Experience-Related Differences in Diagnosis from Medical Images Displayed on Monitors
Previous studies have noted anecdotally that clinicians with more years of experience tended to perform worse using monitor-displayed images.
The goal of this study was to directly compare diagnostic accuracy using conventional versus monitor-displayed medical images to determine if years of experience as a board certified clinician influences diagnostic performance in either modality.
Two studies were performed, one in radiology and one in pathology .
- Radiology Study
-100 computed radiography chest images
-50 with subtle pneumothorax
-Each image printed to film & saved as soft-copy on optical disk
- Pathology Study
-115 permanent frozen breast biopsy sections
-68 malignant specimens
-47 benign specimens
-Each specimen saved on a microscope slide for viewing directly on the
microscope & via video microscopy
-Viewed film images on a standard viewbox
-Viewed soft-copy on a 1024 x 1538 monitor
-Viewed specimens once via regular microscopy
-Viewed once via video microscopy off a 950 line color monitor
-6 staff radiologists read all chest the images in a randomized order
-Years of experience were : 1,5,18,21,28,30 6 staff pathologists read all
the frozen specimen images in a randomized order. Years of experience were : 2,5,7,11,13,14.
-Report pneumothorax present/absent for radiology
-Report malignant or benign for pathology
-Report confidence in decision using 6-level scale
-Answer questions regarding experience & use of computers and video
systems in general
ROC Az Results - Radiology
Az differences tested using a univariate z-score test Film : correlation between experience & performance r = +0.37 Monitor : correlation between experience & performance r = -0.94
ROC Az Results - Pathology
Az differences tested using a univariate z-score test Light Microscopy : correlation between experience & performance r = +0.87 Video Microscopy : correlation between experience & performance r = -0.91
Survey Question Results
Performance using the monitor displays correlated highly with general experience using monitor displays such as computers and digital/video systems in general.
- There is an experience-related difference in reading medical images from monitors
- Those with more clinical experience tend to have higher performance reading from the traditional modality (film or light microscopy)
- Those with less clinical experience tend to have higher performance reading from video monitors
- More exposure to and use of monitor displays, such as recreational video games and computers, may influence positively the clinician-monitor display system interaction and improve diagnostic performance
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