MammoTutor: An Internet-Based Computer Tutoring System to Teach General Radiol

描述（由申请人提供）：乳腺癌是全球女性中最常见的癌症，也是美国这一人群中癌症相关死亡的第二大原因。与许多其他类型的癌症一样，早期发现可以对患者预后产生重大影响，并且向40岁以上的普通女性推荐乳房x光检查已经挽救了数千人的生命。然而，阅读乳房x光片是一项非常复杂的感知和认知任务，申请人以前已经表明，根据目前的培训指南，在他们的实习结束时，新放射科医生在检测乳腺癌方面并不比没有接受过如何检测这种疾病的任何正式培训的乳腺技术人员更好。此外，这些新手放射科医生中的一小部分将成为通才，也就是说，他们将获得委员会认证，可以阅读许多不同的图像，包括乳房x光片。缺乏乳腺成像方面的专业培训反映在这些普通放射科医生的表现上，与训练有素的放射科医生相比，他们不仅检测到更少的乳腺癌，而且检测到更少的早期乳腺病变。这个问题在非裔美国妇女中很严重，一般来说，由于社会经济地位，她们在社区中心或外联诊所接受乳房x光检查，这些设施往往由普通放射科医生配备。在这个项目中，我们建议建立在先前设计和评估的基于计算机的辅导系统的框架上，该系统名为SlideTutor，它是为医学中的另一个视觉领域，即病理学开发的。在该领域，使用SlideTutor已被证明可以显著提高病理学新手的诊断推理能力，并且随着时间的推移，可以观察到学习材料的保留情况。因此，我们的目标是使用类似的框架来开发基于计算机的认知辅导系统，该系统可以教授通才和新手放射科医生(1)如何检测早期乳腺癌（从而提高总体灵敏度）；（ii）如何减少不必要的活检建议（从而提高特异性）。因此，这是我们的假设，使用认知辅导将。如果成功，这种干预措施应该对向社会经济上处于不利地位的人群提供卫生保健服务产生重大影响，并减少少数群体（如非洲裔美国人）与较富裕人群之间的卫生保健差距。此外，为了接触尽可能多的放射科医生，我们的计算机辅导系统将放在互联网上，任何注册接受这项任务培训的放射科医生都可以免费使用。目前，乳房x光检查的漏检率在10%到30%之间。在这个项目中，我们将开发一个基于计算机的辅导系统来培训放射科医生如何发现乳腺癌的早期迹象。我们的系统将部署在互联网上，并将免费提供。

DESCRIPTION (Provided by Applicant): Breast cancer is the most common cancer among women worldwide, and the second leading cause of cancer-related deaths among this population in the United States. As with many other types of cancer, early detection can have a significant impact in patient prognosis, and the recommendation of mammography screening to the general women population older than 40 years of age has saved thousands of lives. However, the reading of a mammogram is a very complex perceptual and cognitive task, and the applicant has previously shown that, under the current training guidelines, at the end of their residency, novice radiologists are no better at detecting breast cancer than breast technologists, who do not receive any formal training in how to detect this disease. Moreover, a fraction of these novice radiologists will become generalists, namely, they will be board certified to read a lot of different images, including mammograms. The lack of specialized training in breast imaging is reflected in the performance of these general radiologists, who not only detect fewer breast cancers but also detect fewer early-staged breast lesions when compared to better trained breast radiologists. This problem is acute amongst African-American women, who, in general, due to socio-economical status, receive their mammograms at community-based centers or at outreach clinics, facilities that tend to be staffed by general radiologists. In this project we propose to build upon the framework of a previously designed and evaluated computer-based tutoring system, named SlideTutor, which has been developed for another visual domain within Medicine, namely, Pathology. In that domain, use of SlideTutor has been shown to produce significant improvements in diagnostic reasoning among novice pathologists, and retention of the learned material has been observed over time. Thus, it is our goal to use a similar framework to develop a computer-based cognitive tutoring system that can teach generalists and novice radiologists (i) how to detect early-staged breast cancer (thus yielding improvements in overall sensitivity); and (ii) how to reduce the number of unnecessary biopsy recommendations (therefore improving specificity). Hence, it is our hypothesis that use of cognitive tutoring will. If successful, such intervention should have a significant impact in health care delivery to socio-economically disadvantage populations, and to reduce health care disparities between minority populations (such as African-Americans) and more affluent populations. In addition, in order to reach as wide a number of radiologists as possible, our computer-based tutoring system will be placed on the Internet, where it will be available, free of charge, to any radiologists who register to receive training in this task. Currently, the missed rates at mammography screenings are between 10 and 30 percent. In this project, we will develop a computer based tutoring system to train radiologists how to detect early signs of breast cancer. Our system will be deployed over the internet and will be available free of charge.