An analysis of pathologists' viewing processes as they diagnose whole slide digital images.
An analysis of pathologists' viewing processes as they diagnose whole slide digital images.
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DOI：
10.1016/j.jpi.2022.100104
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发表时间：
2022
影响因子：
--
通讯作者：
Elmore, Joann G
中科院分区：
文献类型：
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作者：
Ghezloo, Fatemeh;Wang, Pin-Chieh;Kerr, Kathleen F;Brunye, Tad T;Drew, Trafton;Chang, Oliver H;Reisch, Lisa M;Shapiro, Linda G;Elmore, Joann G
虽然病理学家在诊断时有自己的观看习惯，但导致最准确诊断的观看行为尚未得到调查。数字全切片成像使研究人员能够使用鼠标和视口跟踪技术分析病理学家对组织病理学特征的视觉解释。在这项研究中，我们提供了基本的观察行为变量的定义，并研究了病理学家的特征和观察行为之间的关系，以及它们在解释整个幻灯片图像时与诊断准确性的关系。我们使用32名病理学家的动作记录，同时解释一组36张数字整片皮肤活检图像（5组36例，共180例）。这些视口跟踪数据包括病理学家屏幕上的视口场景的坐标，该视口被查看的放大级别，以及时间戳。我们定义了一组变量来量化病理学家的观察行为，如缩放、平移和与共识参考小组选择的感兴趣区域（ROI）的交互。我们使用交叉分类的多层模型来研究这些观看行为与病理学家的人口统计学、临床特征和诊断准确性之间的关系。视诊行为因病理学家的临床经验而异。具有较高黑色素细胞皮肤活检病例负荷的病理学家和具有委员会认证和/或皮肤病理学研究培训的病理学家具有较低的平均变焦和较低的变焦水平方差。与更高的诊断准确性相关的观看行为包括更高的变焦水平的平均值和方差，更低的放大百分比（连续变焦行为的度量），更高的总解释时间，以及更高的观看roi的时间。扫描行为，指的是固定缩放水平的平移，与精度有边际显著的正相关。病理学家的训练、临床经验和他们接触的一系列病例与他们的观察行为有关，这可能有助于他们诊断的准确性。结合数字成像和临床信息学的计算病理学研究为利用医学教育和培训中的观看行为开辟了新的途径，有可能改善患者护理和临床工作流程的有效性。
Although pathologists have their own viewing habits while diagnosing, viewing behaviors leading to the most accurate diagnoses are under-investigated. Digital whole slide imaging has enabled investigators to analyze pathologists’ visual interpretation of histopathological features using mouse and viewport tracking techniques. In this study, we provide definitions for basic viewing behavior variables and investigate the association of pathologists' characteristics and viewing behaviors, and how they relate to diagnostic accuracy when interpreting whole slide images. We use recordings of 32 pathologists’ actions while interpreting a set of 36 digital whole slide skin biopsy images (5 sets of 36 cases; 180 cases total). These viewport tracking data include the coordinates of a viewport scene on pathologists’ screens, the magnification level at which that viewport was viewed, as well as a timestamp. We define a set of variables to quantify pathologists' viewing behaviors such as zooming, panning, and interacting with a consensus reference panel’s selected region of interest (ROI). We examine the association of these viewing behaviors with pathologists’ demographics, clinical characteristics, and diagnostic accuracy using cross-classified multilevel models. Viewing behaviors differ based on clinical experience of the pathologists. Pathologists with a higher caseload of melanocytic skin biopsy cases and pathologists with board certification and/or fellowship training in dermatopathology have lower average zoom and lower variance of zoom levels. Viewing behaviors associated with higher diagnostic accuracy include higher average and variance of zoom levels, a lower magnification percentage (a measure of consecutive zooming behavior), higher total interpretation time, and higher amount of time spent viewing ROIs. Scanning behavior, which refers to panning with a fixed zoom level, has marginally significant positive association with accuracy. Pathologists’ training, clinical experience, and their exposure to a range of cases are associated with their viewing behaviors, which may contribute to their diagnostic accuracy. Research in computational pathology integrating digital imaging and clinical informatics opens up new avenues for leveraging viewing behaviors in medical education and training, potentially improving patient care and the effectiveness of clinical workflow.