title: Exploring the Relationship Between Eye Movements and Electrocardiogram Interpretation Accuracy.
abstract: Interpretation of electrocardiograms (ECGs) is a complex task involving visual inspection. This paper aims to improve understanding of how practitioners perceive ECGs, and determine whether visual behaviour can indicate differences in interpretation accuracy. A group of healthcare practitioners (n = 31) who interpret ECGs as part of their clinical role were shown 11 commonly encountered ECGs on a computer screen. The participants' eye movement data were recorded as they viewed the ECGs and attempted interpretation. The Jensen-Shannon distance was computed for the distance between two Markov chains, constructed from the transition matrices (visual shifts from and to ECG leads) of the correct and incorrect interpretation groups for each ECG. A permutation test was then used to compare this distance against 10,000 randomly shuffled groups made up of the same participants. The results demonstrated a statistically significant (α  0.05) result in 5 of the 11 stimuli demonstrating that the gaze shift between the ECG leads is different between the groups making correct and incorrect interpretations and therefore a factor in interpretation accuracy. The results shed further light on the relationship between visual behaviour and ECG interpretation accuracy, providing information that can be used to improve both human and automated interpretation approaches.
authors.affiliation: Department of Computer Science, University of Manchester, Manchester, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Davies
authors.affiliation: Department of Computer Science, University of Manchester, Manchester, United Kingdom.
authors.forename: Gavin
authors.initials: G
authors.lastname: Brown
authors.affiliation: Department of Computer Science, University of Manchester, Manchester, United Kingdom.
authors.forename: Markel
authors.initials: M
authors.lastname: Vigo
authors.affiliation: Department of Computer Science, University of Manchester, Manchester, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Harper
authors.affiliation: Department of Medicine, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Horseman
authors.affiliation: Department of Library and Information Science, University of Barcelona, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: Splendiani
authors.affiliation: Department of Surgery, Washington University, Saint Louis, United States.
authors.forename: Elspeth
authors.initials: E
authors.lastname: Hill
authors.affiliation: Department of Computer Science, University of Manchester, Manchester, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Jay
mesh_terms: D000328:Adult; D004562:Electrocardiography; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D010364:Pattern Recognition, Visual / Q000502:physiology*