title: Looking towards objective quality evaluation in colonoscopy: Analysis of visual gaze patterns.
abstract: OBJECTIVE
  There are currently limited training and assessment tools available to novice endoscopists. A potential tool for the objective assessment of endoscopist visual search strategy is eye-tracking technology. The aim of this study is to assess whether eye-tracking technology can be used to differentiate the visual gaze patterns (VGP) of experienced and novice endoscopists, and to characterize any differences arising between the two groups.
  
  
  METHODS
  With the use of portable eye-tracking glasses, VGP of novice (n = 20) and experienced (n = 14) endoscopists were compared while viewing a colonoscopy withdrawal through the hepatic flexure. Analysis was performed by comparing the central versus peripheral distribution and the horizontal distribution of novice and experienced endoscopist fixations, along with comparison of basic eye-tracking metrics.
  
  
  RESULTS
  This study found that experienced endoscopists had a significantly higher percentage of fixations within the periphery of the screen (13.4% vs 23.0%, P = 0.013). Experienced endoscopists also had a significantly greater percentage of fixations on the left side of the screen (18.6% vs 33.5%, P = 0.005) that displayed the poorly visualized "inside bend" of the hepatic flexure.
  
  
  CONCLUSIONS
  This study has detailed specific VGP acquired through expertise, which can potentially explain why adenomas are regularly missed at the hepatic flexure during colonoscopy. These may be useful for the training of novice colonoscopists, and further validation may utilize VGP in the development of an objective proficiency based curriculum to improve the detection of pathology and overall quality in endoscopy.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Edmondson
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.
authors.forename: Philip H
authors.initials: PH
authors.lastname: Pucher
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.|Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
authors.forename: Kumuthan
authors.initials: K
authors.lastname: Sriskandarajah
authors.affiliation: Department of Gastroenterology, St. Mary's Hospital, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hoare
authors.affiliation: Department of Gastroenterology, St. Mary's Hospital, London, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Teare
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.|Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.|Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.affiliation: Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.|Hamlyn Centre for Robotic Surgery, Imperial College London, London, UK.
authors.forename: Mikael H
authors.initials: MH
authors.lastname: Sodergren
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000473:pathology; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000473:pathology; D003113:Colonoscopy / Q000193:education* / Q000379:methods*; D003479:Curriculum; D006801:Humans; D011361:Professional Competence; D011785:Quality Assurance, Health Care
keywords: colonoscopy; endoscopy; eye tracking