How experience and training influence mammography expertise
How experience and training influence mammography expertise
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DOI：
10.1016/s1076-6332(99)80252-9
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发表时间：
1999-10-01
影响因子：
4.8
通讯作者：
Conant, EF
中科院分区：
文献类型：
--
作者：
Nodine, CF;Kundel, HL;Conant, EF
理由和目标。作者评估了感知和认知技能在乳腺X线摄影检测和解释的影响，通过测试三组代表不同水平的乳腺X线摄影专业知识的经验，培训和人才与乳腺X线摄影筛查诊断任务。150张乳房X线照片，由单侧头尾和内外侧斜位视图组成，在数字工作站上成对显示给19名放射科住院医师、3名经验丰富的乳房X线摄影师和9名乳房X线摄影技术人员。三分之一的乳房X光片显示恶性病变;三分之二是无恶性病变。观察者与显示器互动，以指示每张图像是否包含没有恶性病变或指示恶性病变的可疑病变。根据病灶的定位、分类和决策置信度来衡量决策时间。与专家绩效相比，居民的替代自由反应操作特性绩效显著低于技术人员，与技术人员相当。整体性能的分析表明，随着专业知识水平的下降，假阳性结果产生了更大的影响，整体决策的准确性在时间过程中的图像感知。这定义了决定速度-准确性的关系，体现了乳腺X线摄影的专业知识。住院医师表现的差异主要是由于在乳房X线摄影训练期间缺乏感知学习经验，这限制了对象识别技能，并且难以确定恶性病变、良性病变和正常图像扰动之间的差异。一个建议的解决方案是系统的导师指导培训，将图像感知与决策背后的原因反馈联系起来。
Rationale and Objectives. The authors evaluated the influence of perceptual and cognitive skills in mammography detection and interpretation by testing three groups representing different levels of mammography expertise in terms of experience, training, and talent with a mammography screening-diagnostic task.Materials and Methods. One hundred fifty mammograms, composed of unilateral cranial-caudal and mediolateral oblique views, were displayed in pairs on a digital workstation to 19 radiology residents, three experienced mammographers, and nine mammography technologists. One-third of the mammograms showed malignant lesions; two-thirds were malignancy-free. Observers interacted with the display to indicate whether each image contained no malignant lesions or suspicious lesions indicating malignancy. Decision time was measured as the lesions were localized, classified, and rated for decision confidence.Results. Compared with performance of experts, alternative free response operating characteristic performance for residents was significantly lower and equivalent to that of technologists. Analysis of overall performance showed that, as level of expertise decreased, false-positive results exerted a greater effect on overall decision accuracy over the time course of image perception. This defines the decision speed-accuracy relationship that characterizes mammography expertise.Conclusion. Differences in resident performance resulted primarily from lack of perceptual-learning experience during mammography training, which limited object recognition skills and made it difficult to determine differences between malignant lesions, benign lesions, and normal image perturbations. A proposed solution is systematic mentor-guided training that links image perception to feedback about the reasons underlying decision making.