Calvin F. Nodine

Visual scanning, pattern recognition and decision-making in pulmonary nodule detection.

Eye movements were recorded while four subjects searched a set of 60 films, 24 normal and 36 abnormal for pulmonary nodules. Error rates, scanning patterns and the dwell time of fixation clusters on normal and nodule-containing areas of the film were studied. Using the assumption that prolonged dwell time indicates intensive processing of visual data, a model was developed for nodule detection that includes four steps: orientation, scanning, pattern recognition and decision-making. False-negative errors were divided into three classes: scanning errors, recognition errors and decision-making errors. Of 20 false-negative errors, 30% were considered scanning, 25% recognition and 45% decision-making.

The Role of Formal Art Training on Perception and Aesthetic Judgment of Art Compositions

Does formal art training educate the eye by enabling the viewer to carry out the type of in-depth analysis of the composition elements called for in Berlyne’s theory? Do differences in visual exploration contribute to aesthetic judgment? To answer these questions, the present study compares visual exploration patterns of art-trained and untrained viewers who judged compositions that differed in balance through manipulation of symmetrical organization.

How experience and training influence mammography expertise

RATIONALE AND OBJECTIVES The authors evaluated the influence of perceptual and cognitive skills in mammography detection and interpretation by testing three groups representing different levels of mammography expertise in terms of experience, training, and talent with a mammography screening-diagnostic task. MATERIALS AND METHODS One hundred fifty mammograms, composed of unilateral cranial-caudal and mediolateral oblique views, were displayed in pairs on a digital workstation to 19 radiology residents, three experienced mammographers, and nine mammography technologists. One-third of the mammograms showed malignant lesions; two-thirds were malignancy-free. Observers interacted with the display to indicate whether each image contained no malignant lesions or suspicious lesions indicating malignancy. Decision time was measured as the lesions were localized, classified, and rated for decision confidence. RESULTS Compared with performance of experts, alternative free response operating characteristic performance for residents was significantly lower and equivalent to that of technologists. Analysis of overall performance showed that, as level of expertise decreased, false-positive results exerted a greater effect on overall decision accuracy over the time course of image perception. This defines the decision speed-accuracy relationship that characterizes mammography expertise. CONCLUSION Differences in resident performance resulted primarily from lack of perceptual-learning experience during mammography training, which limited object recognition skills and made it difficult to determine differences between malignant lesions, benign lesions, and normal image perturbations. A proposed solution is systematic mentor-guided training that links image perception to feedback about the reasons underlying decision making.

Interpreting Chest Radiographs without Visual Search

Ten radiologists were shown a series of 10 normal and 10 abnormal chest films under two viewing conditions: a 0.2-second flash and unlimited viewing time. The results were compared in terms of verbal content, diagnostic accuracy, and level of confidence. The overall accuracy was surprisingly high (70% true positives) considering that no search was possible. Performance improved as expected with free search (97% true positives). These data support the hypothesis that visual search begins with a global response that establishes content, detects gross deviations from normal, and organizes subsequent foveal checking fixations to conduct a detailed examination of ambiguities. The total search strategy then consists of an ordered sequence of interspersed global and checking fixations.

Searching for Lung Nodules: Visual Dwell Indicates Locations of False-positive and False-negative Decisions

Eye position recordings made while radiologists searched chest images for lung nodules showed that regions falsely reported positive or suspicious received prolonged visual attention. Correlation of regional fixation dwell time with independent ratings of image features indicated that more than 90% of false-positive decisions were caused by some perturbation in the image that aroused the suspicion of the viewer. The remainder apparently arose from within the viewer. Most missed nodules (false-negative reports) also received prolonged visual attention, implying an active decision not to perceive a nodule. The data are interpreted to show that roughly one task-related decision is made during each second of scanning a radiograph. This departs from the central assumption of the traditional signal-detection model based upon one decision per image.

Recording and analyzing eye-position data using a microcomputer workstation

This paper presents a PC-based eye-position data collection and analysis system. Software routines are described that supplement hardware calibration procedures, improving data-collection accuracy and reducing the number of unusable trials. Collected eye-position data can be remapped over a displayed stimulus image and spatially and temporally represented by parameters such as individual fixations, clusters of fixations (Nodine, Carmody, & Kundel, 1978), cumulative clusters, and gaze durations. An important feature of the system is that the software routines preserve scan-path information that provides a sequential dimension to the analysis of eye-position data. A “hotspot” analysis is also described, which cumulates, across 1 or more observers, the frequency of eye-position landings or “hits” on designated areas of interest for a given stimulus. Experimental applications in the fields of radiology, psychology, and art are provided, illustrating how eye-position data can be interpreted both in signal detection and in information-processing frameworks using the present methods of analysis.

SYMMETRY CATCHES THE EYE

Eye movements of ten adults were recorded as they judged the aesthetic potential of the original and altered single and double symmetrical transformations of five structurally complex abstract compositions. It was found that when symmetry was present, both survey and examination fixations were concentrated along the axis of symmetry. When symmetry was absent, however, exploration was more evenly distributed to all areas of the stimulus array. Although symmetry influenced the spatial aspects of exploration, the number of survey and examination fixations used to explore the arrays was not influenced by the presence of symmetry. Results are discussed in terms of a two-step symmetry encoding model and Berlynes theory of aesthetic behavior.

Computer-displayed eye position as a visual aid to pulmonary nodule interpretation

Approximately 30% of nodules are missed during the initial reading of chest radiographs. Eye-position recordings have shown that most nodules that are missed receive prolonged visual attention. A computer algorithm was developed that uses eye-position and gaze-duration times to identify locations on the chest image likely to contain missed nodules. These locations are highlighted on the displayed image to give visual feedback. The current study tested whether visual feedback was an effective aid to nodule detection. Six radiology residents searched 40 chest images for nodules while their eye-position and gaze-duration times were recorded. Half received displayed visual feedback and half were given a second view without feedback. Two months later the two groups returned and viewed the images in the opposite condition to counterbalance for possible practice effects. Performance of readers who were given feedback showed an average of 16% improvement as measured by the alternative free response operating characteristic (AFROC) curve area, A1. Performance of the same readers given a second look without feedback did not improve.

Searching for bone fractures: A comparison with pulmonary nodule search

RATIONALE AND OBJECTIVES We aimed to determine if the characteristics and principles of visual search described for the detection of pulmonary nodules apply to extremity fractures. METHODS The eye positions of staff orthopedic radiologists, radiology residents, and medical students were monitored as they searched hand and wrist X-ray images for fractures and a chest image for nodules. RESULTS More systematic scanning patterns were observed for experienced observers than inexperienced observers. Positive decisions for bone images were associated with prolonged gaze durations; prolonged gaze durations were significantly longer for false-negative versus true-negative decisions. Intercluster jump distances were found to be greater for chest images than bone images. CONCLUSIONS A search for bone fractures can be qualitatively characterized by classifying observer scan paths, dwell times, and jump distances. Gaze duration can be a useful predictor of bone image locations containing potential missed fractures. Perceptual feedback could aid observers in the detection of inconspicuous fractures.

Searching for lung nodules. A comparison of human performance with random and systematic scanning models.

The contrast sensitivity of the retina is greatest in the center and decreases rapidly toward the periphery. Therefore, the detection of low-contrast lung nodules depends upon the manner in which the image is sampled by retinal receptors as eye fixations jump across the image during scanning. The scanning performance of two radiologists was compared with two computed models, a systematic and a random scanner. Although radiologists do not seem to have random scanning patterns, their coverage of the image was matched more closely by the random model. This suggests that radiologists employ a scanning strategy that is designed to cover the image of the lungs in a minimum time using the smallest possible visual field. The visual field size that is most effective in detecting nodules during search has a radius of 3.5 degrees visual angle. Nodule detection may be limited by basic neurologic constraints on human scanning performance.