title: Eye movements as an index of pathologist visual expertise: a pilot study.
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.
authors.affiliation: Department of Psychology, Tufts University, Medford, Massachusetts, United States of America.
authors.forename: Tad T
authors.initials: TT
authors.lastname: Brunyé
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, United States of America.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Palo Alto, California, United States of America.
authors.forename: Kimberly H
authors.initials: KH
authors.lastname: Allison
authors.affiliation: Department of Computer Science and Engineering, University of Washington, Seattle, Washington, United States of America.
authors.forename: Linda G
authors.initials: LG
authors.lastname: Shapiro
authors.affiliation: Department of Pathology, University of Vermont and Vermont Cancer Center, Burlington, Vermont, United States of America.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Weaver
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington, United States of America.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D001706:Biopsy; D001940:Breast / Q000473:pathology*; D005133:Eye Movements; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D015233:Models, Statistical; D010338:Pathology, Clinical; D010820:Physicians
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