Skeletal Radiology

, Volume 42, Issue 2, pp 165–172 | Cite as

Visual expertise in detecting and diagnosing skeletal fractures

  • Greg Wood
  • Karen M. Knapp
  • Benjamin Rock
  • Chris Cousens
  • Carl Roobottom
  • Mark R. Wilson
Scientific Article



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.

Materials and 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.


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.


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.


Visual search Gaze behavior Interpretation Eye movements 



The authors declare that they have no conflicts of interest.


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Copyright information

© ISS 2012

Authors and Affiliations

  • Greg Wood
    • 1
  • Karen M. Knapp
    • 2
  • Benjamin Rock
    • 3
  • Chris Cousens
    • 3
  • Carl Roobottom
    • 3
  • Mark R. Wilson
    • 1
  1. 1.College of Life and Environmental SciencesUniversity of ExeterExeterUK
  2. 2.College of Engineering, Mathematics, and Physical SciencesUniversity of ExeterExeterUK
  3. 3.Peninsula Radiology AcademyPlymouthUK

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