Investigating reading strategies and eye behaviours associated with high diagnostic performance when reading digital breast tomosynthesis (DBT) images

Partridge, George; Phillips, Peter; Darker, Iain T.; Chen, Yan

doi:10.1117/12.2611388

Cited by 2 publications

(2 citation statements)

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“…The 26 participants analysed in this study form a subset of a previously published and more recent study. 21 In Partridge et al 2022, a greater sample of readers were incorporated owing to further data collection since the analysis of this study. Furthermore, a different blink detection algorithm was applied to the raw data in this iteration to account for the noise observed in some of the earlier datasets.…”

Section: Methodsmentioning

confidence: 99%

“…This method has been utilised effectively in a previous experiment of a similar nature. 21 Recordings were taken as part of a normal working day between 8am and 5pm except for one candidate whom started their session at 7:30am. Those which undertook the majority of their session before 12pm and after 12pm were classified as ‘morning’ and ‘afternoon’ participants respectively.…”

Section: Methodsmentioning

confidence: 99%

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Measuring reader fatigue in the interpretation of screening digital breast tomosynthesis (DBT)

Chen

Sudin

Partridge

et al. 2023

BJR

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Objectives: The interpretation of digital breast tomosynthesis (DBT) screening examinations is a complex task for an already overstretched workforce which has the potential to increase pressure on readers leading to fatigue and patient safety issues. Studies in non-medical and medical settings have suggested that changes in blink characteristics can reflect fatigue. The purpose of this study is to investigate the use of blink characteristics as an objective marker of fatigue in readers interpreting DBT breast screening examinations. Methods: Twenty-six DBT readers involved in the UK PROSPECTS trial interpreted a test set of 40 DBT cases while being observed by an eye tracking device from November 2019 to February 2021. Raw data from the eye tracker were collected and automated processing software was used to produce eye blinking characteristics data which were analysed using multiple linear regression statistical models. Results: Of the 26 DBT readers recruited, eye tracking data from 23 participants were analysed due to missing data rendering 3 participants’ data uninterpretable. The mean reading time per DBT case was 2.81 min. There was a statistically significant increase in blinking duration of 0.38 ms/case as the reading session progressed (p < 0.0001). This was the result of a significant decrease in the number of ultra-short blinks lasting ≤50 ms (p = 0.0005) and a significant increase in longer blinks lasting 51–100 ms (p = 0.008). Conclusion Changes in blinking characteristics could serve as objective measures of reader fatigue and may prove useful in the development of DBT reading protocols. Advances in knowledge: Blink characteristics can be used as an objective measure of fatigue; however there is limited evidence of their use in radiological settings. Our study suggests that changes in blink duration and frequency could be used to monitor fatigue in DBT reading sessions.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Measuring reader fatigue in the interpretation of screening digital breast tomosynthesis (DBT)

Chen

Sudin

Partridge

et al. 2023

BJR

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Take a break: should breaks be enforced during digital breast tomosynthesis reading sessions?

Partridge,

Taib,

Phillips

et al. 2023

Eur Radiol

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Objectives Digital breast tomosynthesis (DBT) can improve diagnostic accuracy compared to 2D mammography, but DBT reporting is time-consuming and potentially more fatiguing. Changes in diagnostic accuracy and subjective and objective fatigue were evaluated over a DBT reporting session, and the impact of taking a reporting break was assessed. Materials and methods Forty-five National Health Service (NHS) mammography readers from 6 hospitals read a cancer-enriched set of 40 DBT cases whilst eye tracked in this prospective cohort study, from December 2020 to April 2022. Eye-blink metrics were assessed as objective fatigue measures. Twenty-one readers had a reporting break, 24 did not. Subjective fatigue questionnaires were completed before and after the session. Diagnostic accuracy and subjective and objective fatigue measures were compared between the cohorts using parametric and non-parametric significance testing. Results Readers had on average 10 years post-training breast screening experience and took just under 2 h (105.8 min) to report all cases. Readers without a break reported greater levels of subjective fatigue (44% vs. 33%, p = 0.04), which related to greater objective fatigue: an increased average blink duration (296 ms vs. 286 ms, p < 0.001) and a reduced eye-opening velocity (76 mm/s vs. 82 mm/s, p < 0.001). Objective fatigue increased as the trial progressed for the no break cohort only (ps < 0.001). No difference was identified in diagnostic accuracy between the groups (accuracy: 87% vs. 87%, p = 0.92). Conclusions Implementing a break during a 2-h DBT reporting session resulted in lower levels of subjective and objective fatigue. Breaks did not impact diagnostic accuracy, which may be related to the extensive experience of the readers. Clinical relevance statement DBT is being incorporated into many mammography screening programmes. Recognising that reporting breaks are required when reading large volumes of DBT studies ensures this can be factored in when setting up reading sessions. Trial registration Clinical trials registration number: NCT03733106 Key Points • Use of digital breast tomosynthesis (DBT) in breast screening programmes can cause significant reader fatigue. • The effectiveness of incorporating reading breaks into DBT reporting sessions, to reduce mammography reader fatigue, was investigated using eye tracking. • Integrating breaks into DBT reporting sessions reduced reader fatigue; however, diagnostic accuracy was unaffected.

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Investigating reading strategies and eye behaviours associated with high diagnostic performance when reading digital breast tomosynthesis (DBT) images

Cited by 2 publications

References 1 publication

Measuring reader fatigue in the interpretation of screening digital breast tomosynthesis (DBT)

Measuring reader fatigue in the interpretation of screening digital breast tomosynthesis (DBT)

Take a break: should breaks be enforced during digital breast tomosynthesis reading sessions?

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