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Addressing the Invisible Gorilla Enigma


Overlooking a gorilla image in a CT scan doesn't equal missing radiological findings. Radiologists target their skills during reading, ignoring unrelated information.

[[{"type":"media","view_mode":"media_crop","fid":"12004","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7130966485295","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"227","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]I first saw the original invisible gorilla video at a four-day leadership conference. I will admit that while at the conference I was not in my typical image interpretation paradigm. I was thinking about non-radiology issues, not CT or MRI. We were role playing around my small group table.

The leader showed us a video, part of a famous study related to attention, with two teams - one wearing white shirts, another in black - passing two basketballs between them. We were told to specifically count the number of passes made by individuals in white shirts, and while I counted the correct number of passes, along with everyone else at my table, I did miss the gorilla walk through the scene.

In an updated study, researchers placed the image of a dancing gorilla on one of five CT scans. They asked radiologists to identify white nodules. They found that 83 percent of the radiologists didn’t see the gorilla.

The fact that the gorilla was missed shouldn’t be surprising to any of us in radiology, but “missing” the gorilla and missing radiological findings are not analogous for several reasons. (It’s worth noting, too, that the radiologists were much better at finding the nodules.)

First of all, we rigorously train for five years of post-graduate training to become radiologists. We sharpen our inspection skills over and over for years. When we participate in the exercise of reviewing the gorilla video, we are told very specifically what to do and then we immediately are launched into the exercise. There is no time to practice or train our “video review” skills.

Secondly, in the video review exercise (and similarly the CT scan exercise) we are instructed to look for only one specific thing to the deliberate exclusion of all other visual data. It doesn’t work like that in the real world of radiology.

Although we may know a specific piece of clinical history or know that we are on a “metastatic disease hunt,” we are trained to systematically review all areas of all images for any pathology that might be present. This is the art of being a radiologist and what separates us from other physicians. It’s what keeps our miss rate so low relative to non-radiologists. However to remain on the cutting edge, we need to constantly hone our skills.

Thirdly, when we dictate our reports while we are actually looking at the images at our workstations, our minds should undergo a paradigm shift away from extraneous thoughts, ideas and other contaminating data and into what I like to call “dictation mode.” Our careful search pattern automatically and subconsciously engages as we begin to analyze and dictate.

How many times have we been asked to “review” a case when we have been doing something else like visiting with a colleague, having lunch or reviewing a different case? We are quick to comply to assist our clinical (or even fellow radiology) colleagues, but commonly when we do this our mind is not in “dictation mode.” We may render an opinion without careful scrutiny and only later actually sit down at our workstation to report the case.

Now we have already shifted paradigms into our “dictation mode” and are chagrinned to notice some findings we previously overlooked. Our brains weren’t fully engaged before so we overlooked a small (or not) finding and now we find ourselves calling our colleague to explain why we didn’t see the finding previously.

It’s an interesting, but specious argument to link a gorilla miss with radiological misses, assuming our physical and mental setting is optimal for image interpretation and reporting. We need to make sure we don’t let our work environment slide so we can stay completely focused on the business at hand or we may find ourselves landing back on the “Planet of the Apes.”

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