pyramid tent features

Spivey, M. J., & Tanenhaus, M. K

Spivey, M. J., & Tanenhaus, M. K. (1998). Cain, M. S., & Mitroff, S. R. (2013).

As described in Kundel and colleagues model, expert diagnosticians are likely to detect cancer on a mammogram before any visual scanning (search) takes place, referred to a an initial holistic, gestalt-like perception of a medical image (Kundel et al., 2008). We have focused primarily on competency development through education and training, and performance differences between novices and experts. It is worth noting that eye trackers with high temporal and spatial resolution and coverage range (e.g., across large or multiple displays) can still be quite cost prohibitive. fixation visual study frontiersin stimuli tracking viewing adults half eye patterns face during

This is typically considered a major downfall of eye tracking: that many real-world visual tasks likely involve both covert and overt visual attention, though eye tracking can only measure the latter. In J. W. Senders, D. F. Fisher, & R. A. Monty (Eds. Indeed, many medical images are becoming more complex and dynamic; for example, interpreting live and replayed coronary angiograms, simulated dynamic patients during training, or navigating multiple layers of volumetric chest x-rays (Drew, V, & Wolfe, 2013; Rubin, 2015). Lecture Notes in Computer Science, 8077, 3748. In Proceedings of the SIGCHI Conference on Human factors in Computing SystemsCHI 05, (pp. https://doi.org/10.1016/j.biopsycho.2016.10.002. Saccadic eye movements and cognition. Balslev, T., Jarodzka, H., Holmqvist, K., De Grave, W., Muijtjens, A. M. M., Eika, B., Scherpbier, A. J. J. Thus, in both search and decision-making there appear to be critical roles for working-memory capacity in predicting clinician performance. Cognitive, Affective, & Behavioral Neuroscience, 10(2), 252269. A taxonomy for far transfer. Velichkovsky, B. M. (1995). https://doi.org/10.1080/0142159X.2017.1391373. Simon, H. A. Jungk, A., Thull, B., Hoeft, A., & Rau, G. (2000). https://doi.org/10.1016/j.learninstruc.2012.11.004. Studies of eye movements and visual search in radiology.

Perspectives on Psychological Science, 7(1), 1827. Specifically, when an observer is searching for multiple features (targets), if they identify one feature they may maintain that feature in working memory while searching for another feature.

Tien, T., Pucher, P. H., Sodergren, M. H., Sriskandarajah, K., Yang, G. Z., & Darzi, A. Cognitive Psychology, 30, 3978. Finally, latency measures allow for an assessment of the temporal dynamics of fixations and saccades, including first and subsequent fixation durations and saccade duration.

Dynamic decision making: human control of complex systems. Viewing expert or novice eye movements improved a novices ability to locate pulmonary nodules relative to a free search, as long as the depicted eye movements showed a successful nodule search. Context bias: a problem in diagnostic radiology. https://doi.org/10.4324/9781315727080. PubMed For instance, because experts tend to move their eyes and navigate visual images differently than novices, viewing expert eye movements and patterns of navigation behavior may help observers develop more efficient search strategies. eeg basics tracking eye waves brain iom ionm study linked neural understand connection picower better between gaze intelligence Annual Review of Neuroscience, 28, 403450. In The nature of expertise, (pp. This possibility has not yet been examined in the context of medical image interpretation and diagnosis, and it is unclear how working-memory capacity might influence clinician eye movements, though it is an exciting direction for future research. Providers do not verify patient identity during computer order entry. Cognitive Research: Principles and Implications, 3, 38. Google Scholar. 269293). Eye tracking also carries value for understanding longitudinal aspects of competency progression in medical education. This active maintenance of previously detected features may deplete working memory resources that could otherwise be used to search for lower-salience and prevalence targets. Boston: Butterworths. Clarifying students feedback-seeking behaviour in clinical clerkships. The influence of cognitive load and amount of stimuli on entropy through eye tracking measures. https://doi.org/10.1016/j.ijpsycho.2017.07.008.

London: Cambridge University Press.

https://doi.org/10.1523/JNEUROSCI.0582-14.2014.

Expertise in a complex skill: diagnosing x-ray pictures. Another persons eye gaze as a cue in solving programming problems. About 25% of errors were due to a recognition failure, and the remaining 45% of errors were due to decision failure. Accessed 1 Feb 2019.

https://doi.org/10.1371/journal.pone.0103447.

Aston-Jones, G., & Cohen, J. D. (2005). Roads, B. D., Xu, B., Robinson, J. K., & Tanaka, J. W. (2018). Recognition is an example of attentional mechanisms working together to dynamically guide attention toward features that may be of diagnostic relevance and mapping them to stored knowledge.

https://doi.org/10.3109/0142159X.2015.1017448. Furthermore, second opinions can also induce diagnostic disagreements among expert clinicians and necessitate time and expense for resolving disagreement and reaching a consensus diagnosis. Medical Education, 47, 282291. Over the past four decades since this original research, eye tracking has been expanded to understanding diagnostic interpretation in several medical specializations, including radiology, breast pathology, general surgery, neurology, emergency medicine, anesthesiology, ophthalmology, and cardiology (Balslev et al., 2012; Berbaum et al., 2001; Bruny et al., 2014; Giovinco et al., 2015; Henneman et al., 2008; Jungk, Thull, Hoeft, & Rau, 2000; Krupinski et al., 2006; Kundel, Nodine, Krupinski, & Mello-Thoms, 2008; Matsumoto et al., 2011; ONeill et al., 2011; Sibbald, de Bruin, Yu, & van Merrienboer, 2015; Wood, Batt, Appelboam, Harris, & Wilson, 2014). Eye tracking has the potential to revolutionize clinical practice and medical education, with far-reaching implications for the development of automated competency assessments (Bond et al., 2014; Krupinski, Graham, & Weinstein, 2013; Richstone et al., 2010; Tien et al., 2014), advanced clinical tutorials (e.g., watching an experts eye movements over an image; (Khan et al., 2012; OMeara et al., 2015)), biologically inspired artificial intelligence to enhance computer-aided diagnosis (Buettner, 2013; Young & Stark, 1963), and the automated detection and mitigation of emergent interpretive errors during the diagnostic process (Ratwani & Trafton, 2011; Tourassi, Mazurowski, Harrawood, & Krupinski, 2010; Voisin, Pinto, Morin-Ducote, Hudson, & Tourassi, 2013). Kieras, D. E., & Bovair, S. (1984). Inhibition of return to successively stimulated locations in a sequential visual search paradigm.

Diagnostic pathology: breast, (2nd ed., ). In P. Robbins, & M. Aydede (Eds. Analysis of mental workload during en-route air traffic control task execution based on eye-tracking technique. Many programs, however, have struggled to create meaningful, relevant, and repeatable outcome-based assessments for use in graduate medical education, residency, and fellowships (Holmboe, Edgar, & Hamstra, 2016). https://doi.org/10.1037/a0020082. (1990).

Nature, 435, 439. https://doi.org/10.1038/435439a. Sox, H. C., Blatt, M. A., Higgins, M. C., & Marton, K. I. Localization of diagnostically relevant regions of interest in whole slide images: a comparative study. Human Pathology, 44, 357364. Gur, D., Sumkin, J. H., Rockette, H. E., Ganott, M., Hakim, C., Hardesty, L., Wallace, L. (2004). (2008). The invisible gorilla strikes again: sustained inattentional blindness in expert observers. Human Pathology, 37(12), 15431556. In most research to date, eye gaze has been used to provide immediate feedback and guidance for a novice during the active exploration of a visual stimulus. https://doi.org/10.1016/j.acra.2008.01.023. If the clinician has confirmed a hypothesis, the search may terminate; search may continue if the clinician identifies potential support for multiple hypotheses (e.g., diagnoses with overlapping features) and must continue in the service of differential diagnosis. For instance, a breast pathologist examining histological features may categorize a case as benign, atypia, ductal (DCIS) or lobular carcinoma in situ, or invasive carcinoma (Lester & Hicks, 2016). Mechanism of satisfaction of search: eye position recordings in the reading of chest radiographs. In medical domains involving visual image inspection, the viewed action is the sequence of an expert clinicians fixations and saccades over the medical image, along with their verbal narration. Visual search patterns and experience with radiological images. Eye tracker data quality: what it is and how to measure it. Berbaum, K. S., Brandser, E. A., Franken, E. A., Dorfman, D. D., Caldwell, R. T., & Krupinski, E. A. Drew, T., V, M. L. H., & Wolfe, J. M. (2013).

Correspondence to A. London: Psychology Press. Hypothesis generation, probability judgment, and individual differences in working memory capacity. For example, Kundel and Nodine used a 600-ms threshold, and Mello-Thoms and colleagues used a 1000-ms threshold; fixation durations shorter than the threshold indicated failed recognition, whereas durations lengthier than the threshold indicated successful recognition (Kundel & Nodine, 1978; Mello-Thoms et al., 2005). Manion, E., Cohen, M. B., & Weydert, J. An integrative theory of locus coeruleus-norepinephrine function: adaptive gain and optimal performance. https://doi.org/10.1080/01421590220120713. Radiographics, 7, 12411250. Table1 provides an overview of commonly used eye-tracking measures, and current theoretical perspectives on their relationships to perceptual and cognitive processing. Lobmaier, J. S., Fischer, M. H., & Schwaninger, A. Ashraf, H., Sodergren, M. H., Merali, N., Mylonas, G., Singh, H., & Darzi, A. Thus, the premise is that educators can use eye tracking to demonstrate, train, and assess gaze patterns during medical education, possibly accelerating the transition from novice to expert.

In G. Underwood (Ed. Chetwood, A. S. A., Kwok, K. W., Sun, L. W., Mylonas, G. P., Clark, J., Darzi, A., & Yang, G. Z.

Assessing computerized eye tracking technology for gaining insight into expert interpretation of the 12-lead electrocardiogram: an objective quantitative approach. In this manner, the task demands working-memory storage (to memorize the words) while also processing distracting arithmetic problems. International Journal of Industrial Ergonomics, 35, 112. Pupil diameter is constantly changing as a function of both contextual lighting conditions and internal cognitive states. Here we consider one individual difference that warrants more consideration in the domains of medical image interpretation and decision-making: working-memory capacity. The impact of speed and bias on the cognitive processes of experts and novices in medical image decision-making. In other words, while previous research assumes that lengthy fixation durations indicate successful recognition, they can also indicate the perceptual uncertainty preceding incorrect recognition. Oxford: Oxford University Press.

SensoMotoric Instruments Remote Eye-tracking Device mobile. (2006). A real-time eye tracking system for predicting and preventing postcompletion errors. In other words, their eye movements increasingly resemble those of experts as they progress through training. A follow-up study confirmed that fixations over 300 ms did not improve recognition, but did improve decision accuracy; furthermore, fixations within 2 of the nodule were associated with higher recognition accuracy (Carmody, Nodine, & Kundel, 1980). Covert shifts of attention function as an implicit aid to insight. However, more recent research has demonstrated that microsaccades reflect shifts in covert attention (Meyberg, Werkle-Bergner, Sommer, & Dimigen, 2015; Yuval-Greenberg, Merriam, & Heeger, 2014). Learning and Instruction, 25, 6270. 2537). Medical Education, 35, 520521. The content is solely the responsibility of the authors and does not necessarily represent the views of the National Cancer Institute or the National Institutes of Health. https://doi.org/10.1016/S0001-6918(03)00033-7. https://doi.org/10.1177/1541931213601289. (2010). Rubin, G. D. (2015).

Searching in the dark: cognitive relevance drives attention in real-world scenes. While decision-related errors may not be readily detected in existing eye-tracking metrics, some recent research suggests that relatively disorganized movements of the eyes over a visual image may indicate higher workload, decision uncertainty, and a higher likelihood of errors (Bruny, Haga, Houck, & Taylor, 2017; Fabio et al., 2015). Why should machines learn?

Manage cookies/Do not sell my data we use in the preference centre. Manning, D., Ethell, S., Donovan, T., & Crawford, T. (2006). Indeed, a lack of effective assessment methods and tools is noted as a primary challenge for implementing the Milestones initiative in internal medicine education (Holmboe, Call, & Ficalora, 2016; Holmboe, Edgar, & Hamstra, 2016). In the control condition, there was expert narration during video playback. In a recent taxonomy of visual search errors, Cain and colleagues demonstrated that working memory resources are an important source of errors (Cain et al., 2013). Their results demonstrated that about 30% of all errors were due to a failed search. Kundel, H. L., & La Follette, P. S. (1972). While eye tracking provides valuable insights into the distribution of visual attention over a scene, it is important to realize that eye trackers are restricted to monitoring foveal vision. Transfer describes the ability to apply knowledge, skills and abilities to novel contexts and tasks that have not been previously experienced (Bransford, Brown, & Cocking, 2000). The impact of expert visual guidance on trainee visual search strategy, visual attention and motor skills. On the other hand, this approach could introduce bias in the second physician and unintentionally increase agreement; if the first physician arrived at an incorrect interpretation, such agreement could be detrimental, demonstrating the importance of continuing research in this regard (Gandomkar, Tay, Brennan, Kozuch, & Mello-Thoms, 2018). Visual Cognition, 21, 899921.

Varying target prevalence reveals two dissociable decision criteria in visual search. It is unknown whether this refined knowledge would subsequently enable successful transfer to cases with structures and features at least partially overlapping with the learned case, suggesting an avenue for future research. Satisfaction of search in chest radiography 2015. In each of these cases, methods were evaluated and implemented for integrating CBME, including new standards for curriculum, teaching, and assessment. This may be especially the case when diagnostic features can only be perceived at high-power magnification levels, rendering the remainder of the image immediately imperceptible and making it necessary to zoom out to consider other regions. Journal of Electrocardiology, 47, 895906. Bordage, G. (1999).

Research with neurologists and pathologists has demonstrated that novice diagnosticians, such as medical residents, tend to detect features with high visual salience sooner and more often than experienced diagnosticians; this focus on highly salient visual features can be at the cost of neglecting the detection of critical features with relatively low visual salience (Bruny et al., 2014; Matsumoto et al., 2011). Second opinion in breast pathology: policy, practice and perception.

Attention guidance during example study via the models eye movements. Bruny, T. T., & Gardony, A. L. (2017). Krupinski, E. A., Berbaum, K. S., Schartz, K. M., Caldwell, R. T., & Madsen, M. T. (2017). Similar strategies might be applied to peer cohorts or medical students and residents, allowing them to learn from each others search patterns and successes and failures. The authors suggest that detecting a target during search may not induce search termination, but rather change response thresholds during a multiple-target search. Journal of Digital Imaging.

(1999). 289300). https://doi.org/10.1037/0033-2909.124.3.372.

Yu, B., Ma, W.-Y., Nahrstedt, K., & Zhang, H.-J. Becchio, C., Sartori, L., Bulgheroni, M., & Castiello, U. Eye-movement modeling examples typically involve not only showing a video of expert eye movements, but also the experts audio narrative of the interpretive process (Jarodzka, Van Gog, Dorr, Scheiter, & Gerjets, 2013; van Gog, Jarodzka, Scheiter, Gerjets, & Paas, 2009). https://doi.org/10.1016/j.acra.2005.03.068. Findlay, J. M., & Gilchrist, I. D. (2008). The risk is that after finding a single target a diagnostician may terminate search prematurely and fail to detect a target with higher value for a correct diagnosis. Montagnini, A., & Chelazzi, L. (2005). ), Eye movements and the higher psychological processes, (pp.

But there are few methods for providing feedback regarding the dynamic interpretive process; for instance, how a microscope was panned and zoomed, which features were inspected, and precisely where in the process difficulties may have arisen (Bok et al., 2013; 2016; Kogan, Conforti, Bernabeo, Iobst, & Holmboe, 2011; Wald, Davis, Reis, Monroe, & Borkan, 2009). PRISMS: new educational strategies for medical education. Most existing research in this regard leverages the well-established finding that experts move their eyes differently from novices (Bruny et al., 2014; Gegenfurtner, Lehtinen, & Slj, 2011; Krupinski, 2005; Krupinski et al., 2006; Kundel et al., 2008; Lesgold et al., 1988). (1983).

Thus, it remains possible that some of a diagnosticians interpretive process may occur through peripheral vision (parafoveal vision), limiting our interpretation of eye-tracking patterns made during medical image inspection. This method could be used to understand the spatial allocation of attention over a digital image (e.g., a radiograph, histology slide, angiography), and the time-course of that allocation. As evidence for relatively implicit attention guidance, novice lung x-ray interpretation can improve when they receive implicit cueing based on an experts eye movements (Ball & Litchfield, 2017). Nature Reviews Neuroscience, 9(6), 467479. Journal of Vision, 8, 15. https://doi.org/10.1167/8.15.15.

Why verifying diagnostic decisions with a checklist can help: insights from eye tracking. Consistent with this line of thinking, Manning and colleagues found that false-positives when examining chest radiographs were typically associated with longer cumulative dwell time than true-positives (Manning et al., 2006).

Simpson, J. G., Furnace, J., Crosby, J., Cumming, A. D., Evans, P. A., Ben David, F., Macpherson, S. G. (2002). https://doi.org/10.1016/j.learninstruc.2009.02.019. Vision Research, 45, 33913401. When and where do we apply what we learn? https://doi.org/10.1109/TPAMI.2009.30.

Eye metrics as an objective assessment of surgical skill. Psychophysiology, 45(5), 679687. Carmody, D. P., Nodine, C. F., & Kundel, H. L. (1980). (2011). A search error would be evidenced by a failure to fixate on a nodule, and a recognition or decision error would occur when a fixation on a nodule is not followed by a successful identification and diagnosis. https://doi.org/10.1118/1.3501882. https://doi.org/10.1145/957013.957095. Eye-tracking research has shed light on the dynamics of this interpretive process, including qualitative and quantitative differences that help distinguish and possibly predict successes and errors.

https://doi.org/10.1007/978-3-662-12405-5_2. In this study, a participating pathologist is inspecting a digital breast biopsy (Bruny, Mercan, et al., 2017).

The earliest research examining eye tracking for feedback in medicine leveraged the concept of perceptual feedback, which involves showing an observer the regions they tended to focus on during an image interpretation (Kundel, Nodine, & Krupinski, 1990). Baltimore: Johns Hopkins University Press.

Human stopping strategies in multiple-target search.

(2018). https://doi.org/10.1037/0278-7393.24.6.1521. Once these ROIs are established and known to the eye-tracking system, fixations can be parsed as falling within or outside of ROIs. Both your intention and mine are reflected in the kinematics of my reach-to-grasp movement. Mandatory second opinion surgical pathology at a large referral hospital. Hong, S. K. (2005). Trueblood, J. S., Holmes, W. R., Seegmiller, A. C., Douds, J., Compton, M., Szentirmai, E., Eichbaum, Q. https://doi.org/10.1207/s15327043hup1002_1. Transfer can be relatively near-transfer versus far-transfer (Barnett & Ceci, 2002), and is considered a critical trademark of successful learning (Simon, 1983). Differences in eye tracking and gaze patterns between trainees and experts reading plain film bunion radiographs. Medical Physics, 40, 101906. https://doi.org/10.1118/1.4820536. A passing glance? Leveraging the concept of using ones own eye movements as a feedback tool, one recent study suggests that eye tracking may be especially valuable for clinical feedback with emergency medicine residents (Szulewski et al., 2018). The main function of examining a visual image and recognizing features is to develop and test diagnostic hypotheses (Sox, Blatt, Higgins, & Marton, 1988). et al. Accuracy is in the eyes of the pathologist: the visual interpretive process and diagnostic accuracy with digital whole slide images. For example, a malignant tumor appearing in a screening mammography examination has a very low prevalence rate at or below 1% of all cases reviewed (Gur et al., 2004).

Reflecting on reflections: enhancement of medical education curriculum with structured field notes and guided feedback. Barnett, S. M., & Ceci, S. J.

Opening the black box of clinical skills assessment via observation: a conceptual model. In diagnostic pathology, automated feedback may be possible by parsing medical images into diagnostically relevant versus irrelevant regions of interest (ROIs) using expert annotations and/or automated machine-vision techniques (Bruny et al., 2014; Mercan et al., 2016; Nagarkar et al., 2016). Kern, D. E., Thomas, P. A., & Hughes, M. T. (1998). PLoS One, 9(8). B. In A. Miyake, & P. Shah (Eds. Berbaum, K. S., Krupinski, E. A., Schartz, K. M., Caldwell, R. T., Madsen, M. T., Hur, S., Franken, E. A.

(1998). Leff, D. R., James, D. R. C., Orihuela-Espina, F., Kwok, K.-W., Sun, L. W., Mylonas, G., Yang, G.-Z. Bruny, T. T., Mercan, E., Weaver, D. L., & Elmore, J. G. (2017). Results demonstrated increased diagnostic performance of students after viewing the spotlight condition, suggesting that this specific condition was most effective at conveying expert visual search patterns. For instance, subtle visual cues, such as a momentary flash of light in a specific scene region, can selectively orient attention to that region for further inspection (Danziger, Kingstone, & Snyder, 1998). Computer-displayed eye position as a visual aid to pulmonary nodule interpretation. Can think aloud be used to teach and assess clinical reasoning in graduate medical education? Medical Teacher, 24, 136143. Giovinco, N. A., Sutton, S. M., Miller, J. D., Rankin, T. M., Gonzalez, G. W., Najafi, B., & Armstrong, D. G. (2015). Center for Applied Brain and Cognitive Sciences, Tufts University, 200 Boston Ave., Suite 3000, Medford, MA, 02155, USA, Department of Psychology, University of Utah, 380 1530 E, Salt Lake City, UT, 84112, USA, Department of Pathology and University of Vermont Cancer Center, University of Vermont, 111 Colchester Ave., Burlington, VT, 05401, USA, Department of Medicine, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 10833 Le Conte Ave., Los Angeles, CA, 90095, USA, You can also search for this author in ), Models of working memory: mechanisms of active maintenance and executive control, (pp.

https://doi.org/10.1016/j.chb.2009.02.007. TB conceived the review and prepared the manuscript, with critical revisions and feedback from authors JE, TD, and DW. V, M. L. H., Aizenman, A. M., & Wolfe, J. M. (2016). How visual search relates to visual diagnostic performance: a narrative systematic review of eye-tracking research in radiology. https://doi.org/10.3758/PBR.17.5.718.

https://doi.org/10.1145/1054972.1054993. Learning and Instruction, 20(2), 146154. Developing and testing hypotheses is a cyclical process that involves identifying features that allow the observer to select a set of candidate hypotheses, gathering data to test each hypothesis, and confirming or disconfirming a hypothesis. Some of the earliest research using eye tracking during medical image interpretation was done during x-ray film inspection (Kundel & Nodine, 1978). Academic Radiology, 24, 10581063. Matsumoto, H., Terao, Y., Yugeta, A., Fukuda, H., Emoto, M., Furubayashi, T., Ugawa, Y.

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Spivey, M. J., & Tanenhaus, M. K