The role of extra-foveal processing in 3D imaging

The field of medical image quality has relied on the assumption that metrics of image quality for simple visual detection tasks are a reliable proxy for the more clinically realistic visual search tasks. Rank order of signal detectability across conditions often generalizes from detection to search tasks. Here, we argue that search in 3D images represents a paradigm shift in medical imaging: radiologists typically cannot exhaustively scrutinize all regions of interest with the high acuity fovea requiring detection of signals with extra-foveal areas (visual periphery) of the human retina. We hypothesize that extra-foveal processing can alter the detectability of certain types of signals in medical images with important implications for search in 3D medical images. We compare visual search of two different types of signals in 2D vs. 3D images. We show that a small microcalcification-like signal is more highly detectable than a larger mass-like signal in 2D search, but its detectability largely decreases (relative to the larger signal) in the 3D search task. Utilizing measurements of observer detectability as a function retinal eccentricity and observer eye fixations we can predict the pattern of results in the 2D and 3D search studies. Our findings: 1) suggest that observer performance findings with 2D search might not always generalize to 3D search; 2) motivate the development of a new family of model observers that take into account the inhomogeneous visual processing across the retina (foveated model observers).