Abstract
A pilot study examined the extent to which eye movements occurring during interpretation of digitized breast biopsy whole slide images (WSI) can distinguish novice interpreters from experts, informing assessments of competency progression during training and across the physician-learning continuum. A pathologist with fellowship training in breast pathology interpreted digital WSI of breast tissue and marked the region of highest diagnostic relevance (dROI). These same images were then evaluated using computer vision techniques to identify visually salient regions of interest (vROI) without diagnostic relevance. A non-invasive eye tracking system recorded pathologists’ (N = 7) visual behavior during image interpretation, and we measured differential viewing of vROIs versus dROIs according to their level of expertise. Pathologists with relatively low expertise in interpreting breast pathology were more likely to fixate on, and subsequently return to, diagnostically irrelevant vROIs relative to experts. Repeatedly fixating on the distracting vROI showed limited value in predicting diagnostic failure. These preliminary results suggest that eye movements occurring during digital slide interpretation can characterize expertise development by demonstrating differential attraction to diagnostically relevant versus visually distracting image regions. These results carry both theoretical implications and potential for monitoring and evaluating student progress and providing automated feedback and scanning guidance in educational settings.
Highlights
Developing visual expertise is fundamental to the accuracy of physicians’ interpretations of optical images, such as those integral to pathology, radiology, and dermatology practice
Because no quantitative methods or metrics exist for evaluating the development of visual expertise independent from diagnostic accuracy, we propose that dissociating attention toward visually salient versus diagnostically relevant image regions may prove valuable in monitoring progress in visual expertise development and potentially informing the design of educational curricula
A test set of 10 digital whole slide image (WSI) breast specimens was selected from a larger test set developed as part of an ongoing National Cancer Institute (NCI) funded breast pathology study [18]
Summary
Developing visual expertise is fundamental to the accuracy of physicians’ interpretations of optical images, such as those integral to pathology, radiology, and dermatology practice. Little is known about how visual expertise develops during and after training, which perceptual and cognitive mechanisms are responsible for expertise development, and how educators can evaluate its progress over time [1,2,3]. These issues are especially important given the Accreditation Council on Graduate Medical Education’s (ACGME) focus on competency development, which is part of their Accreditation System [4]. Novices tend to overtly fixate on multiple image features that are both relevant and irrelevant to the ultimate diagnosis
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