Laubrock Jochen, Krutz Alexander, Nübel Jonathan, Spethmann Sebastian
University of Potsdam, Cognitive Science, Department of Psychology, Potsdam, Germany.
Heart Centre Brandenburg, Department of Cardiology, Bernau, Germany.
J Med Imaging (Bellingham). 2023 Feb;10(Suppl 1):S11906. doi: 10.1117/1.JMI.10.S1.S11906. Epub 2023 Mar 22.
Echocardiography is the most important modality in cardiac imaging. Rapid valid visual assessment is a critical skill for image interpretation. However, it is unclear how skilled viewers assess echocardiographic images. Therefore, guidance and implicit advice are needed for learners to achieve valid image interpretation.
Using a signal detection approach, we compared 15 certified experts with 15 medical students in their diagnostic decision-making and viewing behavior. To quantify attention allocation, we recorded eye movements while viewing dynamic echocardiographic imaging loops of patients with reduced ejection fraction and healthy controls. Participants evaluated left ventricular ejection fraction and image quality (as diagnostic and visual control tasks, respectively).
Experts were much better at discriminating between patients and healthy controls ( of 2.58, versus 0.98 for novices). Eye tracking revealed that experts fixated diagnostically relevant areas earlier and more often, whereas novices were distracted by visually salient task-irrelevant stimuli. We show that expertise status can be almost perfectly classified either based on judgments or purely on eye movements and that an expertise score derived from viewing behavior predicts diagnostic quality.
Judgments and eye tracking revealed significant differences between echocardiography experts and novices that can be used to derive numerical expertise scores. Experts have implicitly learned to ignore the salient motion cue presented by the mitral valve and to focus on the diagnostically more relevant left ventricle. These findings have implications for echocardiography training, objective characterization of echocardiographic expertise, and the design of user-friendly interfaces for echocardiography.
超声心动图是心脏成像中最重要的方式。快速有效的视觉评估是图像解读的一项关键技能。然而，目前尚不清楚经验丰富的观察者如何评估超声心动图图像。因此，需要为学习者提供指导和隐性建议，以实现有效的图像解读。
我们采用信号检测方法，比较了15名认证专家和15名医学生在诊断决策和观察行为方面的差异。为了量化注意力分配，我们在观察射血分数降低患者和健康对照者的动态超声心动图成像循环时记录了眼动情况。参与者分别评估左心室射血分数和图像质量（作为诊断和视觉控制任务）。
专家在区分患者和健康对照方面表现得好得多（平均差值为2.58，新手为0.98）。眼动追踪显示，专家更早且更频繁地注视诊断相关区域，而新手则被视觉上突出的与任务无关的刺激分散了注意力。我们表明，专业水平状态几乎可以根据判断或仅根据眼动完美分类，并且从观察行为得出的专业水平分数可预测诊断质量。
判断和眼动追踪揭示了超声心动图专家和新手之间的显著差异，这些差异可用于得出数字专业水平分数。专家已经隐性地学会忽略二尖瓣呈现的突出运动线索，而专注于诊断上更相关的左心室。这些发现对超声心动图培训、超声心动图专业知识的客观表征以及超声心动图用户友好界面的设计具有重要意义。
