Missing more than a gorilla in the reading room

According to radiologists, they make about 40 million mistakes each year Insight Imaging Survey. However, a significant portion of these errors can result from inadvertent blindness. That is, when you are concentrating on something else, you cannot clearly see what is in front of you. And it affects all radiologists equally.

Trafton Drew, Ph.D., Associate Professor of Psychology. You may remember a 2013 study in which a team of researchers at the University of Utah, led by the University of Utah, asked a radiologist to examine a chest CT scan containing an image of a gorilla of a lung nodule. Eighty-three percent of radiologists literally missed the gorilla in the room.

However, missing something unrelated to a diagnostic scan is not necessarily the same as a radiologist who overlooks medical findings that may affect the patient’s health or change treatment strategies. So in a new study, Psychonomic Bulletin & Review, Drew’s team investigated how often providers could miss something outside the scope of the question they were asked to answer.

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“We have long known that many mistakes in radiology are retroactively visible,” he said. “This means that if a patient has a problem, we can go back to the patient’s image and see that there were visible signs (such as lung nodules) on something like a chest CT.”

This time, Drew’s team asked 50 radiologists to evaluate seven chest CT scans of lung cancer. These images also contained two obvious abnormalities: a serious breast lump and lymphadenopathy. According to radiologist performance, two-thirds of providers did not see breast lumps and one-third overlooked lymphadenopathy.

“I think many radiologists, like those who are experiencing inadvertent blindness, are simply surprised to find that they missed something,” said a recent graduate of Utah and the University of California, San Diego. Lauren Williams, the school’s current postdoc, said. “Our intuition is to detect when something is completely visible, but when we look elsewhere, we have experienced the feeling that important information that is retroactively apparent is missing. “

As important as the number of providers who missed potentially significant discoveries is the fact that years of experience haven’t made a difference, the team said. Both veterans and early radiologists made these mistakes. Not only does this not outweigh the presence and impact of inadvertent blindness, but it also suggests that the lack of anomalies does not reflect the skills and abilities of the provider.

However, the team also checked to see if broader instructions could impact performance. In the second experiment, the team asked the same radiologist to check the same scan and report various abnormalities. Now, according to the team, only 3% of providers overlooked breast lumps and 10% overlooked lymphadenopathy.

However, simply knowing how often providers miss things invisibly leaves an important part of the puzzle unanswered. What are radiologists looking for when they pass things at a glance?

“Our study shows that focusing on one task can cause radiologists to miss unexpected abnormalities, even if those abnormalities are critical to the outcome of the patient.” Williams said. “But if the abnormalities match the expectations of the radiologist, intensive attention is probably beneficial.”

She said small clinical changes could be beneficial, such as performing a general assessment of the scan before examining the details of the scan, or using a checklist of what is often overlooked. .. These tactics can be more effective than artificial intelligence (AI) tools that focus on specific findings rather than detecting everything that may be included in the scan.

“Radologists may benefit from thinking twice about what they are looking for. [than] If they see it, they assume they perceive it, “Drew said. “AI has the same limitations in several respects. It’s just good at detecting what you’re told to detect.”

Ultimately, Drew said these results provide a deeper understanding of how often people see only what they are looking for.

“Even experts can miss what looks really obvious if we aren’t looking for them,” he said. “If you searched for a cell phone throughout the apartment, you might think you noticed the key during that search. Our research suggests why you probably have to search for the key again specifically. “

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