The Development of Expertise in Radiology: In Chest Radiograph Interpretation, “Expert” Search Pattern May Predate “Expert” Levels of Diagnostic Accuracy for Pneumothorax Identification

Abstract

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.

The future of endoscopy: Advances in endoscopic image innovations

“…82 Experts in non-endoscopic studies have demonstrated fewer fixations required compared to non-experts to cover a region of interest. 83 Visual gaze patterns (VGPs), in particular gaze time per area of interest, significantly correlates with the colonic area examined with greater overlap in gaze position per area of interest and the determined area of colonic surface. 84 Heat patterns and gaze plots generated using LCI provide an objective marker of colonic mucosa visualised 85 (Fig.…”

Impact of an educational intervention on eye gaze behaviour in retinal image interpretation by consultant and trainee ophthalmologists

“…However, the in-depth detail that is provided by the eye gaze metrics reflects the significant differences in how visual tasks are performed between physicians of different experience. Kelly et al 10 reported similar findings, with registrars in their study having similar eye-tracking behaviour as consultants but lower levels of diagnostic accuracy, suggesting interpretation skills may predate expert diagnostic skills. With further investigation into these metrics and the role they have as markers of efficiency, they could be used as a tool to assess trainees transitioning into consultant roles.…”

Visual Search Performance and Strategy for Three-Dimensional Visualization Systems: Impact of Radiologist Experience

“…Previously, the domain-general temporal aspects of radiologists' performance were examined using eye-tracking [33,35], and by recording the reaction time [29,30] and trial completion time [34]. However, no differences were reported for gaze fixation characteristics [35], and radiologists demonstrated considerably faster reactions than other participants when detecting slight changes in non-radiological images [29] and finding low contrast targets [28,30], which allowed us to assume that the physical properties of stimuli might play a critical role in the temporal evaluation of performance depending on radiologist experience. In our study, we saw a tendency for students to consume more time compared to radiologists and residents when target-distractor similarity was high, however, no significance was reached.…”

“…Extensive training leads to the increased tuning of visual perception [28] and changes in search strategy which radiologists implement during image reading [29]. Most previous studies have demonstrated the strong top-down influence of expertise when comparing the performance of radiologists and non-radiologists viewing medical images [29][30][31][32][33].…”