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Retrospectively obvious events are frequently missed when attention is engaged in another task-a phenomenon known as inattentional blindness. Although the task characteristics that predict inattentional blindness rates are relatively well understood, the observer characteristics that predict inattentional blindness rates are largely unknown. Previously, expert radiologists showed a surprising rate of inattentional blindness to a gorilla photoshopped into a CT scan during lung-cancer screening. However, inattentional blindness rates were higher for a group of naïve observers performing the same task, suggesting that perceptual expertise may provide protection against inattentional blindness. Here, we tested whether expertise in radiology predicts inattentional blindness rates for unexpected abnormalities that were clinically relevant. Fifty radiologists evaluated CT scans for lung cancer. The final case contained a large (9.1 cm) breast mass and lymphadenopathy. When their attention was focused on searching for lung nodules, 66% of radiologists did not detect breast cancer and 30% did not detect lymphadenopathy. In contrast, only 3% and 10% of radiologists (N = 30), respectively, missed these abnormalities in a follow-up study when searching for a broader range of abnormalities. Neither experience, primary task performance, nor search behavior predicted which radiologists missed the unexpected abnormalities. These findings suggest perceptual expertise does not protect against inattentional blindness, even for unexpected stimuli that are within the domain of expertise.

Pleural effusions are categorized as transudative or exudative, with transudative effusions usually reflecting the sequala of a systemic etiology and exudative effusions usually resulting from a process localized to the pleura. Common causes of transudative pleural effusions include congestive heart failure, cirrhosis, and renal failure, whereas exudative effusions are typically due to infection, malignancy, or autoimmune disorders. This document summarizes appropriateness guidelines for imaging in four common clinical scenarios in patients with known or suspected pleural effusion or pleural disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]