title: Tracking with virtual slides: a tool to study diagnostic error in histopathology.
abstract: OBJECTIVE
  To determine the reasons for diagnostic error by virtual slides which allow unsupervised study of diagnosis and error.
  
  
  RESULTS
  Software was developed to produce visualizations of the diagnostic track followed by pathologists as they viewed virtual slides. These showed the diagnostic path in four dimensions (x, y, time and zoom), areas studied for >1000 ms, and included pathologists' comments about the areas viewed. The system was used to study two trainee and two expert pathologists diagnosing 60 Barrett's oesophageal biopsy specimens. Comparisons of the diagnostic tracks showed the reason for errors. Forty-six cases had an expert consensus diagnosis. The trainees made errors in 21 and 15 cases, respectively, of which 11 and nine were clinically significant. Errors were made across the whole spectrum of diagnoses from negative to intramucosal carcinoma. Detailed examination of the tracks showed that in all errors there was incorrect interpretation of information; in three errors there was an additional failure to identify diagnostic features.
  
  
  CONCLUSIONS
  Tracking with virtual slides is a useful tool in studying diagnosis and error, which has the potential for use in training and assessment.
authors.affiliation: Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK. darrentreanor@nhs.net
authors.forename: Darren
authors.initials: D
authors.lastname: Treanor
authors.forename: Chee Hooi
authors.initials: CH
authors.lastname: Lim
authors.forename: Derek
authors.initials: D
authors.lastname: Magee
authors.forename: Andy
authors.initials: A
authors.lastname: Bulpitt
authors.forename: Phil
authors.initials: P
authors.lastname: Quirke
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology; D001706:Biopsy; D003951:Diagnostic Errors / Q000517:prevention & control*; D003952:Diagnostic Imaging / Q000295:instrumentation / Q000379:methods; D016591:Histocytological Preparation Techniques / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D010338:Pathology, Clinical / Q000193:education / Q000295:instrumentation / Q000379:methods*; D012984:Software; D014584:User-Computer Interface