Improving Radiology Trainees’ Perception Using Where's Waldo?

Rationale and Objectives: Perception is an essential skill leading to expertise in diagnostic radiology. We determined if practicing "Where's Waldo?" images improves accuracy and speed with which first and second year radiology residents detect abnormalities on chest radiographs (CXRs). Materials and Methods: Residents at three institutions were pretested using 50 CXRs, identifying locations of potential abnormalities. They were then split into trained (examining 7 "Where's Waldo?" images over three weeks) and control groups (no "Where's Waldo?"). They were then re-tested on the 50 CXRs. At one site, visual search parameters were acquired. Data were analyzed with repeated measures ANOVAs. Results: There was no significant difference in performance for trained vs control (F = 0.622, p = 0.436), with both improving significantly on post-test (F = 4.72, p = 0.037). Session time decreased significantly for both groups from pre to post-test (F = 81.47, p < 0.0001) and the decrease was significantly more (F = 31.59, p < 0.0001) for the trained group than the control group as well as for PGY with PGY3 having a larger average decrease in session time than PGY2. Eye-tracking data also showed significant increases in per image search efficiency with training. Conclusion: Practicing "Where's Waldo?" or similar nonradiology search tasks may facilitate the acquisition of radiology image search but not detection skills, impacting reading efficiency more than detection accuracy.