objective of this proposal is to understand the perception of multiple
abnormalities in an imaging examination and to develop strategies for improved
diagnostic accuracy and patient outcome. We are one of the few laboratories in
the world pursuing the goal of reducing detection errors through a better
understanding of the underlying perceptual processes involved.
Failure to detect an abnormality
is the most common class of error in diagnostic imaging and generally is considered
the most serious by the medical community. Many of these errors have been
attributed to “satisfaction of search,” which occurs when a lesion is not
reported because discovery of another abnormality has “satisfied” the goal of
Although we have gained some understanding of the mechanisms
of satisfaction of search (SOS), there are significant questions that remain.
The failure of human pattern recognition underlying satisfaction of search
error has not been explained. Our previous research may offer the key: the
clinical importance of abnormalities may determine how much they interfere with
detection of other abnormalities.
Helical computed tomography (CT) may replace radiography as
the most common and useful radiology examination because it offers more
accurate and earlier lesion detection. But the large number of images produced
by modern CT and other cross-sectional modalities may quickly overload the
radiologists’ perceptual resources, creating increased risk of satisfaction of
search error. There have been no experimental studies of SOS error in the
There are few interventions that hold promise to remedy SOS
error. The goal of computer-aided diagnosis is to improve cancer detection.
Whether computer-aided diagnosis can reduce SOS error has not been considered
or studied until now.
We propose six
definitive experiments to approach the complex questions that remain. The
research methods will include experiments using analysis of receiver operating
characteristic curves, the time course of detection responses and termination
of search, and display commands issued by the observer to interrogate the image
data array. The knowledge gained from this programmatic research will lead to
reduction in observer error.