Influences of medical expertise on visual diagnosis in pathology

Jaarsma, T., Jarodzka, H., Nap, M., Van Merriënboer, J. J. G., & Boshuizen, H. P. A. (2012, 9 November). Expertise development in clinical pathology: From novice to expert in a highly visual medical domain. Poster presented at the ICO Fall School, Girona, Spain.Visual expertise is becoming more and more a crucial part of medical expertise. The amount of medical images has grown tremendously and the last decades have welcomed several new and increasingly dynamic imaging techniques (Krupinski, 2010). Nevertheless, visual expertise has so far mainly been studied in domains using static images, such as X-ray images (Reingold & Sheridan, 2011). This is also true for the domain of clinical pathology, where, in their natural context, pathologists interactively navigate and zoom within microscopic slides. Research in this domain either restricted these navigation possibilities (Krupinski et al., 2006; Tiersma, Peters, Mooij, & Fleuren, 2003) or neglected the visual processes (Crowley, Naus, Stewart, & Friedman, 2003). Hence, not much is known on visual expertise in domains that deal with interactive, medical images. In this study, 38 clinical pathologists with three different expertise levels, performed diagnostic tasks on a virtual microscope (i.e., computer software displaying scanned tissue samples in a similar way as a light microscope). By measuring eye movements, microscope navigation and thinking aloud, insight in both visual and cognitive expertise was gained. Each participant viewed seven interactive slides, representing different diseases of the colon. At the time of writing this submission, the analysis was not fully completed, yet. However, both literature and a previous study in this project, using static images only, revealed that novices spent less time and fixations in diagnostically relevant areas. This study will contribute to the understanding of visual expertise by developing a methodology which is fit for the study of interactive images

Visuele expertise: ontwikkeling en didactiek bij klinisch pathologen

Jaarsma, T., Jarodzka, H., Nap, M., Van Merriënboer, J. J. G., & Boshuizen, H. P. A. (2012, 23 August). Visual expertise development among clinical pathologists. Paper presented at the EARLI Special Interest Group 14, Antwerp, Belgium.Visual expertise is becoming more and more a crucial part of medical expertise. The amount of medical images produced has grown tremendously and the last decades have welcomed several new and increasingly dynamic imaging techniques (Krupinski, 2010). Nevertheless, visual expertise has so far mainly been studied in domains using static images, such as X-ray images (Reingold & Sheridan, 2011). This is also true for the domain of clinical pathology, where pathologists interactively navigate and zoom within digital slides. Research in this domain either restricted these navigation possibilities (Krupinski et al., 2006; Tiersma, Peters, Mooij, & Fleuren, 2003) or neglected the visual processes (Crowley, Naus, Stewart, & Friedman, 2003). Hence, not much is known on visual expertise in domains that deal with interactive, medical images. In this study, six clinical pathologists of different expertise levels, performed diagnostic tasks on a virtual microscope (i.e., computer software displaying scanned tissue samples in a similar way as a light microscope). By measuring eye movements, microscope navigation and thinking aloud, insight in both visual and cognitive expertise was gained. Each participant viewed four histological slides, representing different diseases of the colon and annotated diagnostically relevant areas in the slide, while thinking-aloud. At the time of writing this submission, the data collection was just finished, hence the analysis is not fully completed, yet. However, some expected results – based on theory and prior studies – are given in the extended summary. This study will contribute to the understanding of visual expertise by developing a methodology which is fit for the study of interactive images

Influence of study design on digital pathology image quality evaluation : the need to define a clinical task

Despite the current rapid advance in technologies for whole slide imaging, there is still no scientific consensus on the recommended methodology for image quality assessment of digital pathology slides. For medical images in general, it has been recommended to assess image quality in terms of doctors’ success rates in performing a specific clinical task while using the images (clinical image quality, cIQ). However, digital pathology is a new modality, and already identifying the appropriate task is difficult. In an alternative common approach, humans are asked to do a simpler task such as rating overall image quality (perceived image quality, pIQ), but that involves the risk of nonclinically relevant findings due to an unknown relationship between the pIQ and cIQ. In this study, we explored three different experimental protocols: (1) conducting a clinical task (detecting inclusion bodies), (2) rating image similarity and preference, and (3) rating the overall image quality. Additionally, within protocol 1, overall quality ratings were also collected (task-aware pIQ). The experiments were done by diagnostic veterinary pathologists in the context of evaluating the quality of hematoxylin and eosin-stained digital pathology slides of animal tissue samples under several common image alterations: additive noise, blurring, change in gamma, change in color saturation, and JPG compression. While the size of our experiments was small and prevents drawing strong conclusions, the results suggest the need to define a clinical task. Importantly, the pIQ data collected under protocols 2 and 3 did not always rank the image alterations the same as their cIQ from protocol 1, warning against using conventional pIQ to predict cIQ. At the same time, there was a correlation between the cIQ and task-aware pIQ ratings from protocol 1, suggesting that the clinical experiment context (set by specifying the clinical task) may affect human visual attention and bring focus to their criteria of image quality. Further research is needed to assess whether and for which purposes (e.g., preclinical testing) task-aware pIQ ratings could substitute cIQ for a given clinical task

Prospects for Theranostics in Neurosurgical Imaging: Empowering Confocal Laser Endomicroscopy Diagnostics via Deep Learning

Confocal laser endomicroscopy (CLE) is an advanced optical fluorescence imaging technology that has the potential to increase intraoperative precision, extend resection, and tailor surgery for malignant invasive brain tumors because of its subcellular dimension resolution. Despite its promising diagnostic potential, interpreting the gray tone fluorescence images can be difficult for untrained users. In this review, we provide a detailed description of bioinformatical analysis methodology of CLE images that begins to assist the neurosurgeon and pathologist to rapidly connect on-the-fly intraoperative imaging, pathology, and surgical observation into a conclusionary system within the concept of theranostics. We present an overview and discuss deep learning models for automatic detection of the diagnostic CLE images and discuss various training regimes and ensemble modeling effect on the power of deep learning predictive models. Two major approaches reviewed in this paper include the models that can automatically classify CLE images into diagnostic/nondiagnostic, glioma/nonglioma, tumor/injury/normal categories and models that can localize histological features on the CLE images using weakly supervised methods. We also briefly review advances in the deep learning approaches used for CLE image analysis in other organs. Significant advances in speed and precision of automated diagnostic frame selection would augment the diagnostic potential of CLE, improve operative workflow and integration into brain tumor surgery. Such technology and bioinformatics analytics lend themselves to improved precision, personalization, and theranostics in brain tumor treatment.Comment: See the final version published in Frontiers in Oncology here: https://www.frontiersin.org/articles/10.3389/fonc.2018.00240/ful

‘Do you see what I see?’ Medical imaging: the interpretation of visual information

Röntgen's discovery of x-rays in 1895, gave to medicine the extraordinary benefit of being able to see inside the living body without surgery. Over time, technology has added to the sophistication of imaging processes in medicine and we now have a wide range of techniques at our disposal for the investigation and early detection of disease. But radiology deals with visual information; and like any information this requires interpretation. It is a practical field and medical images are used to make inferences about the state of peoples' health. These inferences are subject to the same variability and error as any decision-making process and so the criteria for the success of medical imaging are based not entirely on the images themselves but on the performance of the decision-makers. Research in the accuracy of medical imaging must draw on techniques from a wide range of disciplines including physics, psychology, computing, neuroscience and medicine in attempting to better understand the processes involved in visual decision-making in this context and to minimise diagnostic error

'Treatment of the Sportsman's groin': British Hernia Society's 2014 position statement based on the Manchester Consensus Conference

<b>Introduction</b> The aim was to produce a multidisciplinary consensus to determine the current position on the nomenclature, definition, diagnosis, imaging modalities and management of Sportsman's groin (SG).<p></p> <b>Methods</b> Experts in the diagnosis and management of SG were invited to participate in a consensus conference held by the British Hernia Society in Manchester, UK on 11–12 October 2012. Experts included a physiotherapist, a musculoskeletal radiologist and surgeons with a proven track record of expertise in this field. Presentations detailing scientific as well as outcome data from their own experiences were given. Records were made of the presentations with specific areas debated openly.<p></p> <b>Results</b> The term ‘inguinal disruption’ (ID) was agreed as the preferred nomenclature with the term ‘Sportsman's hernia’ or ‘groin’ rejected, as no true hernia exists. There was an overwhelming agreement of opinion that there was abnormal tension in the groin, particularly around the inguinal ligament attachment. Other common findings included the possibility of external oblique disruption with consequent small tears noted as well as some oedema of the tissues. A multidisciplinary approach with tailored physiotherapy as the initial treatment was recommended with any surgery involving releasing the tension in the inguinal canal by various techniques and reinforcing it with a mesh or suture repair. A national registry should be developed for all athletes undergoing surgery.<p></p> <b>Conclusions</b> ID is a common condition where no true hernia exists. It should be managed through a multidisciplinary approach to ensure consistent standards and outcomes are achieved

Learning Microscopic Pathology: Scaffolding the Early Development of Expertise in Medical Image Interpretation

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