Looking towards objective quality evaluation in colonoscopy: Analysis of visual gaze patterns

Area of Science:

• Medical training and simulation
• Gastroenterology and endoscopy
• Human factors and ergonomics

Background:

• Limited objective assessment tools exist for novice endoscopists.
• Eye-tracking technology offers a potential method for evaluating visual search strategies.
• Understanding gaze patterns is crucial for improving endoscopic proficiency.

Purpose of the Study:

• To determine if eye-tracking can differentiate visual gaze patterns (VGP) between experienced and novice endoscopists.
• To characterize specific differences in VGP related to endoscopic expertise.
• To explore the application of eye-tracking in developing objective endoscopy training.

Main Methods:

• Portable eye-tracking glasses were used to record VGP in novice (n=20) and experienced (n=14) endoscopists.
• Participants viewed a colonoscopy withdrawal video up to the hepatic flexure.
• Analysis focused on central vs. peripheral and horizontal fixation distributions, alongside basic eye-tracking metrics.

Main Results:

• Experienced endoscopists showed a significantly higher percentage of fixations in the screen periphery (23.0% vs 13.4%, P=0.013).
• Experienced endoscopists directed significantly more fixations to the left side of the screen (33.5% vs 18.6%, P=0.005), where the hepatic flexure's 'inside bend' was poorly visualized.
• These VGP differences highlight expertise-driven visual search strategies.

Conclusions:

• Specific VGP associated with expertise were identified, potentially explaining missed adenomas at the hepatic flexure.
• These findings can inform the training of novice colonoscopists.
• Further validation may lead to an objective, proficiency-based curriculum for improved endoscopy quality and pathology detection.