Exploring the effect of context and expertise on attention: is attention shifted by information in medical images?

Abstract

Radiologists make critical decisions based on searching and interpreting medical images. The probability of a lung nodule differs across anatomical regions within the chest, raising the possibility that radiologists might have a prior expectation that creates an attentional bias. The development of expertise is also thought to cause “tuning” to relevant features, allowing radiologists to become faster and more accurate at detecting potential masses within their domain of expertise. Here, we tested both radiologists and control participants with a novel attentional-cueing paradigm to investigate whether the deployment of attention was affected (1) by a context that might invoke prior knowledge for experts, (2) by a nodule localized either on the same or on opposite sides as a subsequent target, and (3) by inversion of the nodule-present chest radiographs, to assess the orientation specificity of any effects. The participants also performed a nodule detection task to verify that our presentation duration was sufficient to extract diagnostic information. We saw no evidence of priors triggered by a normal chest radiograph cue affecting attention. When the cue was an upright abnormal chest radiograph, radiologists were faster when the lateralised nodule and the subsequent target appeared at the same rather than at opposite locations, suggesting attention was captured by the nodule. The opposite pattern was present for inverted images. We saw no evidence of cueing for control participants in any condition, which suggests that radiologists are indeed more sensitive to visual features that are not perceived as salient by naïve observers.