Additional Information:• ABSTRACTHistorically, radiology research has been dominated by chest and breast screening. Few studies have examined complex interpretative tasks such as the reading of multidimensional brain CT or MRI scans. Additionally, no studies at the time of writing have explored the interpretation of stroke images; from novices through to experienced practitioners using eye movement analysis. Finally, there appears a lack of evidence on the clinical effects of radiology reports and their influence on image appraisal and clinical diagnosis. A computer-based, eye-tracking study was designed to assess diagnostic accuracy and interpretation in stroke CT and MR imagery. Eight predetermined clinical cases, five images per case, were presented to participants (novices, trainee, and radiologists; n=8). The presence or absence of abnormalities was rated on a five-point Likert scale and their locations reported. Half cases of the cases were accompanied by clinical information; half were not, to assess the impact of information on observer performance. Results highlight differences in visual search patterns amongst novice, trainee and expert observers; the most marked differences occurred between novice readers and experts. Experts spent more time in challenging areas of interest (AOI) than novices and trainee, and were more confident unless a lesion was large and obvious. The time to first AOI fixation differed by size, shape and clarity of lesion. 'Time to lesion' dropped significantly when recognition appeared to occur between slices. The influence of clinical information was minimal.
Additional Information:• Copyright 2010 Society of Photo-Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic electronic or print reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited. This paper can also be found ABSTRACTAlthough CT and MR imaging is now commonplace in the radiology department, few studies have examined complex interpretative tasks such as the reading of multidimensional brain CT or MRI scans from the observer performance perspective, especially with reference to Stroke. Modality performance studies have demonstrated a similar sensitivity of less than 50% for both conventional modalities, with neither modality proving superior to the other in Stroke observer performance tasks (Mohr, 1995;Lansberg, 2000;Wintermark, 2007). Visual search studies have not extensively explored stroke imaging and an in-depth, comparative eye-movement study between CT and MRI has not yet been conducted. A computer-based, eye-tracking study was designed to assess diagnostic accuracy and interpretation in stroke CT and MR imagery. Forty eight predetermined clinical cases, with five images per case, were presented to participants (novices, trainees and radiologists; n=28). The presence or absence of abnormalities was rated on a four-point Likert scale and their locations reported. Results highlight differences in visual search patterns amongst novice, trainee and expert observers; the most marked differences occurred between novice readers and experts. In terms of modality differences; novice and expert readers spent longer appraising CT images than MR, compared with trainees, who spent longer appraising MR than CT images. Image analysis trends did not appear to differ between modalities, but time spent within clinical images, accuracy and relative confidence performing the task did differ between CT and MR reader groups. To-date few studies have explored observer performance in neuroradiology and the present study examines multi-slice image appraisal by comparing matched pairs of CT and MRI Stroke cases.
Denys-Drash syndrome is a genetic disorder characterized by ambiguous genitalia, cryptorchidism, nephrotic syndrome, and a high predilection for Wilms tumor with intravascular invasion. We report a 5-year-old male with Denys-Drash syndrome who rapidly developed Wilms tumor with vascular invasion, subsequent saddle tumor embolus, and required emergent embolectomy. This case illustrates the rapid emergence of Wilms tumor in a patient with Denys-Drash syndrome and the importance of considering embolectomy over thrombolytic therapy for PE in this population, given a high likelihood of tumor embolus.
International audienceThis paper presents a novel study investigating the influences of Magnetic Resonance (MR) image anatomical information and observer expertise on an abnormality detection task. MRI is exquisitely sensitive for detecting brain abnormalities, particularly in the evaluation of white matter diseases, e.g. multiple sclerosis (MS). For this reason, MS lesions are simulated as the target stimuli for detection in the present study. Two different image backgrounds are used in the following experiments: a) homogeneous region of white matter tissue, and b) one slice of a healthy brain MR image. One expert radiologist (more than 10 years' experience), three radiologists (less than 5 years' experience) and eight nave observers (without any prior medical knowledge) have performed these experiments, during which they have been asked different questions dependent upon level of experience; the three radiologists and eight nave observers were asked if they were aware of any hyper-signal, likely to represent an MS lesion, while the most experienced consultant was asked if a clinically significant sign was present. With the percentages of response "yes" displayed on the y-axis and the lesion intensity contrasts on the x-axis, psychometric function is generated from the observer' responses. Results of psychometric functions and calculated thresholds indicate that radiologists have better hyper-signal detection ability than nave observers, which is intuitively shown by the lower simple visibility thresholds of radiologists. However, when radiologists perform a task with clinical implications, e.g. to detect a clinically significant sign, their detection thresholds are elevated. Moreover, the study indicates that for the radiologists, the simple visibility thresholds remain the same with and without the anatomical information, which reduces the threshold for the clinically significant sign detection task. Findings provide further insight into human visual system processing for this specific task, and this study provides the foundation for a series of studies investigating numerical observer modeling to be designed, with the ultimate aim of investigating the medical image quality assessment approach by addressing the perspective of radiologist diagnostic performance
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