title: How visual search relates to visual diagnostic performance: a narrative systematic review of eye-tracking research in radiology.
abstract: Eye tracking research has been conducted for decades to gain understanding of visual diagnosis such as in radiology. For educational purposes, it is important to identify visual search patterns that are related to high perceptual performance and to identify effective teaching strategies. This review of eye-tracking literature in the radiology domain aims to identify visual search patterns associated with high perceptual performance. Databases PubMed, EMBASE, ERIC, PsycINFO, Scopus and Web of Science were searched using 'visual perception' OR 'eye tracking' AND 'radiology' and synonyms. Two authors independently screened search results and included eye tracking studies concerning visual skills in radiology published between January 1, 1994 and July 31, 2015. Two authors independently assessed study quality with the Medical Education Research Study Quality Instrument, and extracted study data with respect to design, participant and task characteristics, and variables. A thematic analysis was conducted to extract and arrange study results, and a textual narrative synthesis was applied for data integration and interpretation. The search resulted in 22 relevant full-text articles. Thematic analysis resulted in six themes that informed the relation between visual search and level of expertise: (1) time on task, (2) eye movement characteristics of experts, (3) differences in visual attention, (4) visual search patterns, (5) search patterns in cross sectional stack imaging, and (6) teaching visual search strategies. Expert search was found to be characterized by a global-focal search pattern, which represents an initial global impression, followed by a detailed, focal search-to-find mode. Specific task-related search patterns, like drilling through CT scans and systematic search in chest X-rays, were found to be related to high expert levels. One study investigated teaching of visual search strategies, and did not find a significant effect on perceptual performance. Eye tracking literature in radiology indicates several search patterns are related to high levels of expertise, but teaching novices to search as an expert may not be effective. Experimental research is needed to find out which search strategies can improve image perception in learners.
authors.affiliation: Radiology Department, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. A.vanderGijp-2@umcutrecht.nl.
authors.forename: A
authors.initials: A
authors.lastname: van der Gijp
authors.affiliation: Radiology Department, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Ravesloot
authors.affiliation: Center for Learning Science and Technologies, Open University of the Netherlands, Heerlen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Jarodzka
authors.affiliation: Department of Education, Utrecht University, Utrecht, The Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: van der Schaaf
authors.affiliation: Radiology Department, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: I C
authors.initials: IC
authors.lastname: van der Schaaf
authors.affiliation: Radiology Department, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: J P J
authors.initials: JPJ
authors.lastname: van Schaik
authors.affiliation: Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Th J
authors.initials: TJ
authors.lastname: Ten Cate
mesh_terms: D001288:Attention / Q000502:physiology*; D002983:Clinical Competence; D004501:Education, Medical; D005133:Eye Movements / Q000502:physiology*; D006801:Humans; D011871:Radiology / Q000193:education*; D014796:Visual Perception / Q000502:physiology*
keywords: Eye tracking; Image interpretation; Medical education; Radiology; Search patterns; Visual diagnosis