Purpose To investigate the development of chest radiograph interpretation skill through medical training by measuring both diagnostic accuracy and eye movements during visual search. Materials and Methods An institutional exemption from full ethical review was granted for the study. Five consultant radiologists were deemed the reference expert group, and four radiology registrars, five senior house officers (SHOs), and six interns formed four clinician groups. Participants were shown 30 chest radiographs, 14 of which had a pneumothorax, and were asked to give their level of confidence as to whether a pneumothorax was present. Receiver operating characteristic (ROC) curve analysis was carried out on diagnostic decisions. Eye movements were recorded with a Tobii TX300 (Tobii Technology, Stockholm, Sweden) eye tracker. Four eye-tracking metrics were analyzed. Variables were compared to identify any differences between groups. All data were compared by using the Friedman nonparametric method. Results The average area under the ROC curve for the groups increased with experience (0.947 for consultants, 0.792 for registrars, 0.693 for SHOs, and 0.659 for interns; P = .009). A significant difference in diagnostic accuracy was found between consultants and registrars (P = .046). All four eye-tracking metrics decreased with experience, and there were significant differences between registrars and SHOs. Total reading time decreased with experience; it was significantly lower for registrars compared with SHOs (P = .046) and for SHOs compared with interns (P = .025). Conclusion Chest radiograph interpretation skill increased with experience, both in terms of diagnostic accuracy and visual search. The observed level of experience at which there was a significant difference was higher for diagnostic accuracy than for eye-tracking metrics. (©) RSNA, 2016 Online supplemental material is available for this article.

Objective-Orthopedic injury and intracranial hemorrhage are commonly encountered in emergency radiology, and accurate and timely diagnosis is important. The purpose of this study was to determine whether the diagnostic accuracy of handheld computing devices is comparable to that of monitors that might be used in emergency teleconsultation.Materials and Methods-Two handheld devices, a Dell Axim personal digital assistant (PDA) and an Apple iPod Touch device, were studied. The diagnostic efficacy of each device was tested against that of secondary-class monitors (primary class being clinical workstation display) for each of two image types-posteroanterior wrist radiographs and slices from CT of the brain-yielding four separate observer performance studies. Participants read a bank of 30 wrist or brain images searching for a specific abnormality (distal radial fracture, fresh intracranial bleed) and rated their confidence in their decisions. A total of 168 readings by examining radiologists of the American Board of Radiology were gathered, and the results were subjected to receiver operating characteristics analysis.Results-In the PDA -CT brain study, the scores from PDA readings were significantly higher than those from the monitor readings for all observers (p≤0.01) and for radiologists who were not neuroradiology specialists (p≤0.05). No statistically significant differences were noted for the wrist images or in the iPod Touch studies, although some comparisons approached significance.Conclusion-Handheld devices show promise in the field of emergency teleconsultation for detection of basic orthopaedic injuries and intracranial haemorrhage, although further investigation is warranted.

Respiration-related movement of organs is a complication in a range of diagnostic and interventional procedures. The development and validation of techniques to compensate for such movement requires appropriate models. Human cadavers embalmed with the Thiel method remain flexible and could provide a suitable model. In this study liver displacement during ventilation was assessed in eight Thiel embalmed cadavers, all of which showed thoracic and abdominal motion. Four cadavers displayed realistic lung behaviour, one showed some signs of pneumothorax after prolonged ventilation, one had limited filling of the lungs, and two displayed significant leakage of air into the thorax. A coronal slice containing the largest section through the liver was imaged with a real-time Fast Gradient Echo (FGR) MRI sequence: Craniocaudal displacement of the liver was then determined from a time-series of slices. The maximum liver displacement observed in the cadavers ranged from 7 to 35 mm. The ventilation applied was comparable to tidal breathing at rest and the results found for liver displacement are similar to values in the literature for respiratory motion of the liver under similar conditions. This indicates that Thiel embalmed cadavers have potential as a model for research and training in minimally invasive procedures.

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