Interpretation of electrocardiograms (ECGs) is a complex task involving visual inspection. This paper aims to improve understanding of how practitioners perceive ECGs, and determine whether visual behaviour can indicate differences in interpretation accuracy. A group of healthcare practitioners (n = 31) who interpret ECGs as part of their clinical role were shown 11 commonly encountered ECGs on a computer screen. The participants’ eye movement data were recorded as they viewed the ECGs and attempted interpretation. The Jensen-Shannon distance was computed for the distance between two Markov chains, constructed from the transition matrices (visual shifts from and to ECG leads) of the correct and incorrect interpretation groups for each ECG. A permutation test was then used to compare this distance against 10,000 randomly shuffled groups made up of the same participants. The results demonstrated a statistically significant (α  0.05) result in 5 of the 11 stimuli demonstrating that the gaze shift between the ECG leads is different between the groups making correct and incorrect interpretations and therefore a factor in interpretation accuracy. The results shed further light on the relationship between visual behaviour and ECG interpretation accuracy, providing information that can be used to improve both human and automated interpretation approaches.

No abstract

Background/Aims: This article aims to improve the understanding of the applied cognitive processes when interpreting electrocardiograms in clinical practice. It will do this by examining the self-reported approach practitioners take to interpret any barriers they encounter. Methods: This was a qualitative study in which medical practitioners, who routinely interpret electrocardiograms (n=31), were interviewed. The semi-structured interviews covered: their experience of interpretation; use of a system; pitfalls; changes to approach over time. An inductive thematic analysis was used to identify commonly occurring themes. A further set of practitioners (n=31), completed surveys that concerned their approach to an interpretation and use of interpretation frameworks/systems. Results: Practitioners find it easier to interpret electrocardiograms as they gain experience, but the process remains difficult. Barriers to successful interpretation include artefacts altering the waveform, lack of familiarity with the presenting condition, stress/panic at the prospect of making an inaccurate judgement, and overconfidence in one's interpretation abilities. Conclusions: The results support a dual-process system model that is developed with experience and enhances performance. Over time, experienced practitioners become able to move fluidly between a more formal systematic method and an experience-driven pattern recognition system. Potential errors that may arise from a reliance on pattern recognition (e.g. missing details) can be mitigated by using a systematic approach.

No abstract

Visual content in biomedical academic papers is a growing source of critical information, but it is not always fully readable for people with visual impairments. We aimed to assess current image processing practices, accessibility policies, and submission policies in a sample of 12 highly cited biomedical journals. We manually checked the application of text-based alternative image descriptions for every image in 12 articles (one for each journal). We determined whether the journals claimed to follow an accessibility policy and we reviewed their submission policy and their guidelines related to the visual content. We identified important features concerning the processing of images and the characteristics of the visual and the retrieval options of visual content offered by the publishers. The evaluation shows that the actual practices of textual image description in highly cited biomedical journals do not follow general guidelines on accessibility. The images within the articles analyzed lack alternative descriptions or have uninformative descriptions, even in the case of journals claiming to follow an accessibility policy. Consequently, the visual information of scientific articles is not accessible to people with severe visual disabilities.Instructions on image submission are heterogeneous and a declaration of accessibility guidelines was only found in two thirds of the sample of journals, with one third not explicitly following any accessibility policy, although they are required to by law.