【摘要】：現(xiàn)代醫(yī)學(xué)影像技術(shù)通過非侵入式的檢測方法,提供了關(guān)于人體組織、器官的結(jié)構(gòu)和功能圖像,已經(jīng)在醫(yī)療診斷中發(fā)揮著越來越重要的作用。據(jù)統(tǒng)計(jì),單就胸部及乳腺X光片檢查而言,每年全球進(jìn)行約10億人次檢查,每秒平均有120張醫(yī)學(xué)圖像產(chǎn)生。影像的迅速發(fā)展使得臨床醫(yī)生對病人的病情診斷更加精確,效率更高。但已有研究表明,放射學(xué)檢查中,大約有20-30%的漏報(bào)率。在所有影像檢查中,胸部X光片檢查應(yīng)用最廣,占所有放射影像檢查的40%以上。然而放射科醫(yī)生在胸部X光片診斷時(shí)的漏報(bào)率更高(26%以上)。漏報(bào)危害到患者的生命安全,引起醫(yī)療糾紛,甚至引發(fā)重大醫(yī)療事故。眾多研究表明,專家在醫(yī)學(xué)圖像視覺搜索的準(zhǔn)確性和反應(yīng)速度均優(yōu)于新手。探明專家優(yōu)異表現(xiàn)背后的認(rèn)知加工機(jī)制有助于提高醫(yī)療診斷績效,為放射學(xué)領(lǐng)域提供有效的專家成長模式。本研究將場景知覺、視覺搜索等心理學(xué)領(lǐng)域相關(guān)的理論和方法應(yīng)用于醫(yī)學(xué)圖像視覺搜索的研究,采用胸部X光片肺結(jié)節(jié)檢測任務(wù),應(yīng)用專家——新手范式,從視覺復(fù)雜度、任務(wù)因素和線索提示三個(gè)方面探討專家和新手放射科醫(yī)生進(jìn)行醫(yī)學(xué)圖像視覺搜索的差異。本論文包括三項(xiàng)研究,共8個(gè)實(shí)驗(yàn),均采用視覺搜索范式。研究一通過改變材料的視覺復(fù)雜度,探索專家與新手放射科醫(yī)生進(jìn)行醫(yī)學(xué)圖像視覺搜索的差異,包括3個(gè)實(shí)驗(yàn)。實(shí)驗(yàn)1探討專家與新手在不同顯著結(jié)節(jié)醫(yī)學(xué)圖像上的視覺搜索差異。15名專家和15名新手參加實(shí)驗(yàn),為2(經(jīng)驗(yàn):專家、新手)×3(結(jié)節(jié)顯著性:高、中、低)的混合設(shè)計(jì)。結(jié)果發(fā)現(xiàn),專家不僅漏報(bào)率更低,且掃描模式更簡潔高效。在難度高的實(shí)驗(yàn)材料上,專家表現(xiàn)出更大的優(yōu)勢。在漏報(bào)類型上,專家傾向于決策錯(cuò)誤,新手傾向于掃描錯(cuò)誤。同時(shí)研究表明,經(jīng)驗(yàn)和結(jié)節(jié)顯著性共同影響著觀察者的搜索績效以及注視的分配。進(jìn)一步分析發(fā)現(xiàn),二者在掃描階段對圖像的視覺注視是共同起作用的,而在確認(rèn)階段對視覺注視獨(dú)立起作用。研究還表明經(jīng)驗(yàn)僅在掃描階段起促進(jìn)作用。實(shí)驗(yàn)2探討結(jié)節(jié)大小和結(jié)節(jié)位置對專家與新手進(jìn)行醫(yī)學(xué)圖像視覺搜索的影響。15名專家和20名新手參加實(shí)驗(yàn),為2(經(jīng)驗(yàn):專家、新手)×2(結(jié)節(jié)大小:大、小)×2(結(jié)節(jié)位置:隱蔽位置、非隱蔽位置)的混合設(shè)計(jì)。結(jié)果發(fā)現(xiàn),專家在搜索績效及加工效率方面均優(yōu)于新手,且專家的注視偏好位置與重要的解剖學(xué)區(qū)域有很好的相關(guān)。研究還表明,經(jīng)驗(yàn)和結(jié)節(jié)大小、結(jié)節(jié)位置共同影響著觀察者的搜索績效及注視的分配。進(jìn)一步分析發(fā)現(xiàn),經(jīng)驗(yàn)和結(jié)節(jié)大小在掃描階段對圖像的視覺注視是共同起作用的,而在確認(rèn)階段二者對視覺注視是獨(dú)立起作用的。同時(shí)研究還表明經(jīng)驗(yàn)僅在掃描階段起促進(jìn)作用。實(shí)驗(yàn)3探討結(jié)節(jié)大小和結(jié)節(jié)密度對專家與新手進(jìn)行醫(yī)學(xué)圖像視覺搜索的影響。15名專家和15名新手參加實(shí)驗(yàn),為2(經(jīng)驗(yàn):專家、新手)×2(結(jié)節(jié)大小:大、小)×2(結(jié)節(jié)密度:高密度、低密度)的混合設(shè)計(jì)。結(jié)果發(fā)現(xiàn),專家在搜索績效及加工效率方面均優(yōu)于新手。研究還表明,經(jīng)驗(yàn)和結(jié)節(jié)密度共同影響著觀察者的搜索績效以及注視的分配。進(jìn)一步分析發(fā)現(xiàn),經(jīng)驗(yàn)和結(jié)節(jié)密度在掃描階段對圖像的視覺注視是共同起作用的,而在確認(rèn)階段二者對視覺注視是獨(dú)立起作用的。同時(shí)研究還表明經(jīng)驗(yàn)僅在掃描階段起促進(jìn)作用。研究二通過操縱不同的時(shí)間壓力和事件率,探索任務(wù)因素對專家與新手放射科醫(yī)生進(jìn)行醫(yī)學(xué)圖像視覺搜索的影響,揭示漏報(bào)錯(cuò)誤產(chǎn)生的機(jī)制。包括2個(gè)實(shí)驗(yàn)。實(shí)驗(yàn)4探討專家與新手在不同時(shí)間壓力條件下的視覺搜索差異。13名專家和13名新手參加實(shí)驗(yàn),為2(經(jīng)驗(yàn):專家、新手)×8(時(shí)間壓力:1-8)×2(結(jié)節(jié)大小:大、小)的混合設(shè)計(jì)。研究結(jié)果表明,時(shí)間壓力顯著影響專家與新手的漏報(bào)錯(cuò)誤。8種時(shí)間壓力條件下,專家的敏感性均好于新手。專家與新手在各時(shí)間壓力條件下漏報(bào)錯(cuò)誤的趨勢略有不同:大結(jié)節(jié)條件下,專家與新手均表現(xiàn)出在10s后的漏報(bào)錯(cuò)誤趨于穩(wěn)定,小結(jié)節(jié)條件下,專家在25s后的漏報(bào)錯(cuò)誤趨于穩(wěn)定,而新手在20s后的漏報(bào)錯(cuò)誤趨于穩(wěn)定。專家與新手均隨著時(shí)間壓力的增加,判斷變得更加保守。實(shí)驗(yàn)5探討專家與新手在不同事件率下的視覺搜索差異。15名專家和15名新手參加實(shí)驗(yàn),為2(經(jīng)驗(yàn):專家、新手)×2(事件率:50%、10%)×2(結(jié)節(jié)大小:大、小)的混合設(shè)計(jì)。研究結(jié)果表明新手在大、小結(jié)節(jié)上的漏報(bào)錯(cuò)誤均出現(xiàn)低事件率效應(yīng),專家在小結(jié)節(jié)上的漏報(bào)錯(cuò)誤出現(xiàn)低事件率效應(yīng),但受低事件率的影響程度遠(yuǎn)遠(yuǎn)小于新手。研究結(jié)果還表明,低事件率條件下,掃描錯(cuò)誤可能是導(dǎo)致專家與新手漏報(bào)錯(cuò)誤的主要原因。研究三通過操縱線索提示的不同類型,探討線索提示對專家與新手放射科醫(yī)生進(jìn)行醫(yī)學(xué)圖像視覺搜索的影響。包括3個(gè)實(shí)驗(yàn)。實(shí)驗(yàn)6探討有、無線索提示對專家與新手視覺搜索的影響。15名專家和20名新手參加實(shí)驗(yàn),為2(經(jīng)驗(yàn):專家、新手)×2(線索提示類別:有、無)×2(結(jié)節(jié)大小:大、小)×2(結(jié)節(jié)位置:隱蔽位置、非隱蔽位置)的混合設(shè)計(jì)。結(jié)果表明,專家在有線索提示下的隱蔽位置小結(jié)節(jié)上的漏報(bào)率低于無線索提示,而新手在有線索提示下的四種類型結(jié)節(jié)上的漏報(bào)率均低于無線索提示。專家受線索提示的影響程度小于新手。有線索提示條件下,專家與新手搜索目標(biāo)時(shí)的注視次數(shù)和總注視時(shí)間均增多�；匾暣螖�(shù)說明新手花更多的認(rèn)知資源對提示語進(jìn)行加工。實(shí)驗(yàn)7探討線索提示的權(quán)威水平對專家與新手視覺搜索的影響。15名專家和19名新手參加實(shí)驗(yàn),為2(經(jīng)驗(yàn):專家、新手)×3(線索提示的權(quán)威水平:高、低、無)的混合設(shè)計(jì)。結(jié)果表明,新手在高權(quán)威線索提示、低權(quán)威線索提示下的漏報(bào)率均低于無線索提示。專家在高權(quán)威線索提示下的漏報(bào)率低于無線索提示,但專家受高權(quán)威線索提示的影響程度小于新手。高權(quán)威線索提示增加了專家的注視次數(shù)和總注視時(shí)間;新手在高、低權(quán)威線索提示下的注視次數(shù)和總注視時(shí)間顯著增多。實(shí)驗(yàn)8探討線索提示的一致性對專家與新手視覺搜索的影響。16名專家和20名新手參加實(shí)驗(yàn),為2(經(jīng)驗(yàn):專家、新手)×3(線索提示的一致性:一致、不一致、無)的混合設(shè)計(jì)。專家在線索提示一致下的漏報(bào)率邊緣高于線索提示不一致,但二者與無線索提示下的漏報(bào)率差異均不顯著。在線索提示一致時(shí),專家與新手的漏報(bào)率無差異;在線索提示不一致時(shí),專家的漏報(bào)率低于新手。新手在線索提示一致時(shí)的漏報(bào)率低,線索提示不一致時(shí)的高。在本論文研究條件下,得出以下結(jié)論:(1)醫(yī)學(xué)圖像視覺搜索存在專長的知覺編碼優(yōu)勢效應(yīng),專家不僅漏報(bào)率更低、而且搜索目標(biāo)更快,掃描模式簡潔高效,知覺廣度更大,可以選擇性加工圖像信息。(2)專家的優(yōu)勢表現(xiàn)在難度較高的醫(yī)學(xué)圖像的視覺搜索。(3)醫(yī)學(xué)圖像對目標(biāo)物體的識(shí)別是通過自上而下和自下而上的兩條加工通路的整合而實(shí)現(xiàn)的。但是知識(shí)經(jīng)驗(yàn)和目標(biāo)物體特征的交互影響在視覺搜索的不同階段存在著差異,體現(xiàn)在掃描階段二者對圖像的視覺注視是共同起作用的,而在確認(rèn)階段二者對視覺注視是獨(dú)立起作用的。知識(shí)經(jīng)驗(yàn)僅在掃描階段起促進(jìn)作用。(4)專家與新手的漏報(bào)錯(cuò)誤都受到時(shí)間壓力的影響,但二者在各時(shí)間壓力條件下漏報(bào)錯(cuò)誤的趨勢不同。醫(yī)學(xué)圖像視覺搜索的時(shí)間至少要25s。(5)醫(yī)學(xué)圖像視覺搜索呈現(xiàn)低事件率效應(yīng)特點(diǎn),新手在大、小結(jié)節(jié)上的漏報(bào)錯(cuò)誤均出現(xiàn)低事件率效應(yīng),專家在小結(jié)節(jié)上的漏報(bào)錯(cuò)誤出現(xiàn)低事件率效應(yīng),但專家受低事件率的影響程度小于新手。低事件率條件下,掃描錯(cuò)誤可能是導(dǎo)致專家與新手漏報(bào)錯(cuò)誤的主要原因。(6)放射科醫(yī)生做決策時(shí),其知識(shí)經(jīng)驗(yàn)與他人的影響共同起作用。他人影響對新手來說作用更大。(7)經(jīng)驗(yàn)影響了醫(yī)生的判斷傾向,在低顯著結(jié)節(jié)條件下,專家診斷漏報(bào)傾向于決策錯(cuò)誤,新手傾向于掃描錯(cuò)誤。(8)醫(yī)學(xué)圖像視覺搜索漏報(bào)錯(cuò)誤的影響因素研究發(fā)現(xiàn),高視覺復(fù)雜度、高時(shí)間壓力、低事件率、錯(cuò)誤的線索會(huì)顯著增加醫(yī)學(xué)圖像視覺搜索中的漏報(bào)錯(cuò)誤。
[Abstract]:Modern medical imaging technology has been playing a more and more important role in medical diagnosis through non-invasive testing, which has been playing an increasingly important role in medical diagnosis. According to statistics, about 1 billion times a year, there are about 120 medical images per second on the basis of the single chest and breast X ray examination. Emergence. The rapid development of the image makes the clinician more accurate and more efficient in diagnosing the patient's condition. However, there has been a study showing that there is a 20-30% leakage rate in the radiological examination. In all imaging examinations, the chest X ray examination is the most widely used, accounting for more than 40% of all radiographic examinations. However, the radiologist is in the chest X ray. The leakage rate of the diagnosis is higher (more than 26%). The missing report endangers the patient's life safety, causes medical disputes and even causes major medical accidents. Many studies show that the accuracy and reaction speed of the visual search of medical images are better than those of the novice. The cognitive processing mechanism behind the excellent performance of the experts is helpful to improve the medical diagnosis. Performance, providing an effective expert growth model for the field of radiology. This study applies the theories and methods related to the field of psychology, such as scene perception and visual search, to the research of medical image visual search, using the chest X light slice lung nodule detection task, and applying the expert - Novice paradigm from visual complexity, task factors and clue hints. The three aspect discusses the differences between the experts and the novice radiologists for the visual search of medical images. This paper includes three studies, with a total of 8 experiments, all using visual search paradigm. The first is to explore the differences in visual search of medical images by the experts and the novice radiologists, including 3 experiments. Experiment 1 explored the visual search differences between experts and novice in different significant nodular medical images by.15 experts and 15 novice participants, for 2 (experience: expert, novice) x 3 (nodular significance: high, medium, low). The results showed that the experts not only had lower missing rates, and the scanning mode was more concise and efficient. The difficult experimental materials were more difficult. Experts show a greater advantage. In the type of leakage, experts tend to make mistakes in decision-making and novice tends to scan errors. Meanwhile, the study shows that experience and nodular significance have a common influence on the observer's search performance and the distribution of gaze. Further analysis shows that the visual fixation of the images is the common effect of the two in the scanning phase. The study also showed that experience only played a role in the scanning phase. Experiment 2 explored the effects of nodule size and nodule position on visual search for medical images by experts and novice.15 experts and 20 novice participants, for 2 (experience: expert, novice) * 2 (large, small) * 2 (large, small). Nodular position: a mixed design of concealed position and non concealed position. Results show that experts are superior to novice in both search performance and processing efficiency, and the position of expert's fixation preference is well related to important anatomical areas. The distribution of fixations. Further analysis shows that experience and nodule size are common to the visual gaze of the image at the scanning stage, while the two in the confirmation stage are independent of visual fixation. At the same time, the study also shows that experience only plays a role in the scanning phase. Experiment 3 explores the size and density of nodules for experts and new Hand performed visual search for medical images,.15 experts and 15 newcomers participated in the experiment, and a hybrid design for 2 (experience: expert, novice) x 2 (nodular size: large, small) x 2 (nodular density: density, low density). The results showed that experts were superior to the novice in terms of search performance and efficiency. The study also showed that experience and nodular density were common. It affects the performance of the observer and the distribution of the gaze. Further analysis shows that experience and nodule density play a role in the visual gaze of the image at the scanning stage, while the two in the confirmation stage are independent of visual fixation. At the same time, the study also shows that experience only promotes the scan stage. Study two through the operation. Different time pressure and event rate, explore the effect of task factors on the visual search of medical images by experts and novice radiologists, and reveal the mechanism of missing report errors. Including 2 experiments. Experiment 4 discuss the.13 name experts and 13 novice experts and novice experts and novice experts and novice candidates under different time pressure conditions. A mixed design of 2 (experience: expert, novice) x 8 (time pressure: 1-8) x 2 (nodular size: large, small). The results show that the time pressure significantly affects the.8 time pressure of the experts and novice, the sensitivity of the expert is better than that of the novice. Under the condition of large nodules, both experts and novice showed a tendency to be stable after 10s. Under the condition of small nodules, the mistakes of the experts after 25s tended to be stable, and the novice's error after 20s tended to be stable. Both experts and novice were more conservative with the increase of time pressure. Experiment 5 explored the differences between experts and novice. Visual search differences under event rates.15 experts and 15 novice participants were experimentation, for 2 (experience: expert, novice) x 2 (event rate: 50%, 10%) x 2 (nodular size: large, small). The results showed that novice's leakage errors on large and small nodules all had low event rate effects, and the expert's leakage error on small nodules appeared low events. Rate effect, but the effect of low event rate is far less than that of novice. The results also show that scanning errors may be the main cause of the mistake of the experts and novice in low event rate. Study three explore clues to the medical images of experts and novice radiologists through the different types of manipulating clues. The effect of sense search. Including 3 experiments. Experiment 6 explored the effects of no clues on the visual search of experts and novice,.15 experts and 20 novice students participated in the experiment, for 2 (experience: expert, novice) x 2 (cue category: no) x 2 (nodule size: large, small) x 2 (nodule location: concealed position, non concealed position). The rate of leakage on the small nodules on the hidden location under clues was lower than that without clues, and the novice's rate of leakage on the four types of nodules under clues was lower than that without clues. The degree of influence of the clues prompted by the expert was less than that of the novice. The number and the total fixation time were increased. The number of recalling times indicated that the novice spent more cognitive resources on the processing of the hint. Experiment 7 explored the influence of the authority level on the visual search of the experts and the novice,.15 experts and 19 novice participants, for 2 (experience: expert, novice) * 3 (the level of clues: high, low, and no) mixed. The results show that the novice's reporting rate under the hint of low authoritative clues is lower than that without clue. The leakage rate of experts under the hint of high authoritative clues is lower than that without clue, but the influence degree of the expert is less than that of the novice. The total fixation time; the number of fixations and the total fixation time of the novice at high and low authoritative clues. Experiment 8 explored the effect of consistency on the visual search of experts and novice,.16 experts and 20 novice participants participated in the experiment, and 2 (experience: expert, novice) * 3 (consistency, inconsistency, and no) of the 2 (experience: expert, novice) The leakage rate of the expert online cue is higher than that of the clue, but the difference of the leakage rate between the two and the uncue is not significant. The leakage rate of the expert and the novice is not different when the online cable hints are consistent. When the online cable hints are inconsistent, the rate of the leakage of the experts is lower than that of the novice. Under the conditions of this paper, the following conclusions are obtained: (1) the visual search of medical images has the advantage effect of special perceptual coding, the expert not only has lower false rate, but also the search target is faster, the scanning mode is simple and efficient, the perceptual span is greater, and the image information can be processed selectively. (2) experts (2) experts The advantages are visual search for difficult medical images. (3) the recognition of target objects by medical images is achieved through the integration of two processing paths from top to bottom and bottom-up. However, the interaction between knowledge experience and target object features varies in different stages of visual search, which is reflected in the scanning order. The visual fixation of the two segments is common to the visual fixation of the image, while the two parties play an independent role in the visual fixation during the confirmation stage. Knowledge and experience can only play a role in the scanning phase. (4) the errors of the experts and the novice are all influenced by the time pressure, but the trend of the two in each time pressure condition is different. The time of visual search, like visual search, is at least 25s. (5) of medical image visual search, which shows low event rate effect. The novice's leakage error on large and small nodules all have low event rate effect, and the expert's leakage error on small nodules appears low event rate effect, but the degree of low event rate is less than the novice. Under the low event rate condition, Scanning errors may be the main cause of errors that lead to an error between experts and novice. (6) when a radiologist makes a decision, his knowledge and experience work together with the influence of others. The influence of others is more important to the novice. (7) experience affects the doctor's judgment tendency. Under the condition of low significant nodules, the expert's diagnosis is prone to error decision. The novice is inclined to scan the error. (8) research on the influence factors of medical image visual search leakage error, it is found that high visual complexity, high time pressure, low event rate, and wrong clue can significantly increase the error of medical image visual search.
【學(xué)位授予單位】：天津師范大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：TP391.41
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本文編號：2144066