Eye Tracking in Digital Pathology: A Comprehensive Literature Review

Overview

Journal J Pathol Inform

Specialty Medical Informatics

Date 2024 Jun 13

PMID 38868488

Authors

Alana Lopes

Aaron D Ward

Matthew Cecchini

Affiliations

Soon will be listed here.

Abstract

Eye tracking has been used for decades in attempt to understand the cognitive processes of individuals. From memory access to problem-solving to decision-making, such insight has the potential to improve workflows and the education of students to become experts in relevant fields. Until recently, the traditional use of microscopes in pathology made eye tracking exceptionally difficult. However, the digital revolution of pathology from conventional microscopes to digital whole slide images allows for new research to be conducted and information to be learned with regards to pathologist visual search patterns and learning experiences. This has the promise to make pathology education more efficient and engaging, ultimately creating stronger and more proficient generations of pathologists to come. The goal of this review on eye tracking in pathology is to characterize and compare the visual search patterns of pathologists. The PubMed and Web of Science databases were searched using 'pathology' AND 'eye tracking' synonyms. A total of 22 relevant full-text articles published up to and including 2023 were identified and included in this review. Thematic analysis was conducted to organize each study into one or more of the 10 themes identified to characterize the visual search patterns of pathologists: (1) effect of experience, (2) fixations, (3) zooming, (4) panning, (5) saccades, (6) pupil diameter, (7) interpretation time, (8) strategies, (9) machine learning, and (10) education. Expert pathologists were found to have higher diagnostic accuracy, fewer fixations, and shorter interpretation times than pathologists with less experience. Further, literature on eye tracking in pathology indicates that there are several visual strategies for diagnostic interpretation of digital pathology images, but no evidence of a superior strategy exists. The educational implications of eye tracking in pathology have also been explored but the effect of teaching novices how to search as an expert remains unclear. In this article, the main challenges and prospects of eye tracking in pathology are briefly discussed along with their implications to the field.

References

Jaarsma T, Jarodzka H, Nap M, van Merrienboer J, Boshuizen H . Expertise under the microscope: processing histopathological slides. Med Educ. 2014; 48(3):292-300. DOI: 10.1111/medu.12385. View

Hansen D, Ji Q . In the eye of the beholder: a survey of models for eyes and gaze. IEEE Trans Pattern Anal Mach Intell. 2010; 32(3):478-500. DOI: 10.1109/TPAMI.2009.30. View

Kahneman D, Beatty J . Pupil diameter and load on memory. Science. 1966; 154(3756):1583-5. DOI: 10.1126/science.154.3756.1583. View

Kok E, Jarodzka H . Before your very eyes: the value and limitations of eye tracking in medical education. Med Educ. 2016; 51(1):114-122. DOI: 10.1111/medu.13066. View

Brunye T, Balla A, Drew T, Elmore J, Kerr K, Shucard H . From Image to Diagnosis: Characterizing Sources of Error in Histopathologic Interpretation. Mod Pathol. 2023; 36(7):100162. PMC: 11386950. DOI: 10.1016/j.modpat.2023.100162. View

Brunye T, Mercan E, Weaver D, Elmore J . Accuracy is in the eyes of the pathologist: The visual interpretive process and diagnostic accuracy with digital whole slide images. J Biomed Inform. 2017; 66:171-179. PMC: 5316368. DOI: 10.1016/j.jbi.2017.01.004. View

Brams S, Ziv G, Hooge I, Levin O, De Brouwere T, Verschakelen J . Focal lung pathology detection in radiology: Is there an effect of experience on visual search behavior?. Atten Percept Psychophys. 2020; 82(6):2837-2850. DOI: 10.3758/s13414-020-02033-y. View

Malon C, Brachtel E, Cosatto E, Graf H, Kurata A, Kuroda M . Mitotic figure recognition: agreement among pathologists and computerized detector. Anal Cell Pathol (Amst). 2011; 35(2):97-100. PMC: 4605539. DOI: 10.3233/ACP-2011-0029. View

Carmody D, NODINE C, KUNDEL H . An analysis of perceptual and cognitive factors in radiographic interpretation. Perception. 1980; 9(3):339-44. DOI: 10.1068/p090339. View

10.

Oestmann J, Greene R, Kushner D, Bourgouin P, Linetsky L, Llewellyn H . Lung lesions: correlation between viewing time and detection. Radiology. 1988; 166(2):451-3. DOI: 10.1148/radiology.166.2.3336720. View

11.

Mariam K, Afzal O, Hussain W, Javed M, Kiyani A, Rajpoot N . On Smart Gaze Based Annotation of Histopathology Images for Training of Deep Convolutional Neural Networks. IEEE J Biomed Health Inform. 2022; 26(7):3025-3036. DOI: 10.1109/JBHI.2022.3148944. View

12.

Cree I, Tan P, Travis W, Wesseling P, Yagi Y, White V . Counting mitoses: SI(ze) matters!. Mod Pathol. 2021; 34(9):1651-1657. PMC: 8376633. DOI: 10.1038/s41379-021-00825-7. View

13.

Raghunath V, Braxton M, Gagnon S, Brunye T, Allison K, Reisch L . Mouse cursor movement and eye tracking data as an indicator of pathologists' attention when viewing digital whole slide images. J Pathol Inform. 2013; 3:43. PMC: 3551530. DOI: 10.4103/2153-3539.104905. View

14.

Sudin E, Searjeant M, Partridge G, Phillips P, Hiller L, Snead D . Digital pathology: the effect of experience on visual search behavior. J Med Imaging (Bellingham). 2022; 9(3):035501. PMC: 9082631. DOI: 10.1117/1.JMI.9.3.035501. View

15.

Brunye T, Drew T, Kerr K, Shucard H, Weaver D, Elmore J . Eye tracking reveals expertise-related differences in the time-course of medical image inspection and diagnosis. J Med Imaging (Bellingham). 2023; 7(5):051203. PMC: 10355124. DOI: 10.1117/1.JMI.7.5.051203. View

16.

Drew T, Vo M, Olwal A, Jacobson F, Seltzer S, Wolfe J . Scanners and drillers: characterizing expert visual search through volumetric images. J Vis. 2013; 13(10). PMC: 3736761. DOI: 10.1167/13.10.3. View

17.

Caputo A, LImperio V, Merolla F, Girolami I, Leoni E, Della Mea V . The slow-paced digital evolution of pathology: lights and shadows from a multifaceted board. Pathologica. 2023; 115(3):127-136. PMC: 10462988. DOI: 10.32074/1591-951X-868. View

18.

Chong Y, Kim D, Jung C, Kim D, Song S, Joo H . Recommendations for pathologic practice using digital pathology: consensus report of the Korean Society of Pathologists. J Pathol Transl Med. 2020; 54(6):437-452. PMC: 7674756. DOI: 10.4132/jptm.2020.08.27. View

19.

van der Wel P, van Steenbergen H . Pupil dilation as an index of effort in cognitive control tasks: A review. Psychon Bull Rev. 2018; 25(6):2005-2015. PMC: 6267528. DOI: 10.3758/s13423-018-1432-y. View

20.

Eivazi S, Hafez A, Fuhl W, Afkari H, Kasneci E, Lehecka M . Optimal eye movement strategies: a comparison of neurosurgeons gaze patterns when using a surgical microscope. Acta Neurochir (Wien). 2017; 159(6):959-966. DOI: 10.1007/s00701-017-3185-1. View