Satisfaction of Search in Diagnostic Radiology

描述（由申请人提供）：本提案的长期目标是了解在影像学检查中对多种异常的感知，并制定提高诊断准确性和患者结局的策略。我们是世界上少数几个通过更好地理解所涉及的潜在感知过程来追求减少检测错误目标的实验室之一。未能检测到异常是诊断成像中最常见的一类错误，通常被医学界认为是最严重的。其中许多错误被归因于“搜索满意度”，即由于发现另一异常“满足”了搜索目标而未报告病变时发生的错误。虽然我们已经对搜索满意度（SOS）的机制有了一些了解，但仍然存在一些重要的问题。计算机断层扫描（CT）可能会取代放射线摄影作为最常见的放射学检查。CT产生大量的图像，可以以多种格式显示。要检查的数据量可能会迅速压倒放射科医师的感知资源，从而增加搜索错误的满意度风险。直到最近，还没有对高级成像中的SOS误差进行实验研究。我们在CT中的第一项研究证明了有限的SOS效应，但在我们可以安全地得出SOS不是CT成像的主要问题之前，还需要进一步的实验。目前，很少有干预措施来纠正SOS错误。创新的报告方法和诊断问题的方向可能有希望。语音提示检查表可以防止放射科医生忽略一些关键结构，而不需要他们把眼睛从图像上移开。临床病史提示了某些异常，即使存在其他异常，也能保护放射科医生避免遗漏。但是，提示可能会增加自发异常的SOS错误。我们提出了四个决定性的实验来解决剩下的复杂问题。研究方法将包括分析接收机的工作特性曲线，检测响应的时间过程和观察员的导航和探索通过CT图像数据阵列。从这一纲领性研究中获得的知识将导致减少观测误差。较新的成像方法，如计算机断层扫描在诊断放射学中发挥着越来越重要的作用。虽然CT使更小和更微妙的病变可见，发现它们需要检查更多的图像。现代放射学研究中的图像数量庞大，可能会分散放射科医生的注意力并导致错误。该项目追求通过更好地理解潜在的感知过程来减少诊断错误的方法。

DESCRIPTION (provided by applicant): The long-term objective of this proposal is to understand the perception of multiple abnormalities in an imaging examination and to develop strategies for improved diagnostic accuracy and patient outcome. We are one of the few laboratories in the world pursuing the goal of reducing detection errors through a better understanding of the underlying perceptual processes involved. Failure to detect an abnormality is the most common class of error in diagnostic imaging and generally is considered the most serious by the medical community. Many of these errors have been attributed to "satisfaction of search", which occurs when a lesion is not reported because discovery of another abnormality has "satisfied" the goal of the search. Although we have gained some understanding of the mechanisms of satisfaction of search (SOS), there are significant questions that remain. Computed tomography (CT) may replace radiography as the most common radiology examination. CT produces a large number of images that can be displayed in many formats. The volume of data to be inspected may quickly overwhelm the radiologists' perceptual resources, creating increased risk of satisfaction of search error. Until recently, there had been no experimental studies of SOS error in the advanced imaging. Our first studies in CT demonstrated limited SOS effects, but further experiments are needed before we can safely conclude that SOS is not a major problem for CT imaging. Currently, there are few interventions to remedy SOS error. Innovative reporting methods and direction from diagnostic questions may hold promise. A voice-prompted checklist may prevent the radiologist from neglecting some crucial structure without requiring them to take their eyes off of the image. Clinical history prompts certain abnormalities, protects the radiologist from missing them even when other abnormalities are present. However, the prompts may increase SOS errors for unprompted abnormalities. We propose four definitive experiments to approach the complex questions that remain. The research methods will include analysis of receiver operating characteristic curves, the time course of detection responses and the observer's navigation and exploration through the CT image data array. The knowledge gained from this programmatic research will lead to reduction of observer error. Newer imaging methods such as computed tomography play an increasingly prominent role in diagnostic radiology. Although CT makes smaller and subtler lesions visible, finding them requires inspection of many more images. The sheer number of images in a modern radiology study can stretch the attention of the radiologist and lead to errors. This project pursues methods to reduce diagnostic errors through a better understanding of the underlying perceptual processes.