The Role of Cue-Based Strategies in Skilled Diagnosis Among Pathologists.

OBJECTIVE: This research was designed to test whether behavioral indicators of pathology-related cue utilization were associated with performance on a diagnostic task. BACKGROUND: Across many domains, including pathology, successful diagnosis depends on pattern recognition that is supported by associations in memory in the form of cues. Previous studies have focused on the specific information or knowledge on which medical image expertise relies. The target in this study is the more general ability to identify and interpret relevant information. METHOD: Data were collected from 54 histopathologists in both conference and online settings. The participants completed a pathology edition of the Expert Intensive Skills Evaluation 2.0 (EXPERTise 2.0) to establish behavioral indicators of context-related cue utilization. They also completed a separate diagnostic task designed to examine related diagnostic skills. RESULTS: Behavioral indicators of higher or lower cue utilization were based on the participants' performance across five tasks. Accounting for the number of cases reported per year, higher cue utilization was associated with greater accuracy on the diagnostic task. A post hoc analysis suggested that higher cue utilization may be associated with a greater capacity to recognize low prevalence cases. CONCLUSION: This study provides support for the role of cue utilization in the development and maintenance of skilled diagnosis amongst pathologists. APPLICATION: Pathologist training needs to be structured to ensure that learners have the opportunity to form cue-based strategies and associations in memory, especially for less commonly seen diseases.

Differentiating Experience From Cue Utilization in Radiological Assessments.

OBJECTIVE: This research was designed to examine the contribution of self-reported experience and cue utilization to diagnostic accuracy in the context of radiology. BACKGROUND: Within radiology, it is unclear how task-related experience contributes to the acquisition of associations between features with events in memory, or cues, and how they contribute to diagnostic performance. METHOD: Data were collected from 18 trainees and 41 radiologists. The participants completed a radiology edition of the established cue utilization assessment tool EXPERTise 2.0, which provides a measure of cue utilization based on performance on a number of domain-specific tasks. The participants also completed a separate image interpretation task as an independent measure of diagnostic performance. RESULTS: Consistent with previous research, a k-means cluster analysis using the data from EXPERTise 2.0 delineated two groups, the pattern of centroids of which reflected higher and lower cue utilization. Controlling for years of experience, participants with higher cue utilization were more accurate on the image interpretation task compared to participants who demonstrated relatively lower cue utilization (p = .01). CONCLUSION: This study provides support for the role of cue utilization in assessments of radiology images among qualified radiologists. Importantly, it also demonstrates that cue utilization and self-reported years of experience as a radiologist make independent contributions to performance on the radiological diagnostic task. APPLICATION: Task-related experience, including training, needs to be structured to ensure that learners have the opportunity to acquire feature-event relationships and internalize these associations in the form of cues in memory.

The mere presence of a mobile phone: Does it influence driving performance?

The ubiquity of mobile phones has led to a rapid increase in its presence and use in vehicles, especially among young adults (up to 25 years), who are generally the least experienced group of drivers. The potential for phones to draw attention away from the main driving task has significant consequences for road safety. Previous studies have found that the mere presence of a mobile phone can be distracting by impairing attention in experimental non-driving contexts. However, the effect of phone presence, independent to usage, has not yet been examined in the context of driving. As such, the present study examined whether the mere presence of a mobile phone, its proximity to the driver, and power status (on/off) influenced the driving performance of young drivers. Additionally, this study assessed whether the effects of phone presence and proximity were moderated by an individual's level of dependence on, or emotional attachment to, their phone. A sample of 127 undergraduate psychology students (M = 19.76, SD = 1.63) were randomly assigned to one of four conditions: (1) phone absent (control), (2) phone on, in holder, (3) phone off, in holder, and (4) phone on, in pocket. They all completed the same simulated drive, and were measured for degree of phone dependence and phone emotional attachment. Overall, drivers in all the phone present conditions made significantly more driving errors (speeding and collision) compared to those in the phone absent (control) condition, irrespective of proximity to the phone and whether it was on or off. Phone dependence, but not phone emotional attachment, moderated the effect of phone presence on speeding behaviour. These findings suggest that the mere presence of a phone is distracting for drivers, especially so for those who are highly dependent on their phone, which may place them at a greater risk of a distraction induced crash.

Characteristics of expert search behavior in volumetric medical image interpretation.

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.

Do target detection and target localization always go together? Extracting information from briefly presented displays.

The human visual system is capable of processing an enormous amount of information in a short time. Although rapid target detection has been explored extensively, less is known about target localization. Here we used natural scenes and explored the relationship between being able to detect a target (present vs. absent) and being able to localize it. Across four presentation durations (~ 33-199 ms), participants viewed scenes taken from two superordinate categories (natural and manmade), each containing exemplars from four basic scene categories. In a two-interval forced choice task, observers were asked to detect a Gabor target inserted in one of the two scenes. This was followed by one of two different localization tasks. Participants were asked either to discriminate whether the target was on the left or the right side of the display or to click on the exact location where they had seen the target. Targets could be detected and localized at our shortest exposure duration (~ 33 ms), with a predictable improvement in performance with increasing exposure duration. We saw some evidence at this shortest duration of detection without localization, but further analyses demonstrated that these trials typically reflected coarse or imprecise localization information, rather than its complete absence. Experiment 2 replicated our main findings while exploring the effect of the level of "openness" in the scene. Our results are consistent with the notion that when we are able to extract what objects are present in a scene, we also have information about where each object is, which provides crucial guidance for our goal-directed actions.

Exploring the effect of context and expertise on attention: is attention shifted by information in medical images?

Radiologists make critical decisions based on searching and interpreting medical images. The probability of a lung nodule differs across anatomical regions within the chest, raising the possibility that radiologists might have a prior expectation that creates an attentional bias. The development of expertise is also thought to cause "tuning" to relevant features, allowing radiologists to become faster and more accurate at detecting potential masses within their domain of expertise. Here, we tested both radiologists and control participants with a novel attentional-cueing paradigm to investigate whether the deployment of attention was affected (1) by a context that might invoke prior knowledge for experts, (2) by a nodule localized either on the same or on opposite sides as a subsequent target, and (3) by inversion of the nodule-present chest radiographs, to assess the orientation specificity of any effects. The participants also performed a nodule detection task to verify that our presentation duration was sufficient to extract diagnostic information. We saw no evidence of priors triggered by a normal chest radiograph cue affecting attention. When the cue was an upright abnormal chest radiograph, radiologists were faster when the lateralised nodule and the subsequent target appeared at the same rather than at opposite locations, suggesting attention was captured by the nodule. The opposite pattern was present for inverted images. We saw no evidence of cueing for control participants in any condition, which suggests that radiologists are indeed more sensitive to visual features that are not perceived as salient by naïve observers.

Finding cancer in mammograms: if you know it's there, do you know where?

Humans can extract considerable information from scenes, even when these are presented extremely quickly. The ability of an experienced radiologist to rapidly detect an abnormality on a mammogram may build upon this general capacity. Although radiologists have been shown to be able to detect an abnormality 'above chance' at short durations, the extent to which abnormalities can be localised at brief presentations is less clear. Extending previous work, we presented radiologists with unilateral mammograms, 50% containing a mass, for 250 or 1000 ms. As the female breast varies with respect to the level of normal fibroglandular tissue, the images were categorised into high and low density (50% of each), resulting in difficult and easy searches, respectively. Participants were asked to decide whether there was an abnormality (detection) and then to locate the mass on a blank outline of the mammogram (localisation). We found both detection and localisation information for all conditions. Although there may be a dissociation between detection and localisation on a small proportion of trials, we find a number of factors that lead to the underestimation of localisation including stimulus variability, response imprecision and participant guesses. We emphasise the importance of taking these factors into account when interpreting results. The effect of density on detection and localisation highlights the importance of considering breast density in medical screening.

A 'snapshot' of the visual search behaviours of medical sonographers.

Introduction: Visual search is a task that humans perform in everyday life. Whether it involves looking for a pen on a desk or a mass in a mammogram, the cognitive and perceptual processes that underpin these tasks are identical. Radiologists are experts in visual search of medical images and studies on their visual search behaviours have revealed some interesting findings with regard to diagnostic errors. In Australia, within the modality of ultrasound, sonographers perform the diagnostic scan, select images and present to the radiologist for reporting. Therefore the visual task and potential for errors is similar to a radiologist. Our aim was to explore and understand the detection, localisation and eye-gaze behaviours of a group of qualified sonographers. Method: We measured clinical performance and analysed diagnostic errors by presenting fifty sonographic breast images that varied on cancer present and degree of difficulty to a group of sonographers in their clinical workplace. For a sub-set of sonographers we obtained eye-tracking metrics such as time-to-first fixation, total visit duration and cumulative dwell time heat maps. Results: The results indicate that the sonographers' clinical performance was high and the eye-tracking metrics showed diagnostic error types similar to those found in studies on radiologist visual search. Conclusion: This study informs us about sonographer visual search patterns and highlights possible ways to improve diagnostic performance via targeted education.