Rapid perceptual processing in two- and three-dimensional prostate images

Dissonance Between Law Courts and the Science of Visual Perception in Medical Imaging

Lawsuits for spending too little time interpreting each radiological image are a vexatious charge to level against a radiologist in medical malpractice court. In this article, we recount two medicolegal cases where the defendant radiologists were accused of missing a life-threatening diagnosis due to not spending enough time reviewing each image. We consider the literature in vision sciences, visual perception in radiology and interpretive biases to demonstrate that using reading speed as evidence of negligence in a malpractice court represents in incorrect understanding of how radiologists perceive images, including three-dimensional volumetric studies.

Statistical feature training improves fingerprint-matching accuracy in novices and professional fingerprint examiners

Forensic science practitioners compare visual evidence samples (e.g. fingerprints) and decide if they originate from the same person or different people (i.e. fingerprint ‘matching’). These tasks are perceptually and cognitively complex—even practising professionals can make errors—and what limited research exists suggests that existing professional training is ineffective. This paper presents three experiments that demonstrate the benefit of perceptual training derived from mathematical theories that suggest statistically rare features have diagnostic utility in visual comparison tasks. Across three studies (N = 551), we demonstrate that a brief module training participants to focus on statistically rare fingerprint features improves fingerprint-matching performance in both novices and experienced fingerprint examiners. These results have applied importance for improving the professional performance of practising fingerprint examiners, and even other domains where this technique may also be helpful (e.g. radiology or banknote security).

Comparable prediction of breast cancer risk from a glimpse or a first impression of a mammogram

Expert radiologists can discern normal from abnormal mammograms with above-chance accuracy after brief (e.g. 500 ms) exposure. They can even predict cancer risk viewing currently normal images (priors) from women who will later develop cancer. This involves a rapid, global, non-selective process called “gist extraction”. It is not yet known whether prolonged exposure can strengthen the gist signal, or if it is available solely in the early exposure. This is of particular interest for the priors that do not contain any localizable signal of abnormality. The current study compared performance with brief (500 ms) or unlimited exposure for four types of mammograms (normal, abnormal, contralateral, priors). Groups of expert radiologists and untrained observers were tested. As expected, radiologists outperformed naïve participants. Replicating prior work, they exceeded chance performance though the gist signal was weak. However, we found no consistent performance differences in radiologists or naïves between timing conditions. Exposure time neither increased nor decreased ability to identify the gist of abnormality or predict cancer risk. If gist signals are to have a place in cancer risk assessments, more efforts should be made to strengthen the signal.

Characteristics of expert search behavior in volumetric medical image interpretation

Purpose: Experienced radiologists have enhanced global processing ability relative to novices, allowing experts to rapidly detect medical abnormalities without performing an exhaustive search. However, evidence for global processing models is primarily limited to two-dimensional image interpretation, and it is unclear whether these findings generalize to volumetric images, which are widely used in clinical practice. We examined whether radiologists searching volumetric images use methods consistent with global processing models of expertise. In addition, we investigated whether search strategy (scanning/drilling) differs with experience level. Approach: Fifty radiologists with a wide range of experience evaluated chest computed-tomography scans for lung nodules while their eye movements and scrolling behaviors were tracked. Multiple linear regressions were used to determine: (1) how search behaviors differed with years of experience and the number of chest CTs evaluated per week and (2) which search behaviors predicted better performance. Results: Contrary to global processing models based on 2D images, experience was unrelated to measures of global processing (saccadic amplitude, coverage, time to first fixation, search time, and depth passes) in this task. Drilling behavior was associated with better accuracy than scanning behavior when controlling for observer experience. Greater image coverage was a strong predictor of task accuracy. Conclusions: Global processing ability may play a relatively small role in volumetric image interpretation, where global scene statistics are not available to radiologists in a single glance. Rather, in volumetric images, it may be more important to engage in search strategies that support a more thorough search of the image.