Does preference influence performance when reading different sizes of cranial computed tomography?

Lack of agreement between radiologists: implications for image-based model observers

We tested the agreement of radiologists' rankings of different reconstructions of breast computed tomography images based on their diagnostic (classification) performance and on their subjective image quality assessments. We used 102 pathology proven cases (62 malignant, 40 benign), and an iterative image reconstruction (IIR) algorithm to obtain 24 reconstructions per case with different image appearances. Using image feature analysis, we selected 3 IIRs and 1 clinical reconstruction and 50 lesions. The reconstructions produced a range of image quality from smooth/low-noise to sharp/high-noise, which had a range in classifier performance corresponding to AUCs of 0.62 to 0.96. Six experienced Mammography Quality Standards Act (MQSA) radiologists rated the likelihood of malignancy for each lesion. We conducted an additional reader study with the same radiologists and a subset of 30 lesions. Radiologists ranked each reconstruction according to their preference. There was disagreement among the six radiologists on which reconstruction produced images with the highest diagnostic content, but they preferred the midsharp/noise image appearance over the others. However, the reconstruction they preferred most did not match with their performance. Due to these disagreements, it may be difficult to develop a single image-based model observer that is representative of a population of radiologists for this particular imaging task.

Image Size Influences Visual Search and Perception of Hemorrhages When Reading Cranial CT: An Eye-Tracking Study

OBJECTIVE

The aim of this study was to explore reader gaze, performance, and preference during interpretation of cranial computed tomography (cCT) in stack mode at two different sizes.

BACKGROUND

Digital display of medical images allows for the manipulation of many imaging factors, like image size, by the radiologists, yet it is often not known what display parameters better suit human perception.

METHOD

Twenty-one radiologists provided informed consent to be eye tracked while reading 20 cCT cases. Half of these cases were presented at a size of 14 × 14 cm (512 × 512 pixels), half at 28 × 28 cm (1,024 × 1,024 pixels). Visual search, performance, and preference for the two image sizes were assessed.

RESULTS

When reading small images, significantly fewer, but longer, fixations were observed, and these fixations covered significantly more slices. Time to first fixation of true positive findings was faster in small images, but dwell time on true findings was longer. Readers made more false positive decisions in small images, but no overall difference in either jackknife alternative free-response receiver operating characteristic or reading time was found.

CONCLUSION

Overall performance is not affected by image size. However, small-stack-mode cCT images may better support the use of motion perception and acquiring an overview, whereas large-stack-mode cCT images seem better suited for detailed analyses.

APPLICATION

Subjective and eye-tracking data suggest that image size influences how images are searched and that different search strategies might be beneficial under different circumstances.