The Holistic Processing Account of Visual Expertise in Medical Image Perception: A Review

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.

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

“…Namely, in more than half of trials, radiologists did not change the location of slices on the display and inspected the entire three-dimensional image. This approach might be consistent with the global processing of visual information, which is a characteristic feature of radiologists' perception, previously reported for medical image reading [41]. According to this approach, experienced radiologists effectively use their parafoveal and peripheral vision to obtain a global impression of the image in contrast to novices who mostly focus on details and rely more on foveal vision.…”

“…The ability of experienced radiologists to engage in the global processing of the entire image is another piece of evidence for their tuned visual perception. Namely, experts can process large regions of the image in parallel using their parafoveal and/or peripheral vision [41]. The psychophysical assessment of perceptual expertise has revealed that experienced radiologists can quickly extract the relevant information from the complete visual scene, guiding their selective visual attention efficiently, and further conducting a more organized visual search when compared to their less-experienced colleagues.…”

“…Active navigation through images is characteristic to the local search. In the human-centered design of a three-dimensional visualization system, one should consider the alternation of global and local search when radiologists read medical images [41], and ensure flexible and meaningful navigation through the rendered images, which will facilitate both modes of search. As an alternative to traditionally used navigation devices, a gaming controller has been proposed to facilitate visual search in the three-dimensional environment [1,16].…”

“…In our study, residents and students intensively navigated through most three-dimensional images and reduced the amount of information presented in search tasks. This search strategy may be associated with the lack of so called perceptual knowledge, comprehensively reported in several reviews [41,55], which limits the ability to benefit from viewing the entire presentation of information. On the one hand, it means that we may suggest the three-dimensional visualization system to be implemented in medical image reading for use only by experienced radiologists.…”

Lay Beliefs About Interaction Quality: An Expertise Perspective on Individual Differences in Interpersonal Emotion Ability

“…One demonstration of holistic processing involves focusing on the overall stimulus and then very quickly honing in on only the most relevant details for making an informed decision. Holistic processing is exemplified by radiologists looking first at an entire CT image before narrowing in quickly on the parts of the image that are consistent with lesions (Wood, 1999;Sheridan and Reingold, 2017), or car experts first looking at the car as a whole before zeroing in on the aspects that identify the unique make and model of the vehicle (Gauthier et al, 2000;Sunday et al, 2018b). Further, these visual ability metrics and fluid intelligence are both associated with successful performance on a visual detection task in radiological images (Sunday et al, 2018a) and performance on these tasks has been linked with specific activation in the fusiform face area, an area associated with expertise (Gauthier et al, 1999;Tarr and Gauthier, 2000;Gauthier and Nelson, 2001;Sunday et al, 2018b).…”