title: Visual expertise in detecting and diagnosing skeletal fractures.
abstract: OBJECTIVE
  Failure to identify fractures is the most common error in accident and emergency departments. Therefore, the current research aimed to understand more about the processes underlying perceptual expertise when interpreting skeletal radiographs.
  
  
  METHODS
  Thirty participants, consisting of ten novices, ten intermediates, and ten experts were presented with ten clinical cases of normal and abnormal skeletal radiographs of varying difficulty (obvious or subtle) while wearing eye tracking equipment.
  
  
  RESULTS
  Experts were significantly more accurate, more confident, and faster in their diagnoses than intermediates or novices and this performance advantage was more pronounced for the subtle cases. Experts were also faster to fixate the site of the fracture and spent more relative time fixating the fracture than intermediates or novices and this was again most pronounced for subtle cases. Finally, a multiple linear regression analysis found that time to fixate the fracture was inversely related to diagnostic accuracy and explained 34 % of the variance in this variable.
  
  
  CONCLUSIONS
  The results suggest that the performance advantage of expert radiologists is underpinned by superior pattern recognition skills, as evidenced by a quicker time to first fixate the pathology, and less time spent searching the image.
authors.affiliation: College of Life and Environmental Sciences, University of Exeter, Richards Building, St Luke's Campus, Exeter, EX1 2LU, UK. gw230@ex.ac.uk
authors.forename: Greg
authors.initials: G
authors.lastname: Wood
authors.forename: Karen M
authors.initials: KM
authors.lastname: Knapp
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rock
authors.forename: Chris
authors.initials: C
authors.lastname: Cousens
authors.forename: Carl
authors.initials: C
authors.lastname: Roobottom
authors.forename: Mark R
authors.initials: MR
authors.lastname: Wilson
mesh_terms: D005133:Eye Movements / Q000502:physiology*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015588:Observer Variation; D010364:Pattern Recognition, Visual / Q000502:physiology*; D011361:Professional Competence; D011859:Radiography; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013647:Task Performance and Analysis; D006113:United Kingdom