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Cited by 45Radiology practices and educationVisual Attention and Saliency DetectionVisual perception and processing mechanisms

The invisible breast cancer: experience does not protect against inattentional blindness to clinically relevant findings in radiology

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Williams, Lauren, Carrigan, Ann, Auffermann, William, Mills, Megan, Rich, Anina, Elmore, Joann, Drew, Trafton·2021·Psychonomic Bulletin & Review
DOI 10.3758/s13423-020-01826-4PMC PMC8068567
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Abstract

Retrospectively obvious events are frequently missed when attention is engaged in another task-a phenomenon known as inattentional blindness. Although the task characteristics that predict inattentional blindness rates are relatively well understood, the observer characteristics that predict inattentional blindness rates are largely unknown. Previously, expert radiologists showed a surprising rate of inattentional blindness to a gorilla photoshopped into a CT scan during lung-cancer screening. However, inattentional blindness rates were higher for a group of naïve observers performing the same task, suggesting that perceptual expertise may provide protection against inattentional blindness. Here, we tested whether expertise in radiology predicts inattentional blindness rates for unexpected abnormalities that were clinically relevant. Fifty radiologists evaluated CT scans for lung cancer. The final case contained a large (9.1 cm) breast mass and lymphadenopathy. When their attention was focused on searching for lung nodules, 66% of radiologists did not detect breast cancer and 30% did not detect lymphadenopathy. In contrast, only 3% and 10% of radiologists (N = 30), respectively, missed these abnormalities in a follow-up study when searching for a broader range of abnormalities. Neither experience, primary task performance, nor search behavior predicted which radiologists missed the unexpected abnormalities. These findings suggest perceptual expertise does not protect against inattentional blindness, even for unexpected stimuli that are within the domain of expertise.

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  • Human experts may face challenges in detecting certain endoscopic targets, even in high-resolution still images.

    “Taken together, these perceptual and cognitive bottlenecks indicate that human experts may face challenges in detecting certain endoscopic targets, even in high-resolution still images ( Fig. 2 ) [ 11,30 ].”

    From Enhancing human-AI collaboration: The case of colonoscopy (2024) · cites this paper as [11]

    The Results (Detection of Incidental Breast Cancer) report that 66% of radiologists missed a large breast mass while searching CT scans for lung cancer, supporting the general point that experts can miss visible targets. The paper studies radiology CT scans, not endoscopic targets in high-resolution still images, so it does not establish that specific setting. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Guided search can overlook relevant but untargeted objects, producing inattentional blindness.

    “The guided search can even overlook relevant but untargeted objects, producing astonishing phenomena like inattentional blindness [11 , 12] .”

    From Enhancing human-AI collaboration: The case of colonoscopy (2024) · cites this paper as [11]

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Research works printed but not linked: 42

  1. Adibi A, Sin D, & Sadatsafavi M (2019). Lowering the P Value Threshold. JAMA, 321(15), 1532– 1533. 10.1001/jama.2019.0566 30990544 · DOI
  2. Armato SG, McLennan G, Bidaut L, McNitt-Gray MF, Meyer CR, Reeves AP, Zhao B, Aberle DR, Henschke CI, Hoffman EA, Kazerooni EA, MacMahon H, Van Beeke EJR, Yankelevitz D, Biancardi AM, Bland PH, Brown MS, Engelmann RM, Laderach GE, … Croft BY (2011). The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI): A completed reference database of lung nodules on CT scans. Medical Physics, 38(2), 915– 931. 10.1118/1.3528204 21452728 PMC3041807 · DOI · Paper page
  3. Barry MJ (2014). Incidentaloma Fatigue. JAMA Internal Medicine, 174(6), 851– 852. 10.1001/jamainternmed.2014.672 24733384 · DOI
  4. Berbaum KS, Franken JE, Dorfman DD, Rooholamini SA, Kathol MH, & Barloon TJ (1990). Satisfaction of search in diagnostic radiology. Investigative Radiology, 25. 10.1097/00004424-199002000-00006 2312249 · DOI
  5. Brainard DH (1997). The Psychophysics Toolbox. Spatial Vision, 10(4), 433– 436. 9176952
  6. Bredemeier K, & Simons DJ (2012). Working memory and inattentional blindness. Psychonomic Bulletin & Review, 19(2), 239– 244. 22222359
  7. Cain MS, Adamo SH, & Mitroff SR (2013). A taxonomy of errors in multiple-target visual search. Visual Cognition, 21(7), 899– 921.
  8. Carrigan AJ, Wardle SG, & Rich AN (2018). Finding cancer in mammograms: If you know it’s there, do you know where? Cognitive Research: Principles and Implications, 3. 29707615 PMC5904219
  9. Cheng P. (Xin), & Rich AN. (2018). More is better: Relative prevalence of multiple targets affects search accuracy. Journal of Vision, 18(4), 2– 2. 10.1167/18.4.2 29614156 · DOI
  10. Drew T, Evans K, Võ MLH, Jacobson FL, & Wolfe JM (2013). Informatics in radiology: What can you see in a single glance and how might this guide visual search in medical images? Radiographics, 33. 10.1148/rg.331125023 PMC3545617 23104971 · DOI
  11. Drew T, Võ MLH, & Wolfe JM (2013). The invisible gorilla strikes again: Sustained inattentional blindness in expert observers. Psychological Science, 24. 10.1177/0956797613479386 PMC3964612 23863753 · DOI
  12. Evans KK, Georgian-Smith D, Tambouret R, Birdwell RL, & Wolfe JM (2013). The gist of the abnormal: Above-chance medical decision making in the blink of an eye. Psychonomic Bulletin & Review, 20. 10.3758/s13423-013-0459-3 PMC3851597 23771399 · DOI
  13. Fougnie D, & Marois R (2007). Executive working memory load induces inattentional blindness. Psychonomic Bulletin & Review, 14(1), 142– 147. 17546744
  14. Hawkesford MPH, & Kalogrianitis S (2015). Delayed diagnosis of lung cancer after missed vertebral metastasis on CT. BJR Case Reports, 1(1). 10.1259/bjrcr.20140001 PMC6159164 30363223 · DOI
  15. Hitzeman N, Cotton E, & Center SM (2014). Incidentalomas: Initial Management. 90(11), 6. 25611713
  16. Jeffreys H (1998). The theory of probability. OUP Oxford.
  17. Kim YW, & Mansfield LT (2014). Fool Me Twice: Delayed Diagnoses in Radiology With Emphasis on Perpetuated Errors. American Journal of Roentgenology, 202(3), 465– 470. 10.2214/AJR.13.11493 24555582 · DOI
  18. Koivisto M, & Revonsuo A (2007). How Meaning Shapes Seeing. Psychological Science, 18(10), 845– 849. 10.1111/j.1467-9280.2007.01989.x 17894599 · DOI
  19. Kreitz C, Furley P, Memmert D, & Simons DJ (2015). Inattentional Blindness and Individual Differences in Cognitive Abilities. PLOS ONE, 10(8), e0134675. 10.1371/journal.pone.0134675 26258545 PMC4530948 · DOI
  20. Loy CT, & Irwig L (2004). Accuracy of diagnostic tests read with and without clinical information: A systematic review. Jama, 292(13), 1602– 1609. 15467063
  21. Lum TE, Fairbanks RJ, Pennington EC, & Zwemer FL (2005). Profiles in patient safety: Misplaced femoral line guidewire and multiple failures to detect the foreign body on chest radiography. Academic Emergency Medicine, 12(7), 658– 662. 15995100
  22. Lumbreras B, Donat L, & Hernández-Aguado I (2010). Incidental findings in imaging diagnostic tests: A systematic review. The British Journal of Radiology, 83(988), 276– 289. 10.1259/bjr/98067945 20335439 PMC3473456 · DOI
  23. Mack A, & Rock, 1998. (1998). Inattentions! blindness. MIT Press.
  24. Makary MA, & Daniel M (2016). Medical error—The third leading cause of death in the US. BMJ, 353, i2139. 10.1136/bmj.i2139 27143499 · DOI · Paper page
  25. Memmert D (2006). The effects of eye movements, age, and expertise on inattentional blindness. Consciousness and Cognition, 15(3), 620– 627. 16487725
  26. Memmert D, Simons DJ, & Grimme T (2009). The relationship between visual attention and expertise in sports. Psychology of Sport and Exercise, 10(1), 146– 151.
  27. Most SB (2013). Setting sights higher: Category-level attentional set modulates sustained inattentional blindness. Psychological Research, 77(2), 139– 146. 10.1007/s00426-011-0379-7 21947745 · DOI
  28. Most SB, Simons DJ, Scholl BJ, Jimenez R, Clifford E, & Chabris CF (2001). How not to be Seen: The Contribution of Similarity and Selective Ignoring to Sustained Inattentional Blindness. Psychological Science, 12(1), 9– 17. 10.1111/1467-9280.00303 11294235 · DOI
  29. Munk M-D, Peitzman AB, Hostler DP, & Wolfson AB (2010). Frequency and follow-up of incidental findings on trauma computed tomography scans: Experience at a level one trauma center. The Journal of Emergency Medicine, 38(3), 346– 350. 10.1016/j.jemermed.2008.01.021 18804935 · DOI
  30. Neisser U, & Becklen R (1975). Selective looking: Attending to visually specified events. Cognitive Psychology Cognitive Psychology, 7(4), 480– 494. /z-wcorg/.
  31. O’Sullivan JW, Muntinga T, Grigg S, & Ioannidis JPA (2018). Prevalence and outcomes of incidental imaging findings: Umbrella review. BMJ, 361, k2387. 10.1136/bmj.k2387 29914908 PMC6283350 · DOI
  32. Simons DJ, & Chabris CF (1999). Gorillas in our midst: Sustained inattentional blindness for dynamic events. Perception, 28(9), 1059– 1074. 10.1068/p281059 10694957 · DOI · Paper page
  33. Simons Daniel J., & Jensen MS. (2009). The effects of individual differences and task difficulty on inattentional blindness. Psychonomic Bulletin & Review, 16(2), 398– 403. 10.3758/PBR.16.2.398 19293113 · DOI
  34. Tehrani ASS, Lee H, Mathews SC, Shore A, Makary MA, Pronovost PJ, & Newman-Toker DE (2013). 25-Year summary of US malpractice claims for diagnostic errors 1986–2010: An analysis from the National Practitioner Data Bank. BMJ Quality & Safety, 22(8), 672– 680. 10.1136/bmjqs-2012-001550 23610443 · DOI
  35. Thomassen Ø, Storesund A, Søfteland E, & Brattebø G (2014). The effects of safety checklists in medicine: A systematic review. Acta Anaesthesiologica Scandinavica, 58(1), 5– 18. 24116973
  36. Tuddenham WJ (1962). Visual Search, Image Organization, and Reader Error in Roentgen Diagnosis: Studies of the Psychophysiology of Roentgen Image Perception Memorial Fund Lecture. Radiology, 78(5), 694– 704. 13923013
  37. van der Gijp A, Ravesloot CJ, Jarodzka H, van der Schaaf MF, van der Schaaf IC, van Schaik JPJ, & Ten Cate TJ (2017). How visual search relates to visual diagnostic performance: A narrative systematic review of eye-tracking research in radiology. Advances in Health Sciences Education: Theory and Practice, 22(3), 765– 787. 10.1007/s10459-016-9698-1 27436353 PMC5498587 · DOI
  38. Ward EJ, & Scholl BJ (2015). Inattentional blindness reflects limitations on perception, not memory: Evidence from repeated failures of awareness. Psychonomic Bulletin & Review, 22(3), 722– 727. 10.3758/s13423-014-0745-8 25515671 · DOI
  39. White RC, & Davies AA (2008). Attention set for number: Expectation and perceptual load in inattentional blindness. Journal of Experimental Psychology: Human Perception and Performance, 34(5), 1092. 18823197
  40. Wolfe JM, Evans KK, Drew T, Aizenman A, & Josephs E (2016). How do radiologists use the human search engine? Radiation Protection Dosimetry, 169. 10.1093/rpd/ncv501 PMC4911962 26656078 · DOI
  41. Wolfe JM, Soce AA, & Schill HM (2017). How did I miss that? Developing mixed hybrid visual search as a ‘model system’for incidental finding errors in radiology. Cognitive Research: Principles and Implications, 2. 28890920 PMC5569644
  42. Wood K, & Simons DJ (2019). The spatial allocation of attention in an interactive environment. Cognitive Research: Principles and Implications, 4(1), 13. 10.1186/s41235-019-0164-5 30997621 PMC6470233 · DOI

Cited by

Sorted by citations

Authors
Williams, L., Carrigan, A., Auffermann, W., Mills, M., Rich, A., Elmore, J., & Drew, T.
Affiliations
  • University of Utah (US)
  • Macquarie University (AU)
  • University of California, Los Angeles (US)
Corresponding author
Williams, Lauren
ORCID
Venue
Psychonomic Bulletin & Review
Publisher
Springer Science and Business Media LLC
Published
2020-11-02
Volume
28
Issue
2
Pages
503-511
ISSN
  • 1069-9384 (ISSN-L)
  • 1531-5320
DOI
10.3758/s13423-020-01826-4
PMC
PMC8068567
OpenAlex
W3094972072
Cited by
45
References
0
Citations by year
2026: 3 · 2025: 3 · 2024: 6 · 2023: 21 · 2022: 6 · 2021: 6
FWCI
3.93
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychonomic Bulletin & Review (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Radiological Society of North America
  • National Cancer Institute
  • National Institute of Biomedical Imaging and Bioengineering (F32EB011959)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Visual Attention and Saliency Detection
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Visual perception and processing mechanisms
Keywords
inattentional blindness, perceptual expertise, radiologists, breast cancer detection, CT scan interpretation, lung cancer screening, lymphadenopathy, attentional capture, observer experience
MeSH terms
Adult, Attention, Breast Neoplasms, Female, Follow-Up Studies, Humans, Lung Neoplasms, Pattern Recognition, Visual, Practice, Psychological, Professional Competence, Radiology, Task Performance and Analysis

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