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PURPOSE: To identify and compare key stages of the visual process in experienced and inexperienced readers and to examine how these processes are used to search a moving three-dimensional ( 3D three-dimensional ) image and their relationship to false-negative errors. MATERIALS AND METHODS: Institutional review board research ethics approval was granted to use anonymized computed tomographic (CT) colonographic data from previous studies and to obtain eye-tracking data from volunteers. Sixty-five radiologists (27 experienced, 38 inexperienced) interpreted 23 endoluminal 3D three-dimensional CT colonographic videos. Eye movements were recorded by using eye tracking with a desk-mounted tracker. Readers indicated when they saw a polyp by clicking a computer mouse. Polyp location and boundary on each video frame were quantified and gaze data were related to the polyp boundary for each individual reader and case. Predefined metrics were quantified and used to describe and compare visual search patterns between experienced and inexperienced readers by using multilevel modeling. RESULTS: Time to first pursuit was significantly shorter in experienced readers (hazard ratio, 1.22 [95% confidence interval: 1.04, 1.44]; P = .017) but other metrics were not significantly different. Regardless of expertise, metrics such as assessment, identification period, and pursuit times were extended in videos where polyps were visible on screen for longer periods of time. In 97% (760 of 787) of observations, readers correctly pursued polyps. CONCLUSION: Experienced readers had shorter time to first eye pursuit, but many other characteristics of eye tracking were similar between experienced and inexperienced readers. Readers pursued polyps in 97% of observations, which indicated that errors during interpretation of 3D three-dimensional CT colonography in this study occurred in either the discovery or the recognition phase, but rarely in the scanning phase of radiologic image inspection.

Type

Journal article

Journal

Radiology

Publication Date

12/2014

Volume

273

Pages

783 - 792

Addresses

From the Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, England (S.M., T.R.F.); Health and Medical Sciences Group, University of Cumbria, Lancaster, England (P.P.); Centre for Medical Imaging, University College London, London, England (E.H., S.A.T., S.H., D.B.); Applied Vision Research Centre, Loughborough University, Loughborough, England (A.G.); School of Medicine, Lancaster University, Lancaster, England (D.M.); and Centre for Statistics in Medicine, University of Oxford, Oxford, England (D.G.A.).

Keywords

Humans, Colonic Polyps, Colonography, Computed Tomographic, Imaging, Three-Dimensional, Eye Movements, Reproducibility of Results, Visual Perception, Clinical Competence, Video Recording, Adult, Female, Male