Ghezloo Fatemeh, Wang Pin-Chieh, Kerr Kathleen F, Brunyé Tad T, Drew Trafton, Chang Oliver H, Reisch Lisa M, Shapiro Linda G, Elmore Joann G
Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, USA.
Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
J Pathol Inform. 2022 May 21;13:100104. doi: 10.1016/j.jpi.2022.100104. eCollection 2022.
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.
尽管病理学家在诊断时有自己的观察习惯，但导致最准确诊断的观察行为却研究不足。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来分析病理学家对组织病理学特征的视觉解读。在本研究中，我们为基本观察行为变量提供了定义，并调查了病理学家的特征与观察行为之间的关联，以及在解读全切片图像时它们与诊断准确性的关系。我们使用了32位病理学家在解读一组36张数字全切片皮肤活检图像（共5组，每组36例；总计180例）时的操作记录。这些视口跟踪数据包括病理学家屏幕上视口场景的坐标、查看该视口时的放大倍数以及时间戳。我们定义了一组变量来量化病理学家的观察行为，如缩放、平移以及与共识参考面板选定的感兴趣区域（ROI）进行交互。我们使用交叉分类多级模型来研究这些观察行为与病理学家的人口统计学特征、临床特征以及诊断准确性之间的关联。观察行为因病理学家的临床经验而异。黑色素细胞皮肤活检病例量较高的病理学家以及具有皮肤病理学委员会认证和/或进修培训的病理学家，其平均缩放倍数较低且缩放水平的方差较小。与更高诊断准确性相关的观察行为包括更高的平均缩放倍数和缩放水平方差、更低的放大百分比（一种连续缩放行为的度量）、更长的总解读时间以及查看ROI所花费的更多时间。扫描行为，即固定缩放水平下的平移，与准确性有微弱的显著正相关。病理学家的培训、临床经验以及他们接触的病例范围与他们的观察行为相关，这可能有助于提高他们的诊断准确性。将数字成像和临床信息学相结合的计算病理学研究为在医学教育和培训中利用观察行为开辟了新途径，有可能改善患者护理和临床工作流程的有效性。
