Academic journal article Attention, Perception and Psychophysics

Current Perspectives in Medical Image Perception

Academic journal article Attention, Perception and Psychophysics

Current Perspectives in Medical Image Perception

Article excerpt

Medical images constitute a core portion of the information a physician utilizes to render diagnostic and treatment decisions. At a fundamental level, this diagnostic process involves two basic processes: visually inspecting the image (visual perception) and rendering an interpretation (cognition). The likelihood of error in the interpretation of medical images is, unfortunately, not negligible. Errors do occur, and patients' lives are impacted, underscoring our need to understand how physicians interact with the information in an image during the interpretation process. With improved understanding, we can develop ways to further improve decision making and, thus, to improve patient care. The science of medical image perception is dedicated to understanding and improving the clinical interpretation process.

When people think about imaging in medicine, radiology is typically the first specialty that comes to mind, and, in fact, that is where most of the image perception research has taken place. However, medical imaging covers a much broader range of medical specialties, including cardiology, radiation oncology, pathology, and ophthalmology. Pathology has traditionally been limited to the glass-slide specimen images rendered by the microscope for the pathologist to view. With the advent of digital slide scanners in recent years, however, virtual slides viewed on computer displays are becoming more prevalent, not only for telepathology applications, but also in everyday reading (Weinstein et al., 2009). Ophthalmology has used images (35-mm film prints or slides) for years for evaluating such conditions as diabetic retinopathy. However, digital acquisition devices and high-performance color displays are increasingly being used by ophthalmology screeners-especially those screening for diabetic retinopathy. Telemedicine has fostered an entirely new area, in which medical images are being acquired, transferred, and stored to diagnose and treat patients (Krupinski et al., 2002). Teledermatology, teleophthalmology, telewound/ burn care, and telepodiatry are all using images on a regular basis for store-and-forward telemedicine applications. Real-time applications such as telepsychiatry, teleneurology, and telerheumatology similarly rely on video images for diagnostic and treatment decisions.

With about a billion radiological imaging exams performed worldwide every year, radiology is clearly the leader in medical imaging volume. There are a variety of exam types, including projection X-ray images (e.g., bone, chest, mammography); dynamic X-ray exams (e.g., fluoroscopy); multislice exams, such as computed tomography (CT) and magnetic resonance imaging (MRI); nuclear medicine; ultrasound; and, more recently, molecular imaging (Thakur, 2009). The pervasiveness of medical imaging can be studied in a number of ways: One approach is to look at how much money is spent yearly on healthcare and then divide out the amount devoted to medical imaging (Beam, Krupinski, Kundel, Sickles, & Wagner, 2006). In Beam et al.'s analysis, data from 2004 from the Centers for Medicare and Medicaid Services showed that approximately 16% ($1.6 trillion) of the gross domestic product (GDP) is allotted to national healthcare expenditures. Medicare expenditures represent 17% of national healthcare expenditures, of which Part B (43%) accounts for the nonfacility or physician-related expenditures. Approximately 8% (nearly $10 billion) of Part B constitutes physician-based imaging procedures. Imaging also accounts for over 40% of all hospital procedures reported in the discharge report, according to the Agency for Healthcare Research and Quality. On the basis of Medicaid Part B spending alone, it could be conservatively determined that imaging procedures comprise 8% of non- Medicaid Part B health spending, so medical imaging in the U.S. alone is estimated to be about $56 billion, or 0.5% of the GDP! For mammography alone, with 1 billion imaging exams performed worldwide every year and an average of four images per exam, an average of 120 medical image perception events take place every second! …

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