The impact of clinical indications on visual search behaviour in skeletal radiographs

The hazards associated with ionizing radiation have been documented in the literature and therefore justifying the need for X-ray examinations has come to the forefront of the radiation safety debate in recent years1. International legislation states that the referrer is responsible for the provision of sufficient clinical information to enable the justification of the medical exposure. Clinical indications are a set of systematically developed statements to assist in accurate diagnosis and appropriate patient management2. In this study, the impact of clinical indications upon fracture detection for musculoskeletal radiographs is analyzed. A group of radiographers (n=6) interpreted musculoskeletal radiology cases (n=33) with and without clinical indications. Radiographic images were selected to represent common trauma presentations of extremities and pelvis. Detection of the fracture was measured using ROC methodology. An eye-tracking device was employed to record radiographers search behavior by analysing distinct fixation points and search patterns, resulting in a greater level of insight and understanding into the influence of clinical indications on observers' interpretation of radiographs. The influence of clinical information on fracture detection and search patterns was assessed. Findings of this study demonstrate that the inclusion of clinical indications result in impressionable search behavior. Differences in eye tracking parameters were also noted. This study also attempts to uncover fundamental observer search strategies and behavior with and without clinical indications, thus providing a greater understanding and insight into the image interpretation process. Results of this study suggest that availability of adequate clinical data should be emphasized for interpreting trauma radiographs.