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Becker AS, Woo S, Leithner D, Tong A, Mayerhoefer ME, Vargas HA. The "Hungry Judge" effect on prostate MRI reporting: Chronobiological trends from 35'004 radiologist interpretations. Eur J Radiol 2024; 179:111665. [PMID: 39128251 DOI: 10.1016/j.ejrad.2024.111665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024]
Abstract
AIM To investigate the associations between the hour of the day and Prostate Imaging-Reporting and Data System (PI-RADS) scores assigned by radiologists in prostate MRI reports. MATERIALS AND METHODS Retrospective single-center collection of prostate MRI reports over an 8-year period. Mean PI-RADS scores assigned between 0800 and 1800 h were examined with a regression model. RESULTS A total of 35'004 prostate MRI interpretations by 26 radiologists were included. A significant association between the hour of day and mean PI-RADS score was identified (β2 = 0.005, p < 0.001), with malignant scores more frequently assigned later in the day. CONCLUSION These findings suggest chronobiological factors may contribute to variability in radiological assessments. Though the magnitude of the effect is small, this may potentially add variability and impact diagnostic accuracy.
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Affiliation(s)
- Anton S Becker
- Department of Radiology, NYU Langone Health and New York University, Grossman School of Medicine, 660 First Ave, New York 10012, United States. https://twitter.com/becker_rad
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health and New York University, Grossman School of Medicine, 660 First Ave, New York 10012, United States
| | - Doris Leithner
- Department of Radiology, NYU Langone Health and New York University, Grossman School of Medicine, 660 First Ave, New York 10012, United States
| | - Angela Tong
- Department of Radiology, NYU Langone Health and New York University, Grossman School of Medicine, 660 First Ave, New York 10012, United States
| | - Marius E Mayerhoefer
- Department of Radiology, NYU Langone Health and New York University, Grossman School of Medicine, 660 First Ave, New York 10012, United States
| | - H Alberto Vargas
- Department of Radiology, NYU Langone Health and New York University, Grossman School of Medicine, 660 First Ave, New York 10012, United States
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Hegde S, Gao J, Vasa R, Nanayakkara S, Cox S. Australian Dentist's Knowledge and Perceptions of Factors Affecting Radiographic Interpretation. Int Dent J 2024; 74:589-596. [PMID: 38184458 PMCID: PMC11123563 DOI: 10.1016/j.identj.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Errors of interpretation of radigraphic images, also known as interpretive errors, are a critical concern as they can have profound implications for clinical decision making. Different types of interpretive errors, including errors of omission and misdiagnosis, have been described in the literature. These errors can lead to unnecessary or harmful treat/or prolonged patient care. Understanding the nature and contributing factors of interpretive errors is important in developing solutions to minimise interpretive errors. By exploring the knowledge and perceptions of dental practitioners, this study aimed to shed light on the current understanding of interpretive errors in dentistry. METHODS An anonymised online questionnaire was sent to dental practitioners in New South Wales (NSW) between September 2020 and March 2022. A total of 80 valid responses were received and analysed. Descriptive statistics and bivariate analysis were used to analyse the data. RESULTS The study found that participants commonly reported interpretive errors as occurring 'occasionally', with errors of omission being the most frequently encountered type. Participants identified several factors that most likely contribute to interpretive errors, including reading a poor-quality image, lack of clinical experience and knowledge, and excessive workload. Additionally, general practitioners and specialists held different views regarding factors affecting interpretive errors. CONCLUSION The survey results indicate that dental practitioners are aware of the common factors associated with interpretive errors. Errors of omission were identified as the most common type of error to occur in clinical practice. The findings suggest that interpretive errors result from a mental overload caused by factors associated with image quality, clinician-related, and image interpretation. Managing and identifying solutions to mitigate these factors are crucial for ensuring accurate and timely radiographic diagnoses. The findings of this study can serve as a foundation for future research and the development of targeted interventions to enhance the accuracy of radiographic interpretations in dentistry.
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Affiliation(s)
- Shwetha Hegde
- Sydney Dental School, University of Sydney, Surry Hills, NSW, Australia.
| | - Jinlong Gao
- Institute of Dental Research, Westmead Centre for Oral Health, University of Sydney, Westmead, NSW, Australia
| | - Rajesh Vasa
- Applied Artificial Intelligence, Deakin University, Melbourne, Australia
| | - Shanika Nanayakkara
- Institute of Dental Research, Westmead Centre for Oral Health, University of Sydney, Westmead, NSW, Australia
| | - Stephen Cox
- Sydney Dental School, University of Sydney, Surry Hills, NSW, Australia
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3
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Penn L, Golden ED, Tomblinson C, Sugi M, Nickerson JP, Peterson RB, Tigges S, Kennedy TA. Training the New Radiologists: Approaches for Education. Semin Ultrasound CT MR 2024; 45:139-151. [PMID: 38373671 DOI: 10.1053/j.sult.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
The field of Radiology is continually changing, requiring corresponding evolution in both medical student and resident training to adequately prepare the next generation of radiologists. With advancements in adult education theory and a deeper understanding of perception in imaging interpretation, expert educators are reshaping the training landscape by introducing innovative teaching methods to align with increased workload demands and emerging technologies. These include the use of peer and interdisciplinary teaching, gamification, case repositories, flipped-classroom models, social media, and drawing and comics. This publication aims to investigate these novel approaches and offer persuasive evidence supporting their incorporation into the updated Radiology curriculum.
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Affiliation(s)
- Lauren Penn
- University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | | | | | | | | | | | | | - Tabassum A Kennedy
- University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Klein DS, Lago MA, Abbey CK, Eckstein MP. A 2D Synthesized Image Improves the 3D Search for Foveated Visual Systems. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:2176-2188. [PMID: 37027767 PMCID: PMC10476603 DOI: 10.1109/tmi.2023.3246005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Current medical imaging increasingly relies on 3D volumetric data making it difficult for radiologists to thoroughly search all regions of the volume. In some applications (e.g., Digital Breast Tomosynthesis), the volumetric data is typically paired with a synthesized 2D image (2D-S) generated from the corresponding 3D volume. We investigate how this image pairing affects the search for spatially large and small signals. Observers searched for these signals in 3D volumes, 2D-S images, and while viewing both. We hypothesize that lower spatial acuity in the observers' visual periphery hinders the search for the small signals in the 3D images. However, the inclusion of the 2D-S guides eye movements to suspicious locations, improving the observer's ability to find the signals in 3D. Behavioral results show that the 2D-S, used as an adjunct to the volumetric data, improves the localization and detection of the small (but not large) signal compared to 3D alone. There is a concomitant reduction in search errors as well. To understand this process at a computational level, we implement a Foveated Search Model (FSM) that executes human eye movements and then processes points in the image with varying spatial detail based on their eccentricity from fixations. The FSM predicts human performance for both signals and captures the reduction in search errors when the 2D-S supplements the 3D search. Our experimental and modeling results delineate the utility of 2D-S in 3D search-reduce the detrimental impact of low-resolution peripheral processing by guiding attention to regions of interest, effectively reducing errors.
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Hegde S, Gao J, Vasa R, Cox S. Factors affecting interpretation of dental radiographs. Dentomaxillofac Radiol 2023; 52:20220279. [PMID: 36472942 PMCID: PMC9974235 DOI: 10.1259/dmfr.20220279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To identify the factors influencing errors in the interpretation of dental radiographs. METHODS A protocol was registered on Prospero. All studies published until May 2022 were included in this review. The search of the electronic databases spanned Ovid Medline, PubMed, EMBASE, Web of Science and Scopus. The quality of the studies was assessed using the MMAT tool. Due to the heterogeneity of the included studies, a meta-analysis was not conducted. RESULTS The search yielded 858 articles, of which eight papers met the inclusion and exclusion criteria and were included in the systematic review. These studies assessed the factors influencing the accuracy of the interpretation of dental radiographs. Six factors were identified as being significant that affected the occurrence of interpretation errors. These include clinical experience, clinical knowledge, and technical ability, case complexity, time pressure, location and duration of dental education and training and cognitive load. CONCLUSIONS The occurrence of interpretation errors has not been widely investigated in dentistry. The factors identified in this review are interlinked. Further studies are needed to better understand the extent of the occurrence of interpretive errors and their impact on the practice of dentistry.
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Affiliation(s)
- Shwetha Hegde
- Academic Fellow, Dentomaxillofacial Radiology, Sydney Dental School, University of Sydney, Sydney, Australia
| | - Jinlong Gao
- Senior Lecturer, Sydney Dental School, Institute of Dental Research, Westmead Centre for Oral Health, University of Sydney, Sydney, Australia
| | - Rajesh Vasa
- Head of Translational Research and Development, Applied Artificial Intelligence, Deakin University, Melbourne, Australia
| | - Stephen Cox
- Head of Discipline, Discipline of Oral Surgery, Sydney Dental School, University of Sydney, Sydney, Australia
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Pavel DG, Henderson TA, DeBruin S, Cohen PF. The Legacy of the TTASAAN Report - Premature Conclusions and Forgotten Promises About SPECT Neuroimaging: A Review of Policy and Practice Part II. Front Neurol 2022; 13:851609. [PMID: 35655621 PMCID: PMC9152128 DOI: 10.3389/fneur.2022.851609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970s. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was not stabilized until 1993 and most early SPECT scans were performed on single-head gamma cameras. These early scans were of inferior quality. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. This two-part series explores the policies and procedures related to perfusion SPECT functional neuroimaging. In Part I, the comparison between the quality of the SPECT scans and the depth of the data for key neurological and psychiatric indications at the time of the TTASAAN report vs. the intervening 25 years were presented. In Part II, the technical aspects of perfusion SPECT neuroimaging and image processing will be explored. The role of color scales will be reviewed and the process of interpreting a SPECT scan will be presented. Interpretation of a functional brain scans requires not only anatomical knowledge, but also technical understanding on correctly performing a scan, regardless of the scanning modality. Awareness of technical limitations allows the clinician to properly interpret a functional brain scan. With this foundation, four scenarios in which perfusion SPECT neuroimaging, together with other imaging modalities and testing, lead to a narrowing of the differential diagnoses and better treatment. Lastly, recommendations for the revision of current policies and practices are made.
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Affiliation(s)
- Dan G Pavel
- PathFinder Brain SPECT, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States.,Neuro-Laser Foundation, Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Baltimore, MD, United States
| | - Philip F Cohen
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Nuclear Medicine, Lions Gate Hospital, Vancouver, BC, Canada.,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Pavel DG, Henderson TA, DeBruin S. The Legacy of the TTASAAN Report-Premature Conclusions and Forgotten Promises: A Review of Policy and Practice Part I. Front Neurol 2022; 12:749579. [PMID: 35450131 PMCID: PMC9017602 DOI: 10.3389/fneur.2021.749579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Brain perfusion single photon emission computed tomography (SPECT) scans were initially developed in 1970's. A key radiopharmaceutical, hexamethylpropyleneamine oxime (HMPAO), was originally approved in 1988, but was unstable. As a result, the quality of SPECT images varied greatly based on technique until 1993, when a method of stabilizing HMPAO was developed. In addition, most SPECT perfusion studies pre-1996 were performed on single-head gamma cameras. In 1996, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (TTASAAN) issued a report regarding the use of SPECT in the evaluation of neurological disorders. Although the TTASAAN report was published in January 1996, it was approved for publication in October 1994. Consequently, the reported brain SPECT studies relied upon to derive the conclusions of the TTASAAN report largely pre-date the introduction of stabilized HMPAO. While only 12% of the studies on traumatic brain injury (TBI) in the TTASAAN report utilized stable tracers and multi-head cameras, 69 subsequent studies with more than 23,000 subjects describe the utility of perfusion SPECT scans in the evaluation of TBI. Similarly, dementia SPECT imaging has improved. Modern SPECT utilizing multi-headed gamma cameras and quantitative analysis has a sensitivity of 86% and a specificity of 89% for the diagnosis of mild to moderate Alzheimer's disease-comparable to fluorodeoxyglucose positron emission tomography. Advances also have occurred in seizure neuroimaging. Lastly, developments in SPECT imaging of neurotoxicity and neuropsychiatric disorders have been striking. At the 25-year anniversary of the publication of the TTASAAN report, it is time to re-examine the utility of perfusion SPECT brain imaging. Herein, we review studies cited by the TTASAAN report vs. current brain SPECT imaging research literature for the major indications addressed in the report, as well as for emerging indications. In Part II, we elaborate technical aspects of SPECT neuroimaging and discuss scan interpretation for the clinician.
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Affiliation(s)
- Dan G Pavel
- Pathfinder Brain SPECT Imaging, Deerfield, IL, United States.,The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States
| | - Theodore A Henderson
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,The Synaptic Space, Inc., Denver, CO, United States.,Neuro-Luminance, Inc., Denver, CO, United States.,Dr. Theodore Henderson, Inc., Denver, CO, United States
| | - Simon DeBruin
- The International Society of Applied Neuroimaging (ISAN), Denver, CO, United States.,Good Lion Imaging, Columbia, SC, United States
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van Montfort D, Kok E, Vincken K, van der Schaaf M, van der Gijp A, Ravesloot C, Rutgers D. Expertise development in volumetric image interpretation of radiology residents: what do longitudinal scroll data reveal? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:437-466. [PMID: 33030627 PMCID: PMC8041671 DOI: 10.1007/s10459-020-09995-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
The current study used theories on expertise development (the holistic model of image perception and the information reduction hypothesis) as a starting point to identify and explore potentially relevant process measures to monitor and evaluate expertise development in radiology residency training. It is the first to examine expertise development in volumetric image interpretation (i.e., CT scans) within radiology residents using scroll data collected longitudinally over five years of residency training. Consistent with the holistic model of image perception, the percentage of time spent on full runs, i.e. scrolling through more than 50% of the CT-scan slices (global search), decreased within residents over residency training years. Furthermore, the percentage of time spent on question-relevant areas in the CT scans increased within residents over residency training years, consistent with the information reduction hypothesis. Second, we examined if scroll patterns can predict diagnostic accuracy. The percentage of time spent on full runs and the percentage of time spent on question-relevant areas did not predict diagnostic accuracy. Thus, although scroll patterns over training years are consistent with visual expertise theories, they could not be used as predictors of diagnostic accuracy in the current study. Therefore, the relation between scroll patterns and performance needs to be further examined, before process measures can be used to monitor and evaluate expertise development in radiology residency training.
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Affiliation(s)
- Dorien van Montfort
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands
| | - Ellen Kok
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands.
| | - Koen Vincken
- Image Sciences Institute, Imaging Dept, University Medical Center, Utrecht, The Netherlands
| | - Marieke van der Schaaf
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk van der Gijp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cécile Ravesloot
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk Rutgers
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Krupinski EA. The important role of task-based model observers and related techniques in medical imaging. J Nucl Cardiol 2021; 28:638-640. [PMID: 31144227 DOI: 10.1007/s12350-019-01769-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Elizabeth A Krupinski
- Department of Radiology & Imaging Sciences Emory University, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA.
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10
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Plascencia H, Díaz M, Ordinola-Zapata R, Vázquez-Sánchez ME, Juárez-Broon N, Ruíz-Gutiérrez A, Gascón G, Cruz A. Intra- and Interobserver Agreement during the Assessment of the Different Stages of Root Development Using 4 Radiographic Classifications. J Endod 2021; 47:906-913. [PMID: 33705830 DOI: 10.1016/j.joen.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/18/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study analyzed intra- and interobserver agreements during radiographic assessment of the different stages of root development using the dichotomous, Moorrees, Demirjian, and Cvek classifications, as well as the effect of the observer's level of experience on the result. METHODS Two hundred eighty-five digital periapical radiographs were examined via visual inspection by 3 experienced and 3 nonexperienced observers (n = 6) under strict technological and viewing conditions. After observer calibration, determination of the presence or absence of an open apex and the assignment of a root development stage according to the different subdivisions of the 4 indexes were performed. This evaluation was carried out by each observer in duplicate in the first round (n = 8) and repeated in the second round (n = 8). The 16 examinations performed by each observer (N = 96) were analyzed to determine the percentage of concordance followed by intraobserver, interobserver, and global observer agreement using the kappa coefficient and a weighted kappa. Additionally, to determine the level of concordance between the visual determination of an open or closed apex and the apical foramen width measured in millimeters, a dichotomized kappa coefficient was applied. RESULTS A good level of global observer agreement was found for the dichotomous, Demirjian, and Cvek classifications. However, a significantly low percentage of total concordance and global observer agreement (6.66% and 0.498, respectively) was obtained using the Moorrees classification, which was more pronounced among nonexperienced observers (0.247). Apical foramen width measurements indicated the presence of 143 roots with an open apex (50.2%) and 142 with a closed apex (49.8%), and the dichotomized kappa coefficient test revealed a good level of agreement during the visual determination of an open or closed apex (range, 0.611-0.636). CONCLUSIONS The classifications of Cvek and Demirjian provided reliable results when determining the different stages of root development. In contrast, the Moorrees classification provided the lowest agreement values, with a significant negative effect among nonexperienced observers. Finally, the visual estimation of the presence (or absence) of an open apex provided a good level of concordance with the radiographic apical foramen width.
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Affiliation(s)
- Hugo Plascencia
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico.
| | - Mariana Díaz
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Ronald Ordinola-Zapata
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, Minnesota
| | - María Eugenia Vázquez-Sánchez
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Norberto Juárez-Broon
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Aloysia Ruíz-Gutiérrez
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Gerardo Gascón
- Endodontic Postgraduate Program, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
| | - Alvaro Cruz
- Research Institute in Biomedical Sciences, University Center of Health Sciences (CUCS), University of Guadalajara, Guadalajara, Mexico
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Lago MA, Jonnalagadda A, Abbey CK, Barufaldi BB, Bakic PR, Maidment ADA, Leung WK, Weinstein SP, Englander BS, Eckstein MP. Under-exploration of Three-Dimensional Images Leads to Search Errors for Small Salient Targets. Curr Biol 2021; 31:1099-1106.e5. [PMID: 33472051 PMCID: PMC8048135 DOI: 10.1016/j.cub.2020.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/09/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
Advances in 3D imaging technology are transforming how radiologists search for cancer1,2 and how security officers scrutinize baggage for dangerous objects.3 These new 3D technologies often improve search over 2D images4,5 but vastly increase the image data. Here, we investigate 3D search for targets of various sizes in filtered noise and digital breast phantoms. For a Bayesian ideal observer optimally processing the filtered noise and a convolutional neural network processing the digital breast phantoms, search with 3D image stacks increases target information and improves accuracy over search with 2D images. In contrast, 3D search by humans leads to high miss rates for small targets easily detected in 2D search, but not for larger targets more visible in the visual periphery. Analyses of human eye movements, perceptual judgments, and a computational model with a foveated visual system suggest that human errors can be explained by interaction among a target's peripheral visibility, eye movement under-exploration of the 3D images, and a perceived overestimation of the explored area. Instructing observers to extend the search reduces 75% of the small target misses without increasing false positives. Results with twelve radiologists confirm that even medical professionals reading realistic breast phantoms have high miss rates for small targets in 3D search. Thus, under-exploration represents a fundamental limitation to the efficacy with which humans search in 3D image stacks and miss targets with these prevalent image technologies.
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Affiliation(s)
- Miguel A Lago
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA 93106, USA
| | - Aditya Jonnalagadda
- Department of Electrical and Computer Engineering, University of California, Santa Barbara, Santa Barbara, CA 93106, USA; Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA 93106, USA
| | - Craig K Abbey
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA 93106, USA
| | - Bruno B Barufaldi
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Predrag R Bakic
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Andrew D A Maidment
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Winifred K Leung
- Ridley-Tree Cancer Center, Sansum Clinic, 540 W. Pueblo Street, Santa Barbara, CA 93105, USA
| | - Susan P Weinstein
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Brian S Englander
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Miguel P Eckstein
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, Santa Barbara, CA 93106, USA; Department of Electrical and Computer Engineering, University of California, Santa Barbara, Santa Barbara, CA 93106, USA; Institute for Collaborative Biotechnologies, University of California, Santa Barbara, Santa Barbara, CA 93106, USA.
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12
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Alexander RG, Waite S, Macknik SL, Martinez-Conde S. What do radiologists look for? Advances and limitations of perceptual learning in radiologic search. J Vis 2020; 20:17. [PMID: 33057623 PMCID: PMC7571277 DOI: 10.1167/jov.20.10.17] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/14/2020] [Indexed: 12/31/2022] Open
Abstract
Supported by guidance from training during residency programs, radiologists learn clinically relevant visual features by viewing thousands of medical images. Yet the precise visual features that expert radiologists use in their clinical practice remain unknown. Identifying such features would allow the development of perceptual learning training methods targeted to the optimization of radiology training and the reduction of medical error. Here we review attempts to bridge current gaps in understanding with a focus on computational saliency models that characterize and predict gaze behavior in radiologists. There have been great strides toward the accurate prediction of relevant medical information within images, thereby facilitating the development of novel computer-aided detection and diagnostic tools. In some cases, computational models have achieved equivalent sensitivity to that of radiologists, suggesting that we may be close to identifying the underlying visual representations that radiologists use. However, because the relevant bottom-up features vary across task context and imaging modalities, it will also be necessary to identify relevant top-down factors before perceptual expertise in radiology can be fully understood. Progress along these dimensions will improve the tools available for educating new generations of radiologists, and aid in the detection of medically relevant information, ultimately improving patient health.
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Affiliation(s)
- Robert G Alexander
- Department of Ophthalmology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Stephen Waite
- Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Stephen L Macknik
- Department of Ophthalmology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Susana Martinez-Conde
- Department of Ophthalmology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Ba A, Shams M, Schmidt S, Eckstein MP, Verdun FR, Bochud FO. Search of low-contrast liver lesions in abdominal CT: the importance of scrolling behavior. J Med Imaging (Bellingham) 2020; 7:045501. [PMID: 32743016 PMCID: PMC7380560 DOI: 10.1117/1.jmi.7.4.045501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/15/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose: Visual search using volumetric images is becoming the standard in medical imaging. However, we do not fully understand how eye movement strategies mediate diagnostic performance. A recent study on computed tomography (CT) images showed that the search strategies of radiologists could be classified based on saccade amplitudes and cross-quadrant eye movements [eye movement index (EMI)] into two categories: drillers and scanners. Approach: We investigate how the number of times a radiologist scrolls in a given direction during analysis of the images (number of courses) could add a supplementary variable to use to characterize search strategies. We used a set of 15 normal liver CT images in which we inserted 1 to 5 hypodense metastases of two different signal contrast amplitudes. Twenty radiologists were asked to search for the metastases while their eye-gaze was recorded by an eye-tracker device (EyeLink1000, SR Research Ltd., Mississauga, Ontario, Canada). Results: We found that categorizing radiologists based on the number of courses (rather than EMI) could better predict differences in decision times, percentage of image covered, and search error rates. Radiologists with a larger number of courses covered more volume in more time, found more metastases, and made fewer search errors than those with a lower number of courses. Our results suggest that the traditional definition of drillers and scanners could be expanded to include scrolling behavior. Drillers could be defined as scrolling back and forth through the image stack, each time exploring a different area on each image (low EMI and high number of courses). Scanners could be defined as scrolling progressively through the stack of images and focusing on different areas within each image slice (high EMI and low number of courses). Conclusions: Together, our results further enhance the understanding of how radiologists investigate three-dimensional volumes and may improve how to teach effective reading strategies to radiology residents.
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Affiliation(s)
- Alexandre Ba
- Lausanne University Hospital and University of Lausanne, Institute of Radiation Physics, Lausanne, Switzerland
| | - Marwa Shams
- University of Lausanne, Lausanne, Switzerland
| | - Sabine Schmidt
- Lausanne University Hospital and University of Lausanne, Department of Radiology, Lausanne, Switzerland
| | - Miguel P Eckstein
- University of California Santa Barbara, Department of Psychological and Brain Sciences, Santa Barbara, California, United States.,University of California Santa Barbara, Department of Electrical and Computing Engineering, Santa Barbara, California, United States
| | - Francis R Verdun
- Lausanne University Hospital and University of Lausanne, Institute of Radiation Physics, Lausanne, Switzerland
| | - François O Bochud
- Lausanne University Hospital and University of Lausanne, Institute of Radiation Physics, Lausanne, Switzerland
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14
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Banerjee S, Drew T, Mills MK, Auffermann WF. Perceptual training: learning versus attentional shift. J Med Imaging (Bellingham) 2020; 7:022407. [PMID: 31903409 DOI: 10.1117/1.jmi.7.2.022407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/05/2019] [Indexed: 11/14/2022] Open
Abstract
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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Affiliation(s)
- Soham Banerjee
- University of Utah School of Medicine, Department of Radiology and Imaging Sciences, Salt Lake City, Utah, United States
| | - Trafton Drew
- University of Utah, Department of Psychology, Salt Lake City, Utah, United States
| | - Megan K Mills
- University of Utah School of Medicine, Department of Radiology and Imaging Sciences, Salt Lake City, Utah, United States
| | - William F Auffermann
- University of Utah School of Medicine, Department of Radiology and Imaging Sciences, Salt Lake City, Utah, United States
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15
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Waite S, Farooq Z, Grigorian A, Sistrom C, Kolla S, Mancuso A, Martinez-Conde S, Alexander RG, Kantor A, Macknik SL. A Review of Perceptual Expertise in Radiology-How it develops, How we can test it, and Why humans still matter in the era of Artificial Intelligence. Acad Radiol 2020; 27:26-38. [PMID: 31818384 DOI: 10.1016/j.acra.2019.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
As the first step in image interpretation is detection, an error in perception can prematurely end the diagnostic process leading to missed diagnoses. Because perceptual errors of this sort-"failure to detect"-are the most common interpretive error (and cause of litigation) in radiology, understanding the nature of perceptual expertise is essential in decreasing radiology's long-standing error rates. In this article, we review what constitutes a perceptual error, the existing models of radiologic image perception, the development of perceptual expertise and how it can be tested, perceptual learning methods in training radiologists, and why understanding perceptual expertise is still relevant in the era of artificial intelligence. Adding targeted interventions, such as perceptual learning, to existing teaching practices, has the potential to enhance expertise and reduce medical error.
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16
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Yokoo T, Singal AG, Diaz de Leon A, Ananthakrishnan L, Fetzer DT, Pedrosa I, Khatri G. Prevalence and clinical significance of discordant LI-RADS ® observations on multiphase contrast-enhanced MRI in patients with cirrhosis. Abdom Radiol (NY) 2020; 45:177-187. [PMID: 31342103 DOI: 10.1007/s00261-019-02133-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the prevalence and clinical significance of discordant LI-RADS® (Liver Imaging Reporting and Data System) liver observations on multiphase contrast-enhanced (MCE) magnetic resonance imaging (MRI) in patients with cirrhosis. METHODS This cross-sectional study included 93 cirrhosis patients who underwent 1.5 or 3 T MCE MRI for evaluation of hepatocellular carcinoma (HCC). Two abdominal radiologists independently reviewed T1-, T2-, diffusion-weighted unenhanced images as well as MCE T1-weighted fat-suppressed images and reported liver observations using LI-RADS®. Concordance were recorded for detection (co-detected by both radiologists or not), size category (< 10; 10-19; ≥ 20 mm), and LI-RADS® category assignment as reportable (LR-3/4/5/M) and actionable (LR-4/5/M). The overall concordance (i.e., concordant in detection, size, and LR-category) was calculated with 95% confidence interval [CI], and separately for detection, size, and LR-category. Clinical significance of discordance was assessed as impact on follow-up imaging, referral for biopsy, liver transplant eligibility, or treatment modality. RESULTS Reportable and actionable observations were overall concordant between two radiologists only in 32.3% [24.6, 41.0] and 40.1% [29.5, 51.5] of cases, respectively. Poor overall concordance was related to detection concordance of 52.0% [44.3, 59.5] and 62.5% [52.3, 71.8], as well as LR-category concordance of 73.7% [61.6, 83.1] and 70.9% [57.3, 81.6], for reportable and actionable observations, respectively. Discordant LI-RADS® observations would have impacted clinical management in 30 subjects (43.5%), most (66.7%) of whom were due to discordant detection. CONCLUSION Discordant MRI LI-RADS® observations are common in patients with cirrhosis and may have potential implications for patient management.
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Affiliation(s)
- Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Amit G Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alberto Diaz de Leon
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - Lakshmi Ananthakrishnan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - David T Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9085, USA
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17
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Manassi M, Kristjánsson Á, Whitney D. Serial dependence in a simulated clinical visual search task. Sci Rep 2019; 9:19937. [PMID: 31882657 PMCID: PMC6934778 DOI: 10.1038/s41598-019-56315-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022] Open
Abstract
In everyday life, we continuously search for and classify objects in the environment around us. This kind of visual search is extremely important when performed by radiologists in cancer image interpretation and officers in airport security screening. During these tasks, observers often examine large numbers of uncorrelated images (tumor x-rays, checkpoint x-rays, etc.) one after another. An underlying assumption of such tasks is that search and recognition are independent of our past experience. Here, we simulated a visual search task reminiscent of medical image search and found that shape classification performance was strongly impaired by recent visual experience, biasing classification errors 7% more towards the previous image content. This perceptual attraction exhibited the three main tuning characteristics of Continuity Fields: serial dependence extended over 12 seconds back in time (temporal tuning), it occurred only between similar tumor-like shapes (feature tuning), and only within a limited spatial region (spatial tuning). Taken together, these results demonstrate that serial dependence influences shape perception and occurs in visual search tasks. They also raise the possibility of a detrimental impact of serial dependence in clinical and practically relevant settings, such as medical image perception.
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Affiliation(s)
- Mauro Manassi
- Department of Psychology University of California, Berkeley, CA, USA.
- School of Psychology, University of Aberdeen, Kings College, Aberdeen, UK.
| | - Árni Kristjánsson
- The Icelandic Vision Laboratory, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- School of Psychology, National Research University Higher School of Economics, Moscow, Russian Federation
| | - David Whitney
- Department of Psychology University of California, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
- Vision Science Group, University of California, Berkeley, CA, USA
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18
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Patel SH, Stanton CL, Miller SG, Patrie JT, Itri JN, Shepherd TM. Risk Factors for Perceptual-versus-Interpretative Errors in Diagnostic Neuroradiology. AJNR Am J Neuroradiol 2019; 40:1252-1256. [PMID: 31296527 DOI: 10.3174/ajnr.a6125] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/09/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diagnostic errors in radiology are classified as perception or interpretation errors. This study determined whether specific conditions differed when perception or interpretation errors occurred during neuroradiology image interpretation. MATERIALS AND METHODS In a sample of 254 clinical error cases in diagnostic neuroradiology, we classified errors as perception or interpretation errors, then characterized imaging technique, interpreting radiologist's experience, anatomic location of the abnormality, disease etiology, time of day, and day of the week. Interpretation and perception errors were compared with hours worked per shift, cases read per shift, average cases read per shift hour, and the order of case during the shift when the error occurred. RESULTS Perception and interpretation errors were 74.8% (n = 190) and 25.2% (n = 64) of errors, respectively. Logistic regression analyses showed that the odds of an interpretation error were 2 times greater (OR, 2.09; 95% CI, 1.05-4.15; P = .04) for neuroradiology attending physicians with ≤5 years of experience. Interpretation errors were more likely with MR imaging compared with CT (OR, 2.10; 95% CI, 1.09-4.01; P = .03). Infectious/inflammatory/autoimmune diseases were more frequently associated with interpretation errors (P = .04). Perception errors were associated with faster reading rates (6.01 versus 5.03 cases read per hour; P = .004) and occurred later during the shift (24th-versus-18th case; P = .04). CONCLUSIONS Among diagnostic neuroradiology error cases, interpretation-versus-perception errors are affected by the neuroradiologist's experience, technique, and the volume and rate of cases read. Recognition of these risk factors may help guide programs for error reduction in clinical neuroradiology services.
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Affiliation(s)
- S H Patel
- From the Departments of Radiology and Medical Imaging (S.H.P.)
| | - C L Stanton
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York
| | - S G Miller
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York
| | - J T Patrie
- Public Health Sciences (J.T.P.), University of Virginia Health System, Charlottesville, Virginia
| | - J N Itri
- Department of Radiology (J.N.I.), Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - T M Shepherd
- Department of Radiology (C.L.S., S.G.M., T.M.S.), New York University Langone Medical Center, New York, New York.,Center for Advanced Imaging Innovation and Research (T.M.S.), New York, New York
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19
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Waite S, Grigorian A, Alexander RG, Macknik SL, Carrasco M, Heeger DJ, Martinez-Conde S. Analysis of Perceptual Expertise in Radiology - Current Knowledge and a New Perspective. Front Hum Neurosci 2019; 13:213. [PMID: 31293407 PMCID: PMC6603246 DOI: 10.3389/fnhum.2019.00213] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/07/2019] [Indexed: 12/14/2022] Open
Abstract
Radiologists rely principally on visual inspection to detect, describe, and classify findings in medical images. As most interpretive errors in radiology are perceptual in nature, understanding the path to radiologic expertise during image analysis is essential to educate future generations of radiologists. We review the perceptual tasks and challenges in radiologic diagnosis, discuss models of radiologic image perception, consider the application of perceptual learning methods in medical training, and suggest a new approach to understanding perceptional expertise. Specific principled enhancements to educational practices in radiology promise to deepen perceptual expertise among radiologists with the goal of improving training and reducing medical error.
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Affiliation(s)
- Stephen Waite
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Arkadij Grigorian
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Robert G. Alexander
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Stephen L. Macknik
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Marisa Carrasco
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - David J. Heeger
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - Susana Martinez-Conde
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
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20
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Rutgers DR, van Raamt F, ten Cate TJ. Development of competence in volumetric image interpretation in radiology residents. BMC MEDICAL EDUCATION 2019; 19:122. [PMID: 31046749 PMCID: PMC6498553 DOI: 10.1186/s12909-019-1549-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND During residency, radiology residents learn to interpret volumetric radiological images. The development of their competence for volumetric image interpretation, as opposed to 2D image reading, is not completely understood. The purpose of the present study was to investigate how competence for volumetric image interpretation develops in radiology residents and how this compares with competence development for 2D image interpretation, by studying resident scores on image-based items in digital radiology tests. METHODS We reviewed resident scores on volumetric and 2D image-based test items in 9 consecutive semi-annual digital radiology tests that were carried out from November 2013 to April 2018. We assessed percentage-correct sum scores for all test items about volumetric images and for all test items about 2D images in each test as well as for all residents across the 9 tests (i.e. 4.5 years of test materials). We used a paired t-test to analyze whether scores differed between volumetric and 2D image-based test items in individual residents in postgraduate year (PGY) 0-5, subdivided in 10 half-year phases (PGY 0-0.5, 0.5-1.0, 1.0-1.5 et cetera). RESULTS The percentage-correct scores on volumetric and 2D image-based items showed a comparable trend of development, increasing in the first half of residency and flattening off in the second half. Chance-corrected scores were generally lower in volumetric than in 2D items (on average 1-5% points). In PGY 1.5-4.5, this score difference was statistically significant (p-values ranging from 0.02 to < 0.001), with the largest difference found in PGY 2.5 (mean: 5% points; 95% CI: -7.3 - -3.4). At the end of training in PGY 5, there was no statistically significant score difference between both item types. CONCLUSIONS The development of competence in volumetric image interpretation fits a similar curvilinear growth curve during radiology residency as 2D image interpretation competence in digital radiology tests. Although residents performed significantly lower on volumetric than 2D items in PGY 1.5-4.5, we consider the magnitude of this difference as relatively small for our educational setting and we suggest that throughout radiology training there are no relevant differences in the development of both types of competences, as investigated by digital radiology tests.
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Affiliation(s)
- D. R. Rutgers
- Department of Radiology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Radiological Society of the Netherlands, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - F. van Raamt
- Department of Radiology, Gelre Hospitals, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands
- Radiological Society of the Netherlands, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Th. J. ten Cate
- Center for Research and Development of Education, University Medical Center, P.O. Box # 85500, 3508 GA Utrecht, The Netherlands
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21
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McWade MA, Thomas G, Nguyen JQ, Sanders ME, Solórzano CC, Mahadevan-Jansen A. Enhancing Parathyroid Gland Visualization Using a Near Infrared Fluorescence-Based Overlay Imaging System. J Am Coll Surg 2019; 228:730-743. [PMID: 30769112 PMCID: PMC6487208 DOI: 10.1016/j.jamcollsurg.2019.01.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Misidentifying parathyroid glands (PGs) during thyroidectomies or parathyroidectomies could significantly increase postoperative morbidity. Imaging systems based on near infrared autofluorescence (NIRAF) detection can localize PGs with high accuracy. These devices, however, depict NIRAF images on remote display monitors, where images lack spatial context and comparability with actual surgical field of view. In this study, we designed an overlay tissue imaging system (OTIS) that detects tissue NIRAF and back-projects the collected signal as a visible image directly onto the surgical field of view instead of a display monitor, and tested its ability for enhancing parathyroid visualization. STUDY DESIGN The OTIS was first calibrated with a fluorescent ink grid and initially tested with parathyroid, thyroid, and lymph node tissues ex vivo. For in vivo measurements, the surgeon's opinion on tissue of interest was first ascertained. After the surgeon looked away, the OTIS back-projected visible green light directly onto the tissue of interest, only if the device detected relatively high NIRAF as observed in PGs. System accuracy was determined by correlating NIRAF projection with surgeon's visual confirmation for in situ PGs or histopathology report for excised PGs. RESULTS The OTIS yielded 100% accuracy when tested ex vivo with parathyroid, thyroid, and lymph node specimens. Subsequently, the device was evaluated in 30 patients who underwent thyroidectomy and/or parathyroidectomy. Ninety-seven percent of exposed tissue of interest was visualized correctly as PGs by the OTIS, without requiring display monitors or contrast agents. CONCLUSIONS Although OTIS holds novel potential for enhancing label-free parathyroid visualization directly within the surgical field of view, additional device optimization is required for eventual clinical use.
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Affiliation(s)
- Melanie A McWade
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Giju Thomas
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - John Q Nguyen
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Melinda E Sanders
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Carmen C Solórzano
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center, Department of Biomedical Engineering, Vanderbilt University, Nashville, TN.
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Dournes G, Bricault I, Chateil JF. Analysis of the French national evaluation of radiology residents. Diagn Interv Imaging 2018; 100:185-193. [PMID: 30527527 DOI: 10.1016/j.diii.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE In France, a national evaluation is given annually to radiology residents. The aim of this study was to perform both a docimological analysis of the quality of the questionnaire and a statistical analysis of the results. MATERIALS AND METHODS This retrospective study, which included French radiology residents from Year 1 to Year 5 of residency, was performed from 2015 to 2017 across 25 medical universities in France. Both qualitative and quantitative docimological analyses were performed as assessed by the Cronbach alpha coefficient, the difficulty of question (PDI), and the coefficient of discrimination (Rir). Results to the questionnaire were compared between years of residency. RESULTS The results of the analysis confirmed the quality of the questionnaire (Cronbach alpha coefficient=0.71, mean [PDI=0.40]) though the majority of questions could be answered by memory rather than cognitive ability. The mean Rir was 0.02, indicating that students could not be certified using only the questionnaire. The results measuring resident level of knowledge were moderate, with mean results ranging from 9.2/20 at the first year to 11.3/20 at the fifth year of residency (P<0.001). There were no significant differences in results obtained between the third, fourth, and fifth year of residency but results were significantly different among university hospitals. CONCLUSION Even if close interactions exist between learning and pedagogic environment, our results suggest that it may be useful to further develop an evaluation process in relation with pedagogic instructions in order to provide more optimal training.
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Affiliation(s)
- G Dournes
- Centre de recherche cardio-thoracique de Bordeaux, U1045, Bordeaux University, 33000 Bordeaux, France; Inserm, centre de recherche cardio-thoracique de Bordeaux, U1045, 33000 Bordeaux, France; Department of cardiovascular and thoracic imaging, CHU de Bordeaux, 33600 Pessac, France.
| | - I Bricault
- Department of medical imaging, hôpital Nord, CHU de Grenoble, 38043 Grenoble, France; Université Grenoble-Alpes, TIMC-IMAG, 38000 Grenoble, France
| | - J-F Chateil
- Department of pediatric imaging, CHU de Bordeaux, 33000 Bordeaux, France; Centre de résonance magnétique des systèmes biologiques, UMR 5536, Bordeaux University, 33076 Bordeaux, France
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Kyroudi A, Petersson K, Ozsahin M, Bourhis J, Bochud F, Moeckli R. Analysis of the treatment plan evaluation process in radiotherapy through eye tracking. Z Med Phys 2018; 28:318-324. [DOI: 10.1016/j.zemedi.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/08/2017] [Accepted: 11/21/2017] [Indexed: 11/25/2022]
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24
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Precht H, Gerke O, Thygesen J, Egstrup K, Auscher S, Waaler D, Lambrechtsen J. Image quality in coronary computed tomography angiography: influence of adaptive statistical iterative reconstruction at various radiation dose levels. Acta Radiol 2018; 59:1194-1202. [PMID: 29359950 DOI: 10.1177/0284185117753657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Computed tomography (CT) technology is rapidly evolving and software solution developed to optimize image quality and/or lower radiation dose. Purpose To investigate the influence of adaptive statistical iterative reconstruction (ASIR) at different radiation doses in coronary CT angiography (CCTA) in detailed image quality. Material and Methods A total of 160 CCTA were reconstructed as follows: 55 scans with filtered back projection (FBP) (650 mA), 51 scans (455 mA) with 30% ASIR (ASIR30), and 54 scans (295 mA) with 60% ASIR (ASIR60). For each reconstruction, subjective image quality was assessed by five independent certified cardiologists using a visual grading analysis (VGA) with five predefined image quality criteria consisting of a 5-point scale. Objective measures were contrast, noise, and contrast-to-noise ratio (CNR). Results The CTDIvol resulted in 10.3 mGy, 7.4 mGy, and 4.6 mGy for FBP, ASIR30, and ASIR60, respectively. Homogeneity of the left ventricular lumen was the sole aspect in which reconstruction algorithms differed with a decreasing effect for ASIR60 compared to FBP (estimated odds ratio [OR] = 0.49 [95% confidence interval (CI) = 0.32-0.76; P = 0.001]). Decreased sharpness and spatial- and low-contrast resolutions were observed when using ASIR instead of FBP, but differences were not statistically significant. Concerning objective measurements, noise increased significantly for ASIR30 (OR = 1.08; 95% CI = 1.02-1.14; P = 0.006) and ASIR60 (OR = 1.06; 95% CI = 1.01-1.12; P = 0.034) compared to FBP. Conclusion ASIR significantly decreased the subjectively assessed homogeneity of the left ventricular lumen and increased the objectively measured noise compared to FBP. Considering these results, ASIR at a reduced radiation dose should be implemented with caution.
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Affiliation(s)
- Helle Precht
- 1 Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
- 2 Conrad Research Center, University College Lillebelt, Odense, Denmark
| | - Oke Gerke
- 3 Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- 4 Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Thygesen
- 5 Department of Clinical Engineering, Central Denmark Region, Århus, Denmark
| | - Kenneth Egstrup
- 1 Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Søren Auscher
- 1 Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Dag Waaler
- 6 Norwegian University of Science and Technology, Gjøvik, Norway
| | - Jess Lambrechtsen
- 1 Department of Medical Research, Odense University Hospital Svendborg, Svendborg, Denmark
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den Boer L, van der Schaaf MF, Vincken KL, Mol CP, Stuijfzand BG, van der Gijp A. Volumetric image interpretation in radiology: scroll behavior and cognitive processes. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:783-802. [PMID: 29767400 PMCID: PMC6132416 DOI: 10.1007/s10459-018-9828-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 05/07/2018] [Indexed: 05/12/2023]
Abstract
The interpretation of medical images is a primary task for radiologists. Besides two-dimensional (2D) images, current imaging technologies allow for volumetric display of medical images. Whereas current radiology practice increasingly uses volumetric images, the majority of studies on medical image interpretation is conducted on 2D images. The current study aimed to gain deeper insight into the volumetric image interpretation process by examining this process in twenty radiology trainees who all completed four volumetric image cases. Two types of data were obtained concerning scroll behaviors and think-aloud data. Types of scroll behavior concerned oscillations, half runs, full runs, image manipulations, and interruptions. Think-aloud data were coded by a framework of knowledge and skills in radiology including three cognitive processes: perception, analysis, and synthesis. Relating scroll behavior to cognitive processes showed that oscillations and half runs coincided more often with analysis and synthesis than full runs, whereas full runs coincided more often with perception than oscillations and half runs. Interruptions were characterized by synthesis and image manipulations by perception. In addition, we investigated relations between cognitive processes and found an overall bottom-up way of reasoning with dynamic interactions between cognitive processes, especially between perception and analysis. In sum, our results highlight the dynamic interactions between these processes and the grounding of cognitive processes in scroll behavior. It suggests, that the types of scroll behavior are relevant to describe how radiologists interact with and manipulate volumetric images.
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Affiliation(s)
- Larissa den Boer
- Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands.
| | | | - Koen L Vincken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris P Mol
- University Medical Center Utrecht, Utrecht, The Netherlands
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Tolsgaard MG. A multiple-perspective approach for the assessment and learning of ultrasound skills. PERSPECTIVES ON MEDICAL EDUCATION 2018; 7:211-213. [PMID: 29663275 PMCID: PMC6002291 DOI: 10.1007/s40037-018-0419-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Ultrasound has become a core skill in many specialties. We evaluated the learning and assessment of ultrasound skills in Obstetrics-Gynaecology in a series of eight studies. In the clinical setting, we found that trainees as well as experienced clinicians struggle with technical aspects of performance such as image optimization. We examined how to improve these aspects of performance in the simulated setting by determining mastery learning levels and exploring learning curves for novices. We then examined how to improve the efficiency of training as well as transfer of learning through the use of dyad practice as compared with single practice. We found that the use of simulation-based training focusing on technical aspects of performance in addition to clinical training led to sustained improvements in performance after two months of clinical training in all aspects of performance. In addition, we found an interaction effect between initial simulation-based training and subsequent clinical training on trainees' need for supervision. These findings suggest that simulation-based training can work as preparation for future learning rather than merely as added learning. Finally, we found that the use of simulation-based initial training led to a large decrease in patients' discomfort, improvements in their perceived safety and confidence in their ultrasound operator. However, simulation-based training comes at a cost and in the final study we developed a model for conducting cost-effectiveness studies and provided data from an example study on how to link training costs with quality of care.
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Salkowski LR, Russ R. Cognitive processing differences of experts and novices when correlating anatomy and cross-sectional imaging. J Med Imaging (Bellingham) 2018; 5:031411. [PMID: 29795777 DOI: 10.1117/1.jmi.5.3.031411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/23/2018] [Indexed: 01/15/2023] Open
Abstract
The ability to correlate anatomical knowledge and medical imaging is crucial to radiology and as such, should be a critical component of medical education. However, we are hindered in our ability to teach this skill because we know very little about what expert practice looks like, and even less about novices' understanding. Using a unique simulation tool, this research conducted cognitive clinical interviews with experts and novices to explore differences in how they engage in this correlation and the underlying cognitive processes involved in doing so. This research supported what has been known in the literature, that experts are significantly faster at making decisions on medical imaging than novices. It also offers insight into the spatial ability and reasoning that is involved in the correlation of anatomy to medical imaging. There are differences in the cognitive processing of experts and novices with respect to meaningful patterns, organized content knowledge, and the flexibility of retrieval. Presented are some novice-expert similarities and differences in image processing. This study investigated extremes, opening an opportunity to investigate the sequential knowledge acquisition from student to resident to expert, and where educators can help intervene in this learning process.
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Affiliation(s)
- Lonie R Salkowski
- University of Wisconsin, School of Medicine and Public Health, Department of Radiology, Madison, Wisconsin, United States.,University of Wisconsin, School of Medicine and Public Health, Department of Medical Physics, Madison, Wisconsin, United States
| | - Rosemary Russ
- University of Wisconsin, School of Education, Department of Curriculum and Instruction, Madison, Wisconsin, United States
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Mustafa A, Seeley J, Munirama S, Columb M, McKendrick M, Schwab A, Corner G, Eisma R, Mcleod G. Investigation into the visual perceptive ability of anaesthetists during ultrasound-guided interscalene and femoral blocks conducted on soft embalmed cadavers: a randomised single-blind study. Br J Anaesth 2018; 120:854-859. [DOI: 10.1016/j.bja.2017.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 11/29/2022] Open
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Eckstein MP, Lago MA, Abbey CK. Evaluation of Search Strategies for Microcalcifications and Masses in 3D Images. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10577:105770C. [PMID: 32435079 PMCID: PMC7237824 DOI: 10.1117/12.2293871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Medical imaging is quickly evolving towards 3D image modalities such as computed tomography (CT), magnetic resonance imaging (MRI) and digital breast tomosynthesis (DBT). These 3D image modalities add volumetric information but further increase the need for radiologists to search through the image data set. Although much is known about search strategies in 2D images less is known about the functional consequences of different 3D search strategies. We instructed readers to use two different search strategies: drillers had their eye movements restricted to a few regions while they quickly scrolled through the image stack, scanners explored through eye movements the 2D slices. We used real-time eye position monitoring to ensure observers followed the drilling or the scanning strategy while approximately preserving the percentage of the volumetric data covered by the useful field of view. We investigated search for two signals: a simulated microcalcification and a larger simulated mass. Results show an interaction between the search strategy and lesion type. In particular, scanning provided significantly better detectability for microcalcifications at the cost of 5 times more time to search while there was little change in the detectability for the larger simulated masses. Analyses of eye movements support the hypothesis that the effectiveness of a search strategy in 3D imaging arises from the interaction of the fixational sampling of visual information and the signals' visibility in the visual periphery.
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Affiliation(s)
- Miguel P Eckstein
- Department of Psychological and Brain Sciences, University of California, Santa Barbara
| | - Miguel A Lago
- Department of Psychological and Brain Sciences, University of California, Santa Barbara
| | - Craig K Abbey
- Department of Psychological and Brain Sciences, University of California, Santa Barbara
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Kompaniez-Dunigan E, Abbey CK, Boone JM, Webster MA. Visual adaptation and the amplitude spectra of radiological images. COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2018; 3:3. [PMID: 29399622 PMCID: PMC5783991 DOI: 10.1186/s41235-018-0089-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022]
Abstract
We examined how visual sensitivity and perception are affected by adaptation to the characteristic amplitude spectra of X-ray mammography images. Because of the transmissive nature of X-ray photons, these images have relatively more low-frequency variability than natural images, a difference that is captured by a steeper slope of the amplitude spectrum (~ − 1.5) compared to the ~ 1/f (slope of − 1) spectra common to natural scenes. Radiologists inspecting these images are therefore exposed to a different balance of spectral components, and we measured how this exposure might alter spatial vision. Observers (who were not radiologists) were adapted to images of normal mammograms or the same images sharpened by filtering the amplitude spectra to shallower slopes. Prior adaptation to the original mammograms significantly biased judgments of image focus relative to the sharpened images, demonstrating that the images are sufficient to induce substantial after-effects. The adaptation also induced strong losses in threshold contrast sensitivity that were selective for lower spatial frequencies, though these losses were very similar to the threshold changes induced by the sharpened images. Visual search for targets (Gaussian blobs) added to the images was also not differentially affected by adaptation to the original or sharper images. These results complement our previous studies examining how observers adapt to the textural properties or phase spectra of mammograms. Like the phase spectrum, adaptation to the amplitude spectrum of mammograms alters spatial sensitivity and visual judgments about the images. However, unlike the phase spectrum, adaptation to the amplitude spectra did not confer a selective performance advantage relative to more natural spectra.
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Affiliation(s)
| | - Craig K Abbey
- 2Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA USA
| | - John M Boone
- 3Department of Radiology and Biomeidcal Engineering, University of California, Davis, CA USA
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Biscontine AC, Diliberto AJ, Hatton JF, Woodmansey KF. Intraradicular Appearances Affect Radiographic Interpretation of the Periapical Area. J Endod 2017; 43:2014-2019. [PMID: 29061353 DOI: 10.1016/j.joen.2017.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION No research exists evaluating the influences of specific variables such as obturation length, radiodensity, or the presence of voids on interpretation of periradicular area. The purpose of this study was to evaluate the effects of obturation length, radiodensity, and the presence of voids on the radiographic interpretations of periapical areas. METHODS In a Web-based survey, 3 test image groups of variable obturation lengths, radiodensities, and numbers of voids were presented to observers for evaluation of the periapical areas. Intracanal areas of the images were altered by using Adobe Photoshop to create 3 test image groups. Each observer reviewed 2 control images and 1 image from each test image group. Responses were recorded in a 5-point Likert-type scale. Within each test image group, the periapical areas were identical. Kruskal-Wallis, Mann-Whitney U, and Cliff's delta statistical tests were used to analyze results. RESULTS A total of 748 observer responses were analyzed. Significant differences (P ≤ .01) in the median Likert-type scale responses were identified between the following paired groups: 3 mm short and 1 mm short, 3 mm short and flush, lower radiodensity and higher radiodensity, lower radiodensity and intermediate radiodensity, no voids and several voids, and several voids and single void. Effect sizes ranged from 0.19 to 0.41. CONCLUSIONS Significant differences were noted within all 3 test image groups: length, radiodensity, and presence of voids. Length of obturation had the largest effect on interpretation of the periapical area, with the 3 mm short radiographic obturation length image interpreted less favorably.
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Affiliation(s)
| | - Adam J Diliberto
- Center for Advanced Dental Education, Saint Louis University, St Louis, Missouri
| | - John F Hatton
- Center for Advanced Dental Education, Saint Louis University, St Louis, Missouri
| | - Karl F Woodmansey
- Center for Advanced Dental Education, Saint Louis University, St Louis, Missouri.
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Ravesloot CJ, van der Schaaf MF, Kruitwagen CLJJ, van der Gijp A, Rutgers DR, Haaring C, ten Cate O, van Schaik JPJ. Predictors of Knowledge and Image Interpretation Skill Development in Radiology Residents. Radiology 2017; 284:758-765. [DOI: 10.1148/radiol.2017152648] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Cécile J. Ravesloot
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Marieke F. van der Schaaf
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Cas L. J. J. Kruitwagen
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Anouk van der Gijp
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Dirk R. Rutgers
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Cees Haaring
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Olle ten Cate
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Jan P. J. van Schaik
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
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A method to determine the impact of reduced visual function on nodule detection performance. Radiography (Lond) 2017; 23:19-24. [DOI: 10.1016/j.radi.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/20/2022]
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Waite S, Kolla S, Jeudy J, Legasto A, Macknik SL, Martinez-Conde S, Krupinski EA, Reede DL. Tired in the Reading Room: The Influence of Fatigue in Radiology. J Am Coll Radiol 2016; 14:191-197. [PMID: 27956140 DOI: 10.1016/j.jacr.2016.10.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Commonly conflated with sleepiness, fatigue is a distinct multidimensional condition with physical and mental effects. Fatigue in health care providers and any secondary effects on patient care are an important societal concern. As medical image interpretation is highly dependent on visual input, visual fatigue is of particular interest to radiologists. Humans analyze their surroundings with rapid eye movements called saccades, and fatigue decreases saccadic velocity. Oculomotor parameters may, therefore, be an objective and reproducible metric of fatigue and eye movement analysis can provide valuable insight into the etiology of fatigue-related error.
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Affiliation(s)
- Stephen Waite
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York.
| | - Srinivas Kolla
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Jean Jeudy
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Alan Legasto
- Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Stephen L Macknik
- Departments of Ophthalmology, Neurology, Physiology, and Pharmacology, SUNY Downstate Medical Center, Brooklyn, New York
| | - Susana Martinez-Conde
- Departments of Ophthalmology, Neurology, Physiology, and Pharmacology, SUNY Downstate Medical Center, Brooklyn, New York
| | | | - Deborah L Reede
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, New York
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Medical students' cognitive load in volumetric image interpretation: Insights from human-computer interaction and eye movements. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Movahhedian N, Adibi S, Tavakoli HS, Baseri H. How does triangular-shaped radiolucency affect caries diagnosis? Oral Radiol 2016. [DOI: 10.1007/s11282-016-0243-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Auffermann WF, Little BP, Tridandapani S. Teaching search patterns to medical trainees in an educational laboratory to improve perception of pulmonary nodules. J Med Imaging (Bellingham) 2015; 3:011006. [PMID: 26870749 DOI: 10.1117/1.jmi.3.1.011006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/29/2015] [Indexed: 11/14/2022] Open
Abstract
The goal of this research is to demonstrate that teaching healthcare trainees a formal search or scan pattern for evaluation of the lungs improves their ability to identify pulmonary nodules on chest radiographs (CXRs). A group of physician assistant trainees were randomly assigned to control and experimental groups. Each group was shown two sets of CXRs, each set with a nodule prevalence of approximately 50%. The experimental group received search pattern training between case sets, whereas the control group did not. Both groups were asked to mark nodules when present and indicate their diagnostic confidence. Subject performance at nodule detection was quantified using changes in area under the localization receiver operating characteristic curve ([Formula: see text]). There was no significant improvement in performance between case sets for the control group. There was a significant improvement in subject performance after training for the experimental group, [Formula: see text], [Formula: see text]. These results demonstrate that teaching a search pattern to trainees improves their ability to identify nodules and decreases the number of perceptual errors in nodule identification, and suggest that our knowledge of medical image perception may be used to develop rational tools for the education of healthcare trainees.
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Affiliation(s)
- William F Auffermann
- Emory University School of Medicine , Department of Radiology and Imaging Sciences, 1365 Clifton Road NE, Atlanta, Georgia 30322, United States
| | - Brent P Little
- Emory University School of Medicine , Department of Radiology and Imaging Sciences, 1365 Clifton Road NE, Atlanta, Georgia 30322, United States
| | - Srini Tridandapani
- Georgia Institute of Technology, School of Electrical and Computer Engineering, 777 Atlantic Drive NW, Atlanta, Georgia 30332, United States; Emory University School of Medicine, Winship Cancer Institute, Department of Radiology and Imaging Sciences, 1701 Uppergate Drive NE, Atlanta, Georgia 30332, United States
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Auffermann WF, Henry TS, Little BP, Tigges S, Tridandapani S. Simulation for Teaching and Assessment of Nodule Perception on Chest Radiography in Nonradiology Health Care Trainees. J Am Coll Radiol 2015; 12:1215-22. [DOI: 10.1016/j.jacr.2015.07.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
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Cognitive Themes Emerging from Air Photo Interpretation Texts Published to 1960. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2015. [DOI: 10.3390/ijgi4020551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Faruque J, Beaulieu CF, Rosenberg J, Rubin DL, Yao D, Napel S. Content-based image retrieval in radiology: analysis of variability in human perception of similarity. J Med Imaging (Bellingham) 2015; 2:025501. [PMID: 26158112 DOI: 10.1117/1.jmi.2.2.025501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/10/2015] [Indexed: 11/14/2022] Open
Abstract
We aim to develop a better understanding of perception of similarity in focal computed tomography (CT) liver images to determine the feasibility of techniques for developing reference sets for training and validating content-based image retrieval systems. In an observer study, four radiologists and six nonradiologists assessed overall similarity and similarity in 5 image features in 136 pairs of focal CT liver lesions. We computed intra- and inter-reader agreements in these similarity ratings and viewed the distributions of the ratings. The readers' ratings of overall similarity and similarity in each feature primarily appeared to be bimodally distributed. Median Kappa scores for intra-reader agreement ranged from 0.57 to 0.86 in the five features and from 0.72 to 0.82 for overall similarity. Median Kappa scores for inter-reader agreement ranged from 0.24 to 0.58 in the five features and were 0.39 for overall similarity. There was no significant difference in agreement for radiologists and nonradiologists. Our results show that developing perceptual similarity reference standards is a complex task. Moderate to high inter-reader variability precludes ease of dividing up the workload of rating perceptual similarity among many readers, while low intra-reader variability may make it possible to acquire large volumes of data by asking readers to view image pairs over many sessions.
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Affiliation(s)
- Jessica Faruque
- Stanford University , Department of Electrical Engineering, 350 Serra Mall, Stanford, California 94305, United States
| | - Christopher F Beaulieu
- Stanford University Medical Center , Department of Radiology, 300 Pasteur Drive, Room S078, MC 5105, Stanford, California 94305, United States
| | - Jarrett Rosenberg
- Stanford University , Department of Radiology, Lucas MRS Imaging Center, 1201 Welch Road, Room P-280, Stanford, California 94305-5488, United States
| | - Daniel L Rubin
- Stanford University , Departments of Radiology and Medicine (Biomedical Informatics), Richard M. Lucas Center P285, 1201 Welch Road, Stanford, California 94305-5488, United States
| | - Dorcas Yao
- Stanford University , Department of Radiology, 3801 Miranda Avenue, Palo Alto, California 94304-1290, United States
| | - Sandy Napel
- Stanford University , Department of Radiology, James H. Clark Center, 318 Campus Drive, W3.1, Stanford, California 94305-5441, United States
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Cruz AD, Lobo IC, Lemos ALB, Aguiar MF. Evaluation of low-contrast perceptibility in dental restorative materials under the influence of ambient light conditions. Dentomaxillofac Radiol 2015; 44:20140360. [PMID: 25629721 DOI: 10.1259/dmfr.20140360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES This study aimed to assess how details on dental restorative composites with different radio-opacities are perceived under the influence of ambient light. METHODS Resin composite step wedges (six steps, each 1-mm thick) were custom manufactured from three materials, respectively: (M1) Filtek™ Z350 (3M/ESPE, Saint Paul, MN); (M2) Prisma AP.H™ (Dentsply International Inc., Brazil) and (M3) Glacier(®) (SDI Limited, Victoria, Australia). Each step of the manufactured wedge received three standardized drillings of different diameters and depths. An aluminium (Al) step wedge with 12 steps (1-mm thick) was used as an internal standard to calculate the radio-opacity as pixel intensity values. Standardized digital images of the set were obtained, and 11 observers independently recorded the images, noting the number of noticeable details (drillings) under 2 dissimilar conditions: in a light environment (light was turned on in the room) and in low-light conditions (light in the room was turned off). The differences between images in terms of the number of details that were observed were statistically compared using ANOVA, Cronbach's alpha coefficient and Wilcoxon and Kruskal-Wallis tests, with a significance level setting of 5% (α = 0.05). RESULTS The M2 showed higher radio-opacity, the M1 displayed intermediate radio-opacity and the M3 showed lower radio-opacity, respectively; however, all three were without significance (p > 0.05) compared with each other. The differences in radio-opacity resulted in a significant variation (p < 0.05) in the number of noticeable details in the image, which were influenced by characteristics of details, in addition to the ambient-light level. CONCLUSIONS The radio-opacity of materials and ambient light can affect the perception of details in digital radiographic images.
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Affiliation(s)
- A D Cruz
- 1 Department of Specific Formation, Area of Dental Radiology, Dental School of the Fluminense Federal University, Rio de Janeiro, Brazil
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Williams S, Hackney L, Hogg P, Szczepura K. Breast tissue bulge and lesion visibility during stereotactic biopsy – A phantom study. Radiography (Lond) 2014. [DOI: 10.1016/j.radi.2014.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Depeursinge A, Kurtz C, Beaulieu CF, Napel S, Rubin DL. Predicting visual semantic descriptive terms from radiological image data: preliminary results with liver lesions in CT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1669-76. [PMID: 24808406 PMCID: PMC4129229 DOI: 10.1109/tmi.2014.2321347] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We describe a framework to model visual semantics of liver lesions in CT images in order to predict the visual semantic terms (VST) reported by radiologists in describing these lesions. Computational models of VST are learned from image data using linear combinations of high-order steerable Riesz wavelets and support vector machines (SVM). In a first step, these models are used to predict the presence of each semantic term that describes liver lesions. In a second step, the distances between all VST models are calculated to establish a nonhierarchical computationally-derived ontology of VST containing inter-term synonymy and complementarity. A preliminary evaluation of the proposed framework was carried out using 74 liver lesions annotated with a set of 18 VSTs from the RadLex ontology. A leave-one-patient-out cross-validation resulted in an average area under the ROC curve of 0.853 for predicting the presence of each VST. The proposed framework is expected to foster human-computer synergies for the interpretation of radiological images while using rotation-covariant computational models of VSTs to 1) quantify their local likelihood and 2) explicitly link them with pixel-based image content in the context of a given imaging domain.
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Affiliation(s)
- Adrien Depeursinge
- Department of Radiology of the School of Medicine, Stanford University, CA, USA
| | - Camille Kurtz
- Department of Radiology of the School of Medicine, Stanford University, CA, USA
- C. Kurtz is also with the LIPADE (EA2517), University Paris Descartes, France
| | | | - Sandy Napel
- Department of Radiology of the School of Medicine, Stanford University, CA, USA
| | - Daniel L. Rubin
- Department of Radiology of the School of Medicine, Stanford University, CA, USA
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Tolsgaard MG, Rasmussen MB, Tappert C, Sundler M, Sorensen JL, Ottesen B, Ringsted C, Tabor A. Which factors are associated with trainees' confidence in performing obstetric and gynecological ultrasound examinations? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:444-51. [PMID: 24105723 DOI: 10.1002/uog.13211] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/28/2013] [Accepted: 09/04/2013] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To explore the association between clinical training characteristics and trainees' level of confidence in performing ultrasound scans independently. METHODS A cross-sectional e-survey was distributed to members of the national societies of junior obstetricians/gynecologists in Denmark, Sweden and Norway (n = 973). Multiple linear regression models were used to explore the effect that amount of time spent in specialized ultrasound units and clinical experience had on trainees' confidence in performing ultrasonography independently. Exploratory factor analysis was used to identify factors that contributed to trainees' confidence in performing ultrasonography. Trainees' ultrasound confidence was finally compared with their expected levels of performance. RESULTS Of the 682 respondents (response rate 70.1%), 621 met the inclusion criteria. Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently (P < 0.001). Trainees required more than 24 months of clinical experience and 12-24 days of training in specialized ultrasound units in order to feel confident about performing transvaginal and transabdominal ultrasound scans independently. Three factors were related to ultrasound confidence: technical aspects, image perception and integration of scan into patient care. There were significant differences between trainees' level of confidence and their expected levels of performance (P < 0.001). CONCLUSIONS Clinical experience and time spent in specialized ultrasound units were predictors of trainees' confidence in performing ultrasonography independently. Discrepancies between trainees' confidence and their expected levels of performance raised concerns about the adequacy of current ultrasound training programs.
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Affiliation(s)
- M G Tolsgaard
- Department of Obstetrics, Juliane Marie Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Kompaniez E, Abbey CK, Boone JM, Webster MA. Adaptation aftereffects in the perception of radiological images. PLoS One 2013; 8:e76175. [PMID: 24146833 PMCID: PMC3795775 DOI: 10.1371/journal.pone.0076175] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/23/2013] [Indexed: 11/19/2022] Open
Abstract
Radiologists must classify and interpret medical images on the basis of visual inspection. We examined how the perception of radiological scans might be affected by common processes of adaptation in the visual system. Adaptation selectively adjusts sensitivity to the properties of the stimulus in current view, inducing an aftereffect in the appearance of stimuli viewed subsequently. These perceptual changes have been found to affect many visual attributes, but whether they are relevant to medical image perception is not well understood. To examine this we tested whether aftereffects could be generated by the characteristic spatial structure of radiological scans, and whether this could bias their appearance along dimensions that are routinely used to classify them. Measurements were focused on the effects of adaptation to images of normal mammograms, and were tested in observers who were not radiologists. Tissue density in mammograms is evaluated visually and ranges from "dense" to "fatty." Arrays of images varying in intermediate levels between these categories were created by blending dense and fatty images with different weights. Observers first adapted by viewing image samples of dense or fatty tissue, and then judged the appearance of the intermediate images by using a texture matching task. This revealed pronounced perceptual aftereffects - prior exposure to dense images caused an intermediate image to appear more fatty and vice versa. Moreover, the appearance of the adapting images themselves changed with prolonged viewing, so that they became less distinctive as textures. These aftereffects could not be accounted for by the contrast differences or power spectra of the images, and instead tended to follow from the phase spectrum. Our results suggest that observers can selectively adapt to the properties of radiological images, and that this selectivity could strongly impact the perceived textural characteristics of the images.
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Affiliation(s)
- Elysse Kompaniez
- Department of Psychology, University of Nevada, Reno, Nevada, United States of America
| | - Craig K. Abbey
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California, United States of America
- Department of Radiology, Medical Center, University of California Davis, Sacramento, California, United States of America
| | - John M. Boone
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States of America
- Department of Radiology, Medical Center, University of California Davis, Sacramento, California, United States of America
| | - Michael A. Webster
- Department of Psychology, University of Nevada, Reno, Nevada, United States of America
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Lamb CR, Dale VH. APPROACHES TO INSPECTING COMPUTED TOMOGRAPHIC AND MAGNETIC RESONANCE STUDIES. Vet Radiol Ultrasound 2013; 54:478-88. [DOI: 10.1111/vru.12064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/29/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Christopher R. Lamb
- Department of Clinical Sciences and Services; The Royal Veterinary College, University of London; North Mymms; Hertfordshire; AL9 7TA; U.K
| | - Vicki H.M. Dale
- LIVE Centre for Excellence in Lifelong and Independent Veterinary Education; The Royal Veterinary College, University of London; North Mymms; Hertfordshire; AL9 7TA; U.K
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Tolsgaard MG, Todsen T, Sorensen JL, Ringsted C, Lorentzen T, Ottesen B, Tabor A. International multispecialty consensus on how to evaluate ultrasound competence: a Delphi consensus survey. PLoS One 2013; 8:e57687. [PMID: 23469051 PMCID: PMC3585207 DOI: 10.1371/journal.pone.0057687] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/24/2013] [Indexed: 11/24/2022] Open
Abstract
Objectives To achieve international consensus across multiple specialties on a generic ultrasound rating scale using a Delphi technique. Methods Ultrasound experts from Obstetrics-Gynaecology, Surgery, Urology, Radiology, Rheumatology, Emergency Medicine, and Gastro-Enterology representing North America, Australia, and Europe were identified. A multi-round survey was conducted to obtain consensus between these experts. Of 60 invited experts, 44 experts agreed to participate in the first Delphi round, 41 remained in the second round, and 37 completed the third Delphi round. Seven key elements of the ultrasound examination were identified from existing literature and recommendations from international ultrasound societies. All experts rated the importance of these seven elements on a five-point Likert scale in the first round and suggested potential new elements for the assessment of ultrasound skills. In the second round, the experts re-rated all elements and a third round was conducted to allow final comments. Agreement on which elements to include in the final rating scale was pre-defined as more than 80% of the experts rating an element four or five, on importance to the ultrasound examination. Results Two additional elements were suggested by more than 10% of the experts in the first Delphi round. Consensus was obtained to include these two new elements along with five of the original elements in the final assessment instrument: 1) Indication for the examination 2) Applied knowledge of ultrasound equipment 3) Image optimization 4) Systematic examination 5) Interpretation of images 6) Documentation of examination and 7) Medical decision making. Conclusion International multispecialty consensus was achieved on the content of a generic ultrasound rating scale. This is the first step to ensure valid assessment of clinicians in different medical specialties using ultrasound.
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Affiliation(s)
- Martin G Tolsgaard
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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