PurposeDiagnostic errors are common in radiology. The gestalt impression of an image refers to the rapid holistic understanding one formulates about an image and may facilitate improved diagnostic accuracy. The ability to generate a gestalt impression is typically acquired over time and is generally not explicitly taught. Our study aims to assess whether perceptual training using second look and minification technique (SLMT) can help image interpreters formulate a holistic understanding of an image and become more accurate at evaluating medical images.ApproachFourteen healthcare trainees voluntarily participated in a perceptual training module, comparing the differences in detection of nodules and other actionable finding (OAF) on chest radiographs before and after perceptual training intervention. The experimental group received SLMT training, and the control group did not.ResultsSurvey results were positive for all items, with the p-values < 0.01. There was improvement in the performance in detection of nodules and OAF in both groups. However, this change was statistically significant only for OAFs in the control group (p-value < 0.05) but not the experimental group.ConclusionsSLMT training was viewed by participants as an extremely helpful educational tool. Survey results indicated that participants felt the SLMT was a beneficial educational intervention. The experimental group’s detection of nodules and OAF improved after SLMT, though not statistically significantly so, which may be related to the small sample size or lack of training effect. Perceptual training using SLMT may help as a useful educational technique, help radiologists identify abnormalities, and improve workflow.
PurposePerceptual errors account for a significant percent of errors in radiology. Reasons for failure to identify significant lesions are partially due to suboptimal differences in image contrast. The goal of this study is to determine if teaching trainees how to adjust image contrast, window, and level helps trainees identify pulmonary nodules on chest radiographs (CXRs).ApproachFourteen medical students voluntarily participated. Subjects were asked to identify pulmonary nodules on CXRs before and after being taught how to adjust image contrast, window, and level. At the end of the study, subjects were given a survey assessing their perceptions about their training.ResultsThe experimental group was more confident in their ability to localize nodules relative to the control group (P-value = 0.003). Subjects demonstrated statistically significant improvement in their ability to identify and localize nodules, with the experimental group performing better than the control group, though there was no statistically significant difference between groups. Participant survey indicated that they felt this training was beneficial, P-values for all survey responses were significant (P-values all <0.02).ConclusionsTeaching subjects how to window and level medical images may be a useful adjunct to current training for medical image interpretation.
PurposeGamification is used in several fields as an adjunct to standard educational methods but has found limited application in radiology to date. Gamification may be useful for teaching radiology skills typically acquired through experience, such as perceptual skills. The goal of our study is to use a gamified radiology workstation to teach skills related to identification of pulmonary nodules and evaluate for changes in trainee performance.ApproachWe constructed a game called RADHunters to teach perceptual skills related to identification of pulmonary nodules on chest radiographs. Control and experimental groups were tasked with identifying nodules on chest radiographs on two sets of cases. The experimental group received gamified training for nodule identification using RADHunters between case sets, while the control group did not. Performance at nodule identification, localization, and confidence were compared. A poststudy survey was administered to assess for participants’ thoughts about the gamified nodule detection training.ResultsSurvey responses were very positive with p-values for all survey responses <0.001, indicating subjects felt this training was beneficial. Experimental and control groups had a statistically significant improvement in their ability to identify and localize nodules with p-values < 0.05. There was no significant difference between control and experimental groups. Neither group showed a statistically significant increase in their confidence in nodule localization.ConclusionsPerceptual training using gamification may be a useful adjunct to conventional methods of radiology education.
Identification of abnormalities in radiology is predicated on one’s gestalt understanding of normal imaging findings. This study assesses whether perceptual training using high-volume chest radiography (HVCXR) can help develop an understanding of the normal appearance of a chest radiograph (CXR) and improve one’s ability to identify pulmonary nodules on CXR. Eight radiology residents were split into two groups where the experimental group received high volume chest radiography training, where they viewed 500 CXRs at the rate of 1 CXR every 3 seconds, while the control group did not. Both groups were then tasked to identify pulmonary nodules on a set of chest radiographs. Afterwards, the two groups switched interventions and worked on localizing pulmonary nodules on a third case set of chest radiographs. Performance at nodule identification was worse in the experimental and control groups after they had received HVCXR training, which was unexpected. We hypothesize that this decrease in performance was due to fatigue from the HVCXR intervention.
Physicians interpreting medical images are expected to adjust display parameters on a routine basis, a skill which is generally not explicitly taught. This study examines the effects of perceptual training (PT) on windowing and leveling images and subject ability to identify pulmonary nodules on chest radiographs. Subjects were also given surveys on the perceived value of the PT. There was a statistically significant improvement in nodule identification for both control and experimental groups. Survey results were significantly positive for all questions. These results suggest there is a role for PT on windowing and leveling medical images.
Prior studies have shown positive effects of perceptual training (PT), however there is a paucity of literature regarding the long-term retention. The goal of this study is to assess the degree of long term retention three months after an initial PT training session. Eight first year residents underwent perceptual training with repeat training 87 days later. Comparison of their performance showed that though their performance was lower compared to the initial training, this was not statistically significant, suggesting some degree of retention of PT.
Purpose: Experienced radiologists have enhanced global processing ability relative to novices, allowing experts to rapidly detect medical abnormalities without performing an exhaustive search. However, evidence for global processing models is primarily limited to two-dimensional image interpretation, and it is unclear whether these findings generalize to volumetric images, which are widely used in clinical practice. We examined whether radiologists searching volumetric images use methods consistent with global processing models of expertise. In addition, we investigated whether search strategy (scanning/drilling) differs with experience level.
Approach: Fifty radiologists with a wide range of experience evaluated chest computed-tomography scans for lung nodules while their eye movements and scrolling behaviors were tracked. Multiple linear regressions were used to determine: (1) how search behaviors differed with years of experience and the number of chest CTs evaluated per week and (2) which search behaviors predicted better performance.
Results: Contrary to global processing models based on 2D images, experience was unrelated to measures of global processing (saccadic amplitude, coverage, time to first fixation, search time, and depth passes) in this task. Drilling behavior was associated with better accuracy than scanning behavior when controlling for observer experience. Greater image coverage was a strong predictor of task accuracy.
Conclusions: Global processing ability may play a relatively small role in volumetric image interpretation, where global scene statistics are not available to radiologists in a single glance. Rather, in volumetric images, it may be more important to engage in search strategies that support a more thorough search of the image.
KEYWORDS: Medical imaging, Radiology, Digital breast tomosynthesis, Computer aided diagnosis and therapy, Image processing, Breast cancer, Mammography, Medicine, Medical research, Machine vision
KEYWORDS: Radiology, Chest imaging, Radiography, Statistical analysis, Medicine, Psychology, Medical imaging, Perceptual learning, Medical research, Education and training
Prior research has demonstrated that perceptual training can improve the ability of healthcare trainees in identifying abnormalities on medical images, but it is unclear if the improved performance is due to learning or attentional shift—the diversion of perceptional resources away from other activities to a specified task. Our objective is to determine if research subject performance in perceiving the central venous catheter position on radiographs is improved after perceptional training and if improved performance is due to learning or an attentional shift. Forty-one physician assistant students were educated on the appropriate radiographic position of central venous catheters and then asked to evaluate the catheter position in two sets of radiographic cases. The experimental group was provided perceptional training between case sets one and two. The control group was not. Participants were asked to characterize central venous catheters for appropriate positioning (task of interest) and to assess radiographs for cardiomegaly (our marker for attentional shift). Our results demonstrated increased confidence in localization in the experimental group (p-value <0.001) but not in the control group (p-value = 0.882). The ability of subjects to locate the catheter tip significantly improved in both control and experimental groups. Both the experimental (p-value = 0.007) and control groups (p-value = 0.001) demonstrated equivalent decreased performance in assessing cardiomegaly; the difference between groups was not significant (p-value = 0.234). This suggests the performance improvement was secondary to learning not due to an attentional shift.
The goal of this research was to examine whether search pattern training for central line positioning on chest radiographs (CXRs) improves the ability of healthcare trainees and practitioners to identify malpositioned central venous catheters. Two sets of CXRs with central catheters were shown; half of the images contained catheters that were appropriately positioned, half that were malpositioned. Subjects were asked to: mark the tip of the catheter using the simulated radiology workstations, indicate their confidence in tip localization, and state whether the catheter was appropriately positioned or malpositioned. Subjects were also given a survey assessing their thoughts about the usefulness of search pattern training and the simulated radiology workstation. There was a significant improvement in subjects’ ability to classify a catheter as malpositioned after training, p-value = 0.03. There was no significant difference in localization of the catheter tips or in the confidence for tip localization. Subjects’ responses to the questionnaire were significantly positive for all statements, indicating that they felt search pattern training using a simulated radiology workstation had a positive impact on their education. These results suggest that our knowledge of medical image perception may be useful for developing rational educational tools for image interpretation, and that simulated radiology workstations may be a helpful means of deploying these tools.
The goal of this research is to demonstrate that teaching healthcare trainees a formal search or scan pattern for evaluation of the lungs improves their ability to identify pulmonary nodules on chest radiographs (CXRs). A group of physician assistant trainees were randomly assigned to control and experimental groups. Each group was shown two sets of CXRs, each set with a nodule prevalence of approximately 50%. The experimental group received search pattern training between case sets, whereas the control group did not. Both groups were asked to mark nodules when present and indicate their diagnostic confidence. Subject performance at nodule detection was quantified using changes in area under the localization receiver operating characteristic curve (ΔAUC). There was no significant improvement in performance between case sets for the control group. There was a significant improvement in subject performance after training for the experimental group, ΔAUC=0.1539, p=0.0012. These results demonstrate that teaching a search pattern to trainees improves their ability to identify nodules and decreases the number of perceptual errors in nodule identification, and suggest that our knowledge of medical image perception may be used to develop rational tools for the education of healthcare trainees.
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