear regressions were used to determine: (1) how search behaviors differed with years of experience and the number of chest CTs evaluated per week and (2) which search behaviors predicted better performance.
Results: Contrary to global processing models based on 2D images, experience was unrelated to measures of global processing (saccadic amplitude, coverage, time to first fixation, search time, and depth passes) in this task. Drilling behavior was associated with better accuracy than scanning behavior when controlling for observer experience. Greater image coverage was a strong predictor of task accuracy.
Conclusions: Global processing ability may play a relatively small role in volumetric image interpretation, where global scene statistics are not available to radiologists in a single glance. Rather, in volumetric images, it may be more important to engage in search strategies that support a more thorough search of the image.
KEYWORDS: Radiology, Chest imaging, Radiography, Statistical analysis, Medicine, Psychology, Medical imaging, Perceptual learning, Medical research, Education and training
Prior research has demonstrated that perceptual training can improve the ability of healthcare trainees in identifying abnormalities on medical images, but it is unclear if the improved performance is due to learning or attentional shift—the diversion of perceptional resources away from other activities to a specified task. Our objective is to determine if research subject performance in perceiving the central venous catheter position on radiographs is improved after perceptional training and if improved performance is due to learning or an attentional shift. Forty-one physician assistant students were educated on the appropriate radiographic position of central venous catheters and then asked to evaluate the catheter position in two sets of radiographic cases. The experimental group was provided perceptional training between case sets one and two. The control group was not. Participants were asked to characterize central venous catheters for appropriate positioning (task of interest) and to assess radiographs for cardiomegaly (our marker for attentional shift). Our results demonstrated increased confidence in localization in the experimental group (p-value <0.001) but not in the control group (p-value = 0.882). The ability of subjects to locate the catheter tip significantly improved in both control and experimental groups. Both the experimental (p-value = 0.007) and control groups (p-value = 0.001) demonstrated equivalent decreased performance in assessing cardiomegaly; the difference between groups was not significant (p-value = 0.234). This suggests the performance improvement was secondary to learning not due to an attentional shift.
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