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Can prevalence expectations drive radiologists' behavior?

Warren M Reed1, Suet Ling Candice Chow1, Lay Ee Chew1

  • 1Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Sciences, The University of Sydney, Cumberland Campus, East St, PO Box 170, Lidcombe, New South Wales 1825, Australia.

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Radiologists

Keywords:
Thoracic imagingobserver performancevisual search

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Area of Science:

  • Radiology and Medical Imaging
  • Cognitive Psychology in Medicine
  • Diagnostic Performance Studies

Background:

  • Accurate interpretation of chest radiographs is crucial for diagnosing pulmonary lesions.
  • Radiologists' performance can be influenced by various cognitive biases, including prevalence expectation.
  • Understanding these influences is key to improving diagnostic accuracy.

Purpose of the Study:

  • To investigate how explicit prevalence expectation affects experienced radiologists' performance in detecting pulmonary lesions on chest radiographs.
  • To analyze the impact of varying prevalence expectations on visual search patterns and confidence ratings.

Main Methods:

  • 22 experienced radiologists were divided into three groups, each interpreting 30 chest images (15 abnormal).
  • Pre-interpretation, groups received different explicit prevalence expectations for abnormal images.
  • Eye-tracking metrics, confidence ratings, and decision analyses (false-positive/negative) were recorded.

Main Results:

  • Higher prevalence expectations significantly increased image scrutiny time and fixations per image for normal and abnormal images.
  • Confidence ratings for normal images significantly increased with higher prevalence expectations in one group.
  • The effect of prevalence expectation was more pronounced for normal images.

Conclusions:

  • Explicit prevalence expectations influence radiologists' visual search behavior and confidence levels.
  • These expectations appear to have a greater impact on the interpretation of normal images compared to abnormal ones.
  • Findings suggest that cognitive factors like prevalence expectation play a significant role in diagnostic performance.