Gaze patterns hold key to unlocking successful search strategies and increasing polyp detection rate in colonoscopy

Lami, Mariam; Singh, Harsimrat; Dilley, James H.; Ashraf, Hajra; Edmondon, Matthew; Orihuela‐Espina, Felipe; Hoare, Jonathan; Darzi, Ara; Sodergren, Mikael H.

doi:10.1055/s-0044-101026

Cited by 30 publications

(29 citation statements)

References 16 publications

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“…27,28 In addition, visual gaze patterns differ between endoscopists, and it has been shown that endoscopists with a wider visual gaze pattern or center-looking visual gaze pattern may have a higher adenoma or polyp detection rate than endoscopists with other visual gaze patterns. 29,30 Finally, "inattentional blindness" 31,32 and "change blindness" 33 phenomena may add to intraproceduralist variability, and neither wider-viewing colonoscopes nor second observer strategies may completely address these issues. Therefore, high-performance CADe may serve as a more standardized "second eye" in assisting the endoscopist to avoid missing any lesion.…”

Section: Discussionmentioning

confidence: 99%

Lower Adenoma Miss Rate of Computer-Aided Detection-Assisted Colonoscopy vs Routine White-Light Colonoscopy in a Prospective Tandem Study

et al. 2020

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See Covering the Cover synopsis on page 1193. BACKGROUND AND AIMS: Up to 30% of adenomas might be missed during screening colonoscopy-these could be polyps that appear on-screen but are not recognized by endoscopists or polyps that are in locations that do not appear on the screen at all. Computer-aided detection (CADe) systems, based on deep learning, might reduce rates of missed adenomas by displaying visual alerts that identify precancerous polyps on the endoscopy monitor in real time. We compared adenoma miss rates of CADe colonoscopy vs routine white-light colonoscopy. METHODS: We performed a prospective study of patients, 18-75 years old, referred for diagnostic, screening, or surveillance colonoscopies at a single endoscopy center of Sichuan Provincial People's Hospital from June 3, 2019 through September 24, 2019. Same day, tandem colonoscopies were performed for each participant by the same endoscopist. Patients were randomly assigned to groups that received either CADe colonoscopy (n¼184) or routine colonoscopy (n¼185) first, followed immediately by the other procedure. Endoscopists were blinded to the group each patient was assigned to until immediately before the start of each colonoscopy. Polyps that were missed by the CADe system but detected by endoscopists were classified as missed polyps. False polyps were those continuously traced by the CADe system but then determined not to be polyps by the endoscopists. The primary endpoint was adenoma miss rate, which was defined as the number of adenomas detected in the second-pass colonoscopy divided by the total number of adenomas detected in both passes. RESULTS: The adenoma miss rate was significantly lower with CADe colonoscopy (13.89%; 95% CI, 8.24%-19.54%) than with routine colonoscopy (40.00%; 95% CI, 31.23%-48.77%, P<.0001). The polyp miss rate was significantly lower with CADe colonoscopy (12.98%; 95% CI, 9.08%-16.88%) than with routine colonoscopy (45.90%; 95% CI, 39.65%-52.15%) (P<.0001). Adenoma miss rates in ascending, transverse, and descending colon were significantly lower with CADe colonoscopy than with routine colonoscopy (ascending colon 6.67% vs 39.13%; P¼.0095; transverse colon 16.33% vs 45.16%; P¼.0065; and descending colon 12.50% vs 40.91%, P¼.0364). CONCLUSIONS: CADe colonoscopy reduced the overall miss rate of adenomas by endoscopists using white-light endoscopy. Routine use of CADe might reduce the incidence of interval colon cancers. chictr.org.cn study no: ChiCTR1900023086

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Section: Discussionmentioning

confidence: 99%

Lower Adenoma Miss Rate of Computer-Aided Detection-Assisted Colonoscopy vs Routine White-Light Colonoscopy in a Prospective Tandem Study

et al. 2020

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“…Given the importance of better identification of any precancerous lesions during colonoscopy, tremendous efforts from both hardware engineers and clinicians have been put to make lesions more visible to the endoscopists [26], However, endoscopists still miss a large portion of precancerous lesions within the screen, for both lesions with non-obvious visual features and lesions that briefly flashed across the screen. These conditions are very challenging even for experienced endoscopists, because humans are always susceptible to "inattentional blindness", "change blindness", visual gaze pattern, fatigue, interobserver variabilities or any distractions [18,27,28,29,30,31,32]. Till now, only secondobserver strategies seem helpful to decrease the miss rate of visible polyps for low ADR detectors [26,33].…”

Section: Discussionmentioning

confidence: 99%

Computer aided detection for laterally spreading tumors and sessile serrated adenomas during colonoscopy

Zhou

Xiao

et al. 2020

PLoS ONE

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Background Evidence has shown that deep learning computer aided detection (CADe) system achieved high overall detection accuracy for polyp detection during colonoscopy. Aim The detection performance of CADe system on non-polypoid laterally spreading tumors (LSTs) and sessile serrated adenomas/polyps (SSA/Ps), with higher risk for malignancy transformation and miss rate, has not been exclusively investigated.

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“…These findings showed no correlation with level of experience. 87 Visibility of colorectal lesions using WLE, BLI and LCI with an eye-tracking system was evaluated in 10 endoscopists (9 non-experts). The miss-rate was significantly lower for BLI (6%) and LCI (4.3%), respectively, than with WLE (12.6%) and significantly shorter detection time for BLI and LCI.…”

Section: Eye-trackingmentioning

confidence: 99%

The future of endoscopy: Advances in endoscopic image innovations

Gulati

Patel

Emmanuel

et al. 2019

Digestive Endoscopy

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The latest state of the art technological innovations have led to a palpable progression in endoscopic imaging and may facilitate standardisation of practice. One of the most rapidly evolving modalities is artificial intelligence with recent studies providing real-time diagnoses and encouraging results in the first randomised trials to conventional endoscopic imaging. Advances in functional hypoxia imaging offer novel opportunities to be used to detect neoplasia and the assessment of colitis. Three-dimensional volumetric imaging provides spatial information and has shown promise in the increased detection of small polyps. Studies to date of self-propelling colonoscopes demonstrate an increased caecal intubation rate and possibly offer patients a more comfortable procedure. Further development in robotic technology has introduced ex vivo automated locomotor upper gastrointestinal and small bowel capsule devices. Eye-tracking has the potential to revolutionise endoscopic training through the identification of differences in experts and non-expert endoscopist as trainable parameters. In this review, we discuss the latest innovations of all these technologies and provide perspective into the exciting future of diagnostic luminal endoscopy.

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Gaze patterns hold key to unlocking successful search strategies and increasing polyp detection rate in colonoscopy

Abstract: This study defined distinct VGPs that are associated with expert behavior. These data may allow introduction of visual gaze training within structured training programs, and have implications for adoption in higher-level assessment.

Cited by 30 publications

References 16 publications

Lower Adenoma Miss Rate of Computer-Aided Detection-Assisted Colonoscopy vs Routine White-Light Colonoscopy in a Prospective Tandem Study

Lower Adenoma Miss Rate of Computer-Aided Detection-Assisted Colonoscopy vs Routine White-Light Colonoscopy in a Prospective Tandem Study

Computer aided detection for laterally spreading tumors and sessile serrated adenomas during colonoscopy

The future of endoscopy: Advances in endoscopic image innovations

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