Improving Medical Image Decision-Making by Leveraging Metacognitive Processes and Representational Similarity

Improving the accuracy of medical image interpretation can improve the diagnosis of numerous diseases. We compared different approaches to aggregating repeated decisions about medical images to improve the accuracy of a single decision maker. We tested our algorithms on data from both novices (undergraduates) and experts (medical professionals). Participants viewed images of white blood cells and made decisions about whether the cells were cancerous or not. Each image was shown twice to the participants and their corresponding confidence judgments were collected. The maximum confidence slating (MCS) algorithm leverages metacognitive abilities to consider the more confident response in the pair of responses as the more accurate "final response" (Koriat, 2012), and it has previously been shown to improve accuracy on our task for both novices and experts (Hasan et al., 2021). We compared MCS to similarity-based aggregation (SBA) algorithms where the responses made by the same participant on similar images are pooled together to generate the "final response." We determined similarity by using two different neural networks where one of the networks had been trained on white blood cells and the other had not. We show that SBA improves performance for novices even when the neural network had no specific training on white blood cell images. Using an informative representation (i.e., network trained on white blood cells) allowed one to aggregate over more neighbors and further boosted the performance of novices. However, SBA failed to improve the performance for experts even with the informative representation. This difference in efficacy of the SBA suggests different decision mechanisms for novices and experts.