HOW TO USE GESTALT INTERPRETATION FOR VENTILATION-PERFUSION LUNG SCINTIGRAPHY Introduction: The use of a so-called gestalt interpretation, an integration of different sets of criteria and the physician’s own experience, has been advocated in the interpretation of lung scintigraphs of patients with clinically suspected pulmonary embolism. However, data on the reliability of this approach are limited. The aim of this study was to investigate the observer variability and accuracy of the gestalt interpretation of perfusion scintigraphy (combined with chest radiography) as well as the impact of adding ventilation scintigraphy and clinical pretest information. Methods: Three experienced observers independently reviewed the chest radiograph and ventilation-perfusion scans of 101 consecutive patients with clinically suspected pulmonary embolism. All datasets were reviewed twice by each observer, using a visual analog scale to indicate the estimated probability of pulmonary embolism. The results of the gestalt interpretations were analyzed against the presence or absence of pulmonary embolism. Results: All 3 gestalt interpretations had a good-to-excellent interobserver variability (intraclass correlation coefficient [ICC], 0.73–0.89), with similar intraobserver agreement (ICC, 0.76–0.95). The performance of all 3 readers was comparable. The areas under the curve (AUCs) of all 3 observers were high and similar (for observer 1, the AUCs were 0.96 [95% confidence interval (CI)], 0.93–1.00), 0.96 (95% CI, 0.93–1.00), and 0.95 (95% CI, 0.90–1.00), respectively, for the 3 gestalt interpretations). Conclusion: A gestalt interpretation is a useful classification scheme with good-to-excellent intra- and interobserver variability. However, the interpretation and the consequences of this result are dependent on the observer. Unexpectedly, the addition of information on ventilation scintigraphy and clinical information did not affect the overall assessment.
GESTALT THEORY: IMPLICATIONS FOR RADIOLOGY EDUCATION
OBJECTIVE. The Gestalt theory of modern psychology is grounded in the ideas that holistic rather than atomistic approaches are necessary to understand the mind, and that the mental whole is greater than the sum of its component parts. Although the Gestalt school fell out of favor due to its descriptive rather than explanatory nature, it permanently changed our understanding of perception. For the radiologist, such fundamental Gestalt concepts as figure– ground relationships and a variety of “grouping principles” (the laws of closure, proximity, similarity, common region, continuity, and symmetry) are ubiquitous in daily work, not to mention in art and personal life.
CONCLUSION. By considering the applications of these principles and the stereotypical ways in which humans perceive visual stimuli, a radiology learner may incur fewer errors of diagnosis. This article serves to introduce several important principles of Gestalt theory, identify examples of these principles in widely recognizable fine art, and highlight their implications for radiology education.
Gestalt principles of visual perception play
an integral but often underappreciated role in
both radiology practice and the training of
future radiologists. By familiarizing ourselves
with these ubiquitous principles at an early
stage of training, we can help radiology students
better understand the unconscious work
involved in interpreting radiologic images
and prepare them to avoid common.
Another key Gestalt principle is closure,
which suggests that our minds have a tendency
to fill in empty spaces in an apparently
incomplete image to create a complete and
unified figure  (Fig. 2). To visualize this
principle, consider the Cubist movement in
Modern art. The works of Pablo Picasso
(1881–1973) and Georges Braque (1882–1963)
rely heavily on this grouping principle, which
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