Digital Pathology_Accuracy Viewing Behavior and Image Characterization

描述(申请人提供)：每年约有140万女性依靠病理学家准确地解释乳腺活检以诊断良性疾病或癌症。诊断错误令人震惊地频繁，可能导致患者改变治疗，特别是在不典型增生和导管原位癌的临界点，高达50%的病例被错误分类。这些错误背后的原因在很大程度上仍不清楚。类似于谷歌地图的技术现在允许对玻璃显微镜幻灯片的高分辨率数字图像进行平移和缩放操作。这项技术实际上已经取代了医学院的显微镜，并正在迅速扩散到美国的病理学实践中。还没有研究评估病理学家对数字图像和玻片的解释的准确性和效率。然而，这些“数字幻灯片”提供了一个新的机会来研究大量病理学家在操纵和解释图像时的准确性、效率和观看行为。本申请中提出的创新分析技术类似于用于提高飞行员和空中交通管制员性能的技术。我们的具体目标是：目标1.数字图像与玻片：比较病理学家通过互联网查看数字化玻片图像的解释准确性与他们在显微镜下查看原始玻片的性能。一个随机的全国病理学家样本(N=200)将在两个阶段以一种或两种形式解释240个测试案例。措施将包括对每个测试用例和数字幻灯片、光标(即鼠标)跟踪数据和感兴趣区域(ROI)标记进行诊断评估。完成这一目标将为全幻灯片数字图像的相对诊断准确性确立基准。目的2.解释性筛查行为：确定与诊断准确性和效率相关的视觉扫描模式。另外60名病理学家将同时收集详细的眼睛跟踪和光标跟踪数据，同时他们将解读数字幻灯片，以补充Aim 1的数据。观看模式将从原始运动数据的计算机表示中分析。描述准确、高效的可视扫描和光标移动的视频将是教育下一代数字病理学家的宝贵工具。目标3.图像分析：对目标1和目标2中采集的感兴趣区域的图像特征(包括颜色、纹理和结构)进行检查和分类。将使用基于计算机的统计学习技术来识别导致正确和错误诊断的图像特征。将确定诊断ROI和分散注意力的ROI的特征，将所有三个目标联系起来。总而言之，我们将确定数字化的全幻灯片图像在诊断上是否等同于原始玻璃片。我们对病理学家确定的感兴趣区的观察模式和特征的深入科学评估将对理解诊断错误和分心来源至关重要。优化查看技术将提高诊断性能，从而提高临床护理的质量。

DESCRIPTION (provided by applicant): Approximately 1.4 million women per year depend on pathologists to accurately interpret breast biopsies for a diagnosis of benign disease or cancer. Diagnostic errors are alarmingly frequent and likely lead to altered patient treatment, especially at the thresholds of atypical hyperplasia and ductal carcinoma in situ, where up to 50% of cases are misclassified. The causes underlying these errors remain largely unknown. Technology similar to Google Maps now allows pan and zoom manipulation of high-resolution digital images of glass microscope slides. This technology has virtually replaced the microscope in medical schools and is rapidly diffusing into U.S. pathology practices. No research has evaluated the accuracy and efficiency of pathologists' interpretion of digital images vs. glass slides. However, these "digital slides" offer a novel opportunity to study the accuracy, efficiency, and viewing behavior of a large number of pathologists as they manipulate and interpret images. The innovative analytic techniques proposed in this application are similar to those used to improve the performance of pilots and air traffic controllers. Our specific aims are: Aim 1. Digital Image vs. Glass Slides: To compare the interpretive accuracy of pathologists viewing digitized slide images over the Internet to their performance viewing original glass slides under a microscope. A randomized national sample of pathologists (N=200) will interpret 240 test cases in one or both formats in two phases. Measures will include a diagnostic assessment for each test case and for digital slides, cursor- (i.e., mouse) tracking data and region of interest (ROI) markings. Completion of this aim will establish benchmarks for the comparative diagnostic accuracy of whole-slide digital images. Aim 2. Interpretive Screening Behavior: To identify visual scanning patterns associated with diagnostic accuracy and efficiency. Detailed simultaneous eye-tracking and cursor-tracking data will be collected on 60 additional pathologists while they interpret digital slides to complement data from Aim 1. Viewing patterns will be analyzed from computer representations of raw movement data. Videos depicting accurate, efficient visual scanning and cursor movement will be valuable tools in educating the next generation of digital pathologists. Aim 3. Image Analyses: To examine and classify the image characteristics (including color, texture, and structure) of ROIs captured in Aims 1 and 2. Computer-based statistical learning techniques will be used to identify image characteristics that lead to correct and incorrect diagnoses. Characteristics of both diagnostic and distracting ROIs will be identified, linking all three aims. In summary, we will determine whether digitized whole-slide images are diagnostically equivalent to original glass slides. Our in-depth scientific evaluation of viewing patterns and characteristics of ROIs identified by pathologists will be critical to understanding diagnostic errors and sources of distraction. Optimization of viewing techniques will improve diagnostic performance and thus, the quality of clinical care.