We examined how the ability to detect lung nodules in chest x-ray inspection is reflected in experience-related differences in visual search and decision making, and whether the eye-tracking metric time-to-first hit showed systematic decreases across expertise levels are examined. In the study decision making improved with expertise, however, time-to-first fixate a nodule showed only a non-significant trend to decrease with expertise. Surprisingly, naïve and expert observers allocated less visual attention at nodules compared with first and third year radiography students. This similarity in visual attention at nodules but not in decision making was explained by the fact that naïve observers were more likely to fixate and make errors on distracter regions. Time-to-first hit has been linked to expert performance in mammography, but in this study was not sufficiently sensitive to demonstrate clear linear improvements across expertise groups. This brings into question the use of this metric as an indirect measure of rapid initial holistic processing. Copyright © 2012 John Wiley & Sons, Ltd.