Reader error, object recognition, and visual search

Small abnormalities such as hairline fractures, lung nodules and breast tumors are missed by competent radiologists with sufficient frequency to make them a matter of concern to the medical community; not only because they lead to litigation but also because they delay patient care. It is very easy to attribute misses to incompetence or inattention. To do so may be placing an unjustified stigma on the radiologists involved and may allow other radiologists to continue a false optimism that it can never happen to them. This review presents some of the fundamentals of visual system function that are relevant to understanding the search for and the recognition of small targets embedded in complicated but meaningful backgrounds like chests and mammograms. It presents a model for visual search that postulates a pre-attentive global analysis of the retinal image followed by foveal checking fixations and eventually discovery scanning. The model will be used to differentiate errors of search, recognition and decision making. The implications for computer aided diagnosis and for functional workstation design are discussed.

[1]  Adrian Moise,et al.  Radiology workstation design for the medical intensive care unit. , 2002, Journal of digital imaging.

[2]  R. C. Murry,et al.  The effect of search time on perception. , 1981, Radiology.

[3]  H L Kundel,et al.  Mechanism of satisfaction of search: eye position recordings in the reading of chest radiographs. , 1995, Radiology.

[4]  J. Yerushalmy.  The statistical assessment of the variability in observer perception and description of roentgenographic pulmonary shadows. , 1969, Radiologic clinics of North America.

[5]  H L Kundel,et al.  Visual search patterns and experience with radiological images. , 1972, Radiology.

[6]  E. Conant,et al.  How experience and training influence mammography expertise. , 1999, Academic radiology.

[7]  H L Kundel,et al.  The influence of prior knowledge on visual search strategies during the viewing of chest radiographs. , 1969, Radiology.

[8]  John A. Campbell.  Error and Variation in Diagnostic Radiology , 1968 .

[9]  K. Berbaum,et al.  Error in radiology: classification and lessons in 182 cases presented at a problem case conference. , 1992, Radiology.

[10]  H L Kundel,et al.  Visual scanning, pattern recognition and decision-making in pulmonary nodule detection. , 1978, Investigative radiology.

[11]  W F Taylor,et al.  Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. , 2015, The American review of respiratory disease.

[12]  W. C. Ball,et al.  Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. , 2015, The American review of respiratory disease.

[13]  C J Baines,et al.  The role of the reference radiologist. Estimates of inter-observer agreement and potential delay in cancer detection in the national breast screening study. , 1990, Investigative radiology.

[14]  K S Berbaum,et al.  Role of faulty decision making in the satisfaction of search effect in chest radiography. , 2000, Academic radiology.

[15]  K. Berbaum,et al.  Satisfaction of search in diagnostic radiology. , 1989, Investigative radiology.

[16]  Roy R. Behrens,et al.  On Visual Art and Camouflage , 1978 .

[17]  E. Krupinski,et al.  Searching for lung nodules. Visual dwell indicates locations of false-positive and false-negative decisions. , 1989, Investigative radiology.

[18]  H. Kundel,et al.  Lesion conspicuity, structured noise, and film reader error. , 1976, AJR. American journal of roentgenology.

[19]  L B Lusted,et al.  Signal detectability and medical decision-making. , 1971, Science.

[20]  C. Henschke.  Early lung cancer action project , 2000, Cancer.

[21]  H L Kundel,et al.  Evaluation of a television image processing system. , 1968, Investigative radiology.

[22]  N. Mackworth,et al.  The gaze selects informative details within pictures , 1967 .

[23]  Claudia Mello-Thoms,et al.  Time course of perception and decision making during mammographic interpretation. , 2002, AJR. American journal of roentgenology.

[24]  G Revesz,et al.  Conspicuity and uncertainty in the radiographic detection of lesions. , 1985, Radiology.

[25]  H L Kundel,et al.  Comparison scans while reading chest images. Taught, but not practiced. , 1984, Investigative radiology.

[26]  J. Swets,et al.  Assessment of diagnostic technologies. , 1979, Science.

[27]  C. Beam,et al.  Variability in the interpretation of screening mammograms by US radiologists. Findings from a national sample. , 1996, Archives of internal medicine.

[28]  L. Berlin,et al.  Malpractice and radiologists in Cook County, IL: trends in 20 years of litigation. , 1995, AJR. American journal of roentgenology.

[29]  G. Strauss,et al.  Measuring effectiveness of lung cancer screening: from consensus to controversy and back. , 1997, Chest.

[30]  Tuddenham Wj,et al.  Roentgen image perception--a personal survey of the problem. , 1969, Radiologic clinics of North America.

[31]  D. Hubel,et al.  Segregation of form, color, movement, and depth: anatomy, physiology, and perception. , 1988, Science.

[32]  A. Miller,et al.  Sensitivity and specificity of first screen mammography in 15 NBSS centres. , 1988, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[33]  C. Mello-Thoms,et al.  The perception of breast cancers-a spatial frequency analysis of what differentiates missed from reported cancers , 2003, IEEE Transactions on Medical Imaging.

[34]  E. Krupinski,et al.  Computer-displayed eye position as a visual aid to pulmonary nodule interpretation. , 1990, Investigative radiology.

[35]  F. L. Engel.  Visual conspicuity, directed attention and retinal locus. , 1971, Vision research.

[36]  C. Nodine,et al.  Using eye movements to study visual search and to improve tumor detection. , 1987, Radiographics : a review publication of the Radiological Society of North America, Inc.

[37]  H L Kundel,et al.  Searching for bone fractures: a comparison with pulmonary nodule search. , 1994, Academic radiology.

[38]  H L Kundel,et al.  Visual sampling and estimates of the location of information on chest films. , 1974, Investigative radiology.

[39]  R. H. Morgan.  Visual perception in fluoroscopy and radiography. Annual oration in memory of John D. Reeves, Jr., M. D., 1924-1964. , 1966, Radiology.

[40]  M J SMITH.  ERRORS IN DIAGNOSTIC RADIOLOGY ON THE BASIS OF COMPLACENCY. , 1965, The American journal of roentgenology, radium therapy, and nuclear medicine.

[41]  H L Kundel,et al.  Blinded review of retrospectively visible unreported breast cancers: an eye-position analysis. , 2001, Radiology.

[42]  Eero P. Simoncelli,et al.  Natural image statistics and neural representation. , 2001, Annual review of neuroscience.

[43]  W E CHAMBERLAIN,et al.  Tuberculosis case finding; a comparison of the effectiveness of various roentgenographic and photofluorographic methods. , 1947, Journal of the American Medical Association.

[44]  H L Kundel,et al.  Predictive value and threshold detectability of lung tumors. , 1981, Radiology.

[45]  K S Berbaum,et al.  Cause of satisfaction of search effects in contrast studies of the abdomen. , 1996, Academic radiology.

[46]  L. Koran,et al.  The reliability of clinical methods, data and judgments (first of two parts). , 1975, The New England journal of medicine.