Perceptual training and teaching medical students how to window and level chest radiographs

Abstract

Purpose: Perceptual errors account for a significant percent of errors in radiology. Reasons for failure to identify significant lesions are partially due to suboptimal differences in image contrast. The goal of this study is to determine if teaching trainees how to adjust image contrast, window, and level helps trainees identify pulmonary nodules on chest radiographs (CXRs).

Approach: Fourteen medical students voluntarily participated. Subjects were asked to identify pulmonary nodules on CXRs before and after being taught how to adjust image contrast, window, and level. At the end of the study, subjects were given a survey assessing their perceptions about their training.

Results: The experimental group was more confident in their ability to localize nodules relative to the control group ( $P$ -value = 0.003). Subjects demonstrated statistically significant improvement in their ability to identify and localize nodules, with the experimental group performing better than the control group, though there was no statistically significant difference between groups. Participant survey indicated that they felt this training was beneficial, $P$ -values for all survey responses were significant ( $P$ -values all $<0.02$ ).

Conclusions: Teaching subjects how to window and level medical images may be a useful adjunct to current training for medical image interpretation.

Keywords: medical imaging; perception; perceptual training; radiology.