Focal lung pathology detection in radiology: Is there an effect of experience on visual search behavior?

Abstract

In radiology, 60% to 80% of diagnostic errors are perceptual. The use of more efficient visual search behaviors is expected to reduce these errors. We collected eye-tracking data from participants with different levels of experience when interpreting chest X-rays during the completion of a pathology-detection task. Eye-tracking measures were assessed in the context of three existing visual search theories from the literature to understand the association between visual search behavior and underlying processes: the long-term working memory theory, the information-reduction hypothesis, and the holistic model of image perception. The most experienced participants (radiology residents) showed the highest level of performance, albeit their visual search behaviors did not differ from the intermediate group. This suggests that radiology residents better processed the represented information on the X-ray, using a visual search strategy similar to the intermediate group. Since similar visual search resulted in more information extraction in the radiology residents compared with the intermediates, we suggest that this result might support the long-term working memory theory. Furthermore, compared with novices, intermediates and radiology residents fixated longer on areas that were more important to avoid missing any pathology, which possibly confirms the information-reduction hypothesis. Finally, the larger distances between fixations observed in more experienced participants could support the holistic model of image perception. In addition, measures of generic skills were related to a lower time cost for switching between global and local information processing. Our findings suggest that the three theories may be complementary in chest X-ray interpretation. Therefore, a unified theory explaining perceptual-cognitive superiority in radiology is considered.

Eye movements reflect expertise development in hybrid search

“…With experience, observers' searching and targeting saccades gradually became longer, revealing two novel insights into search performance: (1) FVF size changes within search trials and (2) FVF size changes across search trials. Although the FVF has been shown to change with task demands (e.g., Hulleman and Olivers 2017) and across groups of experts and novices (e.g., Brams et al 2020), our research shows that it also changes within individuals as a function of experience, both within-individual search trials and more globally, as experience develops. These changes to the FVF may have also permitted observers to direct attention to distracting objects less often, making search more efficient.…”

“…Relative to novices, experts are better able to quickly direct attention to relevant screen locations while ignoring distracting or irrelevant information (Brams et al 2019 , 2020 ). The extended visual span implied by such results may arise from task-specific experience or it may be related to self-selection biases (e.g., those with an extended visual span may be drawn to professions in which that ability would be useful).…”

“…10 The development of this expertise also changed the way that viewers examined the visual field: With growing experience, observers needed to visit objects less frequently, they were less likely to view distractors, they viewed objects for shorter durations, and they showed evidence of an expanding visual span, particularly when searching for and locating items. Although abundant research has compared novice to expert search behaviors (e.g., Bilalić et al 2011 ; Brams et al 2020 ; Godwin et al 2015 ; Reingold et al 2001 ; Reingold and Sheridan 2011 ; Van Meeuwen et al 2014 , among many others), the present study adopted a within-subjects design to reveal how experience modifies scanning behaviors while eliminating the possibility of innate between-group differences in skill or interest level.…”

“…With accumulating expertise, any one or more of the phases of a typical search task may be facilitated. In some domains (e.g., medicine), experts are more likely to locate the target with their first fixation (Brams et al 2019 ) and to have larger distances between successive fixations (Brams et al 2020 ), both of which are consistent with an expanded FVF. In other domains (e.g., sports, air traffic control), experts show enhanced guidance and are likely to spend more time inspecting relevant scene regions (Brams et al 2019 ).…”

What do radiologists look for? Advances and limitations of perceptual learning in radiologic search

“…The initial stage of peripheral processing typically produces the greatest differences between experts and novices in radiologic search ( Drew et al, 2013 ; Manning et al, 2006 ). Researchers have therefore begun to ask whether performance differences between expert and novice radiologists may be the result of underlying differences in search strategies ( Brams et al, 2020 ; Wood, 1999 ; Wood et al, 2013 ).…”