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Systematic viewing in radiology: seeing more, missing less?

Ellen M Kok1, Halszka Jarodzka2,3, Anique B H de Bruin4

  • 1Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. e.kok@maastrichtuniversity.nl.

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Radiology textbooks suggest systematic viewing improves lesion detection. However, this study found systematic viewing does not guarantee full image coverage or better diagnostic performance, questioning its effectiveness for improving radiologist accuracy.

Keywords:
EducationErrorEye trackingRadiologySystematic approachSystematic viewing

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Area of Science:

  • Medical Imaging
  • Radiology
  • Cognitive Science in Medicine

Background:

  • Radiology education often recommends systematic viewing to ensure complete image inspection and improve diagnostic performance.
  • The assumption that systematic viewing directly translates to increased coverage and better lesion detection requires empirical validation.

Purpose of the Study:

  • To investigate the relationship between systematic viewing, image coverage, and diagnostic performance in radiology.
  • To determine if expertise influences the adoption of systematic viewing.
  • To assess the benefits of systematic versus full-coverage viewing training for novice radiologists.

Main Methods:

  • Two experiments were conducted involving students, residents, and radiologists inspecting chest radiographs.
  • Eye movements and diagnostic performance were recorded.
  • Participants in the second experiment received specific training in systematic, full-coverage, or non-systematic viewing.

Main Results:

  • No significant correlation was found between systematic viewing and coverage, or coverage and performance in the first experiment.
  • Experts exhibited more systematic viewing than students.
  • In the second experiment, systematic viewing correlated with coverage, but coverage did not correlate with performance. Full-coverage training led to worse performance.

Conclusions:

  • The study challenges the assumption that systematic viewing inherently increases image coverage and improves diagnostic performance.
  • While experts are more systematic, novice radiologists do not benefit from systematic viewing training.
  • Alternative viewing strategies or training methods may be necessary to enhance diagnostic accuracy in radiology.