Satisfaction Of Search Errors Research Articles

Satisfaction of Search in Periapical Radiograph Interpretation

IntroductionSeveral studies in radiology and medicine have evaluated the satisfaction of search (SOS) error effect in chest radiography, abdominal radiography, osteoradiology, and patients with multiple trauma. No research to date has been published evaluating the possible existence of the SOS error phenomenon made during dental periapical radiograph interpretations. The purpose of the present pilot study was to determine if an SOS error effect exists when dental clinicians interpret periapical radiographs. The null hypothesis was that the detection accuracy will be the same or will improve for the detection of native lesions in the presence of an added abnormality. The alternative hypothesis is that there will be a decrease in detection accuracy for native lesions in the presence of an added abnormality. MethodsSix images were selected to be part of the present experiment. One of the 6 images served as the positive control, and another image served as the negative control. Four images, each including a single subtle carious lesion, were selected to represent the experimental images. The single subtle carious lesion present within the 4 experimental radiographs served as the native pathology, and an abnormality such as a periapical radiolucency, resorption, inadequate nonideal root canal obturation material, or recurrent carious lesion was artificially inserted into the image as the added pathology. Thus, the second set of images consisted of the same 4 images containing the native pathology including an added pathology that was inserted into the image using Adobe Photoshop CS6 (Adobe, Inc, San Jose, CA). Purposive sampling was obtained from 16 examiners including residents from endodontics and periodontics as well as alumni and faculty from the Saint Louis University Center for Advanced Dental Education, St Louis, MO. Each observer participated as a subject during 2 time-separated sessions. Each session was separated by a minimum period of 3 months' duration in order to prevent memory bias. Before starting each interpretation session, the participants were given verbal instructions. Subjects were instructed to provide a location (by tooth number), identify, and rate the presence of all suspected pathology using a Likert scale of 1–5 (1: definitely normal, 2: probably normal, 3: possibly abnormal, 4: probably abnormal, and 5: definitely abnormal). In the second session, the radiographs that were initially presented containing only the native lesion were presented again with the added abnormality, and vice versa. The observers' reports and confidence ratings were recorded and analyzed. Ratings of 3–5 were considered as being positive for the presence of pathology. ResultsA true SOS error occurs when the presence of the native lesion is reported correctly without an added abnormality but is not reported (missed) in the presence of an added abnormality. In our study, a true SOS error occurred in 13 of the 64 interpretation sets (20.31%). There was a total of 64 expected native lesions present within the 4 native images viewed by 16 observers. In the 4 added images, there was a total of 64 expected added findings. In the images containing only native lesions, the observers reported 30 of the 64 expected native lesions. In the images containing an artificially added abnormality, the observers reported 58 of the 64 expected added abnormalities and 25 of the 64 expected native lesions. Observers reported fewer native lesions in the presence of an added abnormality. ConclusionsThe current investigation demonstrated the existence of the SOS effect during periapical radiographic interpretations. In 20.31% of interpretations, a true SOS error occurred. This study is clinically relevant because it can help clinicians in reducing false-negative errors made during radiographic interpretation, thus preventing misdiagnosis.

Missed Acute Appendicitis on Multidetector Computed Tomography and Magnetic Resonance Imaging: Legal Ramifications, Challenges, and Avoidance Strategies

The failure to diagnose acute appendicitis (AA) is the third most common medical malpractice allegation related to gastrointestinal disease. There is a paucity of detailed data on this topic; however, publications by Whang et al and by Berlin and Berlin, which analyzed all types of malpractice suits against radiologists, have shown that the incidence of litigation has increased over time in the United States. This is likely true for cases of AA as well. The misinterpretation of cross-sectional imaging in patients with suspected appendicitis may be caused by suboptimal technique, errors of omission, i.e, missing key findings, failure to review a portion of the examination, and satisfaction of search error. This article summarizes the published legal, clinical, and imaging literature regarding litigation in cases of missed AA, and reviews optimized multidetector computed tomography and magnetic resonance imaging protocols for the diagnosis of AA, with examples shown of challenging cases.

The Effect of Emotional Sounds on Multiple Target Search

This study examined the effect of emotional sounds on satisfaction of search (SOS). SOS occurs when detection of a target results in a lesser chance of finding subsequent targets when searching for an unknown number of targets. Previous studies have examined factors that may influence the phenomenon, but the effect of emotional sounds is yet to be identified. Therefore, the current study investigated how emotional sound affects magnitude of the SOS effect. In addition, participants’ eye movements were recorded to determine the source of SOS errors. The search display included abstract T and L-shaped items on a cloudy background and positive and negative sounds. Results demonstrated that negative sounds produced the largest SOS effect by definition, but this was due to superior accuracy in low-salient single target trials. Response time, which represents efficiency, was consistently faster when negative sounds were provided, in all target conditions. On-target fixation classification revealed scanning error, which occurs because targets are not fixated, as the most prominent type of error. These results imply that the two dimensions of emotion - valence and arousal - interactively affect cognitive performance.

Reducing Satisfaction of Search Errors in Visual Search

Several occupations rely upon the ability to accurately and efficiently perform visual search. For example, radiologists must successfully identify abnormalities, and airport luggage screeners must recognize threatening items. By investigating various aspects of such searches, psychological research can reveal ways to improve search performance. We (Fleck, Samei, & Mitroff, in press) have recently focused on one specific influence that had previously been explored almost exclusively within the study of radiology: Satisfaction of Search (SOS), wherein the successful detection of one target can reduce detection of a second target in the same search array. To eliminate SOS errors, we must delineate the sources of the errors. Combined with our prior work, here we examine the specific roles of target heterogeneity and the decision-making component of target-distractor discrimination (i.e., how easy it is to determine whether a stimulus is a target or a distractor). In the current experiments, subjects searched arrays of line-drawn objects for targets of two different categories (tools and bottles) amongst several categories of distractor objects. On any given trial, there could be no targets, one target (either a tool or bottle), or two targets (both a tool and a bottle). The relative occurrence of these trial types varied across experiments. Compared to previous experiments that employed homogeneous targets and that required effortful evaluation to discriminate targets from distractors, the SOS effect was reduced here. That is, search accuracy for easily discriminable, heterogeneous objects was no worse for dual-target trials than for single-target trials. These results suggest that target heterogeneity and target-distractor discriminability may both play key roles in multiple target search accuracy.

Can a Checklist Reduce SOS Errors in Chest Radiography?

A previous study demonstrated unexpected protection from satisfaction of search (SOS) effects when observers verbalized the focus of their attention during visual search and interpretation of chest radiographs. We suggested that protection from SOS might have occurred if each observer developed an informal checklist to help generate the verbal descriptions. The objective of this study is to determine whether a formal checklist reduces SOS effects in chest radiology. Fifty-seven chest radiographs, half of which demonstrated diverse, native abnormalities were read twice by 20 observers, once with and once without the addition of a simulated pulmonary nodule. Area under the receiver operating characteristic (ROC) curve for detecting the native abnormalities was estimated for each observer in each treatment condition using the contaminated binormal ROC model. Radiologists in the current experiment used a checklist during the interpretation, rather than describing their visual search. Results were compared with those of the verbalization study, which used the same set of radiographs. Although no SOS effect was found when the checklist was used, ROC performance was, on average, much poorer with the checklist than when ongoing search was reported verbally (0.68 versus 0.75, F(1, 37) = 17.26, P < .001). Our results indicate that the recommendation to use a self-prompting checklist to counteract SOS is not warranted. The relative superiority of verbalizing search over using an imposed checklist may be based on the consistency of each of these interventions with the observer's internal strategy for searching radiographs.

Role of faulty decision making in the satisfaction of search effect in chest radiography

The authors performed this study to determine whether defective pattern recognition or defective decision making is more to blame for satisfaction of search (SOS) errors in chest radiography. Fifty-eight chest radiographs-half of which demonstrated diverse, native abnormalities-were read by 20 observers. The radiographs were read twice, once with and once without the addition of a simulated pulmonary nodule. Observers provided a verbal account of their focus of attention, indicating suspicious features and regions considered during their inspection of the radiograph. Observers also provided a separate account of the abnormalities they would include in a radiologic report. When the authors considered only those reports that did not refer to the simulated nodules, they found no reduction in the area under the proper receiver operating characteristic (ROC) curves in cases that contained nodules. A smaller SOS effect, however, was demonstrated with analysis of events in which the native abnormality was missed in one condition but not the other. Verbal protocols suggested that the SOS errors were mainly caused by recognition failure rather than faulty decision making. Describing their focus of attention may have prompted observers to inspect the radiographs in a more deliberate, systematic way, thus reducing the SOS effect. More residual SOS errors were caused by defective pattern recognition than by faulty decision making.

Cause of satisfaction of search effects in contrast studies of the abdomen.

Extraintestinal abnormalities visible without contrast material on abdominal radiographs are reported less frequently when contrast examinations are performed. Gaze dwell time was used to determine whether this difference is due to failure by observers to scan plain-film regions of contrast studies or discounting of plain-film abnormalities that were actually scanned. Patients were included whose contrast studies had elicited the largest reductions in positive responses compared with their plain-film studies in a previous detection experiment. Gaze of 10 radiologists was studied. Significantly less time was spent gazing at non-contrast regions of contrast examinations than at the corresponding regions of radiographs. Errors with radiographs were based primarily on failures of recognition and decision making, whereas errors with contrast studies were based primarily on faulty scanning. Satisfaction of search errors on contrast examinations are caused by reduction in scanning of noncontrast regions.