Aim: To optimize automated classification of radiological errors during lung nodule detection from chest radiographs
(CxR) using a support vector machine (SVM) run on the spatial frequency features extracted from the local background
of selected regions. Background: The majority of the unreported pulmonary nodules are visually detected but not
recognized; shown by the prolonged dwell time values at false-negative regions. Similarly, overestimated nodule
locations are capturing substantial amounts of foveal attention. Spatial frequency properties of selected local
backgrounds are correlated with human observer responses either in terms of accuracy in indicating abnormality position
or in the precision of visual sampling the medical images. Methods: Seven radiologists participated in the eye tracking
experiments conducted under conditions of pulmonary nodule detection from a set of 20 postero-anterior CxR. The most
dwelled locations have been identified and subjected to spatial frequency (SF) analysis. The image-based features of
selected ROI were extracted with un-decimated Wavelet Packet Transform. An analysis of variance was run to select SF
features and a SVM schema was implemented to classify False-Negative and False-Positive from all ROI. Results: A
relative high overall accuracy was obtained for each individually developed Wavelet-SVM algorithm, with over 90%
average correct ratio for errors recognition from all prolonged dwell locations. Conclusion: The preliminary results
show that combined eye-tracking and image-based features can be used for automated detection of radiological error
with SVM. The work is still in progress and not all analytical procedures have been completed, which might have an
effect on the specificity of the algorithm.
Aim: To investigate the impact on visual sampling strategy and pulmonary nodule recognition of image-based properties
of background locations in dwelled regions where the first overt decision was made. . Background: Recent studies in
mammography show that the first overt decision (TP or FP) has an influence on further image reading including the
correctness of the following decisions. Furthermore, the correlation between the spatial frequency properties of the local
background following decision sites and the first decision correctness has been reported. Methods: Subjects with
different radiological experience were eye tracked during detection of pulmonary nodules from PA chest radiographs.
Number of outcomes and the overall quality of performance are analysed in terms of the cases where correct or incorrect
decisions were made. JAFROC methodology is applied. The spatial frequency properties of selected local backgrounds
related to a certain decisions were studied. ANOVA was used to compare the logarithmic values of energy carried by
non redundant stationary wavelet packet coefficients. Results: A strong correlation has been found between the number
of TP as a first decision and the JAFROC score (r = 0.74). The number of FP as a first decision was found negatively
correlated with JAFROC (r = -0.75). Moreover, the differential spatial frequency profiles outcomes depend on the first
choice correctness.
We are unsure about what information is extracted from an image to allow a decision about pathology to be made. Our
knowledge of the interplay between top down processing or bottom up, local or global perception, perceptual or
cognitive processes is uncertain. However recent research has emphasised the importance of the global or holistic look in
medical image perception in which recognition of abnormalities precedes search. Reverse Hierarchy Theory [1] is a
useful general theory that helps to explain this. It also enables us to understand what information is extracted from an
image and how this relates to expertise. Essentially the theory states that perceptual learning begins at high levels areas
and progresses down to lower level areas when better signal to noise is needed. So perceptual learning, defined as an
improvement in sensory abilities after training, stems from a gradual top down guided increase in usability of first high
then lower level task relevant information. Evaluation of the scan paths of groups of observers with different levels of
expertise when undertaking a lung nodule perception task seems to be consistent with the theory. Experts' perception is
generally immediate and holistic suggesting high level representations whereas those with an intermediate level of
expertise tend to be more variable in their scan paths. Interestingly naïve observers have eye tracking metrics that are
more similar to experts suggesting they take a common sense approach using perceptual skills we all have as they lack
experience in being able to access the low level information from the chest radiograph.
Aim: The goal of the study is to determine the spatial frequency characteristics at locations in the image of overt and covert observers' decisions and find out if there are any similarities in different observers' groups: the same radiological experience group or the same accuracy scored level. Background: The radiological task is described as a visual searching decision making procedure involving visual perception and cognitive processing. Humans perceive the world through a number of spatial frequency channels, each sensitive to visual information carried by different spatial frequency ranges and orientations. Recent studies have shown that particular physical properties of local and global image-based elements are correlated with the performance and the level of experience of human observers in breast cancer and lung nodule
detections. Neurological findings in visual perception were an inspiration for wavelet applications in vision research
because the methodology tries to mimic the brain processing algorithms. Methods: The wavelet approach to the set of
postero-anterior chest radiographs analysis has been used to characterize perceptual preferences observers with different
levels of experience in the radiological task. Psychophysical methodology has been applied to track eye movements over the image, where particular ROIs related to the observers' fixation clusters has been analysed in the spaces frame by Daubechies functions. Results: Significance differences have been found between the spatial frequency characteristics at the location of different decisions.
We report a study that investigated whether experienced and inexperienced radiographers benefit from knowing
where another person looked during pulmonary nodule detection. Twenty-four undergraduate radiographers (1 year
of experience) and 24 postgraduate radiographers (5+ years of experience) searched 42 chest x-rays for nodules and
rated how confident they were in their decisions. Eye movements were also recorded. Performance was compared
across three within-participant conditions: (1) free search - where radiographers could identify nodules as normal;
(2) image preview - where radiographers were first shown each chest x-ray for 20 seconds before they could then
proceed to mark the location of any nodules; and (3) eye movement preview - which was identical to image preview
except that the 20 second viewing period displayed an overlay of the real-time eye movements of another
radiographer's scanpath for that image. For this preview condition half of each group were shown where a novice
radiographer looked, and the other half were shown where an experienced radiologist looked. This was not made
known to the participants until after the experiment. Performance was assessed using JAFROC analysis. Both groups
of radiographers performed better in the eye movement preview condition compared with the image preview or free
search conditions, with inexperienced radiographers improving the most. We discuss our findings in terms of the
task-specific information interpreted from eye movement previews, task difficulty across images, and whether it
matters if radiographers are previewing the eye movements of an expert or a novice.
Aim: The study aims to help our understanding of the relationship between physical characteristics of local and global
image features and the location of visual attention by observers. Background: Neurological visual pathways are
specified at least in part by particular spatial frequency ranges at different orientations. High spatial frequencies, which
carry the information of local perturbations like edges, are assembled mainly by foveal vision, whereas peripheral vision
provides more global information coded by low frequencies. Recent visual-search studies in mammography (C Mello-Thoms et al) have shown that observers allocate visual attention to regions of the image depending on; i) spatial
frequency characteristics of regions that capture attention and ii) the level of experience of the observer. Both aspects are
considered in this study. Methods: A spatial frequency analysis of postero-anterior (PA) chest images containing
pulmonary nodules has been performed by wavelet packet transforms at different scales. This image analysis has
provided regional physical information over the whole image field on locations both with nodules present and nodules
absent. The relationship between such properties as spatial frequency, orientation, scales, contrast, and phase of localised
perturbations has been compared with eye-tracked search strategies and decision performance of observers with different
levels of expertise. Results: The work is in progress and the results of this initial stage of the project will be presented
with a critical appraisal of the methods used.
In a previously reported study we demonstrated that expert performance can decline following perceptual feedback of
eye movements in the relatively simple radiological task of wrist fracture detection. This study was carried out to
determine if the same effect could be observed using a more complicated radiological task of identifying lung nodules on
chest radiographs. Four groups (n=10 in each group) of observers with different levels of expertise were tested. The
groups were naïve observers, level 1 radiography students, level 2 radiography students and experts. Feedback was
presented to the observers in the form of their scan paths and fixations. Half the observers had feedback and half had no
perceptual feedback. JAFROC analysis was used to measure observer performance. A repeated measures ANOVA was
carried out. There was no significant effect between the pre and post "no feedback" condition. There was a significant
difference between the pre and post "feedback" condition with a significant improvement following feedback
(F(1,16)=6.6,p = 0.021). Overall the mean percentage improvement was small of 3.3%, with most of the improvement
due to the level 1 group where the percentage increase in the figure of merit (FOM) was 8.4% and this was significant
(p<0.05).
Eye tracking metrics indicate that the expert and naïve observers were less affected by feedback or a second look
whereas there were mixed results between the level 1 and level 2 students possibly reflecting the different search
strategies used. Perceptual feedback may be beneficial for those early in their training.
Four observer groups with different levels of expertise were tested to determine the effect of feedback on eye movements and accuracy whilst performing a simple radiological task. The observer groups were 8 experts, 9 year 1 radiography students, 9 year 3 radiography students, and 10 naive observers (psychology students). The task was fracture detection in the wrist. A test bank of 32 films was compiled with 14 normals, 6 grade 1 fractures (subtle appearance), 6 grade 2 fractures, and 6 grade 3 fractures (obvious appearance). Eye tracking was carried out on all observers to demonstrate differences in visual activity. Observers were asked to rate their confidence in their decision on a ten point scale. Feedback was presented to the observers in the form of circles displayed on the film where fixations had occurred, the size of which was proportional to the length of fixation. Observers were asked to repeat their decision rating. Accuracy was determined by ROC analysis and the area under the curve (AUC). In two groups, the novices and first year radiography students, the feedback resulted in no significant difference in the AUC. In the other two groups, experts (p = 0.002) and second year radiography students (p = 0.031), feedback had a negative effect on performance. The eye tracking parameters were measured for all subjects and compared. This is work in progress, but initial analysis of the data suggests that in a simple radiological task such as fracture detection, where search is very limited, feedback by encouraging observers to look harder at the image can have a negative effect on image interpretation performance, however for the novice feedback is beneficial as post feedback eye-tracking parameters measured more closely matched those of the experts.
This paper describes a software framework and analysis tool to support the collection and analysis of eye movement and perceptual feedback data for a variety of diagnostic imaging modalities. The framework allows the rapid creation of experiment software that can display a collection of medical images of a particular modality, capture eye trace data, and record marks added to an image by the observer, together with their final decision. There are also a number of visualisation techniques for the display of eye trace information. The analysis tool supports the comparison of individual eye traces for a particular observer or traces from multiple observers for a particular image. Saccade and fixation data can be visualised, with user control of fixation identification functions and properties. Observer markings are displayed, and predefined regions of interest are supported. The software also supports some interactive and multi-image modalities. The analysis tool includes a novel visualisation of scan paths across multi-image modalities. Using an exploded 3D view of a stack of MRI scan sections, an observer's scan path can be shown traversing between images, in addition to inspecting them.
Twenty-four volunteer observers were divided into groups of eight radiologists, eight radiographers and eight novices to carry out a pulmonary nodule detection task on a test bank of 120 digitized PA chest radiographs. The eight radiographers were tested twice: before and after a six-month training program in interpretation of the adult chest radiograph. During each test session the observers eye movements were tracked. Data on the observers' decisions through AFROC methodology were correlated to their eye-movement and fixation patterns. False negative error-rates were recorded as 41% for the radiologists, 45% for the novices, 47% for the radiographers before training and 42% for the radiographers after training. The errors were sub-classified into search, recognition and decision errors depending on the duration of the fixation-time for each faulty response. Errors due to satisfaction of search were determined from images with multiple nodules. Differences between the groups were shown. Errors due to inefficient search were in the minority for all the observer groups and the dominant cause of unreported nodules was incorrect decision-making. True negative decisions from all observers were associated with shorter fixation times than false negative decisions. No correct negative decisions were made after fixations exceeding three seconds.
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