How doctors generate diagnostic hypotheses: a study of radiological diagnosis with functional magnetic resonance imaging
In medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients; sometimes even before they report their symptoms. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechani...
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| Veröffentlicht in: | PloS one 2011-12, Vol.6 (12), p.e28752-e28752 |
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| creator | Melo, Marcio Scarpin, Daniel J Amaro, Jr, Edson Passos, Rodrigo B D Sato, João R Friston, Karl J Price, Cathy J |
| description | In medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients; sometimes even before they report their symptoms. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life.
To test this proposal we developed an experimental paradigm with functional magnetic resonance imaging (fMRI) using radiological diagnosis as a model. Twenty-five radiologists diagnosed lesions in chest X-ray images and named non-medical targets (animals) embedded in chest X-ray images while being scanned in a fMRI session. Images were presented for 1.5 seconds; response times (RTs) and the ensuing cortical activations were assessed. The mean response time for diagnosing lesions was 1.33 (SD ±0.14) seconds and 1.23 (SD ±0.13) seconds for naming animals. 72% of the radiologists reported cogitating differential diagnoses during trials (3.5 seconds). The overall pattern of cortical activations was remarkably similar for both types of targets. However, within the neural systems shared by both stimuli, activation was significantly greater in left inferior frontal sulcus and posterior cingulate cortex for lesions relative to animals.
Generation of diagnostic hypotheses and differential diagnoses made through the immediate visual recognition of clinical signs can be a fast and automatic process. The co-localization of significant brain activation for lesions and animals suggests that generating diagnostic hypotheses for lesions and naming animals are served by the same neuronal systems. Nevertheless, diagnosing lesions was cognitively more demanding and associated with more activation in higher order cortical areas. These results support the hypothesis that medical diagnoses based on prompt visual recognition of clinical signs and naming in everyday life are supported by similar brain systems. |
| doi_str_mv | 10.1371/journal.pone.0028752 |
| format | Article |
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To test this proposal we developed an experimental paradigm with functional magnetic resonance imaging (fMRI) using radiological diagnosis as a model. Twenty-five radiologists diagnosed lesions in chest X-ray images and named non-medical targets (animals) embedded in chest X-ray images while being scanned in a fMRI session. Images were presented for 1.5 seconds; response times (RTs) and the ensuing cortical activations were assessed. The mean response time for diagnosing lesions was 1.33 (SD ±0.14) seconds and 1.23 (SD ±0.13) seconds for naming animals. 72% of the radiologists reported cogitating differential diagnoses during trials (3.5 seconds). The overall pattern of cortical activations was remarkably similar for both types of targets. However, within the neural systems shared by both stimuli, activation was significantly greater in left inferior frontal sulcus and posterior cingulate cortex for lesions relative to animals.
Generation of diagnostic hypotheses and differential diagnoses made through the immediate visual recognition of clinical signs can be a fast and automatic process. The co-localization of significant brain activation for lesions and animals suggests that generating diagnostic hypotheses for lesions and naming animals are served by the same neuronal systems. Nevertheless, diagnosing lesions was cognitively more demanding and associated with more activation in higher order cortical areas. These results support the hypothesis that medical diagnoses based on prompt visual recognition of clinical signs and naming in everyday life are supported by similar brain systems.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0028752</identifier><identifier>PMID: 22194902</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Activation ; Adult ; Animal cognition ; Animals ; Behavior ; Biology ; Brain ; Brain damage ; Brain Mapping ; Cerebral Cortex - diagnostic imaging ; Cerebral Cortex - physiology ; Chest ; Clinical trials ; Cognitive ability ; Cortex (cingulate) ; Cortex (frontal) ; Diagnosis ; Diagnostic systems ; Functional magnetic resonance imaging ; Health informatics ; Humans ; Hypotheses ; Laboratories ; Lesions ; Localization ; Magnetic resonance ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Medical diagnosis ; Medical imaging ; Medical personnel ; Medical practice ; Medicine ; Middle Aged ; Models, Theoretical ; Names ; Naming ; Neuroimaging ; NMR ; Nuclear magnetic resonance ; Physicians ; Radiography ; Radiography, Thoracic ; Radiology ; Recognition ; Resonance ; Response time ; Semantics ; Social and Behavioral Sciences ; Visual cortex</subject><ispartof>PloS one, 2011-12, Vol.6 (12), p.e28752-e28752</ispartof><rights>COPYRIGHT 2011 Public Library of Science</rights><rights>2011 Melo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Melo et al. 2011</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c691t-40abdc296610b8dbadb50c6203c4f5cf811de9e81ef016c647948a3e71e1ba193</citedby><cites>FETCH-LOGICAL-c691t-40abdc296610b8dbadb50c6203c4f5cf811de9e81ef016c647948a3e71e1ba193</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237491/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237491/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22194902$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Aleman, André</contributor><creatorcontrib>Melo, Marcio</creatorcontrib><creatorcontrib>Scarpin, Daniel J</creatorcontrib><creatorcontrib>Amaro, Jr, Edson</creatorcontrib><creatorcontrib>Passos, Rodrigo B D</creatorcontrib><creatorcontrib>Sato, João R</creatorcontrib><creatorcontrib>Friston, Karl J</creatorcontrib><creatorcontrib>Price, Cathy J</creatorcontrib><title>How doctors generate diagnostic hypotheses: a study of radiological diagnosis with functional magnetic resonance imaging</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients; sometimes even before they report their symptoms. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life.
To test this proposal we developed an experimental paradigm with functional magnetic resonance imaging (fMRI) using radiological diagnosis as a model. Twenty-five radiologists diagnosed lesions in chest X-ray images and named non-medical targets (animals) embedded in chest X-ray images while being scanned in a fMRI session. Images were presented for 1.5 seconds; response times (RTs) and the ensuing cortical activations were assessed. The mean response time for diagnosing lesions was 1.33 (SD ±0.14) seconds and 1.23 (SD ±0.13) seconds for naming animals. 72% of the radiologists reported cogitating differential diagnoses during trials (3.5 seconds). The overall pattern of cortical activations was remarkably similar for both types of targets. However, within the neural systems shared by both stimuli, activation was significantly greater in left inferior frontal sulcus and posterior cingulate cortex for lesions relative to animals.
Generation of diagnostic hypotheses and differential diagnoses made through the immediate visual recognition of clinical signs can be a fast and automatic process. The co-localization of significant brain activation for lesions and animals suggests that generating diagnostic hypotheses for lesions and naming animals are served by the same neuronal systems. Nevertheless, diagnosing lesions was cognitively more demanding and associated with more activation in higher order cortical areas. These results support the hypothesis that medical diagnoses based on prompt visual recognition of clinical signs and naming in everyday life are supported by similar brain systems.</description><subject>Activation</subject><subject>Adult</subject><subject>Animal cognition</subject><subject>Animals</subject><subject>Behavior</subject><subject>Biology</subject><subject>Brain</subject><subject>Brain damage</subject><subject>Brain Mapping</subject><subject>Cerebral Cortex - diagnostic imaging</subject><subject>Cerebral Cortex - physiology</subject><subject>Chest</subject><subject>Clinical trials</subject><subject>Cognitive ability</subject><subject>Cortex (cingulate)</subject><subject>Cortex (frontal)</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Functional magnetic resonance imaging</subject><subject>Health informatics</subject><subject>Humans</subject><subject>Hypotheses</subject><subject>Laboratories</subject><subject>Lesions</subject><subject>Localization</subject><subject>Magnetic resonance</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - 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We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life.
To test this proposal we developed an experimental paradigm with functional magnetic resonance imaging (fMRI) using radiological diagnosis as a model. Twenty-five radiologists diagnosed lesions in chest X-ray images and named non-medical targets (animals) embedded in chest X-ray images while being scanned in a fMRI session. Images were presented for 1.5 seconds; response times (RTs) and the ensuing cortical activations were assessed. The mean response time for diagnosing lesions was 1.33 (SD ±0.14) seconds and 1.23 (SD ±0.13) seconds for naming animals. 72% of the radiologists reported cogitating differential diagnoses during trials (3.5 seconds). The overall pattern of cortical activations was remarkably similar for both types of targets. However, within the neural systems shared by both stimuli, activation was significantly greater in left inferior frontal sulcus and posterior cingulate cortex for lesions relative to animals.
Generation of diagnostic hypotheses and differential diagnoses made through the immediate visual recognition of clinical signs can be a fast and automatic process. The co-localization of significant brain activation for lesions and animals suggests that generating diagnostic hypotheses for lesions and naming animals are served by the same neuronal systems. Nevertheless, diagnosing lesions was cognitively more demanding and associated with more activation in higher order cortical areas. These results support the hypothesis that medical diagnoses based on prompt visual recognition of clinical signs and naming in everyday life are supported by similar brain systems.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22194902</pmid><doi>10.1371/journal.pone.0028752</doi><tpages>e28752</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Activation Adult Animal cognition Animals Behavior Biology Brain Brain damage Brain Mapping Cerebral Cortex - diagnostic imaging Cerebral Cortex - physiology Chest Clinical trials Cognitive ability Cortex (cingulate) Cortex (frontal) Diagnosis Diagnostic systems Functional magnetic resonance imaging Health informatics Humans Hypotheses Laboratories Lesions Localization Magnetic resonance Magnetic resonance imaging Magnetic Resonance Imaging - methods Medical diagnosis Medical imaging Medical personnel Medical practice Medicine Middle Aged Models, Theoretical Names Naming Neuroimaging NMR Nuclear magnetic resonance Physicians Radiography Radiography, Thoracic Radiology Recognition Resonance Response time Semantics Social and Behavioral Sciences Visual cortex |
| title | How doctors generate diagnostic hypotheses: a study of radiological diagnosis with functional magnetic resonance imaging |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-25T05%3A42%3A31IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=How%20doctors%20generate%20diagnostic%20hypotheses:%20a%20study%20of%20radiological%20diagnosis%20with%20functional%20magnetic%20resonance%20imaging&rft.jtitle=PloS%20one&rft.au=Melo,%20Marcio&rft.date=2011-12-14&rft.volume=6&rft.issue=12&rft.spage=e28752&rft.epage=e28752&rft.pages=e28752-e28752&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0028752&rft_dat=%3Cgale_plos_%3EA476860303%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1312176506&rft_id=info:pmid/22194902&rft_galeid=A476860303&rft_doaj_id=oai_doaj_org_article_0dfd7a9627d04934b636418050b5fce7&rfr_iscdi=true |