van Geel Koos, Kok Ellen M, Dijkstra Joost, Robben Simon G F, van Merriënboer Jeroen J G
Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
J Am Coll Radiol. 2017 Feb;14(2):235-241. doi: 10.1016/j.jacr.2016.10.001.
Systematic viewing of images is widely advocated in radiology; it is expected to lead to complete coverage of images and consequently more detection of abnormalities. Evidence on the efficacy of teaching systematic viewing to students is conflicting. The aim of this study was to investigate the effects of teaching systematic viewing to final-year medical students on systematicity of viewing behavior, coverage of the image, and detection.
Final-year medical students (n = 60) viewed 10 chest radiographs in a first series before training and another 10 radiographs in a second series after training. Between series, students were taught basic chest radiographic viewing, in either a systematic or a nonsystematic manner. With eye tracking, systematicity (Levenshtein distances), coverage (percentage of image viewed), and detection (sensitivity and specificity) were measured.
In a mixed two-by-two design, significantly higher sensitivity was found after training compared with before training (F = 6.68, P = .012, η = .11) but no significant effect for type of training (F = 1.24, P = .30) and no significant interaction effect (F = 0.12, P = .73). Thus, training in systematic viewing was not superior to training in nonsystematic viewing. A significant interaction of training type and time of viewing was found on systematicity (F = 20.0, P < .01, η = .29) in favor of the systematic viewing group. No significant interaction was found for coverage (F = 0.43, P = .51) or specificity (F = .124, P = .73).
Both training types showed similar increases in sensitivity. Therefore, it might be advisable to pay less attention to systematic viewing and more attention to content, such as the radiologic appearances of diseases.
在放射学中广泛提倡对图像进行系统观察；期望能全面覆盖图像从而发现更多异常。关于向学生传授系统观察方法有效性的证据存在矛盾。本研究的目的是调查向医学专业最后一年的学生传授系统观察方法对观察行为的系统性、图像覆盖范围和病变检出的影响。
医学专业最后一年的学生（n = 60）在训练前观看了第一组的10张胸部X光片，训练后观看了第二组的另外10张X光片。在两组之间，以系统或非系统的方式向学生传授基本的胸部X光片观察方法。通过眼动追踪测量系统性（莱文斯坦距离）、覆盖范围（观察的图像百分比）和病变检出情况（敏感性和特异性）。
在混合二乘二设计中，与训练前相比，训练后发现敏感性显著更高（F = 6.68，P = .012，η = .11），但训练类型无显著影响（F = 1.24，P = .30），也无显著交互作用影响（F = 0.12，P = .73）。因此，系统观察训练并不优于非系统观察训练。在系统性方面发现训练类型和观察时间存在显著交互作用（F = 20.0，P < .01，η = .29），有利于系统观察组。在覆盖范围（F = 0.43，P = .51）或特异性（F = .124，P = .73）方面未发现显著交互作用。
两种训练类型在敏感性方面都有相似的提高。因此，或许建议少关注系统观察，多关注内容，如疾病的放射学表现。
