title: Searching for bone fractures: a comparison with pulmonary nodule search.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia 19104-6086, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Hu
authors.forename: H L
authors.initials: HL
authors.lastname: Kundel
authors.forename: C F
authors.initials: CF
authors.lastname: Nodine
authors.forename: E A
authors.initials: EA
authors.lastname: Krupinski
authors.forename: L C
authors.initials: LC
authors.lastname: Toto
mesh_terms: D005133:Eye Movements; D005188:False Negative Reactions; D005189:False Positive Reactions; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006225:Hand / Q000000981:diagnostic imaging; D006230:Hand Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods; D013902:Radiography, Thoracic / Q000379:methods; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014953:Wrist / Q000000981:diagnostic imaging