title: Impact of clinical environment on embolus detection: a comparison of automated and manual detection of Doppler embolic signals.
abstract: BACKGROUND
  Transcranial Doppler ultrasound detection of weak embolic signals is inhibited by intrinsic limitations within the human auditory system. Psychoacoustics effects are likely to be exacerbated in a clinical environment, where automated embolus detection has potential to surpass manual detection. In this study we quantify the impact of clinical environment on manual detection of Doppler embolic signals following carotid surgery. We also discuss the implications of psychoacoustics considerations for the evaluation of automated detection systems.
  
  
  METHODS
  Concurrent monitoring by vascular technologists and an automated embolus detection system were performed for 50 consecutive patients during postoperative recovery. Both detection methods were evaluated against a majority decision human expert panel analyzing under ideal conditions.
  
  
  RESULTS
  Clinical environment reduced the overall sensitivity of manual monitoring by approximately 23%, mainly due to a approximately 2-dB increase in the lower threshold for detection. Clinical environment was also associated with a reduction in positive predictive value for manual detection of approximately 9% compared to ideal conditions. Automated monitoring, which is not affected by environment, was marginally more sensitive for detection of weaker embolic signals.
  
  
  CONCLUSIONS
  One in 4 weak embolic signals was missed during routine clinical monitoring compared to ideal conditions. Automated detection (in this study) performed slightly better than human observers but did not approach the performance of the majority decision panel.
authors.affiliation: Department of Medical Physics, University Hospitals of Leicester, Leicester, UK.
authors.forename: Emma M L
authors.initials: EM
authors.lastname: Chung
authors.forename: Lingke
authors.initials: L
authors.lastname: Fan
authors.forename: A Ross
authors.initials: AR
authors.lastname: Naylor
authors.forename: David H
authors.initials: DH
authors.lastname: Evans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D004780:Environment, Controlled; D004867:Equipment Design; D005104:Expert Testimony; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D020766:Intracranial Embolism / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011571:Psychoacoustics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D017585:Ultrasonography, Doppler, Transcranial; D006113:United Kingdom