Eye-tracking visual patterns of sonographers with and without fetal motor assessment expertise.

OBJECTIVES: Fetal motor assessment (FMA) in addition to structural anomaly scan enhances prenatal detection of arthrogryposis multiplex congenita (AMC). In the Amsterdam UMC, sonographers are trained to perform FMA. We examined the effect of motor assessment training by comparing sonographers with (SMA) and without this training (S) on their qualitative motor assessment in fetuses with normal (FNM) and abnormal motility (FAM) and their visual processing by eye-tracking. METHODS: The study was performed from 2019 to 2020. Five SMA and five S observed five FNM and five FAM videos. Qualitative FMA consisted of six aspects of the general movement and the overall conclusion normal or abnormal. The visual processing aspects examined through eye-tracking were fixation duration, number of revisits per region of interest (ROI) and scanpaths of saccades between fixation points. RESULTS: Quality assessment by SMA revealed more correct aspects in FNM than in FAM but overall conclusions were equally correct (92-96 %). S scored aspects of FNM better than in FAM, but overall conclusion correct only in half of FNM and three quarters of FAM. Eye-tracking of SMA and S showed fixation duration and revisits with similar distributions per ROIs for FNM and FAM, but SMA perform more trunk revisits in FNM. Scanpaths had smaller circumference, less outliers and more consistency in SMA than S. CONCLUSION: This modest population of qualified sonographers showed that additional FMA training improved qualitative motor assessment. Eye-tracking revealed differences in visual processing and stimulates continuous education for professionals active in the detection of these rare diseases.

How visual search relates to visual diagnostic performance: a narrative systematic review of eye-tracking research in radiology.

Eye tracking research has been conducted for decades to gain understanding of visual diagnosis such as in radiology. For educational purposes, it is important to identify visual search patterns that are related to high perceptual performance and to identify effective teaching strategies. This review of eye-tracking literature in the radiology domain aims to identify visual search patterns associated with high perceptual performance. Databases PubMed, EMBASE, ERIC, PsycINFO, Scopus and Web of Science were searched using 'visual perception' OR 'eye tracking' AND 'radiology' and synonyms. Two authors independently screened search results and included eye tracking studies concerning visual skills in radiology published between January 1, 1994 and July 31, 2015. Two authors independently assessed study quality with the Medical Education Research Study Quality Instrument, and extracted study data with respect to design, participant and task characteristics, and variables. A thematic analysis was conducted to extract and arrange study results, and a textual narrative synthesis was applied for data integration and interpretation. The search resulted in 22 relevant full-text articles. Thematic analysis resulted in six themes that informed the relation between visual search and level of expertise: (1) time on task, (2) eye movement characteristics of experts, (3) differences in visual attention, (4) visual search patterns, (5) search patterns in cross sectional stack imaging, and (6) teaching visual search strategies. Expert search was found to be characterized by a global-focal search pattern, which represents an initial global impression, followed by a detailed, focal search-to-find mode. Specific task-related search patterns, like drilling through CT scans and systematic search in chest X-rays, were found to be related to high expert levels. One study investigated teaching of visual search strategies, and did not find a significant effect on perceptual performance. Eye tracking literature in radiology indicates several search patterns are related to high levels of expertise, but teaching novices to search as an expert may not be effective. Experimental research is needed to find out which search strategies can improve image perception in learners.