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Vergara J, Miles A, Lopes de Moraes J, Chone CT. Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:821-836. [PMID: 38437030 DOI: 10.1044/2023_jslhr-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.
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Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, São Paulo, Brazil
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, New Zealand
| | - Juliana Lopes de Moraes
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
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Borchers C, Eder TF, Richter J, Keutel C, Huettig F, Scheiter K. A time slice analysis of dentistry students' visual search strategies and pupil dilation during diagnosing radiographs. PLoS One 2023; 18:e0283376. [PMID: 37289785 PMCID: PMC10249848 DOI: 10.1371/journal.pone.0283376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 03/08/2023] [Indexed: 06/10/2023] Open
Abstract
Diagnosing orthopantomograms (OPTs: panoramic radiographs) is an essential skill dentistry students acquire during university training. While prior research described experts' visual search behavior in radiology as global-to-focal for chest radiographs and mammography, generalizability to a hybrid search task in OPTs (i.e., searching for multiple, diverse anomalies) remains unclear. Addressing this gap, this study investigated visual search of N = 107 dentistry students while they were diagnosing anomalies in OPTs. Following a global-to-focal expert model, we hypothesized that students would use many, short fixations representing global search in earlier stages, and few, long fixations representing focal search in later stages. Furthermore, pupil dilation and mean fixation duration served as cognitive load measures. We hypothesized that later stages would be characterized by elaboration and a reflective search strategy, leading to higher cognitive load being associated with higher diagnostic performance in late compared to earlier stages. In line with the first hypothesis, students' visual search comprised of a three-stage process that grew increasingly focal in terms of the number of fixations and anomalies fixated. Contrary to the second hypothesis, mean fixation duration during anomaly fixations was positively associated with diagnostic performance across all stages. As OPTs greatly varied in how difficult it was to identify the anomalies contained therein, OPTs with above-average difficulty were sampled for exploratory analysis. Pupil dilation predicted diagnostic performance for difficult OPTs, possibly capturing elaborative cognitive processes and cognitive load compared to mean fixation duration. A visual analysis of fine-grained time slices indicated large cognitive load differences towards the end of trials, showcasing a richness-resolution-trade-off in data sampling crucial for future studies using time-slicing of eye tracking data.
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Affiliation(s)
| | | | | | - Constanze Keutel
- Department of Oral- and Maxillofacial Radiology, Centre for Dentistry, Oral Medicine, and Maxillofacial Surgery at the University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Fabian Huettig
- Department of Prosthodontics, Centre for Dentistry, Oral Medicine, and Maxillofacial Surgery at the University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Katharina Scheiter
- Eberhard Karls University of Tübingen, Tübingen, Germany
- Leibniz-Institut für Wissensmedien, Tübingen, Germany
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Isosalo A, Inkinen SI, Turunen T, Ipatti PS, Reponen J, Nieminen MT. Independent evaluation of a multi-view multi-task convolutional neural network breast cancer classification model using Finnish mammography screening data. Comput Biol Med 2023; 161:107023. [PMID: 37230016 DOI: 10.1016/j.compbiomed.2023.107023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/30/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Development of deep convolutional neural networks for breast cancer classification has taken significant steps towards clinical adoption. It is though unclear how the models perform for unseen data, and what is required to adapt them to different demographic populations. In this retrospective study, we adopt an openly available pre-trained mammography breast cancer multi-view classification model and evaluate it by utilizing an independent Finnish dataset. METHODS Transfer learning was used, and the pre-trained model was finetuned with 8,829 examinations from the Finnish dataset (4,321 normal, 362 malignant and 4,146 benign examinations). Holdout dataset with 2,208 examinations from the Finnish dataset (1,082 normal, 70 malignant and 1,056 benign examinations) was used in the evaluation. The performance was also evaluated on a manually annotated malignant suspect subset. Receiver Operating Characteristic (ROC) and Precision-Recall curves were used to performance measures. RESULTS The Area Under ROC [95%CI] values for malignancy classification obtained with the finetuned model for the entire holdout set were 0.82 [0.76, 0.87], 0.84 [0.77, 0.89], 0.85 [0.79, 0.90], and 0.83 [0.76, 0.89] for R-MLO, L-MLO, R-CC and L-CC views respectively. Performance on the malignant suspect subset was slightly better. On the auxiliary benign classification task performance remained low. CONCLUSIONS The results indicate that the model performs well also in an out-of-distribution setting. Finetuning allowed the model to adapt to some of the underlying local demographics. Future research should concentrate to identify breast cancer subgroups adversely affecting performance, as it is a requirement for increasing the model's readiness level for a clinical setting.
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Affiliation(s)
- A Isosalo
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - S I Inkinen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; HUS Diagnostic Center, Clinical Physiology and Nuclear Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - T Turunen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - P S Ipatti
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - J Reponen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - M T Nieminen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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DiGirolamo GJ, DiDominica M, Qadri MAJ, Kellman PJ, Krasne S, Massey C, Rosen MP. Multiple expressions of "expert" abnormality gist in novices following perceptual learning. Cogn Res Princ Implic 2023; 8:10. [PMID: 36723822 PMCID: PMC9892374 DOI: 10.1186/s41235-023-00462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/07/2023] [Indexed: 02/02/2023] Open
Abstract
With a brief half-second presentation, a medical expert can determine at above chance levels whether a medical scan she sees is abnormal based on a first impression arising from an initial global image process, termed "gist." The nature of gist processing is debated but this debate stems from results in medical experts who have years of perceptual experience. The aim of the present study was to determine if gist processing for medical images occurs in naïve (non-medically trained) participants who received a brief perceptual training and to tease apart the nature of that gist signal. We trained 20 naïve participants on a brief perceptual-adaptive training of histology images. After training, naïve observers were able to obtain abnormality detection and abnormality categorization above chance, from a brief 500 ms masked presentation of a histology image, hence showing "gist." The global signal demonstrated in perceptually trained naïve participants demonstrated multiple dissociable components, with some of these components relating to how rapidly naïve participants learned a normal template during perceptual learning. We suggest that multiple gist signals are present when experts view medical images derived from the tens of thousands of images that they are exposed to throughout their training and careers. We also suggest that a directed learning of a normal template may produce better abnormality detection and identification in radiologists and pathologists.
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Affiliation(s)
- Gregory J. DiGirolamo
- grid.254514.30000 0001 2174 1885Department of Psychology, College of the Holy Cross, 1 College Street, Worcester, MA 01610 USA ,grid.168645.80000 0001 0742 0364Department of Radiology, University of Massachusetts, Chan Medical School, Worcester, MA USA ,grid.168645.80000 0001 0742 0364Department of Psychiatry, University of Massachusetts, Chan Medical School, Worcester, MA USA
| | - Megan DiDominica
- grid.254514.30000 0001 2174 1885Department of Psychology, College of the Holy Cross, 1 College Street, Worcester, MA 01610 USA
| | - Muhammad A. J. Qadri
- grid.254514.30000 0001 2174 1885Department of Psychology, College of the Holy Cross, 1 College Street, Worcester, MA 01610 USA
| | - Philip J. Kellman
- grid.19006.3e0000 0000 9632 6718Department of Psychology, UCLA, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Physiology, David Geffen School of Medicine, UCLA, Los Angeles, CA USA
| | - Sally Krasne
- grid.19006.3e0000 0000 9632 6718Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA USA
| | - Christine Massey
- grid.19006.3e0000 0000 9632 6718Department of Psychology, UCLA, Los Angeles, CA USA
| | - Max P. Rosen
- grid.168645.80000 0001 0742 0364Department of Radiology, University of Massachusetts, Chan Medical School, Worcester, MA USA
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The effect of clinical history on diagnostic performance of endodontic cone-beam CT interpretation. Clin Radiol 2023; 78:e433-e441. [PMID: 36702710 DOI: 10.1016/j.crad.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/21/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023]
Abstract
AIM To assess the effect of clinical history on the interpretation of endodontic disease in dental cone-beam computed tomography (CBCT). MATERIALS AND METHODS A reader performance study of an image test-set was undertaken using a factorial, free-response, crossover design, accounting for the independent variables: case type, case severity, reader type, and reading modality. Twenty-three readers interpreted 60 CBCT images twice over two reading sessions using a balanced design, once with access to clinical history and once without, where 30 in each session included history. Lesion localisations, specificity, false-positive marks and the weighted alternative free-response receiver operating characteristic (wAFROC1) figure of merit were calculated. RESULTS Clinical history had no significant effect on specificity and false-positive rates in non-diseased cases (p>0.05), but improved lesion localisation in subtle and obvious diseased cases (p<0.01). wAFROC1 values were higher with clinical history for subtle (0.58 versus 0.48; p<0.001) and obvious (0.77 versus 0.71; p=0.006) diseased categories. No associations were observed between clinical history and both readers' years of experience and reading volume in the non-diseased categories. Readers with fewer (p=0.03) and moderate (p=0.008) years of experience and low (p=0.002) CBCT reading volume demonstrated better lesion localisation in subtle diseased cases when clinical history was available. CONCLUSIONS Clinical history improved the interpretation of CBCT images with disease without affecting the interpretation of images without disease. Less and moderately experienced readers and low-volume readers benefitted more from availability of clinical history.
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Fuchs CSK, Ortner VK, Mogensen M, Rossi AM, Pellacani G, Welzel J, Mosterd K, Guitera P, Nayahangan LJ, Johnsson VL, Haedersdal M, Tolsgaard MG. 2021 international consensus statement on optical coherence tomography for basal cell carcinoma: image characteristics, terminology and educational needs. J Eur Acad Dermatol Venereol 2022; 36:772-778. [PMID: 35141952 DOI: 10.1111/jdv.17969] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite the widespread use of optical coherence tomography (OCT) for imaging of keratinocyte carcinoma, we lack an expert consensus on the characteristic OCT features of basal cell carcinoma (BCC), an internationally vetted set of OCT terms to describe various BCC subtypes, and an educational needs assessment. OBJECTIVES To identify relevant BCC features in OCT images, propose terminology based on inputs from an expert panel and identify content for a BCC-specific curriculum for OCT trainees. METHODS Over three rounds, we conducted a Delphi consensus study on BCC features and terminology between March and September 2020. In the first round, experts were asked to propose BCC subtypes discriminable by OCT, provide OCT image features for each proposed BCC subtypes and suggest content for a BCC-specific OCT training curriculum. If agreement on a BCC-OCT feature exceeded 67%, the feature was accepted and included in a final review. In the second round, experts had to re-evaluate features with less than 67% agreement and rank the ten most relevant BCC OCT image features for superficial BCC, nodular BCC and infiltrative and morpheaphorm BCC subtypes. In the final round, experts received the OCT-BCC consensus list for a final review, comments and confirmation. RESULTS The Delphi included six key opinion leaders and 22 experts. Consensus was found on terminology for three OCT BCC image features: (i) hyporeflective areas, (ii) hyperreflective areas and (iii) ovoid structures. Further, the participants ranked the ten most relevant image features for nodular, superficial, infiltrative and morpheaform BCC. The target group and the key components for a curriculum for OCT imaging of BCC have been defined. CONCLUSION We have established a set of OCT image features for BCC and preferred terminology. A comprehensive curriculum based on the expert suggestions will help implement OCT imaging of BCC in clinical and research settings.
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Affiliation(s)
- C S K Fuchs
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - V K Ortner
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - M Mogensen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - A M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J Welzel
- Department of Dermatology, General Hospital Augsburg, Augsburg, Germany
| | - K Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - P Guitera
- Melanoma Institute Australia, Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - L J Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - V L Johnsson
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - M Haedersdal
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - M G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
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Killingsworth CD, Bohil CJ. Breast Tissue Density Influences Tumor Malignancy Perception and Decisions in Mammography. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2021. [DOI: 10.1016/j.jarmac.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Brancato B, Peruzzi F, Saieva C, Schiaffino S, Catarzi S, Risso GG, Cozzi A, Carriero S, Calabrese M, Montemezzi S, Zuiani C, Sardanelli F. Mammography self-evaluation online test for screening readers: an Italian Society of Medical Radiology (SIRM) initiative. Eur Radiol 2021; 32:1624-1633. [PMID: 34480624 DOI: 10.1007/s00330-021-08241-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/06/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To report and analyse the characteristics and performance of the first cohort of Italian radiologists completing the national mammography self-evaluation online test established by the Italian Society of Medical Radiology (SIRM). METHODS A specifically-built dataset of 132 mammograms (24 with screen-detected cancers and 108 negative cases) was preliminarily tested on 48 radiologists to define pass thresholds (62% sensitivity and 86% specificity) and subsequently made available online to SIRM members during a 13-month timeframe between 2018 and 2019. Associations between participants' characteristics, pass rates, and diagnostic accuracy were then investigated with descriptive statistics and univariate and multivariable regression analyses. RESULTS A total of 342 radiologists completed the test, 151/342 (44.2%) with success. All individual variables, except gender, showed a significant correlation with pass rates and diagnostic sensitivity, confirmed by univariate logistic regression, while only involvement in organised screening programs and number of mammograms read per year showed a positive association with specificity at univariate logistic regression. In the multivariable regression analysis, fewer variables remained significant: > 3000 mammograms read per year for success rate; female gender, public practice setting, and higher experience self-judgement for sensitivity; no variables were significantly associated with specificity. CONCLUSIONS This national self-evaluation test effectively differentiated multiple aspects of mammographic reading experience, but specific breast imaging experience was shown not to strictly guarantee good diagnostic accuracy. Due to its easy use and the validity of obtained results, this test could be extended to all Italian breast radiologists, regardless of their experience, also as a Breast Unit accreditation criterion. KEY POINTS • This self-evaluation test was found to be able to differentiate various degrees of mammographic interpretation experience. • Breast cancer screening readers should undergo a self-assessment test, since experience parameters alone do not guarantee diagnostic ability.
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Affiliation(s)
- Beniamino Brancato
- Unit of Breast Imaging, Istituto per lo Studio, la Prevenzione e la Rete Oncologica - ISPRO, Via Cosimo il Vecchio 2, 50139, Firenze, Italy.
| | - Francesca Peruzzi
- Department of Diagnostic Imaging, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Molecular and Lifestyle Epidemiology Branch, Istituto per lo Studio, la Prevenzione e la Rete Oncologica - ISPRO, Via Cosimo il Vecchio 2, 50139, Firenze, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Sandra Catarzi
- Unit of Breast Imaging, Istituto per lo Studio, la Prevenzione e la Rete Oncologica - ISPRO, Via Cosimo il Vecchio 2, 50139, Firenze, Italy
| | - Gabriella Gemma Risso
- Unit of Breast Imaging, Istituto per lo Studio, la Prevenzione e la Rete Oncologica - ISPRO, Via Cosimo il Vecchio 2, 50139, Firenze, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milano, Italy
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Massimo Calabrese
- Unit of Breast Imaging, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Stefania Montemezzi
- Radiology Unit - Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Chiara Zuiani
- Department of Medical Area - Institute of Radiology, Università degli Studi di Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133, Milano, Italy
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Hadadi I, Rae W, Clarke J, McEntee M, Ekpo E. Breast cancer detection: Comparison of digital mammography and digital breast tomosynthesis across non-dense and dense breasts. Radiography (Lond) 2021; 27:1027-1032. [PMID: 33906803 DOI: 10.1016/j.radi.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/24/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Breast density is associated with an increase in breast cancer risk and limits early detection of the disease. This study assesses the diagnostic performance of mammogram readers in digital mammography (DM) and digital breast tomosynthesis (DBT). METHODS Eleven breast readers with 1-39 years of experience reading mammograms and 0-4 years of experience reading DBT participated in the study. All readers independently interpreted 60 DM cases (40 normal/20 abnormal) and 35 DBT cases (20 normal/15 abnormal). Sensitivity, specificity, ROC AUC, and diagnostic confidence were calculated and compared between DM and DBT. RESULTS DBT significantly improved diagnostic confidence in both dense breasts (p = 0.03) and non-dense breasts (p = 0.003) but not in other diagnostic performance metrics. Specificity was higher in DM for readers with >7 years' experience (p = 0.03) in reading mammography, non-radiologists (p = 0.04), readers who had completed a 3-6 months training fellowship in breast imaging (p = 0.04), and those with ≤2 years' experience in reading DBT (p = 0.02), particularly in non-dense breasts. CONCLUSION Diagnostic confidence was higher in DBT when compared to DM. In contrast, other performance metrics appeared to be similar or better with DM and may be influenced by the lack of experience of the reader cohort in reading DBT. IMPLICATIONS FOR PRACTICE The benefits of DBT may not be entirely accrued until radiologists attain expertise in DBT interpretation. Specificity of DBT varied according to reader characteristics, and these characteristics may be useful for optimising pairing strategies in independent double reading of DBT as practiced in Australia to reduce false positive diagnostic errors.
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Affiliation(s)
- I Hadadi
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Khalid University, Saudi Arabia.
| | - W Rae
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | - J Clarke
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia
| | - M McEntee
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; University College Cork, Discipline of Diagnostic Radiography, UG 12 Áras Watson, Brookfield Health Sciences, College Road, Cork, T12 AK54, Ireland
| | - E Ekpo
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Australia; Orange Radiology, Laboratories and Research Centre, Calabar, Nigeria
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Krasne S, Stevens CD, Kellman PJ, Niemann JT. Mastering Electrocardiogram Interpretation Skills Through a Perceptual and Adaptive Learning Module. AEM EDUCATION AND TRAINING 2021; 5:e10454. [PMID: 33796803 PMCID: PMC7995930 DOI: 10.1002/aet2.10454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 06/12/2023]
Abstract
Although accurate interpretation of the standard 12-lead electrocardiogram (ECG) is fundamental to diagnosing heart disease, several prior studies report low accuracy rates among medical students, residents, and practicing physicians. The objective of this study was to determine if an online ECG Perceptual and Adaptive Learning Module (ECG PALM) is an efficient instrument to teach ECG interpretation. The ECG PALM consists of 415 unique ECG tracings with associated pretest, posttest, and delayed tests, each using 30 additional ECGs to gauge the effectiveness and durability of training. Between 2013 and 2015, a total of 113 third-year and 156 fourth-year medical students and 34 first-year, 41 second-year, and 37 third-year emergency medicine residents completed the PALM and associated tests. We measured two mastery criteria: accuracy, the percentage of correct interpretations, and fluency, the percentage of images interpreted accurately within 15 seconds. The ECG PALM produced statistically significant improvements (0.0001 < p < 0.0045) in student and resident performance for both accuracy (effect size = 0.9 to 3.2) and fluency (effect size = 2.5 to 3.1) following training ranging from 46 ± 24 minutes (R3s) to 88 ± 32 minutes (third-year medical students). Medical students and residents performed significantly better on a test the year following training (delayed test) than those without prior ECG PALM training (pretest). The fluency of R3 residents in classifying the 15 diagnostic categories was less than 60% for nine of the 15 diagnoses and greater than 80% for only one. Following PALM training, fluency was higher than 80% for seven of the 15 categories and less than 60% for only two categories. Accuracy in recognizing ST-elevation myocardial infarctions (STEMIs) was high both before and after PALM training for R3s, but fluency was only 64% for anterior STEMIs on the pretest, increasing to 93% following PALM training. These observations suggest that the ECG PALM is an effective and durable supplemental tool for developing mastery in interpreting common ECG abnormalities.
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Affiliation(s)
- Sally Krasne
- Department of PhysiologyDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCA
| | - Carl D. Stevens
- Department of Emergency MedicineDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCA
- Present address:
CareOregonPortlandOR
| | | | - James T. Niemann
- Department of Emergency MedicineHarbor‐UCLA Medical CenterTorranceCA
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Starke SD, Miles GC, Channon SB, May SA. Effect of gamified perceptual learning on visual detection and discrimination skills in equine gait assessment. Vet Rec 2021; 188:e21. [PMID: 33645837 DOI: 10.1002/vetr.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/19/2020] [Accepted: 12/03/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Visual assessment of equine lameness is an everyday veterinary task suffering from poor diagnostic accuracy. The aim of this study was to quantify the impact of the perceptual learning game 'LamenessTrainer' on skill development. METHODS Thirty-six undergraduate veterinary students engaged in four game modules teaching the assessment of fore- and hindlimb lameness. Computer animations of horses in this game displayed 0% (sound) to 70% (moderately lame) vertical movement asymmetry of head and pelvis. Performance, learning effects, diagnostic accuracy, detection thresholds and survey responses were analysed. RESULTS Following staircase learning, more than 80% of students reliably classified horses with ≥20% asymmetry for forelimb lameness, ≥40% asymmetry for simplified hindlimb lameness and ≥50% asymmetry for realistic hindlimb lameness. During random presentation, on average 82% of sound and 65% of lame horses were assessed correctly during forelimb lameness evaluation, dropping to 39% of sound and 56% of lame horses for hindlimb lameness. CONCLUSION In less than two hours, systematic perceptual learning through deliberate practice can develop visual assessment skills to an accuracy level comparable to expert assessors scoring the same animations. Skills should be developed further to improve misclassifications of sound and mildly lame horses, especially for hindlimb lameness evaluation.
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Affiliation(s)
- Sandra D Starke
- Aston Business School, Aston University, Birmingham, UK.,Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Gregory C Miles
- Professional Services, The Royal Veterinary College, Hatfield, UK
| | - Sarah B Channon
- Comparative Biomedical Sciences, The Royal Veterinary College, Hatfield, UK
| | - Stephen A May
- Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
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12
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Papesh MH, Hout MC, Guevara Pinto JD, Robbins A, Lopez A. Eye movements reflect expertise development in hybrid search. Cogn Res Princ Implic 2021; 6:7. [PMID: 33587219 PMCID: PMC7884546 DOI: 10.1186/s41235-020-00269-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
Domain-specific expertise changes the way people perceive, process, and remember information from that domain. This is often observed in visual domains involving skilled searches, such as athletics referees, or professional visual searchers (e.g., security and medical screeners). Although existing research has compared expert to novice performance in visual search, little work has directly documented how accumulating experiences change behavior. A longitudinal approach to studying visual search performance may permit a finer-grained understanding of experience-dependent changes in visual scanning, and the extent to which various cognitive processes are affected by experience. In this study, participants acquired experience by taking part in many experimental sessions over the course of an academic semester. Searchers looked for 20 categories of targets simultaneously (which appeared with unequal frequency), in displays with 0-3 targets present, while having their eye movements recorded. With experience, accuracy increased and response times decreased. Fixation probabilities and durations decreased with increasing experience, but saccade amplitudes and visual span increased. These findings suggest that the behavioral benefits endowed by expertise emerge from oculomotor behaviors that reflect enhanced reliance on memory to guide attention and the ability to process more of the visual field within individual fixations.
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Affiliation(s)
- Megan H Papesh
- Department of Psychology, New Mexico State University, P.O. Box 30001/MSC 3452, Las Cruces, NM, 88003, USA.
| | - Michael C Hout
- Department of Psychology, New Mexico State University, P.O. Box 30001/MSC 3452, Las Cruces, NM, 88003, USA
| | | | - Arryn Robbins
- Department of Psychology, New Mexico State University, P.O. Box 30001/MSC 3452, Las Cruces, NM, 88003, USA
- Carthage College, Kenosha, WI, USA
| | - Alexis Lopez
- Department of Psychology, New Mexico State University, P.O. Box 30001/MSC 3452, Las Cruces, NM, 88003, USA
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13
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Farrell CM, Pinson JA, Dennett AM. CT Attenuation correction and its impact on image quality of myocardial perfusion imaging in coronary artery disease: A systematic review. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2021; 9:31-38. [PMID: 33392347 DOI: 10.22038/aojnmb.2020.50692.1346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Myocardial perfusion imaging is a non-invasive procedure that plays an integral role in the diagnosis and management of coronary artery disease. With the routine use of computerised tomography attenuation correction (CTAC) in myocardial perfusion imaging still under debate, the aim of this review was to determine the impact of CTAC on image quality in myocardial perfusion imaging. Medline, Embase and CINAHL were searched from the earliest available time until August 2019. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2. Details pertaining to image quality and diagnostic accuracy were analysed, and results summarised descriptively. Three studies with 'unclear' risk of bias and low applicability concerns (1002 participants) from a yield of 2725 articles were identified. Two studies demonstrated an increase in image quality, and one study found no difference in image quality when using CTAC compared to no attenuation correction. Benefits of CTAC for improving image quality remain unclear. Given the potential exposure risk with the addition of CTAC, patient and clinician factors should inform decision making for use of CTAC in myocardial perfusion imaging for coronary artery disease.
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Affiliation(s)
- Claire M Farrell
- Department of Medical Imaging, Medical Radiations and Nuclear Medicine, Eastern Health, Victoria, Australia
| | - Jo-Anne Pinson
- Department of Medical Imaging, Monash Health, Peninsula Health, Victoria, Australia.,Department of Medical Imaging and Radiation Sciences, Monash University, Australia
| | - Amy M Dennett
- School of Allied Health, Human Services and Sport, La Trobe University, Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
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14
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Richter J, Scheiter K, Eder TF, Huettig F, Keutel C. How massed practice improves visual expertise in reading panoramic radiographs in dental students: An eye tracking study. PLoS One 2020; 15:e0243060. [PMID: 33270704 PMCID: PMC7714201 DOI: 10.1371/journal.pone.0243060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023] Open
Abstract
The interpretation of medical images is an error-prone process that may yield severe consequences for patients. In dental medicine panoramic radiography (OPT) is a frequently used diagnostic procedure. OPTs typically contain multiple, diverse anomalies within one image making the diagnostic process very demanding, rendering students’ development of visual expertise a complex task. Radiograph interpretation is typically taught through massed practice; however, it is not known how effective this approach is nor how it changes students’ visual inspection of radiographs. Therefore, this study investigated how massed practice–an instructional method that entails massed learning of one type of material–affects processing of OPTs and the development of diagnostic performance. From 2017 to 2018, 47 dental students in their first clinical semester diagnosed 10 OPTs before and after their regular massed practice training, which is embedded in their curriculum. The OPTs contained between 3 to 26 to-be-identified anomalies. During massed practice they diagnosed 100 dental radiographs without receiving corrective feedback. The authors recorded students’ eye movements and assessed the number of correctly identified and falsely marked low- and high prevalence anomalies before and after massed practice. Massed practice had a positive effect on detecting anomalies especially with low prevalence (p < .001). After massed practice students covered a larger proportion of the OPTs (p < .001), which was positively related to the detection of low-prevalence anomalies (p = .04). Students also focused longer, more frequently, and earlier on low-prevalence anomalies after massed practice (ps < .001). While massed practice improved visual expertise in dental students with limited prior knowledge, there is still substantial room for improvement. The results suggest integrating massed practice with more deliberate practice, where, for example, corrective feedback is provided, and support is adapted to students’ needs.
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Affiliation(s)
- Juliane Richter
- Leibniz-Institut für Wissensmedien, Tübingen, Germany
- * E-mail:
| | - Katharina Scheiter
- Leibniz-Institut für Wissensmedien, Tübingen, Germany
- Eberhard Karls University of Tübingen, Tübingen, Germany
| | | | - Fabian Huettig
- Department of Prosthodontics, University Hospital for Dentistry, Oral Medicine, and Maxillofacial Surgery at the University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Constanze Keutel
- Radiology Department of the University Hospital for Dentistry, Oral Medicine, and Maxillofacial Surgery at the University Hospital Tübingen, Eberhard Karls University of Tübingen, Tübingen, Germany
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15
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Hussain Z. An expert advantage in detecting unfamiliar visual signals in noise. Proc Natl Acad Sci U S A 2020; 117:25935-25941. [PMID: 32999072 PMCID: PMC7568295 DOI: 10.1073/pnas.2003761117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Diagnostic radiologists are experts in discriminating and classifying medical images for clinically significant anomalies. Does their perceptual expertise confer an advantage in unfamiliar visual tasks? Here, this issue was investigated by comparing the performance of 10 radiologists and 2 groups of novices on the ability to detect novel visual signals: band-limited textures in noise. Observers performed a yes/no detection task in which texture spatial frequency and external noise levels were varied. The task was performed on two consecutive days. Contrast thresholds and response bias were measured. Contrast thresholds of radiologists were superior to the control groups in all stimulus conditions on both days. Performance improved by an equivalent amount for all groups across days. Response bias differed consistently across stimulus conditions and days but not across groups. The difference in thresholds between the radiologists and control groups suggests that experience in diagnostic medical imaging produces perceptual skills that that transfer beyond the trained domain.
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Affiliation(s)
- Zahra Hussain
- Department of Psychology, American University of Beirut, Riad El-Solh, Beirut 1107 2020, Lebanon
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16
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Krupinski EA. In Memoriam: Calvin F. Nodine, PhD. Acad Radiol 2020. [DOI: 10.1016/j.acra.2020.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Castner N, Appel T, Eder T, Richter J, Scheiter K, Keutel C, Hüttig F, Duchowski A, Kasneci E. Pupil diameter differentiates expertise in dental radiography visual search. PLoS One 2020; 15:e0223941. [PMID: 32469952 PMCID: PMC7259659 DOI: 10.1371/journal.pone.0223941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/13/2020] [Indexed: 01/22/2023] Open
Abstract
Expert behavior is characterized by rapid information processing abilities, dependent on more structured schemata in long-term memory designated for their domain-specific tasks. From this understanding, expertise can effectively reduce cognitive load on a domain-specific task. However, certain tasks could still evoke different gradations of load even for an expert, e.g., when having to detect subtle anomalies in dental radiographs. Our aim was to measure pupil diameter response to anomalies of varying levels of difficulty in expert and student dentists’ visual examination of panoramic radiographs. We found that students’ pupil diameter dilated significantly from baseline compared to experts, but anomaly difficulty had no effect on pupillary response. In contrast, experts’ pupil diameter responded to varying levels of anomaly difficulty, where more difficult anomalies evoked greater pupil dilation from baseline. Experts thus showed proportional pupillary response indicative of increasing cognitive load with increasingly difficult anomalies, whereas students showed pupillary response indicative of higher cognitive load for all anomalies when compared to experts.
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Affiliation(s)
- Nora Castner
- Human-Computer Interaction, Institute of Computer Science, University Tübingen, Tübingen, Germany
- * E-mail:
| | - Tobias Appel
- Human-Computer Interaction, Institute of Computer Science, University Tübingen, Tübingen, Germany
| | - Thérése Eder
- Multiple Representations Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany
| | - Juliane Richter
- Multiple Representations Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany
| | - Katharina Scheiter
- Multiple Representations Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany
- University Tübingen, Tübingen, Germany
| | - Constanze Keutel
- Department of Oral- and Maxillofacial Radiology, University Clinic for Dentistry, Oral Medicine, and Maxillofacial Surgery, University of Tübingen, Tübingen, Germany
| | - Fabian Hüttig
- Department of Prosthodontics, University Clinic for Dentistry, Oral Medicine, and Maxillofacial Surgery, University of Tübingen, Tübingen, Germany
| | - Andrew Duchowski
- Visual Computing, Clemson University, Clemson, South Carolina, United States of America
| | - Enkelejda Kasneci
- Human-Computer Interaction, Institute of Computer Science, University Tübingen, Tübingen, Germany
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18
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Hegdé J. Deep learning can be used to train naïve, nonprofessional observers to detect diagnostic visual patterns of certain cancers in mammograms: a proof-of-principle study. J Med Imaging (Bellingham) 2020; 7:022410. [PMID: 32042860 PMCID: PMC6998757 DOI: 10.1117/1.jmi.7.2.022410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/26/2019] [Indexed: 11/27/2022] Open
Abstract
The scientific, clinical, and pedagogical significance of devising methodologies to train nonprofessional subjects to recognize diagnostic visual patterns in medical images has been broadly recognized. However, systematic approaches to doing so remain poorly established. Using mammography as an exemplar case, we use a series of experiments to demonstrate that deep learning (DL) techniques can, in principle, be used to train naïve subjects to reliably detect certain diagnostic visual patterns of cancer in medical images. In the main experiment, subjects were required to learn to detect statistical visual patterns diagnostic of cancer in mammograms using only the mammograms and feedback provided following the subjects’ response. We found not only that the subjects learned to perform the task at statistically significant levels, but also that their eye movements related to image scrutiny changed in a learning-dependent fashion. Two additional, smaller exploratory experiments suggested that allowing subjects to re-examine the mammogram in light of various items of diagnostic information may help further improve DL of the diagnostic patterns. Finally, a fourth small, exploratory experiment suggested that the image information learned was similar across subjects. Together, these results prove the principle that DL methodologies can be used to train nonprofessional subjects to reliably perform those aspects of medical image perception tasks that depend on visual pattern recognition expertise.
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Affiliation(s)
- Jay Hegdé
- Augusta University, Medical College of Georgia, Departments of Neuroscience and Regenerative Medicine and Ophthalmology, Augusta, Georgia, United States
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19
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Sha LZ, Toh YN, Remington RW, Jiang YV. Perceptual learning in the identification of lung cancer in chest radiographs. COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2020; 5:4. [PMID: 32016647 PMCID: PMC6997313 DOI: 10.1186/s41235-020-0208-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 01/12/2020] [Indexed: 11/18/2022]
Abstract
Extensive research has shown that practice yields highly specific perceptual learning of simple visual properties such as orientation and contrast. Does this same learning characterize more complex perceptual skills? Here we investigated perceptual learning of complex medical images. Novices underwent training over four sessions to discriminate which of two chest radiographs contained a tumor and to indicate the location of the tumor. In training, one group received six repetitions of 30 normal/abnormal images, the other three repetitions of 60 normal/abnormal images. Groups were then tested on trained and novel images. To assess the nature of perceptual learning, test items were presented in three formats – the full image, the cutout of the tumor, or the background only. Performance improved across training sessions, and notably, the improvement transferred to the classification of novel images. Training with more repetitions on fewer images yielded comparable transfer to training with fewer repetitions on more images. Little transfer to novel images occurred when tested with just the cutout of the cancer region or just the background, but a larger cutout that included both the cancer region and some surrounding regions yielded good transfer. Perceptual learning contributes to the acquisition of expertise in cancer image perception.
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Affiliation(s)
- Li Z Sha
- Department of Psychology, University of Minnesota, N240 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA.
| | - Yi Ni Toh
- Department of Psychology, University of Minnesota, N240 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA
| | - Roger W Remington
- Department of Psychology, University of Minnesota, N240 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA.,School of Psychology, University of Queensland, Brisbane, Australia
| | - Yuhong V Jiang
- Department of Psychology, University of Minnesota, N240 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA.
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20
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Ultrasonography-Based Qualitative and Quantitative Evaluation Approaches for Pompe Disease. J Med Biol Eng 2019. [DOI: 10.1007/s40846-019-00502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose
The aim of this study was to propose the qualitative and quantitative approaches to evaluate the skeletal muscle ultrasound images of 23 Pompe disease (i.e., acid maltase deficiency, AMD) patients and 14 normal subjects.
Methods
A cohort of 23 AMD patients and 14 normal subjects has been investigated. We compared the B-mode echo intensity of the rectus femoris muscle with that of its surrounding fat (subcutaneous fat) and proposed a qualitative grading method. Quantitative analysis of the region of interest (ROI) with the echo intensity and the segmented area was also performed.
Results
Qualitative results showed that AMD patients without clinical symptoms (without undergoing ERT) had the highest distribution of Grade 1, and AMD patients undergoing ERT had the widest distribution of Grade 2, and control group (n = 14) with the highest distribution of Grade 1. Using the segmented area approach, quantitative results showed that AMD patients undergoing ERT had the largest and widest distribution. Meanwhile the control subjects (normal subjects) had the lowest and the narrowest areas. The echo intensity of the segmented ROI of AMD patients undergoing ERT displayed the highest and widest (inhomogeneous) distributions. By contrast, the echo intensity of AMD patients without clinical symptoms was slightly increased and with low inhomogeneity.
Conclusion
The proposed ultrasonography-based qualitative and quantitative approach may be used to evaluate the severity of muscle destruction for AMD patients. Besides, the quantitative segmented area with regression analysis could help predict the incidence of onset of Pompe disease patients.
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21
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Yuris NC, Wiggins MW, Auton JC, Gaicon L, Sturman D. Higher cue utilization in driving supports improved driving performance and more effective visual search behaviors. JOURNAL OF SAFETY RESEARCH 2019; 71:59-66. [PMID: 31862045 DOI: 10.1016/j.jsr.2019.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/16/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Once qualified, drivers rarely receive objective feedback concerning their performance. This is especially the case in the context of cognitive skills such as situation assessment. The aim of this study was to test the construct validity of an online assessment of motor-vehicle driver cue utilization that forms the foundation for situation assessment. METHOD Seventy-one undergraduate Psychology students with broadly comparable driving experience completed a motor-vehicle driving version of EXPERTise 2.0, an online tool that enables inferences concerning the utilization of cues based on responses to task-related stimuli. They also completed a simulated driving task while fitted with an eye tracking device, during which a range of hazards were presented with participants' responses recorded. RESULTS The results indicated that higher cue utilization was associated with fewer driving errors and collisions, fewer visual fixations, and fewer saccades in comparison to participants with lower cue utilization. CONCLUSION The results provide support for the construct validity of EXPERTise 2.0 as an effective measure of cue utilization in the context of driving. PRACTICAL APPLICATIONS Providing comparative feedback to drivers concerning their development of situation assessment skills may provide opportunities for further training and development, thereby reducing the likelihood of motor-vehicle accidents.
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Affiliation(s)
- Nadya C Yuris
- Macquarie University, 4 First Walk, Sydney, NSW 2109, Australia.
| | - Mark W Wiggins
- Macquarie University, 4 First Walk, Sydney, NSW 2109, Australia
| | - Jaime C Auton
- The University of Adelaide, Hughes, North Terrace, Adelaide, SA 5005, Australia
| | - Leia Gaicon
- Macquarie University, 4 First Walk, Sydney, NSW 2109, Australia
| | - Daniel Sturman
- Macquarie University, 4 First Walk, Sydney, NSW 2109, Australia
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22
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Rawashdeh M, Abdelrahman M, Zaitoun M, Suleiman M, Taimai RA, Nusairat TA, Brennan P. Accuracy among Jordanian and Australian radiologists reading the same set of test screening cases. BREAST CANCER MANAGEMENT 2019. [DOI: 10.2217/bmt-2018-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate how breast radiologists from Jordan and Australia differ in accuracy when examining the set of test screening cases. Materials & methods: A total of 27 Jordanian and 115 Australian breast radiologists were requested to read 60 mammographic images and to indicate the location of any perceived lesion and record a confidence level ranging from 1 to 5. Jackknife alternative free-response receiver operating characteristic, location sensitivity and specificity were calculated and compared for both Australian and Jordanian readers. Results: Australian readers achieved significantly higher readings accuracy than Jordanian readers retrospectively in terms of Jackknife alternative free-response receiver operating characteristic (75th percentile values: 0.863 vs 0.600; p = 0.001) and location sensitivity (75th percentile values 0.673 vs 0.571; p = 0.022). Conclusion: Australian radiologists achieved higher performance in reading breast mammograms than Jordanian radiologists.
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Affiliation(s)
- Mohammad Rawashdeh
- Faculty of Applied Medical Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Mostafa Abdelrahman
- Faculty of Applied Medical Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Maha Zaitoun
- Faculty of Applied Medical Sciences, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Mo’ayyad Suleiman
- Medical Image Optimisation & Perception Group (MIOPeG), & the Brain & Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Rula Abu Taimai
- Jordan Breast Cancer Program, PO Box: 35102, Amman 11180, Jordan
| | | | - Patrick Brennan
- Medical Image Optimisation & Perception Group (MIOPeG), & the Brain & Mind Centre, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, 2006, Australia
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23
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Ashworth J, Thompson J, Mercer C. Learning to look: Evaluating the student experience of an interactive image appraisal activity. Radiography (Lond) 2019; 25:314-319. [DOI: 10.1016/j.radi.2019.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 11/25/2022]
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24
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Miles A, Hunting A. Development, intra- and inter-rater reliability of the New Zealand Secretion Scale (NZSS). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:377-384. [PMID: 29879369 DOI: 10.1080/17549507.2018.1458901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/27/2017] [Accepted: 03/24/2018] [Indexed: 06/08/2023]
Abstract
Purpose: The New Zealand Secretion Scale (NZSS) has been developed for comprehensive assessment of accumulated secretions during endoscopy. The scale rates secretion severity under the subcategories location, amount and response. This study describes the scale's development and reliability when used by experts and untrained raters. Method: One expert scored 254 endoscopy videos using the NZSS and performed repeat measures on 100 randomly selected videos one month later. These 100 videos were scored by a second expert in a randomised order. In a second arm of the study, 28 raters scored 10 endoscopy videos, without training on the NZSS. Seventeen had experience in endoscopy (mean 1.8 years, SD = 1.0). Reliability was calculated across the entire cohort and as a function of experience interpreting endoscopy. Result: Strong internal consistency (Cronbach's α = 0.88), and high inter-item (>0.60) and corrected item-total correlations (>0.70) were established. Inter-rater (ICC = 0.99) and intra-rater reliability (ICC = 0.95) of the experts was excellent. Inter-rater reliability of the untrained raters ranged from ICC = 0.65-0.79, with no significant influence of experience on reliability. Conclusion: The NZSS is a reliable assessment of secretion severity during endoscopy and can be used without training. This comprehensive scale will support research evaluating the predictive value of accumulated secretions.
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Affiliation(s)
- Anna Miles
- Department of Psychology, The University of Auckland , Auckland , New Zealand
| | - Alexandra Hunting
- Department of Psychology, The University of Auckland , Auckland , New Zealand
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25
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Abstract
Breast cancer is the most common cancer among females worldwide and large volumes of breast images are produced and interpreted annually. As long as radiologists interpret these images, the diagnostic accuracy will be limited by human factors and both false-positive and false-negative errors might occur. By understanding visual search in breast images, we may be able to identify causes of diagnostic errors, find ways to reduce them, and also provide a better education to radiology residents. Many visual search studies in breast radiology have been devoted to mammography. These studies showed that 70% of missed lesions on mammograms attract radiologists' visual attention and that a plethora of different reasons, such as satisfaction of search, incorrect background sampling, and incorrect first impression can cause diagnostic errors in the interpretation of mammograms. Recently, highly accurate tools, which rely on both eye-tracking data and the content of the mammogram, have been proposed to provide feedback to the radiologists. Improving these tools and determining the optimal pathway to integrate them in the radiology workflow could be a possible line of future research. Moreover, in the past few years deep learning has led to improving diagnostic accuracy of computerized diagnostic tools and visual search studies will be required to understand how radiologists interact with the prompts from these tools, and to identify the best way to utilize them. Visual search in other breast imaging modalities, such as breast ultrasound and digital breast tomosynthesis, have so far received less attention, probably due to associated complexities of eye-tracking monitoring and analysing the data. For example, in digital breast tomosynthesis, scrolling through the image results in longer trials, adds a new factor to the study's complexity and makes calculation of gaze parameters more difficult. However, considering the wide utilization of three-dimensional imaging modalities, more visual search studies involving reading stack-view examinations are required in the future. To conclude, in the past few decades visual search studies provided extensive understanding about underlying reasons for diagnostic errors in breast radiology and characterized differences between experts' and novices' visual search patterns. Further visual search studies are required to investigate radiologists' interaction with relatively newer imaging modalities and artificial intelligence tools.
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Affiliation(s)
- Ziba Gandomkar
- BreastScreen Reader Assessment Strategy (BREAST), Discipline of Medical Imaging Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claudia Mello-Thoms
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, US
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26
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Williams LH, Drew T. What do we know about volumetric medical image interpretation?: a review of the basic science and medical image perception literatures. Cogn Res Princ Implic 2019; 4:21. [PMID: 31286283 PMCID: PMC6614227 DOI: 10.1186/s41235-019-0171-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/19/2019] [Indexed: 11/26/2022] Open
Abstract
Interpretation of volumetric medical images represents a rapidly growing proportion of the workload in radiology. However, relatively little is known about the strategies that best guide search behavior when looking for abnormalities in volumetric images. Although there is extensive literature on two-dimensional medical image perception, it is an open question whether the conclusions drawn from these images can be generalized to volumetric images. Importantly, volumetric images have distinct characteristics (e.g., scrolling through depth, smooth-pursuit eye-movements, motion onset cues, etc.) that should be considered in future research. In this manuscript, we will review the literature on medical image perception and discuss relevant findings from basic science that can be used to generate predictions about expertise in volumetric image interpretation. By better understanding search through volumetric images, we may be able to identify common sources of error, characterize the optimal strategies for searching through depth, or develop new training and assessment techniques for radiology residents.
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27
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Brunyé TT, Nallamothu BK, Elmore JG. Eye-tracking for assessing medical image interpretation: A pilot feasibility study comparing novice vs expert cardiologists. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:65-73. [PMID: 30977060 PMCID: PMC6468026 DOI: 10.1007/s40037-019-0505-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION As specialized medical professionals such as radiologists, pathologists, and cardiologists gain education and experience, their diagnostic efficiency and accuracy change, and they show altered eye movement patterns during medical image interpretation. Existing research in this area is limited to interpretation of static medical images, such as digitized whole slide biopsies, making it difficult to understand how expertise development might manifest during dynamic image interpretation, such as with angiograms or volumetric scans. METHODS A two-group (novice, expert) comparative pilot study examined the feasibility and utility of tracking and interpreting eye movement patterns while cardiologists viewed video-based coronary angiograms. A non-invasive eye tracking system recorded cardiologists' (n = 8) visual behaviour while they viewed and diagnosed a series of eight angiogram videos. Analyses assessed frame-by-frame video navigation behaviour, eye fixation behaviour, and resulting diagnostic decision making. RESULTS Relative to novices, expert cardiologists demonstrated shorter and less variable video review times, fewer eye fixations and saccadic eye movements, and less time spent paused on individual video frames. Novices showed repeated eye fixations on critical image frames and regions, though these were not predictive of accurate diagnostic decisions. DISCUSSION These preliminary results demonstrate interpretive decision errors among novices, suggesting they identify and process critical diagnostic features, but sometimes fail to accurately interpret those features. Results also showcase the feasibility of tracking and understanding eye movements during video-based coronary angiogram interpretation and suggest that eye tracking may be valuable for informing assessments of competency progression during medical education and training.
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Affiliation(s)
- Tad T. Brunyé
- Center for Applied Brain & Cognitive Sciences, Tufts University, Medford, MA USA
| | | | - Joann G. Elmore
- Department of Medicine, University of Washington, Seattle, WA USA
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Dournes G, Bricault I, Chateil JF. Analysis of the French national evaluation of radiology residents. Diagn Interv Imaging 2018; 100:185-193. [PMID: 30527527 DOI: 10.1016/j.diii.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE In France, a national evaluation is given annually to radiology residents. The aim of this study was to perform both a docimological analysis of the quality of the questionnaire and a statistical analysis of the results. MATERIALS AND METHODS This retrospective study, which included French radiology residents from Year 1 to Year 5 of residency, was performed from 2015 to 2017 across 25 medical universities in France. Both qualitative and quantitative docimological analyses were performed as assessed by the Cronbach alpha coefficient, the difficulty of question (PDI), and the coefficient of discrimination (Rir). Results to the questionnaire were compared between years of residency. RESULTS The results of the analysis confirmed the quality of the questionnaire (Cronbach alpha coefficient=0.71, mean [PDI=0.40]) though the majority of questions could be answered by memory rather than cognitive ability. The mean Rir was 0.02, indicating that students could not be certified using only the questionnaire. The results measuring resident level of knowledge were moderate, with mean results ranging from 9.2/20 at the first year to 11.3/20 at the fifth year of residency (P<0.001). There were no significant differences in results obtained between the third, fourth, and fifth year of residency but results were significantly different among university hospitals. CONCLUSION Even if close interactions exist between learning and pedagogic environment, our results suggest that it may be useful to further develop an evaluation process in relation with pedagogic instructions in order to provide more optimal training.
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Affiliation(s)
- G Dournes
- Centre de recherche cardio-thoracique de Bordeaux, U1045, Bordeaux University, 33000 Bordeaux, France; Inserm, centre de recherche cardio-thoracique de Bordeaux, U1045, 33000 Bordeaux, France; Department of cardiovascular and thoracic imaging, CHU de Bordeaux, 33600 Pessac, France.
| | - I Bricault
- Department of medical imaging, hôpital Nord, CHU de Grenoble, 38043 Grenoble, France; Université Grenoble-Alpes, TIMC-IMAG, 38000 Grenoble, France
| | - J-F Chateil
- Department of pediatric imaging, CHU de Bordeaux, 33000 Bordeaux, France; Centre de résonance magnétique des systèmes biologiques, UMR 5536, Bordeaux University, 33076 Bordeaux, France
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Ganesan A, Alakhras M, Brennan PC, Mello-Thoms C. A review of factors influencing radiologists' visual search behaviour. J Med Imaging Radiat Oncol 2018; 62:747-757. [PMID: 30198628 DOI: 10.1111/1754-9485.12798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/07/2018] [Indexed: 11/27/2022]
Abstract
This narrative literature review aims to identify the various factors that have significant impact on radiologists' visual search patterns. Identifying the factors that influences readers' visual search behaviour helps to understand their perception and interpretation of medical images, which in turn could lead to the development and implementation of effective strategies that could aid in improving the ability to detect abnormalities. Databases including PubMed, MedLine, Web of Science and ScienceDirect were searched using terms 'visual search', 'eye-tracking', 'radiology OR radiography', 'mammogram OR mammography' published since the early 1960s until June 30, 2016. Some of the factors that have been identified to significantly influence radiologists' visual search patterns were (i) readers' expertise, (ii) Satisfaction of Search, (iii) readers' visual fatigue, (iv) readers' confidence in reporting abnormalities, (v) training received and (vi) readers' prior knowledge. Readers' level of expertise was the factor that has been identified to have the most significant impact on their visual search pattern. Eye-tracking studies have shown the differences in visual search patterns of readers with different levels of experience and not so surprisingly, more experienced readers have shown effective visual search strategies. Readers' expertise has also been found to have significant impact in their confidence in reporting abnormalities and their ability to discriminate lesions from background structures in medical images.
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Affiliation(s)
- Aarthi Ganesan
- The University of Sydney, Sydney, New South Wales, Australia
| | - Maram Alakhras
- The University of Sydney, Sydney, New South Wales, Australia
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Heim E, Roß T, Seitel A, März K, Stieltjes B, Eisenmann M, Lebert J, Metzger J, Sommer G, Sauter AW, Schwartz FR, Termer A, Wagner F, Kenngott HG, Maier-Hein L. Large-scale medical image annotation with crowd-powered algorithms. J Med Imaging (Bellingham) 2018; 5:034002. [PMID: 30840724 DOI: 10.1117/1.jmi.5.3.034002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/26/2018] [Indexed: 01/07/2023] Open
Abstract
Accurate segmentations in medical images are the foundations for various clinical applications. Advances in machine learning-based techniques show great potential for automatic image segmentation, but these techniques usually require a huge amount of accurately annotated reference segmentations for training. The guiding hypothesis of this paper was that crowd-algorithm collaboration could evolve as a key technique in large-scale medical data annotation. As an initial step toward this goal, we evaluated the performance of untrained individuals to detect and correct errors made by three-dimensional (3-D) medical segmentation algorithms. To this end, we developed a multistage segmentation pipeline incorporating a hybrid crowd-algorithm 3-D segmentation algorithm integrated into a medical imaging platform. In a pilot study of liver segmentation using a publicly available dataset of computed tomography scans, we show that the crowd is able to detect and refine inaccurate organ contours with a quality similar to that of experts (engineers with domain knowledge, medical students, and radiologists). Although the crowds need significantly more time for the annotation of a slice, the annotation rate is extremely high. This could render crowdsourcing a key tool for cost-effective large-scale medical image annotation.
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Affiliation(s)
- Eric Heim
- German Cancer Research Center (DKFZ), Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Tobias Roß
- German Cancer Research Center (DKFZ), Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Alexander Seitel
- German Cancer Research Center (DKFZ), Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Keno März
- German Cancer Research Center (DKFZ), Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Bram Stieltjes
- University of Basel, University Hospital Basel, Radiology and Nuclear Medicine Clinic, Basel, Switzerland
| | - Matthias Eisenmann
- German Cancer Research Center (DKFZ), Computer Assisted Medical Interventions, Heidelberg, Germany
| | - Johannes Lebert
- University of Heidelberg, Department of General, Visceral and Transplant Surgery, Heidelberg, Germany
| | - Jasmin Metzger
- German Cancer Research Center (DKFZ), Medical Image Computing, Heidelberg, Germany
| | - Gregor Sommer
- University of Basel, University Hospital Basel, Radiology and Nuclear Medicine Clinic, Basel, Switzerland
| | - Alexander W Sauter
- University of Basel, University Hospital Basel, Radiology and Nuclear Medicine Clinic, Basel, Switzerland
| | - Fides Regina Schwartz
- University of Basel, University Hospital Basel, Radiology and Nuclear Medicine Clinic, Basel, Switzerland
| | - Andreas Termer
- University of Heidelberg, Department of General, Visceral and Transplant Surgery, Heidelberg, Germany
| | - Felix Wagner
- University of Heidelberg, Department of General, Visceral and Transplant Surgery, Heidelberg, Germany
| | - Hannes Götz Kenngott
- University of Heidelberg, Department of General, Visceral and Transplant Surgery, Heidelberg, Germany
| | - Lena Maier-Hein
- German Cancer Research Center (DKFZ), Computer Assisted Medical Interventions, Heidelberg, Germany
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Chin MD, Evans KK, Wolfe JM, Bowen J, Tanaka JW. Inversion effects in the expert classification of mammograms and faces. COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2018; 3:31. [PMID: 30148205 PMCID: PMC6092273 DOI: 10.1186/s41235-018-0123-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 06/23/2018] [Indexed: 11/25/2022]
Abstract
A hallmark of a perceptual expert is the ability to detect and categorize stimuli in their domain of expertise after brief exposure. For example, expert radiologists can differentiate between “abnormal” and “normal” mammograms after a 250 ms exposure. It has been speculated that rapid detection depends on a global analysis referred to as holistic perception. Holistic processing in radiology seems similar to holistic perception in which a stimulus like a face is perceived as an integrated whole, not in terms of its individual features. Holistic processing is typically subject to inversion effects in which the inverted image is harder to process/recognize. Is radiological perception similarly subject to inversion effects? Eleven experienced radiologists (> 5 years of radiological experience) and ten resident radiologists (< 5 years of radiological experience) judged upright and inverted bilateral mammograms as “normal” or “abnormal”. For comparison, the same participants judged whether upright and inverted faces were “happy” or “neutral”. We obtained the expected inversion effect for faces. Expression discrimination was superior for upright faces. For mammograms, experienced radiologists exhibited a similar inversion effect, showing higher accuracy for upright than for inverted mammograms. Less experienced radiology residents performed more poorly than experienced radiologists and demonstrated no inversion effect with mammograms. These results suggest that the ability to discriminate normal from abnormal mammograms is a form of learned, holistic processing.
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Affiliation(s)
- Michael D Chin
- 1Department of Psychology, University of Victoria, Victoria, BC Canada
| | | | | | - Jonathan Bowen
- 1Department of Psychology, University of Victoria, Victoria, BC Canada
| | - James W Tanaka
- 1Department of Psychology, University of Victoria, Victoria, BC Canada
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Gandomkar Z, Tay K, Brennan PC, Mello-Thoms C. Recurrence quantification analysis of radiologists' scanpaths when interpreting mammograms. Med Phys 2018; 45:3052-3062. [PMID: 29694675 DOI: 10.1002/mp.12935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The purpose of this study was to Propose a classifier based on recurrence quantification analysis (RQA) metrics for distinguishing experts' scanpaths from those of less-experienced readers and to explore the association of spatiotemporal dynamics of the mammographic scanpaths with the characteristics of cases and radiologists using RQA metrics. MATERIALS AND METHODS Eye movements were recorded from eight radiologists (two cohorts: four experienced and four less-experienced) while reading 120 mammograms (59 cancer, 61 normal). Ten RQA measures were extracted for each recorded scanpath. The measures described the temporal distribution of recurrent fixations as well as laminar and deterministic eye movements. Recurrent fixations are fixations that are located close to a previously fixated point in a scanpath. Deterministic eye movements represent looking back and forth between two locations, while laminar eye movements indicate detailed scanning of an area with consecutive fixations. The RQA metrics along with six conventional eye-tracking parameters were used to construct a classifier for distinguishing experts' scanpaths from those of less-experienced readers. Leave-one-out cross validation was used for evaluating the classifier. For each reader cohort, the ANOVA analysis was done to study the relationship of RQA measures with breast density, case pathology, readers' expertise, and readers' decisions on the case. The proportions of laminar and deterministic movements involved fixations in the location of lesions were also compared for two reader cohorts using two proportion z-tests. RESULTS All RQA measures differed significantly between scanpaths of experienced readers and those of less-experienced readers. The classifier achieved an area under the receiver operating characteristic curve of 0.89 (0.87-0.91) for detecting experts' scanpaths. Proportionately more refixations and laminar and deterministic sequences were in the location of the lesion for the experienced cohort compared to the less-experienced cohort (all P-values < 0.001). Eight and four RQA measures differed between normal and cancer cases for the experienced and less experienced readers, respectively. None of metrics differed between fatty and dense breasts for the less experienced readers, while two measures resulted into a significant difference for the experienced readers. For experts, six measures differed significantly between true negatives and false positives and nine were significantly different between true positives and false negatives. For the less-experienced cohort, the corresponding figures were seven and one measures, respectively. CONCLUSION The RQA measures can quantify the differences among experienced and less experienced radiologists. They also capture differences among experts' scanpaths related to case pathology and radiologists' decisions on the case.
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Affiliation(s)
- Ziba Gandomkar
- Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging and Radiation Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Kevin Tay
- Medical Imaging Department, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Patrick C Brennan
- Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging and Radiation Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Claudia Mello-Thoms
- Image Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging and Radiation Sciences, The University of Sydney, Sydney, NSW, Australia.,Department of Biomedical Informatics, School of Medicine, The University of Pittsburgh, Pittsburgh, PA, USA
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Crowe EM, Gilchrist ID, Kent C. New approaches to the analysis of eye movement behaviour across expertise while viewing brain MRIs. Cogn Res Princ Implic 2018; 3:12. [PMID: 29721518 PMCID: PMC5915515 DOI: 10.1186/s41235-018-0097-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 03/15/2018] [Indexed: 12/04/2022] Open
Abstract
Brain tumour detection and diagnosis requires clinicians to inspect and analyse brain magnetic resonance images. Eye-tracking is commonly used to examine observers' gaze behaviour during such medical image interpretation tasks, but analysis of eye movement sequences is limited. We therefore used ScanMatch, a novel technique that compares saccadic eye movement sequences, to examine the effect of expertise and diagnosis on the similarity of scanning patterns. Diagnostic accuracy was also recorded. Thirty-five participants were classified as Novices, Medics and Experts based on their level of expertise. Participants completed two brain tumour detection tasks. The first was a whole-brain task, which consisted of 60 consecutively presented slices from one patient; the second was an independent-slice detection task, which consisted of 32 independent slices from five different patients. Experts displayed the highest accuracy and sensitivity followed by Medics and then Novices in the independent-slice task. Experts showed the highest level of scanning pattern similarity, with medics engaging in the least similar scanning patterns, for both the whole-brain and independent-slice task. In the independent-slice task, scanning patterns were the least similar for false negatives across all expertise levels and most similar for experts when they responded correctly. These results demonstrate the value of using ScanMatch in the medical image perception literature. Future research adopting this tool could, for example, identify cases that yield low scanning similarity and so provide insight into why diagnostic errors occur and ultimately help in training radiologists.
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Affiliation(s)
- Emily M. Crowe
- School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
| | - Iain D. Gilchrist
- School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
| | - Christopher Kent
- School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
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Carrigan AJ, Wardle SG, Rich AN. Finding cancer in mammograms: if you know it's there, do you know where? Cogn Res Princ Implic 2018; 3:10. [PMID: 29707615 PMCID: PMC5904219 DOI: 10.1186/s41235-018-0096-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 02/27/2018] [Indexed: 11/23/2022] Open
Abstract
Humans can extract considerable information from scenes, even when these are presented extremely quickly. The ability of an experienced radiologist to rapidly detect an abnormality on a mammogram may build upon this general capacity. Although radiologists have been shown to be able to detect an abnormality 'above chance' at short durations, the extent to which abnormalities can be localised at brief presentations is less clear. Extending previous work, we presented radiologists with unilateral mammograms, 50% containing a mass, for 250 or 1000 ms. As the female breast varies with respect to the level of normal fibroglandular tissue, the images were categorised into high and low density (50% of each), resulting in difficult and easy searches, respectively. Participants were asked to decide whether there was an abnormality (detection) and then to locate the mass on a blank outline of the mammogram (localisation). We found both detection and localisation information for all conditions. Although there may be a dissociation between detection and localisation on a small proportion of trials, we find a number of factors that lead to the underestimation of localisation including stimulus variability, response imprecision and participant guesses. We emphasise the importance of taking these factors into account when interpreting results. The effect of density on detection and localisation highlights the importance of considering breast density in medical screening.
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Affiliation(s)
- Ann J. Carrigan
- Perception in Action Research Centre & Department of Cognitive Science, Macquarie University, Sydney, Australia
- ARC Centre of Excellence in Cognition & Its Disorders, Macquarie University, Sydney, Australia
- Centre for Elite Performance, Expertise, and Training, Macquarie University, Sydney, Australia
| | - Susan G. Wardle
- Perception in Action Research Centre & Department of Cognitive Science, Macquarie University, Sydney, Australia
- ARC Centre of Excellence in Cognition & Its Disorders, Macquarie University, Sydney, Australia
| | - Anina N. Rich
- Perception in Action Research Centre & Department of Cognitive Science, Macquarie University, Sydney, Australia
- ARC Centre of Excellence in Cognition & Its Disorders, Macquarie University, Sydney, Australia
- Centre for Elite Performance, Expertise, and Training, Macquarie University, Sydney, Australia
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Wilson AT, Dey S, Evans JW, Najm M, Qiu W, Menon BK. Minds treating brains: understanding the interpretation of non-contrast CT ASPECTS in acute ischemic stroke. Expert Rev Cardiovasc Ther 2018; 16:143-153. [PMID: 29265903 DOI: 10.1080/14779072.2018.1421069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The Alberta Stroke Program Early CT Score on non-contrast CT is a key component of prognostication and treatment selection in acute stroke care. Previous findings show that the reliability of this scale must be improved to maximize its clinical utility. Areas covered: This review discusses technical, patient-level, and reader-level sources of variability in ASPECTS reading; relevant concepts in the psychology of medical image perception; and potential interventions likely to improve inter- and intra-rater reliability. Expert commentary: Approaching variability in medical decision making from a psychological perspective will afford cognitively informed insights into the development of interventions and training techniques aimed at improving this issue.
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Affiliation(s)
- Alexis T Wilson
- a Department of Clinical Neurosciences , University of Calgary , Calgary , AB , Canada
| | - Sadanand Dey
- a Department of Clinical Neurosciences , University of Calgary , Calgary , AB , Canada
| | - James W Evans
- a Department of Clinical Neurosciences , University of Calgary , Calgary , AB , Canada
| | - Mohamed Najm
- a Department of Clinical Neurosciences , University of Calgary , Calgary , AB , Canada
| | - Wu Qiu
- a Department of Clinical Neurosciences , University of Calgary , Calgary , AB , Canada
| | - Bijoy K Menon
- a Department of Clinical Neurosciences , University of Calgary , Calgary , AB , Canada.,b Department of Radiology , University of Calgary , Calgary , AB , Canada.,c Department of Community Health Sciences , University of Calgary , Calgary , AB , Canada
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Kelly B, Rainford LA, McEntee MF, Kavanagh EC. Influence of radiology expertise on the perception of nonmedical images. J Med Imaging (Bellingham) 2017; 5:031402. [PMID: 29250569 PMCID: PMC5724551 DOI: 10.1117/1.jmi.5.3.031402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/19/2017] [Indexed: 11/14/2022] Open
Abstract
Identifying if participants with differing diagnostic accuracy and visual search behavior during radiologic tasks also differ in nonradiologic tasks is investigated. Four clinician groups with different radiologic experience were used: a reference expert group of five consultant radiologists, four radiology registrars, five senior house officers, and six interns. Each of the four clinician groups is known to have significantly different performance in the identification of pneumothoraces in chest x-ray. Each of the 20 participants was shown 6 nonradiologic images (3 maps and 3 sets of geometric shapes) and was asked to perform search tasks. 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 among the groups. All data were compared by using nonparametric methods of analysis. The average number of targets identified in the maps did not change among groups [mean=5.8 of 6 targets (range 5.6 to 6 p=0.861)]. None of the four eye-tracking metrics investigated varied with experience in either search task (p>0.5). Despite clear differences in radiologic experience, these clinician groups showed no difference in nonradiologic search pattern behavior or skill across complex images. This is another viewpoint adding to the evidence that radiologic image interpretation is a learned skill and is task specific.
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Affiliation(s)
- Brendan Kelly
- St. Vincent's University Hospital, Department of Radiology, Elm Park, Dublin, Ireland
| | - Louise A Rainford
- University College Dublin, School of Medicine and Medical Science, Belfield, Dublin, Ireland
| | - Mark F McEntee
- University of Sydney, Medical Radiation Science, Camperdown, New South Wales, Australia
| | - Eoin C Kavanagh
- Mater Misicordiae University Hospital, Radiology, Dublin, Ireland
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Aizenman A, Drew T, Ehinger KA, Georgian-Smith D, Wolfe JM. Comparing search patterns in digital breast tomosynthesis and full-field digital mammography: an eye tracking study. J Med Imaging (Bellingham) 2017; 4:045501. [PMID: 29098168 DOI: 10.1117/1.jmi.4.4.045501] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Abstract
As a promising imaging modality, digital breast tomosynthesis (DBT) leads to better diagnostic performance than traditional full-field digital mammograms (FFDM) alone. DBT allows different planes of the breast to be visualized, reducing occlusion from overlapping tissue. Although DBT is gaining popularity, best practices for search strategies in this medium are unclear. Eye tracking allowed us to describe search patterns adopted by radiologists searching DBT and FFDM images. Eleven radiologists examined eight DBT and FFDM cases. Observers marked suspicious masses with mouse clicks. Eye position was recorded at 1000 Hz and was coregistered with slice/depth plane as the radiologist scrolled through the DBT images, allowing a 3-D representation of eye position. Hit rate for masses was higher for tomography cases than 2-D cases and DBT led to lower false positive rates. However, search duration was much longer for DBT cases than FFDM. DBT was associated with longer fixations but similar saccadic amplitude compared with FFDM. When comparing radiologists' eye movements to a previous study, which tracked eye movements as radiologists read chest CT, we found DBT viewers did not align with previously identified "driller" or "scanner" strategies, although their search strategy most closely aligns with a type of vigorous drilling strategy.
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Affiliation(s)
- Avi Aizenman
- University of California, Vision Science Department, Berkeley, California, United States
| | - Trafton Drew
- University of Utah, Psychology Department, Salt Lake City, Utah, United States
| | - Krista A Ehinger
- York University, Centre for Vision Research, Toronto, Ontario, Canada
| | - Dianne Georgian-Smith
- Brigham and Women's Hospital, Surgery Department, Boston, Massachusetts, United States
| | - Jeremy M Wolfe
- Brigham and Women's Hospital, Surgery Department, Boston, Massachusetts, United States.,Harvard Medical School, Ophthalmology and Radiology Department, Boston, Massachusetts, United States
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Sheridan H, Reingold EM. The Holistic Processing Account of Visual Expertise in Medical Image Perception: A Review. Front Psychol 2017; 8:1620. [PMID: 29033865 PMCID: PMC5627012 DOI: 10.3389/fpsyg.2017.01620] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 09/04/2017] [Indexed: 12/11/2022] Open
Abstract
In the field of medical image perception, the holistic processing perspective contends that experts can rapidly extract global information about the image, which can be used to guide their subsequent search of the image (Swensson, 1980; Nodine and Kundel, 1987; Kundel et al., 2007). In this review, we discuss the empirical evidence supporting three different predictions that can be derived from the holistic processing perspective: Expertise in medical image perception is domain-specific, experts use parafoveal and/or peripheral vision to process large regions of the image in parallel, and experts benefit from a rapid initial glimpse of an image. In addition, we discuss a pivotal recent study (Litchfield and Donovan, 2016) that seems to contradict the assumption that experts benefit from a rapid initial glimpse of the image. To reconcile this finding with the existing literature, we suggest that global processing may serve multiple functions that extend beyond the initial glimpse of the image. Finally, we discuss future research directions, and we highlight the connections between the holistic processing account and similar theoretical perspectives and findings from other domains of visual expertise.
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Affiliation(s)
- Heather Sheridan
- Department of Psychology, University at Albany, State University of New York, Albany, NY, United States
| | - Eyal M. Reingold
- Department of Psychology, University of Toronto, Mississauga, ON, Canada
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Case based simulation in MRI for suspected appendicitis in children. Clin Imaging 2017; 48:12-16. [PMID: 28963916 DOI: 10.1016/j.clinimag.2017.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/09/2017] [Accepted: 09/19/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To establish the effect on diagnostic confidence of a simulation setting, in which radiologists re-interpret anonymized pediatric MRI cases. MATERIALS In this IRB-approved study, participants completed surveys rating confidence before and after interpreting 10 MRI cases for suspected appendicitis in children. RESULTS 18 radiologists (4 faculty, 5 fellows, and 9 residents) correctly identified an average of 7.44 cases (range 5-9). Self-described confidence regarding technique and interpretation increased from 2.0 (SD 0.77) and 2.33 (SD 0.69) to 2.83 (SD 0.71) and 2.94 (SD 0.73), respectively. CONCLUSION Simulated interpretation of pediatric MRI in suspected appendicitis results in increased self-describe confidence without requiring additional capital/equipment expenses.
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Ravesloot CJ, van der Schaaf MF, Kruitwagen CLJJ, van der Gijp A, Rutgers DR, Haaring C, ten Cate O, van Schaik JPJ. Predictors of Knowledge and Image Interpretation Skill Development in Radiology Residents. Radiology 2017; 284:758-765. [DOI: 10.1148/radiol.2017152648] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Cécile J. Ravesloot
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Marieke F. van der Schaaf
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Cas L. J. J. Kruitwagen
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Anouk van der Gijp
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Dirk R. Rutgers
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Cees Haaring
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Olle ten Cate
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Jan P. J. van Schaik
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
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Ravesloot CJ, van der Gijp A, van der Schaaf MF, Huige JCBM, Ten Cate O, Vincken KL, Mol CP, van Schaik JPJ. Identifying error types in visual diagnostic skill assessment. ACTA ACUST UNITED AC 2017. [PMID: 29536921 DOI: 10.1515/dx-2016-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Misinterpretation of medical images is an important source of diagnostic error. Errors can occur in different phases of the diagnostic process. Insight in the error types made by learners is crucial for training and giving effective feedback. Most diagnostic skill tests however penalize diagnostic mistakes without an eye for the diagnostic process and the type of error. A radiology test with stepwise reasoning questions was used to distinguish error types in the visual diagnostic process. We evaluated the additional value of a stepwise question-format, in comparison with only diagnostic questions in radiology tests. METHODS Medical students in a radiology elective (n=109) took a radiology test including 11-13 cases in stepwise question-format: marking an abnormality, describing the abnormality and giving a diagnosis. Errors were coded by two independent researchers as perception, analysis, diagnosis, or undefined. Erroneous cases were further evaluated for the presence of latent errors or partial knowledge. Inter-rater reliabilities and percentages of cases with latent errors and partial knowledge were calculated. RESULTS The stepwise question-format procedure applied to 1351 cases completed by 109 medical students revealed 828 errors. Mean inter-rater reliability of error type coding was Cohen's κ=0.79. Six hundred and fifty errors (79%) could be coded as perception, analysis or diagnosis errors. The stepwise question-format revealed latent errors in 9% and partial knowledge in 18% of cases. CONCLUSIONS A stepwise question-format can reliably distinguish error types in the visual diagnostic process, and reveals latent errors and partial knowledge.
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Affiliation(s)
- Cécile J Ravesloot
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk van der Gijp
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Koen L Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christian P Mol
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan P J van Schaik
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
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van der Gijp A, Webb EM, Naeger DM. How Radiologists Think: Understanding Fast and Slow Thought Processing and How It Can Improve Our Teaching. Acad Radiol 2017; 24:768-771. [PMID: 28601164 DOI: 10.1016/j.acra.2016.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/08/2016] [Indexed: 10/19/2022]
Abstract
Scholars have identified two distinct ways of thinking. This "Dual Process Theory" distinguishes a fast, nonanalytical way of thinking, called "System 1," and a slow, analytical way of thinking, referred to as "System 2." In radiology, we use both methods when interpreting and reporting images, and both should ideally be emphasized when educating our trainees. This review provides practical tips for improving radiology education, by enhancing System 1 and System 2 thinking among our trainees.
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van der Gijp A, Vincken KL, Boscardin C, Webb EM, Ten Cate OTJ, Naeger DM. The Effect of Teaching Search Strategies on Perceptual Performance. Acad Radiol 2017; 24:762-767. [PMID: 28242103 DOI: 10.1016/j.acra.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES Radiology expertise is dependent on the use of efficient search strategies. The aim of this study is to investigate the effect of teaching search strategies on trainee's accuracy in detecting lung nodules at computed tomography. MATERIALS AND METHODS Two search strategies, "scanning" and "drilling," were tested with a randomized crossover design. Nineteen junior radiology residents were randomized into two groups. Both groups first completed a baseline lung nodule detection test allowing a free search strategy, followed by a test after scanning instruction and drilling instruction or vice versa. True positive (TP) and false positive (FP) scores and scroll behavior were registered. A mixed-design analysis of variance was applied to compare the three search conditions. RESULTS Search strategy instruction had a significant effect on scroll behavior, F(1.3) = 54.2, P < 0.001; TP score, F(2) = 16.1, P < 0.001; and FP score, F(1.3) = 15.3, P < 0.001. Scanning instruction resulted in significantly lower TP scores than drilling instruction (M = 10.7, SD = 5.0 versus M = 16.3, SD = 5.3), t(18) = 4.78, P < 0.001; or free search (M = 15.3, SD = 4.6), t(18) = 4.44, P < 0.001. TP scores for drilling did not significantly differ from free search. FP scores for drilling (M = 7.3, SD = 5.6) were significantly lower than for free search (M = 12.5, SD = 7.8), t(18) = 4.86, P < 0.001. CONCLUSIONS Teaching a drilling strategy is preferable to teaching a scanning strategy for finding lung nodules.
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Affiliation(s)
- Anouk van der Gijp
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628
| | - Koen L Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christy Boscardin
- Office of Medical Education, University of California, San Francisco, San Francisco, California
| | - Emily M Webb
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628
| | - Olle Th J Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David M Naeger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-391, San Francisco, CA 94143-0628.
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Overview of the radiographers' practice in 65 healthcare centers using digital mammography systems in Portugal. Insights Imaging 2017; 8:345-355. [PMID: 28303553 PMCID: PMC5438316 DOI: 10.1007/s13244-017-0550-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/24/2017] [Accepted: 02/22/2017] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To assess current practices in digital mammography (DM) in Portuguese healthcare providers using digital systems. To investigate compliance with European standards regarding mean glandular dose and quality control practice and to identify optimisation needs. METHODS Two questionnaires, targeted at breast radiographers and chief radiographers, were designed and applied in 65 imaging departments offering DM. Questions fielded were focused on the staff profile and technical/clinical practice. RESULTS Prior to starting their activity in DM, 70% (82 out of 118) of the respondents received training in DM. The practice in 29 out of 59 providers was established by the manufacturers' recommendations for image acquisition. Variations were observed between radiographers who belong to the same provider namely the selection of exposure parameters such as the target-filter combination and automatic mode. The use of the manual exposure mode was reported for imaging breast implants (44%) and surgical specimens (22%). The main causes of repeat examinations were skin folding (21%) and absence of pectoral muscle (PM) (20%). CONCLUSIONS The study revealed opportunities to optimise radiographers' practice in DM regarding the selection of exposure parameters. A robust and consistent training programme in DM and established local protocols can help to reduce the variations observed and improve clinical practice. MAIN MESSAGES • Radiographers adopted different practices selecting AEC modes and T/F combinations. • Radiographer practice is more consistent using DR than using CR systems. • The main causes for rejecting images were the visibility of skin folding and PM absence. • Radiographers were partly unaware of the dose indicator. • Radiographers' training needs: QC, interventional procedures and breast dose optimisation.
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Pecaric M, Boutis K, Beckstead J, Pusic M. A Big Data and Learning Analytics Approach to Process-Level Feedback in Cognitive Simulations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:175-184. [PMID: 27224299 DOI: 10.1097/acm.0000000000001234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Collecting and analyzing large amounts of process data for the purposes of education can be considered a big data/learning analytics (BD/LA) approach to improving learning. However, in the education of health care professionals, the application of BD/LA is limited to date. The authors discuss the potential advantages of the BD/LA approach for the process of learning via cognitive simulations. Using the lens of a cognitive model of radiograph interpretation with four phases (orientation, searching/scanning, feature detection, and decision making), they reanalyzed process data from a cognitive simulation of pediatric ankle radiography where 46 practitioners from three expertise levels classified 234 cases online. To illustrate the big data component, they highlight the data available in a digital environment (time-stamped, click-level process data). Learning analytics were illustrated using algorithmic computer-enabled approaches to process-level feedback.For each phase, the authors were able to identify examples of potentially useful BD/LA measures. For orientation, the trackable behavior of re-reviewing the clinical history was associated with increased diagnostic accuracy. For searching/scanning, evidence of skipping views was associated with an increased false-negative rate. For feature detection, heat maps overlaid on the radiograph can provide a metacognitive visualization of common novice errors. For decision making, the measured influence of sequence effects can reflect susceptibility to bias, whereas computer-generated path maps can provide insights into learners' diagnostic strategies.In conclusion, the augmented collection and dynamic analysis of learning process data within a cognitive simulation can improve feedback and prompt more precise reflection on a novice clinician's skill development.
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Affiliation(s)
- Martin Pecaric
- M. Pecaric is lead consultant, Contrail Consulting Services, Toronto, Ontario, Canada. K. Boutis is associate professor and pediatric emergency physician, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. J. Beckstead is associate professor of nursing, University of South Florida College of Nursing, Tampa, Florida. M. Pusic is assistant professor of emergency medicine and director, Division of Learning Analytics, New York University School of Medicine, New York, New York
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Abstract
BACKGROUND AND OBJECTIVE Considerable variation in adenoma detection has been shown between endoscopists, which may be explained by differences in colon inspection. Eye-tracking technology is an objective tool that detects differences in viewing patterns. We investigated the feasibility of eye-tracking technology during real-time, self-performed colonoscopies. METHODS In this pilot study, 10 endoscopists performed two colonoscopies each. A mobile eye-tracking system to register the right eye position was used to determine the gaze across four areas of interest of the endoscopy monitor (upper, lower, left, and right quadrant). The measured gaze across the endoscopy monitor was correlated with the gaze across the endoscopically visualized colonic surface. RESULTS Gaze patterns were measured successfully in 18 of 20 procedures. Significant differences in the time spent per area of interest were observed between endoscopists. The measured total gaze time per area of interest correlated strongly with the time spent on the corresponding area of the colonic surface (Pearson correlation coefficients ranging between 0.91 and 0.97). Endoscopists with more years of colonoscopy experience showed significantly higher percentages of overlap between the measured gaze position in the different areas of interest and the actual inspected area of the colonic surface (r=0.65, P=0.02). More experienced endoscopists had nonsignificantly longer mean gaze times per area of interest (r=0.52, P=0.06). CONCLUSION Eye-tracking technology to measure gaze patterns of endoscopists during real-time, self-performed colonoscopies is feasible and may be used to evaluate and compare viewing behavior across the colonic surface of experienced endoscopists.
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Poot JD, Chetlen AL. A Simulation Screening Mammography Module Created for Instruction and Assessment: Radiology Residents vs National Benchmarks. Acad Radiol 2016; 23:1454-1462. [PMID: 27637285 DOI: 10.1016/j.acra.2016.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/05/2016] [Accepted: 07/01/2016] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES To improve mammographic screening training and breast cancer detection, radiology residents participated in a simulation screening mammography module in which they interpreted an enriched set of screening mammograms with known outcomes. This pilot research study evaluates the effectiveness of the simulation module while tracking the progress, efficiency, and accuracy of radiology resident interpretations and also compares their performance against national benchmarks. MATERIALS AND METHODS A simulation module was created with 266 digital screening mammograms enriched with high-risk breast lesions (seven cases) and breast malignancies (65 cases). Over a period of 27 months, 39 radiology residents participated in the simulation screening mammography module. Resident sensitivity and specificity were compared to Breast Cancer Surveillance Consortium (BCSC data through 2009) national benchmark and American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) acceptable screening mammography audit ranges. RESULTS The sensitivity, the percentage of cancers with an abnormal initial interpretation (BI-RADS 0), among residents was 84.5%, similar to the BCSC benchmark sensitivity of 84.9% (sensitivity for tissue diagnosis of cancer within 1 year following the initial examination) and within the acceptable ACR BI-RADS medical audit range of ≥75%. The specificity, the percentage of noncancers that had a negative image interpretation (BI-RADS 1 or 2), among residents was 83.2% compared to 90.3% reported in the BCSC benchmark data, but lower than the suggested ACR BI-RADS range of 88%-95%. CONCLUSIONS Using simulation modules for interpretation of screening mammograms is a promising method for training radiology residents to detect breast cancer and to help them achieve competence toward national benchmarks.
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Kelly BS, Rainford LA, Darcy SP, Kavanagh EC, Toomey RJ. The Development of Expertise in Radiology: In Chest Radiograph Interpretation, “Expert” Search Pattern May Predate “Expert” Levels of Diagnostic Accuracy for Pneumothorax Identification. Radiology 2016; 280:252-60. [DOI: 10.1148/radiol.2016150409] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Suleiman WI, Rawashdeh MA, Lewis SJ, McEntee MF, Lee W, Tapia K, Brennan PC. Impact of Breast Reader Assessment Strategy on mammographic radiologists' test reading performance. J Med Imaging Radiat Oncol 2016; 60:352-8. [DOI: 10.1111/1754-9485.12461] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Wasfi I Suleiman
- Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Centre; The Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
| | - Mohammad A Rawashdeh
- Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Centre; The Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
- Faculty of Applied Medical Sciences; Jordan University of Science and Technology; Irbid Jordan
| | - Sarah J Lewis
- Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Centre; The Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
| | - Mark F McEntee
- Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Centre; The Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
| | - Warwick Lee
- Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Centre; The Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
| | - Kriscia Tapia
- Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Centre; The Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
| | - Patrick C Brennan
- Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Centre; The Faculty of Health Sciences; The University of Sydney; Sydney New South Wales Australia
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Hawley JR, Taylor CR, Cubbison AM, Erdal BS, Yildiz VO, Carkaci S. Influences of Radiology Trainees on Screening Mammography Interpretation. J Am Coll Radiol 2016; 13:554-61. [PMID: 26924162 DOI: 10.1016/j.jacr.2016.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Participation of radiology trainees in screening mammographic interpretation is a critical component of radiology residency and fellowship training. The aim of this study was to investigate and quantify the effects of trainee involvement on screening mammographic interpretation and diagnostic outcomes. METHODS Screening mammograms interpreted at an academic medical center by six dedicated breast imagers over a three-year period were identified, with cases interpreted by an attending radiologist alone or in conjunction with a trainee. Trainees included radiology residents, breast imaging fellows, and fellows from other radiology subspecialties during breast imaging rotations. Trainee participation, patient variables, results of diagnostic evaluations, and pathology were recorded. RESULTS A total of 47,914 mammograms from 34,867 patients were included, with an overall recall rate for attending radiologists reading alone of 14.7% compared with 18.0% when involving a trainee (P < .0001). Overall cancer detection rate for attending radiologists reading alone was 5.7 per 1,000 compared with 5.2 per 1,000 when reading with a trainee (P = .517). When reading with a trainee, dense breasts represented a greater portion of recalls (P = .0001), and more frequently, greater than one abnormality was described in the breast (P = .013). Detection of ductal carcinoma in situ versus invasive carcinoma or invasive cancer type was not significantly different. The mean size of cancers in patients recalled by attending radiologists alone was smaller, and nodal involvement was less frequent, though not statistically significantly. CONCLUSIONS These results demonstrate a significant overall increase in recall rate when interpreting screening mammograms with radiology trainees, with no change in cancer detection rate. Radiology faculty members should be aware of this potentiality and mitigate tendencies toward greater false positives.
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Affiliation(s)
- Jeffrey R Hawley
- The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | | | | | - B Selnur Erdal
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Vedat O Yildiz
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Selin Carkaci
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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