How Doctors Generate Diagnostic Hypotheses: A Study of Radiological Diagnosis with Functional Magnetic Resonance Imaging

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author MELO, Marcio
SCARPIN, Daniel J.
AMARO JR., Edson FMUSP-HC
PASSOS, Rodrigo B. D. FMUSP-HC
SATO, Joao R. FMUSP-HC
FRISTON, Karl J.
PRICE, Cathy J.
dc.date.issued 2011
dc.identifier.citation PLOS ONE, v.6, n.12, article ID e28752, 8p, 2011
dc.identifier.issn 1932-6203
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/22885
dc.description.abstract Background: 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. Methodology and Principal Findings: 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. Conclusions: 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.
dc.description.sponsorship · Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP), Brazil
· Wellcome Trust, UK
dc.language.iso eng
dc.publisher PUBLIC LIBRARY SCIENCE
dc.relation.ispartof Plos One
dc.rights openAccess
dc.subject.other word production; category use; recognition; fmri; expertise; recall; task; perception; activation; similarity
dc.title How Doctors Generate Diagnostic Hypotheses: A Study of Radiological Diagnosis with Functional Magnetic Resonance Imaging
dc.type article
dc.rights.holder Copyright PUBLIC LIBRARY SCIENCE
dc.description.group LIM/44
dc.identifier.doi 10.1371/journal.pone.0028752
dc.identifier.pmid 22194902
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author AMARO JR., Edson:FM:MDR
hcfmusp.author PASSOS, Rodrigo B. D.:HC:INRAD
hcfmusp.author SATO, Joao R.:HC:LIM/44
hcfmusp.author.external · MELO, Marcio:Univ Sao Paulo, Fac Med, Lab Med Informat LIM 01, Sao Paulo, Brazil
· SCARPIN, Daniel J.:Univ Sao Paulo, Fac Med, Lab Med Informat LIM 01, Sao Paulo, Brazil
· FRISTON, Karl J.:UCL, Wellcome Trust Ctr Neuroimaging, London, England
· PRICE, Cathy J.:UCL, Wellcome Trust Ctr Neuroimaging, London, England
hcfmusp.origem.id WOS:000298369100090
hcfmusp.origem.id 2-s2.0-83355176267
hcfmusp.publisher.city SAN FRANCISCO
hcfmusp.publisher.country USA
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dc.description.index MEDLINE
hcfmusp.citation.scopus 14
hcfmusp.affiliation.country Brasil
hcfmusp.affiliation.country Inglaterra
hcfmusp.scopus.lastupdate 2021-08-27


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