Skip to main content

The effect of expert knowledge on medical search: medical experts have specialized abilities for detecting serious lesions

Abstract

How does domain-specific knowledge influence the experts’ performance in their domain of expertise? Specifically, can visual search experts find, with uniform efficiency, any type of target in their domain of expertise? We examined whether acquired knowledge of target importance influences an expert’s visual search performance. In some professional searches (e.g., medical screenings), certain targets are rare; one aim of this study was to examine the extent to which experts miss such targets in their searches. In one experiment, radiologists (medical experts) engaged in a medical lesion search task in which both the importance (i.e., seriousness/gravity) and the prevalence of targets varied. Results showed decreased target detection rates in the low prevalence conditions (i.e., the prevalence effect). Also, experts were better at detecting important (versus unimportant) lesions. Results of an experiment using novices ruled out the possibility that decreased performance with unimportant targets was due to low target noticeability/visibility. Overall, the findings suggest that radiologists do not have a generalized ability to detect any type of lesion; instead, they have acquired a specialized ability to detect only those important lesions relevant for effective medical practices.

This is a preview of subscription content, access via your institution.

Fig. 1

Notes

  1. To calculate d′ and C, we used the numerical correction values of detection rate and correct rejection rate when they were 1. A general correction method assumes that 1 − 1/2N (N is the number of target-present/-absent trials) (see Macmillan & Creelman, 1991). In this study, there was a large difference in the number of target-absent trials between the two prevalence conditions (18 vs. 882 trials). To equalize the correction values, when detection rate and correct rejection rate in each condition were higher than 0.97 (i.e., 1 − 1/36), we regarded them as 0.97 in all conditions.

References

  • Allard, F., Graham, S., & Paarsalu, M. E. (1980). Perception in sport: basketball. Journal of Sport Psychology, 2, 14–21.

    Google Scholar 

  • Asano, M., Kanaya, S., & Yokosawa, K. (2008). Proofreaders show a generalized ability to allocate spatial attention to detect changes. Psychologia, 51, 126–141.

    Article  Google Scholar 

  • Bédard, J., & Chi, M. T. H. (1992). Expertise. Current Direction Psychological Science, 1, 135–139.

    Article  Google Scholar 

  • Berbaum, K. S., Franklin, E. A. J., Caldwell, R. T., & Schartz, K. M. (2010). Satisfaction of search in traditional radiographic imaging. In E. Samei & E. Krupinski (Eds.), The handbook of medical image perception and techniques (pp. 107–138). Cambridge: Cambridge University Press.

    Google Scholar 

  • Bowditch, R. (1996). Patterns found in false negative cervical cytology. Cytoletter, 3, 22–25.

    Google Scholar 

  • Brainard, D. H. (1997). The psychophysics toolbox. Spatial Vision, 10, 443–446.

    Article  Google Scholar 

  • Brawley, O. W., & Kramer, B. S. (2005). Cancer screening in theory and practice. Journal of Clinical Oncology, 23, 293–300.

    Article  PubMed  Google Scholar 

  • Carmody, D. P., Nodine, C. F., & Kundel, H. L. (1981). Finding lung nodules with and without comparative visual scanning. Perception and Psychophysics, 29, 594–598.

    Article  PubMed  Google Scholar 

  • Chase, W. G., & Ericsson, K. A. (1982). Skill and working memory. The Psychology of Learning and Motivation, 16, 1–58.

    Article  Google Scholar 

  • Chase, W. G., & Simon, H. A. (1973). Perception in chess. Cognitive Psychology, 4, 55–81.

    Article  Google Scholar 

  • Davies, D. R., & Parasuraman, R. (1982). The psychology of vigilance. London: Academic Press.

    Google Scholar 

  • DeMay, R. M. (1997). Common problems in Papanicolaou smear interpretation. Archives of Pathology and Laboratory Medicine, 121, 229–238.

    PubMed  Google Scholar 

  • Evans, K. K., Birdwell, R. L., & Wolfe, J. M. (2013a). If you don’t find it often, you often don’t find it: why some cancers are missed in breast cancer screening. PLoS ONE, 8(5), e64366.

    Article  PubMed Central  PubMed  Google Scholar 

  • Evans, K. K., Cohen, M. A., Tambouret, R., Horowitz, T., Kreindel, E., & Wolfe, J. M. (2011a). Does visual expertise improve visual recognition memory? Attention, Perception, & Psychophysics, 73, 30–35.

    Article  Google Scholar 

  • Evans, K. K., Evered, A., Tambouret, R. H., Wilbur, D. C., & Wolfe, J. M. (2011b). Prevalence of abnormalities influences cytologists’ error rates in screening for cervical cancer. Archives of Pathology and Laboratory Medicine, 135, 1557–1560.

    Article  PubMed Central  PubMed  Google Scholar 

  • Evans, K. K., Georgian-Smith, D., Tambouret, R., Birdwell, R. L., & Wolfe, J. M. (2013b). The gist of the abnormal: above-chance medical decision making in the blink of an eye. Psychonomic Bulletin & Review, 20, 1170–1175.

    Article  Google Scholar 

  • Fleck, M. S., & Mitroff, S. R. (2007). Rare targets are rarely missed in correctable search. Psychological Science, 18, 943–947.

    Article  PubMed  Google Scholar 

  • Fleck, M. S., Samei, E., & Mitroff, S. R. (2010). Generalized “satisfaction of search”: adverse influences on dual-target search accuracy. Journal of Experimental Psychology: Applied, 16, 60–71.

    PubMed  Google Scholar 

  • Hickey, C., Chelazzi, L., & Theeuwes, J. (2010). Reward changes salience in human vision via the anterior cingulate. The Journal of Neuroscience, 30, 11096–11103.

    Article  PubMed  Google Scholar 

  • Hickey, C., Chelazzi, L., & Theeuwes, J. (2011). Reward has a residual impact on target selection in visual search, but not on the suppression of distractors. Visual Cognition, 19, 117–128.

    Article  Google Scholar 

  • Hommel, B., Li, Z. H., & Li, S. C. (2004). Visual search across the life span. Developmental Psychology, 40, 545–558.

    Article  PubMed  Google Scholar 

  • Humphreys, D. G., & Kramer, A. F. (1997). Age differences in visual search for feature, conjunction, and triple-conjunction targets. Psychology and Aging, 12, 704–717.

    Article  Google Scholar 

  • Ishibashi, K., Kita, S., & Wolfe, J. M. (2012). The effects of local prevalence and explicit expectations on search termination times. Attention, Perception, & Psychophysics, 74, 115–123.

    Article  Google Scholar 

  • Krupinski, E. A. (2010). Current perspectives in medical image perception. Attention, Perception, & Psychophysics, 72, 1205–1217.

    Article  Google Scholar 

  • Kundel, H. L. (2006). History of research in medical image perception. Journal of the American College of Radiology, 3, 402–408.

    Article  PubMed  Google Scholar 

  • Kundel, H. L., Nodine, C. F., & Carmody, D. P. (1978). Visual scanning, pattern recognition, and decision-making in pulmonary nodule detection. Investigative Radiology, 13, 175–181.

    Article  PubMed  Google Scholar 

  • Macmillan, N. A., & Creelman, C. D. (1991). Detection theory: A user’s guide. Cambridge: Cambridge University Press.

    Google Scholar 

  • Maeda, E., Yoshikawa, T., Nakashima, R., Kobayashi, K., Yokosawa, K., Hayashi, N., et al. (2013). Experimental system for measurement of radiologists’ performance by visual search task. Springer Plus, 2(607), 1–6.

    Google Scholar 

  • Menneer, T., Barrett, D. J. K., Phillips, L., Donnelly, N., & Cave, K. R. (2004). Search efficiency for multiple targets. Cognitive Technology, 9, 22–25.

    Google Scholar 

  • Menneer, T., Barrett, D. J. K., Phillips, L., Donnelly, N., & Cave, K. R. (2007). Costs in searching for two targets: dividing search across target types could improve airport security screening. Applied Cognitive Psychology, 21, 915–932.

    Article  Google Scholar 

  • Menneer, T., Cave, K. R., & Donnelly, N. (2009). The cost of search for multiple targets: the effect of practice and target similarity. Journal of Experimental Psychology: Applied, 15, 125–139.

    PubMed  Google Scholar 

  • Metz, C. E. (1978). Basic principles of ROC analysis. Seminars in Nuclear Medicine, 8, 283–298.

    Article  PubMed  Google Scholar 

  • Nakashima, R., Kobayashi, K., Maeda, E., Yoshikawa, T., & Yokosawa, K. (2013). Visual search of experts in medical image reading: the effect of training, target prevalence, and expert knowledge. Frontiers in Psychology, 4(166), 1–8.

    Google Scholar 

  • Neider, M. B., & Zelinsky, G. J. (2006). Searching for camouflaged targets: effects of target-background similarity on visual search. Vision Research, 46, 2217–2235.

    Article  PubMed  Google Scholar 

  • Nieuwenhuis, S., Forstmann, B. U., & Wagenmakers, E.-J. (2011). Erroneous analyses of interactions in neuroscience: a problem of significance. Nature Neuroscience, 14, 1105–1107.

    Article  PubMed  Google Scholar 

  • Oestmann, J. W., Greene, R., Kushner, D. C., Bourgouin, P. M., Linetsky, L., & Llewellyn, H. J. (1988). Lung lesions: correlation between viewing time and detection. Radiology, 166, 451–453.

    Article  PubMed  Google Scholar 

  • Palmer, J., Huk, A. C., & Shadlen, M. N. (2005). The effect of stimulus strength on the speed and accuracy of a perceptual decision. Journal of Vision, 5, 376–404.

    Article  PubMed  Google Scholar 

  • Pelli, D. G. (1997). The VideoToolbox software for visual psychophysics: transforming numbers into movies. Spatial Vision, 10, 437–442.

    Article  PubMed  Google Scholar 

  • Rich, A. N., Kunar, M. A., Van Wert, M. J., Hidalgo-Sotelo, B., Horowitz, T. S., & Wolfe, J. M. (2008). Why do we miss rare targets? Exploring the boundaries of the low prevalence effect. Journal of Vision, 8(15), 1–17.

    Article  PubMed  Google Scholar 

  • Sowden, P. T., Davies, I. R. L., & Roling, P. (2000). Perceptual learning of the detection of features in X-ray images: a functional role for improvements in adults’ visual sensitivity? Journal of Experimental Psychology: Human Perception and Performance, 26, 379–390.

    PubMed  Google Scholar 

  • Trick, L. M., & Enns, J. T. (1998). Lifespan changes in attention: the visual search task. Cognitive Development, 13, 369–386.

    Article  Google Scholar 

  • Van Wert, M. J., Horowitz, T. S., & Wolfe, J. M. (2009). Even in correctable search, some types of rare targets are frequently missed. Attention, Perception, & Psychophysics, 71, 541–553.

  • Voss, J. F., Vesonder, G. T., & Spilich, G. J. (1980). Text generation and recall by high-knowledge and low-knowledge individuals. Journal of Verbal Learning and Verbal Behavior, 19, 651–667.

    Article  Google Scholar 

  • Warm, J. S., Parasuraman, R., & Matthews, G. (2008). Vigilance requires hard mental work and is stressful. Human Factors, 50, 433–441.

    Article  PubMed  Google Scholar 

  • Wolfe, J. M., Brunelli, D. N., Rubinstein, J., & Horowitz, T. S. (2013). Prevalence effects in newly trained airport checkpoint screeners: trained observers miss rare targets, too. Journal of Vision, 13(3), 1–9.

    Article  Google Scholar 

  • Wolfe, J. M., Horowitz, T. S., & Kenner, N. M. (2005). Rare items often missed in visual searches. Nature, 435, 439–440.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wolfe, J. M., Horowitz, T. S., Van Wert, M. J., Kenner, N. M., Place, S. S., & Kibbi, N. (2007). Low target prevalence is a stubborn source of errors in visual search tasks. Journal of Experimental Psychology: General, 136, 623–638.

    Article  Google Scholar 

  • Wolfe, J. M., & Van Wert, M. J. (2010). Varying target prevalence reveals two dissociable decision criteria in visual search. Current Biology, 20, 121–124.

    Article  PubMed Central  PubMed  Google Scholar 

  • Yantis, S., Anderson, B. A., Wampler, E. K., & Laurent, P. A. (2012). Reward and attentional control in visual search. In M. D. Dodd & J. H. Flowers (Eds.), Nebraska symposium on motivation: The influence of attention, learning, and motivation on visual search (pp. 91–116). New York: Springer.

    Chapter  Google Scholar 

  • Zenger, B., & Fahle, M. (1997). Missed targets are more frequent than false alarms: a model for error rates in visual search. Journal of Experimental Psychology: Human Perception and Performance, 23, 1783–1791.

    PubMed  Google Scholar 

Download references

Acknowledgments

R. N. is now at Riken as a postdoctoral researcher. I. M. is now at Kanto Rosai Hospital.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ryoichi Nakashima.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakashima, R., Watanabe, C., Maeda, E. et al. The effect of expert knowledge on medical search: medical experts have specialized abilities for detecting serious lesions. Psychological Research 79, 729–738 (2015). https://doi.org/10.1007/s00426-014-0616-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00426-014-0616-y

Keywords