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Christina Vong 24244058

Christina Vong 24244058

RAD4160 Psychophysics of Vision in


Medical Imaging
INTRODUCTION
Visual perception is a one of the fundamental facets of image
interpretation in the medical imaging field. While increasing
technological developments in modern medicine today have lead to
advanced imaging techniques, the interpretation of radiographic
images is still heavily reliant upon the visual system and associated
perception and cognitive processes (Krupinski 2010).
THE EYE AND VISUAL PATHWAY
The visual pathway begins at the retina of the eye, where
information from the environment is received in the form of light
and converted into a neural signal via phototransduction. This
transformation process occurs in the photoreceptors of the retina,
which comprises of two types of cells; rods and cones. Visual
pigments contained in the photoreceptors alter slightly depending
on the photons that are absorbed (McCaa 1982). Rods and cones are
active in different levels of light, with rods more active in dim
lighting (scotopic vision) and cones more active in higher light levels
(Remington 2012a). Cone cells are further designated into three
different types that are excited by different wavelengths of light,
allowing colour perception. On the other hand, scotopic vision is
colourblind, as rods lack the mechanism to retain wavelength
information (Cornsweet 1970).
Once phototransduction is complete, the corresponding rod and
cone bipolar cells are excited and act as either indirect or direct
pathways to the third order neurons known as the ganglion cells.
Axons of the ganglion cells converge at the optic disc to form the
optic nerve as they exit the eye (McCaa 1982). The signal continues

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along until the two optic nerves cross at the optic chiasm to synapse
at the lateral geniculate nucleus (LGN) via the optic tract (Alfano
1961). The LGN serves as a complex processing centre in the
thalamus that is responsible for regulating the visual information
(Remington 2012b).
The final neurons in the visual pathway that pass the signal to the
visual cortex are the optic radiations. The visual cortex itself, is subdivided into several regions known as the Brodmann areas 17
(primary or striate cortex), 18, 19 as well as the extrastriate cortex
(Remington 2012b).

Figure 1. The visual pathway, from the eye to the


visual cortex.

(Remington
2012b)

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VISUAL PERCEPTION AND IMAGE INTERPRETATION


The visual pathway comprises the perceptual processing component
of image interpretation by obtaining information from the external
environment.

The second element in visual perception involves

cognitive processes (Morita et al. 2008).


There are two techniques our visual cortex employs during visual
object recognition; the bottom-up process and top-down process
(Taddei-Ferretti et al. 2008). In bottom-up processing, perceptual
factors drive the cognitive counterpart, where sensory stimulation
from individual features first occurs before they are combined to
form a complete image in the brain (Morita et al. 2008). Conversely,
top-down processing involves initial recognition of the whole image,
followed by segmentation into its distinctive features. Epshtein et al
(2008) proposed a single bottom-up top-down cycle, where the
bottom-up and top-down processes were performed consecutively to
correct for visual errors that were overlooked in the first bottom-up
method.
Visual search and attention is also required due to the restricted
foveal vision of the human eye. Selective attention is executed in
order to find an object or analyse a fixed target. The eye moves
around the image to scrutinize relevant details so that the brain can
better distinguish differences between the target object and its
surroundings (Krupinski 2010). Recognition is then possible, by
connecting the sensory input with stored data in memory. However,
visual search is influenced by context; objects in highly familiar

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settings are recognized more accurately and more information is
retrieved (Epstein 2005).
Furthermore, conceptual knowledge associated with corresponding
visual

stimuli

facilitates

visual

perception

and

interpretation.

Features of the target object such as shape, dimensions and colour,


can assist in more efficient detection when used in conjunction with
the relevant background (Cheung & Gauthier 2014). In situations
where scenic material is not provided, structure of the background
and previous knowledge can be applied as additional information to
aid in accurate object recognition and localization (Oliva & Torralba
2007).
INTERPRETATION IN MEDICAL IMAGING
Image interpretation is especially crucial in radiology, where the
images seen and reported on have a significant impact on the
patients health outcomes. Several elements of interpretation such
as contrast, signal-to-noise ratio (SNR), colour and grey-scale play
important parts in radiologic image interpretation (Sabih et al.
2011).
Depending on the lesion of interest, different contrast levels are
required for target identification.

Low-contrast pathology, for

example, isoechoic lesions on ultrasound, are the most difficult to


detect as they are only distinguishable by other features like border
irregularities (Sabih et al. 2011). In such situations, it is natural to
assume that moving closer or making the target larger will assist in
localisation, however SNRs role in perception indicates otherwise. In
imaging, SNR is related to the amount of photons that are actually
detected at the detector plate. It is a parameter that affects image
quality, which in turn, has an impact on image interpretation
(Krupinski 2010). In fact, increasing viewing distance has shown to
improve perception of many lesions (Sabih et al. 2011).

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While the cone cells in the retina make the human eye sensitive to
colour, medical images are instead displayed in grey scale, as
individuals perceive colours in different ways. Hence in radiology,
colour is not beneficial in terms of identifying normal versus
abnormal anatomy. A broad range of grey shades is required to
avoid the brain seeing adjacent shades as one level of grey (Kimpe
& Tuytschaever 2007).
VISUAL ILLUSIONS IN RADIOLOGIC IMAGE INTERPRETATION
Visual illusions occur when reality is represented in a distorted or
altered way (Figure 2). When imaged, the human body is a complex
combination of overlapping shadows and differing radiographic
densities. Sensory and perceptual aspects of our visual system can
give rise to artefacts that can be mistaken as pathology. Illusions
can be categorized into either sensory or perceptual illusions, where
sensation illusions occur during the phototransduction process and
perceptual illusions emerge from the interpretation phase after
sensory input has been analysed (Buckle et al. 2013). One of the
most common illusions of sensation in radiology is the Mach band
effect (Panikkath & Panikkath 2014).

(Buckle et al.
2013)

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Figure 2. (a) Typical ambiguous image in the form of a visual illusion; Mother or
Wife? which can either be interpreted as (b) a young woman looking away (blue
circle) or (c) as an old woman looking downwards (red circle)

MACH BAND SIGNS


Mach bands appear as bright and dark lines at the borders of two
objects with different contrast levels or optical densities (Daffner
1989). The Mach band effect is a result of lateral inhibition of the
bipolar neurons in the retina by the horizontal cells in the eye. Once
a phototransduced impulse excites a bipolar cell, the adjacent
bipolar neurons are inhibited (Buckle et al. 2013). This either
increases or decreases their response to light signals, depending on
the distance between the two cells (Chasen 2001).
The edge enhancement effect that results is commonly seen in
radiography, such as the borders that demarcate the lungs and
mediastinum. Mach bands can also provide diagnostic information;
the radiologic halo-sign that is indicative of a benign breast mass
describes a Mach band sign where a dark outline surrounds a
smooth-bordered breast lesion (Buckle et al. 2013).
However, Mach bands can also simulate pathology that is not
actually present (Figure 3). Skin folds or the posterior arch of the
atlas projected over the base of the dens is a common illusion
created by a Mach band (Figure 3a) (Daffner 1989). Superimposition
of surrounding bony structures can also give rise to pseudofractures.

(a)

(b)

Figure 3. (a) Mach band seen (arrows) where the posterior arch of the atlas is projected over C2 and mimics a dens fra

Christina Vong 24244058

MEASURING DETECTION ACCURACY IN RADIOLOGY


Taking into account these issues with identification and detection of
pathology, radiologists diagnostic accuracy can be measured by
first determining the sensitivity and specificity (by calculating from
the decision matrix in Figure 4), followed by the overall accuracy of
ACTUAL SITUATION/REALITY
RADIOLOGISTS
INTERPRETATION
Disease present

Disease present

Disease absent

True Positive (TP)

False Positive (FP)

Disease absent

False Negative (FN)

True Negative (TN)

their interpretations (Zhou et al. 2011).

REDUCING ERROR
To reduce perception errors in radiologic reporting, continued
education and training of radiologists is important (Sabih et al.

Figure 4. Decision matrix illustrating how TPs, FPs, FNs and TNs are determined by
comparing
2011). Understanding
the radiologiststhe
interpretations
physiologywith
of visual
the realillusions
situation.such
Sensitivity
as Mach
gives
the proportion of true positives and is calculated by TP/(TP + FN), while specificity
bands
a vital aspect
of image
not+ only
because
gives
theisproportion
of true negatives
andinterpretation,
is given by TN/(TN
FP). Accuracy
can
then be determined by TN + TP/(TN + TP + FP + FN).

they can aid in making diagnoses, but also because they can be
mistaken for pathology (Buckle et al. 2013). If radiologists are aware

of its existence, misinterpretations due to visual illusions are less


likely to occur.
CONCLUSION
The human visual system is a crucial component of the radiologic
image interpretation process; ultimately, the radiologists findings
are based on their visual impression of the images. Images first
interact with the eye, before being processed through the visual

Christina Vong 24244058


pathway to the brain, where the signals are interpreted. In order to
provide accurate diagnostic reports, the basic principles of sensory
and perceptual vision should be understood. Errors associated with
visual perception such as optical illusions do exist; hence the
detection accuracy of radiologists should be measured regularly to
ensure that correct diagnoses are being made.
Word count: 1441

Christina Vong 24244058


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Christina Vong 24244058

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