Dr. Lauren H. Williams Profile

Dr. Lauren H. Williams

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Proceedings Article | 4 April 2022 Presentation + Paper

Experience does not protect against missed incidental-findings in radiology

Lauren Williams, Megan Mills, Ann Carrigan, Anina Rich, Trafton Drew

Proceedings Volume 12035, 120350T (2022) https://doi.org/10.1117/12.2607316

KEYWORDS: Kidney, Liver, Radiology, Medical imaging, Computed tomography

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One of the benefits of expertise is thought to be the ability to reduce complex data to the information that is most relevant to the task at hand. In radiology, this ability manifests as fewer fixations and shorter dwell time in anatomical regions that are considered irrelevant to the observer’s task. Although these findings are generally viewed as an advantage of expertise, this study explored the potential negative effects of top-down guidance when cases had abnormalities that were inconsistent with the observer’s expectations (i.e., incidental findings). 37 radiologists evaluated abdominal CT scans. One group was told the patients were living liver donor candidates and the other group was told they were living kidney donor candidates. Critically, two of the cases had liver abnormalities and two had kidney abnormalities. Overall, abnormalities in the uncued organ were missed ~6% more than in the cued organ, but this difference was not significant and Bayes Factors were inconclusive. Using eyetracking measures, which provide a more sensitive measure of search behavior, we found the uncued organ was searched less thoroughly than the cued organ. There was no significant difference in scanning/drilling behavior between groups. There was no relationship between experience and missed incidental finding rates. Furthermore, radiologists across all levels of experience were equally likely to focus less attention on the uncued organ. Although previous research has found group-level differences between experts and naïve observers on incidentalfinding rates1, these findings add to growing evidence that expertise does not protect experts from missing incidentalfindings2.

SPIE Journal Paper | 14 July 2021

Characteristics of expert search behavior in volumetric medical image interpretation

Lauren Williams, Ann Carrigan, Megan Mills, William Auffermann, Anina Rich, Trafton Drew

JMI, Vol. 8, Issue 04, 041208, (July 2021) https://doi.org/10.1117/12.10.1117/1.JMI.8.4.041208

KEYWORDS: Medical imaging, Scanners, Image processing, Eye, Chest, Lung, Computed tomography, Lung cancer, Radiology, Medical research

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Purpose: Experienced radiologists have enhanced global processing ability relative to novices, allowing experts to rapidly detect medical abnormalities without performing an exhaustive search. However, evidence for global processing models is primarily limited to two-dimensional image interpretation, and it is unclear whether these findings generalize to volumetric images, which are widely used in clinical practice. We examined whether radiologists searching volumetric images use methods consistent with global processing models of expertise. In addition, we investigated whether search strategy (scanning/drilling) differs with experience level. Approach: Fifty radiologists with a wide range of experience evaluated chest computed-tomography scans for lung nodules while their eye movements and scrolling behaviors were tracked. Multiple linear regressions were used to determine: (1) how search behaviors differed with years of experience and the number of chest CTs evaluated per week and (2) which search behaviors predicted better performance. Results: Contrary to global processing models based on 2D images, experience was unrelated to measures of global processing (saccadic amplitude, coverage, time to first fixation, search time, and depth passes) in this task. Drilling behavior was associated with better accuracy than scanning behavior when controlling for observer experience. Greater image coverage was a strong predictor of task accuracy. Conclusions: Global processing ability may play a relatively small role in volumetric image interpretation, where global scene statistics are not available to radiologists in a single glance. Rather, in volumetric images, it may be more important to engage in search strategies that support a more thorough search of the image.

SPIE Journal Paper | 2 March 2018 Open Access

Quantifying the costs of interruption during diagnostic radiology interpretation using mobile eye-tracking glasses

Trafton Drew, Lauren Williams, Booth Aldred, Marta Heilbrun, Satoshi Minoshima

JMI, Vol. 5, Issue 03, 031406, (March 2018) https://doi.org/10.1117/12.10.1117/1.JMI.5.3.031406

KEYWORDS: Diagnostics, Radiology, Medical imaging, Glasses, Psychology, Chest, Computed tomography, Eye, Radiography, Medicine

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What are the costs and consequences of interruptions during diagnostic radiology? The cognitive psychology literature suggests that interruptions lead to an array of negative consequences that could hurt patient outcomes and lead to lower patient throughput. Meanwhile, observational studies have both noted a strikingly high rate of interruptions and rising number of interruptions faced by radiologists. There is some observational evidence that more interruptions could lead to worse patient outcomes: Balint et al. (2014) found that the shifts with more telephone calls received in the reading room were associated with more discrepant calls. The purpose of the current study was to use an experimental manipulation to precisely quantify the costs of two different types of interruption: telephone interruption and an interpersonal interruption. We found that the first telephone interruption led to a significant increase in time spent on the case, but there was no effect on diagnostic accuracy. Eye-tracking revealed that interruptions strongly influenced where the radiologists looked: they tended to spend more time looking at dictation screens and less on medical images immediately after interruption. Our results demonstrate that while radiologists’ eye movements are reliably influenced by interruptions, the behavioral consequences were relatively mild, suggesting effective compensatory mechanisms.

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