Do prevalence expectations affect patterns of visual search and decision-making in interpreting CT colonography endoluminal videos?

Objective: To assess the effect of expected abnormality prevalence on visual search and decision-making in CT colonography (CTC).Methods: 13 radiologists interpreted endoluminal CTC flythroughs of the same group of 10 patient cases, 3 times each. Abnormality prevalence was fixed (50%), but readers were told, before viewing each group, that prevalence was either 20%, 50% or 80% in the population from which cases were drawn. Infrared visual search recording was used. Readers indicated seeing a polyp by clicking a mouse. Multilevel modelling quantified the effect of expected prevalence on outcomes.Results: Differences between expected prevalence were not statistically significant for time to first pursuit of the polyp (median 0.5 s, each prevalence), pursuit rate when no polyp was on screen (median 2.7 s21, each prevalence) or number of mouse clicks [mean 0.75/ video (20% prevalence), 0.93 (50%), 0.97 (80%)]. There was weak evidence of increased tendency to look outside the central screen area at 80% prevalence and reduction in positive polyp identifications at 20% prevalence.Conclusion: This study did not find a large effect of prevalence information on most visual search metrics or polyp identification in CTC. Further research is required to quantify effects at lower prevalence and in relation to secondary outcome measures.Advances in knowledge: Prevalence effects in evaluating CTC have not previously been assessed. In this study, providing expected prevalence information did not have a large effect on diagnostic decisions or patterns of visual search.