The UK national screening program for breast cancer currently uses Full Field Digital Mammography (FFDM). Various studies have shown that DBT has a higher sensitivity and specificity in identifying early breast cancer apart from benign pathologies, even in very dense breasts. This potentially makes DBT a better screening modality to detect early breast cancer, as well as minimize false positive recall rates. However, DBT has multiple image slices and thereby makes reading cases inherently a longer and potentially more visually fatiguing task. Our previous studies (Dong et al, 2017 and 2018) have demonstrated the impact of institutional training on reading techniques in DBT. The reading technique itself appears to have an effect on total reading time. In other follow-on studies we have employed eye tracking which gives rise to complex data sets, including parameters such as eyelid opening and pupil diameter measures, which can then be employed to gauge blinks and fatigue onset. Findings from this work have guided changes in our blink identification techniques and we have now developed semi-automated programmed processes which can analyze the large data set and provide a more accurate assessment of fatigue and vigilance parameters through blink detection. Here, we have considered ‘eyelid opening’ parameters of both the left and the right eye separately. Having such a separated approach allowed us to tease out particular aspects of blinking. Similar to Schleicher et al (2008), we found there to be ultra-short blinks (30-50 milli seconds), short blinks (51- 100 msecs), long blinks (101-500 msecs) and also microsleeps (>500 msecs). We argue that the changes observed in the frequencies of these blinks can be used as a measure of vigilance and fatigue during DBT reading.
Currently in the UK, a national trial to test the effect of a transition from traditional Full Field Digital Mammography (FFDM) to Digital Breast Tomosynthesis (DBT) is being conducted. DBT, having a higher sensitivity and specificity as compared to FFDM alone, could be a better modality in national breast cancer screening. However, its incorporation in the incredibly busy and detailed UK screening program is difficult. Reading times in DBT have been shown to be longer and strenuous (Connor et al, 2012). Therefore, much research needs to be completed to develop recommendations for its efficiency. One key factor in DBT reading is the progression of fatigue, as both a cause and effect of prolonged reading times. We aimed to develop a program to process real time raw eye tracking data to identify a change in fatigue-state through blink detection. Our focus was on analysing the whole data set and defining blinks through observed events. Two real time signals which the eye tracker generates, namely the left and right ‘Eyelid Opening’ value, were considered. Through assessment of these signals, blinks of varying duration were identified. Additional parameters such as recorded frame sequences and time stamps were added to the processing to delineate the exact occurrence of these blinks during the reading process. We aim to analyse past and future large DBT eye tracked files, with our processing software, to identify the point of fatigue onset in a DBT reading session.
The National Health Service (NHS) in the United Kingdom (UK) is on the verge of transitioning into the use of digital pathology. Technological advancements such as whole slide imaging (WSI), whereby microscopy slides are scanned using a high throughput device to produce digital copies of the slides, has enabled such revolution possible. These digital images enable viewing using image viewer systems on computer monitors, hence making eye tracking studies feasible. The Digital Pathology trial has been set up to evaluate the use of virtual microscopy in the UK. As part of this trial, we conducted two pilot studies as our initial evaluation prior to larger scale studies. In this study, we present the initial findings from our latest pilot study which aims to characterise visual search patterns in pathologists of varying experience. This study was conducted with three pathologists at different stages of their careers, looking at core needle biopsy of breast specimens. We found that the more experienced pathologist had shorter reading duration and had lesser number of fixations consistent with our previous pilot study findings. However, this study did not reproduce any significant finding on magnification pattern. Further work would require a larger sample size to reach more certainty.
Pathology in the UK is on the verge of transformation from analogue to digital practice through the development of digital pathology (DP). Advances in technology has allowed for this change to occur through the use of high-throughput slide scanners to obtain whole histopathology glass slides onto computer workstations rather than the use of a conventional light microscope (LM). Previous studies have shown that the use of digital imaging to view histopathology slides has proven to be of benefit to pathology departments. It allows pathologists to analyse samples remote from the laboratory, making sharing of the slides between pathologists more straight-forward, and also enables expert review out of hours. With the ability to electronically transfer slides from the laboratory to the reporting pathologist, it may provide solutions for local shortages of pathologists across NHS trusts in the UK. However, a number of researchers argue that the costs of implementing digital pathology may outweigh its advantages. Moreover, images produced by DP systems are often of inferior resolution when compared to conventional light microscopy. The lack of literature on this subject limits the adoption of this new technology by laboratories across the country. This multi-centre study aims to analyse how the study pathologists examine DP images of different pathology modalities by using eye-tracking technology, thus using data on their reading and interpretation technique to improve performance and contribute to the adoption of DP across the UK.
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