Impact of patient photos on detection accuracy, decision confidence, and eye-tracking parameters in chest and abdomen images with tubes and lines

To minimize errors in imaging studies, a camera system was developed that acquires images of patients simultaneously with radiographic images. 37 chest/abdomen portable radiographs showing central lines, orogastric/nasogastric/endotracheal tubes with patient photographs were viewed by 6 radiologists while eye-position was recorded. They indicated whether each line/tube was present/absent and rated confidence. Images were shown in 3 conditions: radiograph only, small or large photograph with radiograph. There was greater accuracy in detecting nasogastric and orogastric tubes with photographs present. Central lines had the most false positives but showed reduction with photographs. Decision confidence for central lines did not differ by image format, but for all tubes confidence without a photograph was significantly lower than with. For total viewing time there was a significant difference with no photograph format having the lowest viewing time followed by radiograph + large and radiograph + small photograph. For total number of fixations there was a significant difference with no photograph having the lowest number followed by radiograph + large and radiograph + small photograph. There was a significant difference in number of times observers transferred viewing from radiograph to photograph, with large photographs having fewer cross-overs than small. Adding patient photographs to radiographic interpretation of chest and abdomen films can aid in the detection of tubes/lines. If photograph size is large enough, it takes an average of only 3 extra seconds to view compared to the radiograph alone and adds significant confidence to decisions.