Eye-tracking for assessing medical image interpretation: A pilot feasibility study comparing novice vs expert cardiologists

Abstract

Introduction As specialized medical professionals such as radiologists, pathologists, and cardiologists gain education and experience, their diagnostic efficiency and accuracy change, and they show altered eye movement patterns during medical image interpretation. Existing research in this area is limited to interpretation of static medical images, such as digitized whole slide biopsies, making it difficult to understand how expertise development might manifest during dynamic image interpretation, such as with angiograms or volumetric scans. Methods A two-group (novice, expert) comparative pilot study examined the feasibility and utility of tracking and interpreting eye movement patterns while cardiologists viewed video-based coronary angiograms. A non-invasive eye tracking system recorded cardiologists’ ( n = 8) visual behaviour while they viewed and diagnosed a series of eight angiogram videos. Analyses assessed frame-by-frame video navigation behaviour, eye fixation behaviour, and resulting diagnostic decision making. Results Relative to novices, expert cardiologists demonstrated shorter and less variable video review times, fewer eye fixations and saccadic eye movements, and less time spent paused on individual video frames. Novices showed repeated eye fixations on critical image frames and regions, though these were not predictive of accurate diagnostic decisions. Discussion These preliminary results demonstrate interpretive decision errors among novices, suggesting they identify and process critical diagnostic features, but sometimes fail to accurately interpret those features. Results also showcase the feasibility of tracking and understanding eye movements during video-based coronary angiogram interpretation and suggest that eye tracking may be valuable for informing assessments of competency progression during medical education and training.

Automatic Lung Nodule Detection Combined With Gaze Information Improves Radiologists’ Screening Performance

“…Fixation errors, mostly related to stress and fatigue, occur when the expert does not focus a regionof-interest for an enough period of time to identify potential nodule candidates. On the other hand, recognition errors result from failing to correctly identify a found abnormality as a nodule and depends mostly on experience of the radiologist [4].…”

Eye tracking: the silver bullet of competency assessment in medical image interpretation?

“…‘Eye tracking may be valuable for informing assessments of competency progression during medical education and training’ [ 1 ]. Brunye et al.…”

“…Brunye et al. [ 1 ] and other researchers (e.g. [ 2 ]) have made this suggestion to argue the relevance of using eye tracking to investigate medical image interpretation.…”

“…Whereas previous research has shown that eye tracking is a very useful tool to investigate the interpretation of medical images (such as angiograms), the field is not yet at a point where eye tracking can be used for competency assessment in clinical practice. In this commentary on ‘Eye-tracking during dynamic medical image interpretation: a pilot feasibility study comparing novice vs expert cardiologists’ [ 1 ] I discuss what eye tracking could add to competency assessment, which eye-tracking measures are potential markers of expertise, and what is still needed before they can be used for competency assessment.…”

“…Not all of those measures are equally useful as markers of expertise. For example, Brunye and colleagues [ 1 ] have found that experts have, on average, a lower number of fixations than novices. This measure does not exploit the possibilities of eye tracking: It just reflects the fact that experts perform the task more quickly, which can also be observed with a simple (and cheap) stopwatch.…”