The Effect of Expertise on Eye Movement Behaviour in Medical Image Perception

Abstract

The present eye-movement study assessed the effect of expertise on eye-movement behaviour during image perception in the medical domain. To this end, radiologists, computed-tomography radiographers and psychology students were exposed to nine volumes of multi-slice, stack-view, axial computed-tomography images from the upper to the lower part of the abdomen with or without abnormality. The images were presented in succession at low, medium or high speed, while the participants had to detect enlarged lymph nodes or other visually more salient abnormalities. The radiologists outperformed both other groups in the detection of enlarged lymph nodes and their eye-movement behaviour also differed from the other groups. Their general strategy was to use saccades of shorter amplitude than the two other participant groups. In the presence of enlarged lymph nodes, they increased the number of fixations on the relevant areas and reverted to even shorter saccades. In volumes containing enlarged lymph nodes, radiologists’ fixation durations were longer in comparison to their fixation durations in volumes without enlarged lymph nodes. More salient abnormalities were detected equally well by radiologists and radiographers, with both groups outperforming psychology students. However, to accomplish this, radiologists actually needed fewer fixations on the relevant areas than the radiographers. On the basis of these results, we argue that expert behaviour is manifested in distinct eye-movement patterns of proactivity, reactivity and suppression, depending on the nature of the task and the presence of abnormalities at any given moment.

Unboxing the Black Box of Visual Expertise in Medicine

“…We fully agree with that, but would like to point towards research not mentioned by these authors, i.e., by Bertram, Helle, Kaakinen, and Svedström (2013) on CT images and our own research on interactive digital pathology slides (Jaarsma et al, 2016;Jaarsma, Jarodzka, Nap, Van Merriënboer, & Boshuizen, 2015;Jaarsma et al, 2014) and on patient-video cases (Balslev et al, 2012). Moreover, the authors mention on several occasions the potential eye tracking has for medical education.…”

Before your very eyes: the value and limitations of eye tracking in medical education

“…25 ) For some tasks, such as diagnosing lymph node abnormalities on CT images, a longer saccade length is a disadvantage rather than an advantage and experts adapt to the task by making shorter saccades as needed. 26 Thus, making general predictions of differences in expertise using eyemovement measurements without considering the task at hand is too simplistic; eye movements should always be interpreted in relation to the task.…”

The Flash-Preview Moving Window Paradigm: Unpacking Visual Expertise One Glimpse at a Time

“…We therefore see the FPMW paradigm as a continuation of this long tradition to understand visual expertise using eye-tracking methodology alongside traditional 'flash' methodologies. Although this FPMW methodology currently focuses on static image interpretation, and not on how dynamic medical images are interpreted (Bertram, Helle, Kaakinen, & Svedström, 2013;Drew et al, 2013b;Phillips et al, 2013) we are nevertheless excited to see how the FPMW will force us to re-evaluate what we think we know about visual expertise in medical image perception. Unlike many of the other methodologies that can be used to investigate visual expertise and are discussed in this special issue, research has only just begun on using FPMW to understand visual expertise.…”