Visual expertise in detecting and diagnosing skeletal fractures

Wood, Greg; Knapp, Karen; Rock, Benjamin; Cousens, Chris; Roobottom, Carl; Wilson, Mark R.

doi:10.1007/s00256-012-1503-5

Cited by 68 publications

(67 citation statements)

References 14 publications

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“…In general visual search time decreases with increasing levels of expertise (Krupinski 1996; Manning et al 2006; Alzubaidi et al 2009; Cooper et al 2010; Kok et al 2012, 2016; Voisin et al 2013; Wood et al 2013; Giovinco et al 2014; Rubin et al 2015). The average time experts took to view an image varied largely between studies, ranging from 4 s up to around 45 s, due to differences in task characteristics (detection, interpretation or both; lesion subtlety) and time limits.…”

Section: Resultsmentioning

confidence: 99%

“…Despite these differences, there are some consistent patterns in how experts move their eyes compared to less proficient observers: experts fixate faster on an abnormality (Krupinski 1996; Nodine et al 1996; Kundel et al 2007; Cooper et al 2010; Wood et al 2013; Mallett et al 2014) and make more fixations (Manning et al 2006; Alzubaidi et al 2009; Voisin et al 2013; Giovinco et al 2014). Experts or subspecialized experts tended to fixate on an abnormality within 0.5–2 s in mammography and CT studies, around 3 s in skeletal and chest X-rays, and up to 5 s in subtle fracture cases.…”

Section: Resultsmentioning

confidence: 99%

“…For example, do experts pay more attention to the abnormality (the area of interest, AOI), or do they spend more time on the rest of the image to check for other abnormalities? Results were found to differ across tasks: fixation duration on AOIs decreased in higher level experts in detection only tasks (Leong et al 2007; Cooper et al 2010; Donovan and Litchfield 2013), but increased in tasks combining detection and interpretation (Nodine et al 2002; Matsumoto et al 2011; Wood et al 2013). The increase in fixation duration was most prominent in subtle lesions (Matsumoto et al 2011; Wood et al 2013).…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

How visual search relates to visual diagnostic performance: a narrative systematic review of eye-tracking research in radiology

Gijp

Ravesloot

Jarodzka

et al. 2016

Adv in Health Sci Educ

139

102

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Eye tracking research has been conducted for decades to gain understanding of visual diagnosis such as in radiology. For educational purposes, it is important to identify visual search patterns that are related to high perceptual performance and to identify effective teaching strategies. This review of eye-tracking literature in the radiology domain aims to identify visual search patterns associated with high perceptual performance. Databases PubMed, EMBASE, ERIC, PsycINFO, Scopus and Web of Science were searched using ‘visual perception’ OR ‘eye tracking’ AND ‘radiology’ and synonyms. Two authors independently screened search results and included eye tracking studies concerning visual skills in radiology published between January 1, 1994 and July 31, 2015. Two authors independently assessed study quality with the Medical Education Research Study Quality Instrument, and extracted study data with respect to design, participant and task characteristics, and variables. A thematic analysis was conducted to extract and arrange study results, and a textual narrative synthesis was applied for data integration and interpretation. The search resulted in 22 relevant full-text articles. Thematic analysis resulted in six themes that informed the relation between visual search and level of expertise: (1) time on task, (2) eye movement characteristics of experts, (3) differences in visual attention, (4) visual search patterns, (5) search patterns in cross sectional stack imaging, and (6) teaching visual search strategies. Expert search was found to be characterized by a global-focal search pattern, which represents an initial global impression, followed by a detailed, focal search-to-find mode. Specific task-related search patterns, like drilling through CT scans and systematic search in chest X-rays, were found to be related to high expert levels. One study investigated teaching of visual search strategies, and did not find a significant effect on perceptual performance. Eye tracking literature in radiology indicates several search patterns are related to high levels of expertise, but teaching novices to search as an expert may not be effective. Experimental research is needed to find out which search strategies can improve image perception in learners.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

How visual search relates to visual diagnostic performance: a narrative systematic review of eye-tracking research in radiology

Gijp

Ravesloot

Jarodzka

et al. 2016

Adv in Health Sci Educ

139

102

View full text Add to dashboard Cite

show abstract

“…In fact it is reported that students for some tasks can use up to twice as long time as experts (14). The question, however, why the most experienced radiographers (Group 3) in our study used at least as long time as the students did is open to discussion.…”

Section: Sidementioning

confidence: 64%

“…Most of the research on the perceptual and cognitive processes that underlay the diagnostic imaging processes have been from the point of view of the diagnostic decision-maker, and less from the point of the radiographer or radiology technologist (8)(9)(10). Admittedly, there are several studies where radiographers themselves act as diagnostic reporters, in for instance CT imaging (11) and conventional (planar/ skeletal/ projected) X-ray imaging (12)(13)(14)(15), but these are other types of imaging tasks than accepting/ rejecting.…”

Section: Introductionmentioning

confidence: 99%

How radiographers visually perceive X-ray images with the task of accepting or rejecting them – a pilot study

Waaler¹,

Hammer²,

Langdalen³

et al. 2017

RadOpen

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Introduction: Radiographer´s usual role in the medical imaging chain is to acquire relevant and qualitatively good images that help the radiologist or physician to diagnose most accurately. After the image acquisition, the radiographer does a quality evaluation based on established imaging criteria to decide if the image is satisfactory, or otherwise reject it and subsequently take a new one. Contrary to expectations that the number of image rejects should decrease substantially with the introduction of digital imaging, a number of studies have shown that it has not, although the reasons for rejects has changed from exposure errors to positioning and centring errors. Very little research has been on examining how radiographers visually perceive and evaluate the X-ray images in this acceptance/rejection process.

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Exploring Eye‐tracking Technology as an Assessment Tool for Point‐of‐care Ultrasound Training

Lee

Chenkin

2020

AEM Education and Training

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Objectives: Eye-tracking technology has emerged as a potentially useful learner assessment tool in several medical specialties. In the fields of general surgery and anesthesiology, it has been shown to reliably differentiate between different levels of expertise in procedural skills. In the field of radiology, it has been shown to be a valid assessment tool for diagnostic test interpretation. Current methods of competency assessment in point-of-care ultrasound (POCUS) remain a challenge, because they require significant direct observation time by an instructor. The purpose of this study was to determine if eye-tracking technology can accurately distinguish between novice and experts in the interpretation of POCUS clips, specifically of the focused assessment using sonography in trauma (FAST) scan.Methods: A convenience sample of medical students, residents, and emergency physicians from a single academic emergency department were invited to participate. Participants included both novices and experts in POCUS. Each participant completed a baseline questionnaire and viewed 16 video clips of a FAST ultrasound examination while their gaze patterns were recorded by a commercially available eye-tracking device. The primary outcome was total gaze time on the area of interest (AOI). Secondary outcomes included total time to fixation, mean number of fixations, and mean duration of first fixation on the AOI.Results: Fifteen novices and 15 experts completed this study. For total gaze time on the AOI, experts fixated their gaze significantly longer than novices (75.8 AE 16.2 seconds vs. 56.6 AE 12.8 seconds, p = 0.001). Similarly, experts were significantly faster to fixate on the AOI and had a higher fixation count on the AOI (8.5 AE 4.0 seconds vs. 15.1 AE 6.8 seconds, p = 0.003; and 170 AE 30 vs. 143 AE 28 seconds, p = 0.016). There were no differences on the mean duration of first fixation on the AOI (0.42 AE 0.12 seconds vs. 0.39 AE 0.09 seconds, p = 0.467). Conclusion:Eye-tracking technology shows the potential to differentiate between experts and novices by their gaze patterns on video clips of FAST examinations. The total gaze time on the AOI may be a useful metric to help in the assessment of competency in POCUS image interpretation. In addition, the evaluation of gaze patterns may help educators identify causes of interpretation errors. Future studies are needed to further validate these metrics in a larger cohort.

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Visual expertise in detecting and diagnosing skeletal fractures

Abstract: The results suggest that the performance advantage of expert radiologists is underpinned by superior pattern recognition skills, as evidenced by a quicker time to first fixate the pathology, and less time spent searching the image.

Cited by 68 publications

References 14 publications

How visual search relates to visual diagnostic performance: a narrative systematic review of eye-tracking research in radiology

How visual search relates to visual diagnostic performance: a narrative systematic review of eye-tracking research in radiology

How radiographers visually perceive X-ray images with the task of accepting or rejecting them – a pilot study

Exploring Eye‐tracking Technology as an Assessment Tool for Point‐of‐care Ultrasound Training

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