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. ? ? ?

National Institute of Health (NIH)
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Research Project (R01)
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Special Emphasis Panel (ZRG1-SBIB-P (02))
Program Officer
Cohen, Zohara
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University of Iowa
Schools of Medicine
Iowa City
United States
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Berbaum, Kevin S; Krupinski, Elizabeth A; Schartz, Kevin M et al. (2016) The Influence of a Vocalized Checklist on Detection of Multiple Abnormalities in Chest Radiography. Acad Radiol 23:413-20
Schartz, Kevin M; Madsen, Mark T; Kim, John et al. (2016) Trauma in CT: The Role of Severe Injury on Satisfaction of Search Revised. J Am Coll Radiol 13:973-978.e4
Berbaum, Kevin S; Krupinski, Elizabeth A; Schartz, Kevin M et al. (2015) Satisfaction of Search in Chest Radiography 2015. Acad Radiol 22:1457-65
Schartz, K M; Berbaum, K S; Madsen, M T et al. (2013) Multiple diagnostic task performance in CT examination of the chest. Br J Radiol 86:18244135
Berbaum, Kevin S; Schartz, Kevin M; Caldwell, Robert T et al. (2013) Satisfaction of search from detection of pulmonary nodules in computed tomography of the chest. Acad Radiol 20:194-201
Berbaum, Kevin S; Schartz, Kevin M; Caldwell, Robert T et al. (2012) Satisfaction of search for subtle skeletal fractures may not be induced by more serious skeletal injury. J Am Coll Radiol 9:344-51
Berbaum, Kevin S; Franken Jr, Edmund A (2011) Satisfaction of search in radiographic modalities. Radiology 261:1000-1; author reply 1001-2
Berbaum, Kevin S; Caldwell, Robert T; Schartz, Kevin M et al. (2007) Does computer-aided diagnosis for lung tumors change satisfaction of search in chest radiography? Acad Radiol 14:1069-76
Berbaum, Kevin S; El-Khoury, George Y; Ohashi, Kenjirou et al. (2007) Satisfaction of search in multitrauma patients: severity of detected fractures. Acad Radiol 14:711-22
Madsen, Mark T; Berbaum, Kevin S; Ellingson, Andrew N et al. (2006) A new software tool for removing, storing, and adding abnormalities to medical images for perception research studies. Acad Radiol 13:305-12

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