Experience does not protect against missed incidental findings in radiology

One of the benefits of expertise is thought to be the ability to reduce complex data to the information that is most relevant to the task at hand. In radiology, this ability manifests as fewer fixations and shorter dwell time in anatomical regions that are considered irrelevant to the observer s task. Although these findings are generally viewed as an advantage of expertise, this study explored the potential negative effects of top-down guidance when cases had abnormalities that were inconsistent with the observer s expectations (i.e., incidental findings). 37 radiologists evaluated abdominal CT scans. One group was told the patients were living liver donor candidates and the other group was told they were living kidney donor candidates. Critically, two of the cases had liver abnormalities and two had kidney abnormalities. Overall, abnormalities in the uncued organ were missed ~6% more than in the cued organ, but this difference was not significant and Bayes Factors were inconclusive. Using eyetracking measures, which provide a more sensitive measure of search behavior, we found the uncued organ was searched less thoroughly than the cued organ. There was no significant difference in scanning/drilling behavior between groups. There was no relationship between experience and missed incidental finding rates. Furthermore, radiologists across all levels of experience were equally likely to focus less attention on the uncued organ. Although previous research has found group-level differences between experts and naïve observers on incidental finding rates, these findings add to growing evidence that expertise does not protect experts from missing incidental findings.