title: Systematic viewing in radiology: seeing more, missing less?
abstract: To prevent radiologists from overlooking lesions, radiology textbooks recommend "systematic viewing," a technique whereby anatomical areas are inspected in a fixed order. This would ensure complete inspection (full coverage) of the image and, in turn, improve diagnostic performance. To test this assumption, two experiments were performed. Both experiments investigated the relationship between systematic viewing, coverage, and diagnostic performance. Additionally, the first investigated whether systematic viewing increases with expertise; the second investigated whether novices benefit from full-coverage or systematic viewing training. In Experiment 1, 11 students, ten residents, and nine radiologists inspected five chest radiographs. Experiment 2 had 75 students undergo a training in either systematic, full-coverage (without being systematic) or non-systematic viewing. Eye movements and diagnostic performance were measured throughout both experiments. In Experiment 1, no significant correlations were found between systematic viewing and coverage, r = -.10, p = .62, and coverage and performance, r = -.06, p = .74. Experts were significantly more systematic than students F2,25 = 4.35, p = .02. In Experiment 2, significant correlations were found between systematic viewing and coverage, r = -.35, p < .01, but not between coverage and performance, r = .13, p = .31. Participants in the full-coverage training performed worse compared with both other groups, which did not differ between them, F2,71 = 3.95, p = .02. In conclusion, the data question the assumption that systematic viewing leads to increased coverage, and, consequently, to improved performance. Experts inspected cases more systematically, but students did not benefit from systematic viewing training.
authors.affiliation: Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. e.kok@maastrichtuniversity.nl.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Kok
authors.affiliation: Welten Institute, Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, The Netherlands.|Humanities Laboratory, Lund University, Lund, Sweden.
authors.forename: Halszka
authors.initials: H
authors.lastname: Jarodzka
authors.affiliation: Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Anique B H
authors.initials: AB
authors.lastname: de Bruin
authors.affiliation: International Master in Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Hussain A N
authors.initials: HA
authors.lastname: BinAmir
authors.affiliation: Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Simon G F
authors.initials: SG
authors.lastname: Robben
authors.affiliation: Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Jeroen J G
authors.initials: JJ
authors.lastname: van Merriënboer
mesh_terms: D002983:Clinical Competence; D003951:Diagnostic Errors / Q000517:prevention & control; D003952:Diagnostic Imaging; D005133:Eye Movements; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D013902:Radiography, Thoracic; D000072177:Radiologists / Q000193:education; D011871:Radiology / Q000193:education; D055815:Young Adult
keywords: Education; Error; Eye tracking; Radiology; Systematic approach; Systematic viewing