Systematic viewing in radiology: seeing more, missing less?

Abstract

To prevent radiologists from overlooking lesions, radiology textbooks recommend “systematic viewing,” a technique whereby anatomical areas are inspected in a fixed order. This would ensure complete inspection (full coverage) of the image and, in turn, improve diagnostic performance. To test this assumption, two experiments were performed. Both experiments investigated the relationship between systematic viewing, coverage, and diagnostic performance. Additionally, the first investigated whether systematic viewing increases with expertise; the second investigated whether novices benefit from full-coverage or systematic viewing training. In Experiment 1, 11 students, ten residents, and nine radiologists inspected five chest radiographs. Experiment 2 had 75 students undergo a training in either systematic, full-coverage (without being systematic) or non-systematic viewing. Eye movements and diagnostic performance were measured throughout both experiments. In Experiment 1, no significant correlations were found between systematic viewing and coverage, r = −.10, p = .62, and coverage and performance, r = −.06, p = .74. Experts were significantly more systematic than students F2,25 = 4.35, p = .02. In Experiment 2, significant correlations were found between systematic viewing and coverage, r = −.35, p < .01, but not between coverage and performance, r = .13, p = .31. Participants in the full-coverage training performed worse compared with both other groups, which did not differ between them, F2,71 = 3.95, p = .02. In conclusion, the data question the assumption that systematic viewing leads to increased coverage, and, consequently, to improved performance. Experts inspected cases more systematically, but students did not benefit from systematic viewing training.

Examining Expertise Using Interviews and Verbal Protocols

“…The research question can focus on the representations of the problem to be solved, or the task to be performed and how these differ between novices and experts (e.g., Chi, Feltovich, & Glaser, 1981;van de Wiel, Boshuizen, & Schmidt, 2000), or change as a result of practice (Boshuizen, van de Wiel, & Schmidt, 2012). But it may also focus on the knowledge and strategies used in problem solving and in performing a task (e.g,, Diemers, van de Wiel, Scherpbier, Baarveld, & Dolmans, 2015;Gilhooly et al, 1997;Lesgold et al, 1988;Kok et al, 2015). It can focus on the learning processes and how teaching and instruction can help novices to become experts (e.g., Chi, Bassok, Lewis, Reimann, & Glaser, 1989;Kok, de Bruin, Robben, & van Merriënboer, 2013).…”

Medical students' cognitive load in volumetric image interpretation: Insights from human-computer interaction and eye movements

“…For example, it should be acknowledged that experts are better in deciding which information is relevant than novices (Eva, Norman, Neville, Wood, & Brooks, 2002;Lesgold et al, 1988;van Gog, Kester, Nievelstein, Giesbers, & Paas, 2009), and are quicker to find abnormalities in medical images (Kok et al, 2015). Although the medical students participating in the current study are all at similar stages of their training, performance differences caused by differential skill development are likely.…”

Radiology education: a radiology curriculum for all medical students?

“…Interestingly, both clinicians and students consider 'developing a system for viewing chest radiographs' to be important [13,14], although recent research could not establish evidence for the effectiveness of teaching systematic viewing [29,30].…”