Role of faulty decision making in the satisfaction of search effect in chest radiography

Rationale and Objectives, The authors performed this study to determine whe ther defective pattern recognition or defective decision making is more to blame for satisfaction of search (SOS) errors in chest radiography, Materials and Methods. Fifty-eight chest radiographs-half of which demonstr ated diverse, native abnormalities-were read by 20 observers. The radiograp hs were read twice, once with and once without the addition of a simulated pulmonary nodule. Observers provided a verbal account of their focus of att ention, indicating suspicious features and regions considered during their inspection of the radiograph. Observers also provided a separate account of the abnormalities they would include in a radiologic report. Results. When the authors considered only those reports that did not refer to the simulated nodules, they found no reduction in the area under the pro per receiver operating characteristic (ROC) curves in cases that contained nodules. A smaller SOS effect, however, was demonstrated with analysis of e vents in which the native abnormality was missed in one condition but not t he other. Verbal protocols suggested that the SOS errors were mainly caused by recognition failure rather than faulty decision making. Conclusion. Describing their focus of attention may have prompted observers to inspect the radiographs in a more deliberate, systematic way, thus redu cing the SOS effect. More residual SOS errors were caused by defective patt ern recognition than by fault!, decision making.