Neurocognitive Mechanism of Radiologists’ Perceptual Errors: Results of Preliminary Studies

Background The most prevalent type of radiologist error is failing to detect abnormalities on images, the so-called “perceptual error.” The prevalence of this type of false-negative (FN) error remains essentially unchanged since it was first described in 1949.

Purpose The purpose of this research is to identify a potential neurocognitive mechanism contributing to perceptual error, in order to inform intervention strategies to reduce such errors in practice. These experiments evaluated the relationship between brain network activation states and radiologists’ perceptual errors on two distinct visual tasks utilizing functional MRI (fMRI) and functional Near Infrared Spectroscopy (fNIRs).

Materials and Methods A prospective study was carried out with two fMRI experiments conducted on radiologist participants utilizing distinct types of visual tasks: the first requiring their continuous attention and the second task requiring visual search. For the first experiment, two modalities of functional brain imaging, functional MRI (fMRI) and functional Near-Infrared Spectrosocpic Imaging (fNIRs) were utilized. The second experiment was performed using fMRI alone, supplemented with eye-tracking. A third experiment using fNIRs alone was an observational study of subjects’ neurocognitive states during their usual practice.

Results A nearly fourfold increased risk FN perceptual errors (misses) was observed in the presence of a particular error-prone neurocognitive state (EPS) involving simultaneous co-activation of elements of the Default Mode Network (DMN) and Frontoparietal Network (FPN). EPS episodes appeared to be stochastic in occurrence. We also found a high prevalence of the EPS in radiologists performing their normal interpretive tasks in their actual practice setting.

Conclusion Our results suggest that dynamic interactions between brain networks leading to a particular error-prone state (EPS) may underlie a substantial fraction of radiologists’ perceptual errors. We demonstrate that this EPS can be detected unobtrusively in the clinical setting. These results suggest potential intervention strategies for perceptual error, the largest class of radiologist errors in practice.

Key Results

1. Periodic episodes of a discrete neurocognitive state were observed in radiologists during specific visual tasks and in actual clinical settings.

2. There was a nearly fourfold risk of perceptual error during this state. Most FN errors for the two visual tasks occurred during these brief episodes (p < 0.01).

3. There was also a highly significant anti-correlation of the prevalence of the error-prone neurocognitive state (EPS) with subject age (p < 0.001).

Summary Statement We report experimental results corelating perceptual errors by radiologists to episodic fluctuations in brain network activation, which appear to occur on a stochastic basis. These produce an error-prone neurocognitive state outside of operator awareness or control that is associated with a nearly fourfold increase in the risk of perceptual error.