Investigation of viewing procedures for interpretation of breast tomosynthesis image volumes: a detection-task study with eye tracking

Abstract

ObjectivesTo evaluate the efficiency of different methods of reading breast tomosynthesis (BT) image volumes.MethodsAll viewing procedures consisted of free scroll volume browsing and three were combined with initial cine loops at three different frame rates (9, 14 and 25 fps). The presentation modes consisted of vertically and horizontally orientated BT image volumes. Fifty-five normal BT image volumes in mediolateral oblique view were collected. In these, simulated lesions were inserted, creating four unique image sets, one for each viewing procedure. Four observers interpreted the cases in a free-response task. Time efficiency, visual attention and search were investigated using eye tracking.ResultsHorizontally orientated BT image volumes were read faster than vertically when using free scroll browsing only and when combined with fast cine loop. Cine loops at slow frame rates were ruled out as inefficient.ConclusionsIn general, horizontally oriented BT image volumes were read more efficiently. All viewing procedures except for slow frame rates were promising when assuming equivalent detection performance.Key Points• Breast tomosynthesis is increasingly used for breast cancer detection• There is a benefit in reading breast tomosynthesis image volumes presented horizontally• Align image content to visual field, especially for dynamic 3D images• Reading at slow frame rates was considered inefficient

The TOMMY trial: a comparison of TOMosynthesis with digital MammographY in the UK NHS Breast Screening Programme – a multicentre retrospective reading study comparing the diagnostic performance of digital breast tomosynthesis and digital mammography with digital mammography alone

“…[28][29][30] Improved lesion visibility, size and classification compared with standard film or digital mammography have been reported [31][32][33][34][35][36][37][38] and the possibility that DBT could reduce the need for additional mammographic views at least for non-calcified lesions [39][40][41][42] has been suggested. There are mixed reports of the sensitivity of DBT for the detection of microcalcifications 32,[43][44][45][46][47][48][49][50][51] that may be partly as a result of the different techniques used for image reconstruction and the need to combine image slices into thicker slabs for optimal visualisation of microcalcification clusters. These observations suggested that DBT was unlikely to be used as a stand-alone imaging modality if a 2D mammogram was required for optimal microcalcification assessment.…”

“…Since there is some uncertainty over the visibility of microcalcification clusters, 17,43,44,48,49,51 it has been suggested that a standard 2D mammogram may be required along with two-view DBT for optimal microcalcification assessment. 16,25,47,53,88 However, concerns have been raised regarding the additional radiation dose this would involve.…”

Review of prospects and challenges of eye tracking in volumetric imaging

“…The studies that dealt with volumetric imaging material [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] used images suitable for a three-dimensional representation of the human body, however, the presentation of stimulus material differed between them. Eight of the studies presented all slices of a multislice case and allowed radiologists to scroll freely through these stacks; 49,52,[55][56][57][58][59][60] thus, radiologists could scroll back and forth for as long as they wanted to and also determine the pace of their movement through the stack.…”

“…Eight of the studies presented all slices of a multislice case and allowed radiologists to scroll freely through these stacks; 49,52,[55][56][57][58][59][60] thus, radiologists could scroll back and forth for as long as they wanted to and also determine the pace of their movement through the stack. In two experiments, the radiologists were presented with five consecutive slices of MRI and CT cases, but they were only able to scroll in the forward direction, meaning that once they had chosen to scroll on, they were not able to return to a previous slice.…”

“…By contrast, only a limited number of studies have aimed at shedding light on the relationship between visual search, perception, cognition, and performance in the context of volumetric images: five experiments have explored radiologists' reading strategies of stimulus material that was acquired by a volumetric imaging technique, [45][46][47][48][49] while five other studies looked at the influence of expertise on gaze behavior, [50][51][52][53][54] four explored the implications of different workstation configurations on gaze, [55][56][57][58][59] and one study examined the presence of inattentional blindness in the interpretation of chest CT cases. 60 Finally, one study looked at the visual search characteristics of readers when using computer-aided detection in CT colonography presented in the fly through mode.…”