Reader error, object recognition, and visual search

Small abnormalities such as hairline fractures, lung nodules and breast tumors are missed by competent radiologists with sufficient frequency to make them a matter of concern to the medical community; not only because they lead to litigation but also because they delay patient care. It is very easy to attribute misses to incompetence or inattention. To do so may be placing an unjustified stigma on the radiologists involved and may allow other radiologists to continue a false optimism that it can never happen to them. This review presents some of the fundamentals of visual system function that are relevant to understanding the search for and the recognition of small targets embedded in complicated but meaningful backgrounds like chests and mammograms. It presents a model for visual search that postulates a pre-attentive global analysis of the retinal image followed by foveal checking fixations and eventually discovery scanning. The model will be used to differentiate errors of search, recognition and decision making. The implications for computer aided diagnosis and for functional workstation design are discussed.