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Upasani S, Srinivasan D, Zhu Q, Du J, Leonessa A. Eye-Tracking in Physical Human-Robot Interaction: Mental Workload and Performance Prediction. HUMAN FACTORS 2024; 66:2104-2119. [PMID: 37793896 DOI: 10.1177/00187208231204704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND In Physical Human-Robot Interaction (pHRI), the need to learn the robot's motor-control dynamics is associated with increased cognitive load. Eye-tracking metrics can help understand the dynamics of fluctuating mental workload over the course of learning. OBJECTIVE The aim of this study was to test eye-tracking measures' sensitivity and reliability to variations in task difficulty, as well as their performance-prediction capability, in physical human-robot collaboration tasks involving an industrial robot for object comanipulation. METHODS Participants (9M, 9F) learned to coperform a virtual pick-and-place task with a bimanual robot over multiple trials. Joint stiffness of the robot was manipulated to increase motor-coordination demands. The psychometric properties of eye-tracking measures and their ability to predict performance was investigated. RESULTS Stationary Gaze Entropy and pupil diameter were the most reliable and sensitive measures of workload associated with changes in task difficulty and learning. Increased task difficulty was more likely to result in a robot-monitoring strategy. Eye-tracking measures were able to predict the occurrence of success or failure in each trial with 70% sensitivity and 71% accuracy. CONCLUSION The sensitivity and reliability of eye-tracking measures was acceptable, although values were lower than those observed in cognitive domains. Measures of gaze behaviors indicative of visual monitoring strategies were most sensitive to task difficulty manipulations, and should be explored further for the pHRI domain where motor-control and internal-model formation will likely be strong contributors to workload. APPLICATION Future collaborative robots can adapt to human cognitive state and skill-level measured using eye-tracking measures of workload and visual attention.
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Affiliation(s)
| | | | - Qi Zhu
- National Institute of Standards and Technology, Boulder, CO, USA
| | - Jing Du
- University of Florida, Gainesville, FL, USA
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Bapna T, Valles J, Leng S, Pacilli M, Nataraja RM. Eye-tracking in surgery: a systematic review. ANZ J Surg 2023; 93:2600-2608. [PMID: 37668263 DOI: 10.1111/ans.18686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Surgery is constantly evolving with the assistance of rapidly developing novel technology. Eye-tracking devices provide opportunities to monitor the acquisition of surgical skills, gain insight into performance, and enhance surgical practice. The aim of this review was to consolidate the available evidence for the use of eye-tracking in the surgical disciplines. METHODS A systematic literature review was conducted in accordance with PRISMA guidelines. A search of OVID Medline, EMBASE, Cochrane library, Scopus, and Science Direct was conducted January 2000 until December 2022. Studies involving eye-tracking in surgical training, assessment and technical innovation were included in the review. Non-surgical procedures, animal studies, and studies not involving surgical participants were excluded from the review. RESULTS The search returned a total of 12 054 articles, 80 of which were included in the final analysis and review. Seventeen studies involved eye-tracking in surgical training, 48 surgical assessment, and 20 were focussing on technical aspects of this technology. Twenty-six different eye-tracking devices were used in the included studies. Metrics such as the number of fixations, duration of fixations, dwell time, and cognitive workload were able to differentiate between novice and expert performance. Eight studies demonstrated the effectiveness of gaze-training for improving surgical skill. CONCLUSION The current literature shows a broad range of utility for a variety of eye-tracking devices in surgery. There remains a lack of standardization for metric parameters and gaze analysis techniques. Further research is required to validate its use to establish reliability and create uniform practices.
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Affiliation(s)
- Tanay Bapna
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - John Valles
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Samantha Leng
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ramesh Mark Nataraja
- Department of Paediatric Surgery & Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Tonbul G, Topalli D, Cagiltay NE. A systematic review on classification and assessment of surgical skill levels for simulation-based training programs. Int J Med Inform 2023; 177:105121. [PMID: 37290214 DOI: 10.1016/j.ijmedinf.2023.105121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Nowadays, advances in medical informatics have made minimally invasive surgery (MIS) procedures the preferred choice. However, there are several problems with the education programs in terms of surgical skill acquisition. For instance, defining and objectively measuring surgical skill levels is a challenging process. Accordingly, the aim of this study is to conduct a literature review for an investigation of the current approaches for classifying the surgical skill levels and for identifying the skill training tools and measurement methods. MATERIALS AND METHODS In this research, a search is conducted and a corpus is created. Exclusion and inclusion criteria are applied by limiting the number of articles based on surgical education, training approximations, hand movements, and endoscopic or laparoscopic operations. To satisfy these criteria, 57 articles are included in the corpus of this study. RESULTS Currently used surgical skill assessment approaches have been summarized. Results show that various classification approaches for the surgical skill level definitions are being used. Besides, many studies are conducted by omitting particularly important skill levels in between. Additionally, some inconsistencies are also identified across the skill level classification studies. CONCLUSION In order to improve the benefits of simulation-based training programs, a standardized interdisciplinary approach should be developed. For this reason, specific to each surgical procedure, the required skills should be identified. Additionally, appropriate measures for assessing these skills, which can be defined in simulation-based MIS training environments, should be refined. Finally, the skill levels gained during the developmental stages of these skills, with their threshold values referencing the identified measures, should be redefined in a standardized manner.
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Affiliation(s)
- Gokcen Tonbul
- Graduate School of Natural and Applied Sciences, Atilim University, Ankara, Turkey; Strategy and Technology Research Center, Baskent University, Ankara, Turkey.
| | - Damla Topalli
- Department of Computer Engineering, Atilim University, Ankara, Turkey
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Hafner C, Scharner V, Hermann M, Metelka P, Hurch B, Klaus DA, Schaubmayr W, Wagner M, Gleiss A, Willschke H, Hamp T. Eye-tracking during simulation-based echocardiography: a feasibility study. BMC MEDICAL EDUCATION 2023; 23:490. [PMID: 37393288 DOI: 10.1186/s12909-023-04458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Due to the technical progress point-of-care ultrasound (POCUS) is increasingly used in critical care medicine. However, optimal training strategies and support for novices have not been thoroughly researched so far. Eye-tracking, which offers insights into the gaze behavior of experts may be a useful tool for better understanding. The aim of this study was to investigate the technical feasibility and usability of eye-tracking during echocardiography as well as to analyze differences of gaze patterns between experts and non-experts. METHODS Nine experts in echocardiography and six non-experts were equipped with eye-tracking glasses (Tobii, Stockholm, Sweden), while performing six medical cases on a simulator. For each view case specific areas of interests (AOI) were defined by the first three experts depending on the underlying pathology. Technical feasibility, participants' subjective experience on the usability of the eye-tracking glasses as well as the differences of relative dwell time (focus) inside the areas of interest (AOI) between six experts and six non-experts were evaluated. RESULTS Technical feasibility of eye-tracking during echocardiography was achieved with an accordance of 96% between the visual area orally described by participants and the area marked by the glasses. Experts had longer relative dwell time in the case specific AOI (50.6% versus 38.4%, p = 0.072) and performed ultrasound examinations faster (138 s versus 227 s, p = 0.068). Furthermore, experts fixated earlier in the AOI (5 s versus 10 s, p = 0.033). CONCLUSION This feasibility study demonstrates that eye-tracking can be used to analyze experts and non-experts gaze patterns during POCUS. Although, in this study the experts had a longer fixation time in the defined AOIs compared to non-experts, further studies are needed to investigate if eye-tracking could improve teaching of POCUS.
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Affiliation(s)
- Christina Hafner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Vincenz Scharner
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Martina Hermann
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Philipp Metelka
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Benedikt Hurch
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Daniel Alexander Klaus
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Wolfgang Schaubmayr
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Wagner
- Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Harald Willschke
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Vienna, Austria
| | - Thomas Hamp
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
- Emergency Medical Service Vienna, Radetzkystraße 1, 1030, Vienna, Austria.
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Nassar A, Vérité F, Pechereau F, Morel G, Vitrani MA. Adaptative damping assistance in bimanual laparoscopic surgery. Int J Comput Assist Radiol Surg 2023; 18:741-751. [PMID: 36477584 PMCID: PMC9735186 DOI: 10.1007/s11548-022-02796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Laparoscopic surgery has demonstrated various advantages for the patients' care, but also presents some difficulties for the surgeons, such as kinematic restrictions. Robotic comanipulation, in which control of instruments is shared between the robot and the surgeon, can provide adaptative damping assistance which allows stabilisation of movements. The objective of the present study was to determine the contribution of this assistance on a bimanual laparoscopic task. METHODS Adaptative damping was studied on Peg Transfer task, performed by eighteen surgery-naive subjects. This exercise was repeated seven times without (Classic repetitions) and seven times with comanipulated robots (Robot repetitions), in a randomised order. We measured task performance, using Peg Transfer score; gesture performance, using hand oscillations and travelled distance; eye-tracking movements as an indicator of emergence of expertise. Participants' perceived workload was assessed by NASA TLX questionnaire, and difference in impression between the two conditions by UEQ questionnaire. RESULTS Adaptative damping improved gesture performance (oscillations F(1,17) = 23.473, p < 0.001, η2 = 0.580), with a statistically significant simple effect on the tool oscillation for both non-dominant (p < 0.001) and dominant hands (p = 0.005), without influencing task performance (mean Peg Transfer score t(17) = 0.920, p = 0.382, d = 0.29), but deteriorating eye-tracking movements associated with emergence of expertise (mean fixation rate per second F(1,17) = 6.318, p = 0.022, η2 = 0.271), at the cost of a high perceived workload (NASA TLX score 59.78/100). CONCLUSION Assistance by adaptative damping applied by comanipulated robots improved gesture performance during a laparoscopic bimanual task, without impacting task's performance without allowing the emergence of comportments associated with an expertise, and at the cost of a high perceived workload. Further research should investigate this assistance on more precise and clinical tasks performed by professionals.
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Affiliation(s)
- Alexandra Nassar
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France.
| | - Fabien Vérité
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
| | - Félix Pechereau
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
| | - Guillaume Morel
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
| | - Marie-Aude Vitrani
- IInstitut des Systèmes Intelligents et de Robotique, Sorbonne Universités, 4, Place Jussieu, 75005, Paris, France
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Kulkarni CS, Deng S, Wang T, Hartman-Kenzler J, Barnes LE, Parker SH, Safford SD, Lau N. Scene-dependent, feedforward eye gaze metrics can differentiate technical skill levels of trainees in laparoscopic surgery. Surg Endosc 2023; 37:1569-1580. [PMID: 36123548 PMCID: PMC11062149 DOI: 10.1007/s00464-022-09582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION In laparoscopic surgery, looking in the target areas is an indicator of proficiency. However, gaze behaviors revealing feedforward control (i.e., looking ahead) and their importance have been under-investigated in surgery. This study aims to establish the sensitivity and relative importance of different scene-dependent gaze and motion metrics for estimating trainee proficiency levels in surgical skills. METHODS Medical students performed the Fundamentals of Laparoscopic Surgery peg transfer task while recording their gaze on the monitor and tool activities inside the trainer box. Using computer vision and fixation algorithms, five scene-dependent gaze metrics and one tool speed metric were computed for 499 practice trials. Cluster analysis on the six metrics was used to group the trials into different clusters/proficiency levels, and ANOVAs were conducted to test differences between proficiency levels. A Random Forest model was trained to study metric importance at predicting proficiency levels. RESULTS Three clusters were identified, corresponding to three proficiency levels. The correspondence between the clusters and proficiency levels was confirmed by differences between completion times (F2,488 = 38.94, p < .001). Further, ANOVAs revealed significant differences between the three levels for all six metrics. The Random Forest model predicted proficiency level with 99% out-of-bag accuracy and revealed that scene-dependent gaze metrics reflecting feedforward behaviors were more important for prediction than the ones reflecting feedback behaviors. CONCLUSION Scene-dependent gaze metrics revealed skill levels of trainees more precisely than between experts and novices as suggested in the literature. Further, feedforward gaze metrics appeared to be more important than feedback ones at predicting proficiency.
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Affiliation(s)
- Chaitanya S Kulkarni
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), 1145 Perry Street, Blacksburg, VA, 24061, USA
| | - Shiyu Deng
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), 1145 Perry Street, Blacksburg, VA, 24061, USA
| | - Tianzi Wang
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), 1145 Perry Street, Blacksburg, VA, 24061, USA
| | | | - Laura E Barnes
- Environmental and Systems Engineering, University of Virginia, Charlottesville, VA, USA
| | | | - Shawn D Safford
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Harrisburg, PA, USA
| | - Nathan Lau
- Grado Department of Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), 1145 Perry Street, Blacksburg, VA, 24061, USA.
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Otsuka T, Izumi T, Yamamoto M, Seshita Y, Kohama T, Nishihori M, Tsukada T, Saito R. Differences in gaze behaviors between trainees and experts during endovascular therapy for cerebral aneurysms: a preliminary study using a cerebral aneurysm model. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:50-58. [PMID: 36923614 PMCID: PMC10009636 DOI: 10.18999/nagjms.85.1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/21/2022] [Indexed: 03/18/2023]
Abstract
In the neuroendovascular field, the training of operators has become an important issue. Recently, eye-tracking technology has been introduced into various fields of medical education. This study aimed to apply eye-tracking technology to the training of neuroendovascular therapy. Six neurosurgeons, including three neuroendovascular specialists and three trainees, at our institution and related facilities participated in the study. Eye movement was recorded by the eye-tracking device during the microcatheter navigation and coil placement into the silastic aneurysm model under biplane X-ray fluoroscopy. Eye-tracking analysis during neuroendovascular therapy was feasible in all six subjects. In microcatheter navigation, specialists tended to more frequently switch their attention between frontal and lateral images than trainees. In coil embolization, the overall gaze frequency tended to increase, and the average fixation duration tended to decrease as the number of experienced cases increased. Inexperienced operators tend to fix their gaze when they are operators than when they are assistants. More experienced operators tended to look at the microcatheter longer in the coil insertion task. The eye-tracking analysis may be useful for operator training in neuroendovascular therapy. Experts may have moved their eyes more frequently than trainees to gaze at the right place. In the future, it will be necessary to collect gaze data for more operators in various tasks.
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Affiliation(s)
- Takafumi Otsuka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaya Yamamoto
- Department of Electronic Robot Engineering, Aichi University of Technology, Gamagori, Japan
| | - Yusuke Seshita
- Department of Electronic Robot Engineering, Aichi University of Technology, Gamagori, Japan
| | - Takeshi Kohama
- Department of Computational Systems Biology, Faculty of Biology-Oriented Science and Technology, Kindai University,Kinokawa, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Tsukada
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Niederhauser L, Gunser S, Waser M, Mast FW, Caversaccio M, Anschuetz L. Training and proficiency level in endoscopic sinus surgery change residents' eye movements. Sci Rep 2023; 13:79. [PMID: 36596830 PMCID: PMC9810736 DOI: 10.1038/s41598-022-25518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/30/2022] [Indexed: 01/04/2023] Open
Abstract
Nose surgery is challenging and needs a lot of training for safe and efficient treatments. Eye tracking can provide an objective assessment to measure residents' learning curve. The aim of the current study was to assess residents' fixation duration and other dependent variables over the course of a dedicated training in functional endoscopic sinus surgery (FESS). Sixteen residents performed a FESS training over 18 sessions, split into three surgical steps. Eye movements in terms of percent fixation on the screen and average fixation duration were measured, in addition to residents' completion time, cognitive load, and surgical performance. Results indicated performance improvements in terms of completion time and surgical performance. Cognitive load and average fixation duration showed a significant change within the last step of training. Percent fixation on screen increased within the first step, and then stagnated. Results showed that eye movements and cognitive load differed between residents of different proficiency levels. In conclusion, eye tracking is a helpful objective measuring tool in FESS. It provides additional insights of the training level and changes with increasing performance. Expert-like gaze was obtained after half of the training sessions and increased proficiency in FESS was associated with increased fixation duration.
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Affiliation(s)
- Laura Niederhauser
- grid.5734.50000 0001 0726 5157Department of Psychology, University of Bern, Bern, Switzerland
| | - Sandra Gunser
- grid.5734.50000 0001 0726 5157Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Freiburgstrasse 18, University of Bern, 3010 Bern, Switzerland
| | - Manuel Waser
- grid.5734.50000 0001 0726 5157Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Freiburgstrasse 18, University of Bern, 3010 Bern, Switzerland
| | - Fred W. Mast
- grid.5734.50000 0001 0726 5157Department of Psychology, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- grid.5734.50000 0001 0726 5157Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Freiburgstrasse 18, University of Bern, 3010 Bern, Switzerland
| | - Lukas Anschuetz
- grid.5734.50000 0001 0726 5157Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Freiburgstrasse 18, University of Bern, 3010 Bern, Switzerland
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Kojima Y, Wong HJ, Kuchta K, Denham W, Haggerty S, Linn J, Ujiki M. Resident performance in simulation module is associated with operating room performance for laparoscopic cholecystectomy. Surg Endosc 2022; 36:9273-9280. [PMID: 35312848 DOI: 10.1007/s00464-022-09152-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/17/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Simulation is an important tool in surgical training. However, the transferability of skills obtained in the simulation setting to the operating room (OR) is uncertain. This study explores the association between resident simulation performance and OR performance in a laparoscopic cholecystectomy (LC) simulation module. METHODS A simulation module focused on LC utilizing a virtual reality simulator was completed by general surgery residents. Simulation performance was evaluated using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) and Objective Structured Assessment of Technical Skills (OSATS), as well as a LC-specific simulation assessment form (LC-SIM). Resident subsequent OR performances of LC were measured by the Surgical Training and Assessment Tool (STAT), an online mobile-based evaluation completed by attending surgeons. RESULTS Twenty-one residents who completed the simulation module and also with STAT data on LC from 2016 to 2020 were included. Higher scores on incision/port placement on LC-SIM is associated with better tissue handling (coefficient 0.20, p = 0.048) and better time & economy of motion on STAT (coefficient 0.22, p = 0.037). However, higher scores on time and motion on OSATS are associated with worse tissue handling (- 0.28, p = 0.046), worse time & economy of motion (- 0.37, p = 0.009), and worse overall grade (- 0.21, p = 0.044). Higher scores on overall performance on OSATS is associated with worse time & economy of motion (- 0.80, p = 0.008). Higher scores on depth perception on GOALS are associated with worse tissue handling (- 0.28, p = 0.044). CONCLUSION We found significant positive and negative associations between resident simulation performance and OR performance, particularly in tissue handling and economy of motion. This could suggest that simulation performance does not reliably predict OR performance. However, this could highlight the concept of excessive caution in the real OR environment and longer operative time which could be interpreted as worse time and economy of motion by the attending surgeons.
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Affiliation(s)
- Yohei Kojima
- Department of Surgery, Kyorin University, Tokyo, Japan
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Harry J Wong
- Department of Surgery, Kyorin University, Tokyo, Japan.
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA.
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Woody Denham
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Stephen Haggerty
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - John Linn
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
| | - Michael Ujiki
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA
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Valles J, Zhang T, McIntosh P, Pacilli M, Nataraja RM. Assessment of Core Surgical Skills Using a Mixed Reality Headset - The MoTOR Study. J Med Syst 2022; 46:102. [PMID: 36418760 DOI: 10.1007/s10916-022-01891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgical skill assessment utilises direct observation and feedback by an expert which is potentially subjective, therefore obtaining objective data for hand and eye tracking is essential. Our aim was to evaluate a wearable mixed reality (MR) headset in these domains. METHODS Participants with differing levels of surgical expertise [novice (N), intermediate (I) & expert (E)] performed 4 simulated surgical tasks; 2 general dexterity (tasks 1&2) and 2 surgical skills (tasks 3&4) wearing the MR headset capturing their hand and eye movements (median & range). Metrics included hand path length and the speed of each index or thumb tip. Gaze data were also captured. Participant demographics, prior expertise and current experience were captured with an electronic survey. Data were analysed with a Shapiro-Wilk test or ANOVA as appropriate. A p-value of < 0.05 was significant. RESULTS Thirty-six participants were analysed (N = 18, I = 8, E = 8). Tasks 1&2 revealed 2 speed outcomes (left index and left-hand speed) which were significant. For tasks 3&4, various outcomes were significant: path length for left hand (N:45 cm vs. I:31 cm vs. E:27 cm, p = 0.03) and right hand (N:48 cm vs. I:29 cm vs. E:28 cm, p = 0.01) and total time (N:456s vs. I:292 vs. E: 245, p = 0.0002). With left-hand-tying, average path length (N:61 cm vs. I:39 vs. E:36, p = 0.04), average speed (N:11 cm/s vs. I:23 vs. E:24, p = 0.03), and total time (N:156s vs. I:43 vs. E:37, p = 0.003) were significant. The gaze-tracking was not statistically significant. CONCLUSION The MR headset can be utilised as a valid tool for surgical performance assessment. Outcomes including path length and speed can be valuable metrics captured by the MR Headset during the task completion for detecting surgical proficiency.
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Affiliation(s)
- John Valles
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, 3168, Melbourne, Australia.,Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Taiqing Zhang
- Virtual and Augmented Reality Services Unit, Monash eSolutions, Monash University, Melbourne, VIC, Australia
| | - Paul McIntosh
- Virtual and Augmented Reality Services Unit, Monash eSolutions, Monash University, Melbourne, VIC, Australia.,Human Centred Computing, Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, 3168, Melbourne, Australia.,Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, 246 Clayton Road, Clayton, 3168, Melbourne, Australia. .,Departments of Paediatrics & Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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11
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Chainey J, O'Kelly CJ, Zhang Y, Kim MJ, Zheng B. Gaze Behaviors of Neurosurgeon in Performing Gross Movements under Microscope. World Neurosurg 2022; 166:e469-e474. [PMID: 35843576 DOI: 10.1016/j.wneu.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Frequent intermittent bleeding control and suction are often necessary during microneurosurgical procedures. We compared the visual searching strategy that guides these types of gross hand movements between expert surgeons and neurosurgical residents. METHODS A total of 70 trials of a microsurgical task consisting of moving a cotton ball with bipolar forceps and a suction instrument under the microscope were recorded. Based on surgical videos, we extracted total task time, boarding time, gaze-tool time gap, number of fixations during the boarding time, and target-locked fixation duration. A comparison of these measures between experts and resident surgeons were performed. RESULTS No significant difference was found for total task time, boarding time, and number of fixations during the boarding time between the 2 groups of surgeons. However, we found significant differences in the measure of gaze-tool time gap (P < 0.001, partial η2 = 0.54) and the target-locked fixation (P < 0.001, partial η2 = 0.24). Specifically, expert microsurgeons' eyes move to the target board earlier before their tools in hands move (1.01 ± 0.30 seconds) compared with resident microsurgeons (0.44 ± 0.17 seconds). The target-locked fixation duration was also longer among experts comparing to residents (experts: 1.16 ± 0.82 seconds, residents: 0.40 ± 0.30 seconds). CONCLUSIONS Task time analysis for this basic microsurgical task is not sufficient to evaluate participants' level of expertise. Gaze behavior analysis helps to reveal hidden differences between experts and residents. This research provides more evidence that supports the use of gaze analysis for assessing surgeons' skills in microsurgery.
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Affiliation(s)
- Jonathan Chainey
- Division of Neurosurgery, University of Alberta, Edmonton, Canada
| | - Cian J O'Kelly
- Division of Neurosurgery, University of Alberta, Edmonton, Canada
| | - Yao Zhang
- Surgical Simulation Research Lab, University of Alberta, Edmonton, Canada
| | - Michael J Kim
- Division of General Surgery, University of Alberta Hospital, Edmonton, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, University of Alberta, Edmonton, Canada.
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12
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Ferrier-Barbut E, Gauthier P, Luengo V, Canlorbe G, Vitrani MA. Measuring the Quality of Learning in a Human–Robot Collaboration: A Study of Laparoscopic Surgery. ACM TRANSACTIONS ON HUMAN-ROBOT INTERACTION 2022. [DOI: 10.1145/3476414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Robot-Assisted Laparoscopic Surgery (RALS) is now prevalent in operating rooms. This situation requires future surgeons to learn Classic Laparoscopic Surgery (CLS) and RALS simultaneously. Therefore, along with the investigation of the differences in performance between the two techniques, it is essential to study the impact of training in RALS on the skills mastered in CLS. In this article, we study comanipulated RALS (Co-RALS), one of the two designs for RALS, where the human and the robot share the execution of the task. We use a rarely used in Human–Robot Interaction measuring tool: gaze tracking and time recording to measure for the acquisition of skills in CLS when training in Co-RALS or in CLS and time recording to compare the learning curves between Co-RALS and CLS. These metrics allow us to observe differences in Co-RALS and CLS. Training in Co-RALS develops slightly better but not significantly better hand–eye coordination skills and significantly better timewise performance compared with training in CLS alone. Co-RALS enhances timewise performance in laparoscopic surgery on specific types of tasks that require precision rather than depth perception skills compared with CLS. The results obtained enable us to further define the Human–Robot Interaction quality in Co-RALS.
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13
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Kojima Y, Wong HJ, Kuchta K, Linn JG, Haggerty SP, Denham W, Ujiki MB. Subjective vs. objective assessment of simulation performance on laparoscopic cholecystectomy: are we evaluating the right things? Surg Endosc 2022; 36:6661-6671. [PMID: 35106638 DOI: 10.1007/s00464-021-08936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/06/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Simulation using virtual reality (VR) simulators is an important tool in surgical training. VR laparoscopic simulators can provide immediate objective performance assessment without observer evaluation. This study aims to explore the correlation between subjective observer evaluation and VR laparoscopic simulator performance metrics in a laparoscopic cholecystectomy (LC) simulation module. METHODS A LC simulation module using a VR laparoscopic simulator was completed by PGY2-3 general surgery residents at a single institution. Simulation performance was recorded and evaluated by a trained evaluator using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) form, the Objective Structured Assessment of Technical Skills (OSATS) form, and a LC-specific simulation assessment form (LC-SIM). Objective performance metrics were also obtained from the simulator system. Performance before the curriculum (pre-test) and after the curriculum (post-test) were compared. RESULTS Fourteen residents were included in the study. There were significant improvements from pre-test to post-test on each component of GOALS, OSATS, and LC-SIM scores (all p values < 0.05). In terms of objective simulator metrics, significant improvements were noted in time to extract gallbladder (481 ± 221 vs 909 ± 366 min, p = 0.019), total number of movements (475 ± 264 vs 839 ± 324 min, p = 0.012), and total path length (955 ± 475 vs 1775 ± 632 cm, p = 0.012) from pre-test to post-test. While number of movements and total path lengths of both hands decreased, speed of right instrument also decreased from 4.1 + 2.7 to 3.0 ± 0.7 cm/sec (p = 0.007). Average speed of left instrument was associated with respect for tissue (r = 0.60, p < 0.05) and depth perception (r = 0.68, p < 0.05) on post-test evaluations. CONCLUSION Our study demonstrated significant improvement in technical skills based on subjective evaluator assessment as well as objective simulator metrics after simulation. The few correlations identified between the subjective evaluator and the objective simulator assessments suggest the two evaluation modalities were measuring different aspects of the technical skills and should both be considered in the evaluation process.
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Affiliation(s)
- Yohei Kojima
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Surgery, Kyorin University, Tokyo, Japan
| | - Harry J Wong
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - John G Linn
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Stephen P Haggerty
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Woody Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
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14
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Karamchandani U, Erridge S, Evans-Harvey K, Darzi A, Hoare J, Sodergren MH. Visual gaze patterns in trainee endoscopists - a novel assessment tool. Scand J Gastroenterol 2022; 57:1138-1146. [PMID: 35450506 DOI: 10.1080/00365521.2022.2064723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colonoscopy proficiency is significantly influenced by skills achieved during training. Although assessment scores exist, they do not evaluate the impact of visual search strategies and their use is time and labour intensive. Eye-tracking has shown significant differences in visual gaze patterns (VGPs) between expert endoscopists with varying polyp detection rates, so may provide a means of automated assessment and guidance for trainees. This study aimed to assess the feasibility of eye-tracking as a novel assessment method for trainee endoscopists. METHODS Eye-tracking glasses were used to record 26 colonoscopies from 12 endoscopy trainees who were assessed with directly observed procedural scores (DOPS), devised by the Joint Advisory Group (JAG) on GI endoscopy, and a visual analogue score of overall competence. A 'total weighted procedure score' (TWPS) was calculated from 1 to 20. Primary outcomes of fixation duration (FixD) and fixation frequency (FixF) were analysed according to areas of interest (AOIs) with the bowel surface and lumen represented by three concentric rings. Correlation was assessed using Pearson's coefficient. Significance was set at p<.050. RESULTS Trainees displayed a significant positive correlation between TWPS and FixD (R = 0.943, p<.0001) and FixF (R = 0.936, p<.0001) in the anatomical bowel mucosa peripheries. Conversely, they had significant negative correlations between TWPS and the anatomical bowel lumen (FixD: R= -0.546, p=.004; FixF: R= -0.568, p=.002). CONCLUSIONS Higher objective performance scores were associated with VGPs focussing on bowel mucosa. This is consistent with prior analysis showing peripheral VGPs correspond with higher polyp detection rates. Analysis of VGPs, therefore, has potential for training and assessment in colonoscopy.
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Affiliation(s)
- Urvi Karamchandani
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Simon Erridge
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Keane Evans-Harvey
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Jonathan Hoare
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - Mikael Hans Sodergren
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
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15
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The development of an eye movement-based deep learning system for laparoscopic surgical skills assessment. Sci Rep 2022; 12:11036. [PMID: 35970911 PMCID: PMC9378740 DOI: 10.1038/s41598-022-15053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
The development of valid, reliable, and objective methods of skills assessment is central to modern surgical training. Numerous rating scales have been developed and validated for quantifying surgical performance. However, many of these scoring systems are potentially flawed in their design in terms of reliability. Eye-tracking techniques, which provide a more objective investigation of the visual-cognitive aspects of the decision-making process, recently have been utilized in surgery domains for skill assessment and training, and their use has been focused on investigating differences between expert and novice surgeons to understand task performance, identify experienced surgeons, and establish training approaches. Ten graduate students at the National Taiwan University of Science and Technology with no prior laparoscopic surgical skills were recruited to perform the FLS peg transfer task. Then k-means clustering algorithm was used to split 500 trials into three dissimilar clusters, grouped as novice, intermediate, and expert levels, by an objective performance assessment parameter incorporating task duration with error score. Two types of data sets, namely, time series data extracted from coordinates of eye fixation and image data from videos, were used to implement and test our proposed skill level detection system with ensemble learning and a CNN algorithm. Results indicated that ensemble learning and the CNN were able to correctly classify skill levels with accuracies of 76.0% and 81.2%, respectively. Furthermore, the incorporation of coordinates of eye fixation and image data allowed the discrimination of skill levels with a classification accuracy of 82.5%. We examined more levels of training experience and further integrated an eye tracking technique and deep learning algorithms to develop a tool for objective assessment of laparoscopic surgical skill. With a relatively unbalanced sample, our results have demonstrated that the approach combining the features of visual fixation coordinates and images achieved a very promising level of performance for classifying skill levels of trainees.
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16
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Eye Tracking Use in Surgical Research: A Systematic Review. J Surg Res 2022; 279:774-787. [PMID: 35944332 DOI: 10.1016/j.jss.2022.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/18/2022] [Accepted: 05/22/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Eye tracking (ET) is a popular tool to study what factors affect the visual behaviour of surgical team members. To our knowledge, there have been no reviews to date that evaluate the broad use of ET in surgical research. This review aims to identify and assess the quality of this evidence, to synthesize how ET can be used to inform surgical practice, and to provide recommendations to improve future ET surgical studies. METHODS In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was conducted. An electronic search was performed in MEDLINE, Cochrane Central, Embase, and Web of Science databases up to September 2020. Included studies used ET to measure the visual behaviour of members of the surgical team during surgery or surgical tasks. The included studies were assessed by two independent reviewers. RESULTS A total of 7614 studies were identified, and 111 were included for data extraction. Eleven applications were identified; the four most common were skill assessment (41%), visual attention assessment (22%), workload measurement (17%), and skills training (10%). A summary was provided of the various ways ET could be used to inform surgical practice, and three areas were identified for the improvement of future ET studies in surgery. CONCLUSIONS This review provided a comprehensive summary of the various applications of ET in surgery and how ET could be used to inform surgical practice, including how to use ET to improve surgical education. The information provided in this review can also aid in the design and conduct of future ET surgical studies.
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Sipatchin A, García García M, Sauer Y, Wahl S. Application of Spatial Cues and Optical Distortions as Augmentations during Virtual Reality (VR) Gaming: The Multifaceted Effects of Assistance for Eccentric Viewing Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159571. [PMID: 35954927 PMCID: PMC9368505 DOI: 10.3390/ijerph19159571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022]
Abstract
The present study investigates the effects of peripheral spatial cues and optically distorting augmentations over eccentric vision mechanisms in normally sighted participants with simulated scotoma. Five different augmentations were tested inside a virtual reality (VR)-gaming environment. Three were monocular spatial cues, and two were binocular optical distortions. Each was divided into three conditions: baseline with normal viewing, augmentation with one of the assistance methods positioned around the scotoma, and one with only the simulated central scotoma. The study found that the gaming scenario induced eccentric viewing for the cued augmentation groups, even when the peripheral assistance was removed, while for the optical distortions group, the eccentric behavior disappeared after the augmentation removal. Additionally, an upwards directionality of gaze relative to target during regular gaming was found. The bias was maintained and implemented during and after the cued augmentations but not after the distorted ones. The results suggest that monocular peripheral cues could be better candidates for implementing eccentric viewing training in patients. At the same time, it showed that optical distortions might disrupt such behavior. Such results are noteworthy since distortions such as zoom are known to help patients with macular degeneration see targets of interest.
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Affiliation(s)
| | | | - Yannick Sauer
- Institute for Ophthalmic Research, 72076 Tübingen, Germany
| | - Siegfried Wahl
- Institute for Ophthalmic Research, 72076 Tübingen, Germany
- Carl Zeiss Vision International GmbH, 73430 Aalen, Germany
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Matsumoto S, Kawahira H, Oiwa K, Maeda Y, Nozawa A, Lefor AK, Hosoya Y, Sata N. Laparoscopic surgical skill evaluation with motion capture and eyeglass gaze cameras: A pilot study. Asian J Endosc Surg 2022; 15:619-628. [PMID: 35598888 DOI: 10.1111/ases.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An eyeglass gaze camera and a skeletal coordinate camera without sensors attached to the operator's body were used to monitor gaze and movement during a simulated surgical procedure. These new devices have the potential to change skill assessment for laparoscopic surgery. The suitability of these devices for skill assessment was investigated. MATERIAL AND METHODS Six medical students, six intermediate surgeons, and four experts performed suturing tasks in a dry box. The tip positions of the instruments were identified from video recordings. Performance was evaluated based on instrument movement, gaze, and skeletal coordination. RESULTS Task performance time and skeletal coordinates were not significantly different among skill levels. The total movement distance of the right instrument was significantly different depending on the skill level. The SD of the gaze coordinates was significantly different depending on skill level and was less for experts. The expert's gaze stayed in a small area with little blurring. CONCLUSIONS The SD of gaze point coordinates correlates with laparoscopic surgical skill level. These devices may facilitate objective intraoperative skill evaluation in future studies.
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Affiliation(s)
- Shiro Matsumoto
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hiroshi Kawahira
- Medical Simulation Center, Jichi Medical University, Tochigi, Japan
| | - Kosuke Oiwa
- Department of Electrical Engineering and Electronics, Aoyama Gakuin University, Kanagawa, Japan
| | - Yoshitaka Maeda
- Medical Simulation Center, Jichi Medical University, Tochigi, Japan
| | - Akio Nozawa
- Department of Electrical Engineering and Electronics, Aoyama Gakuin University, Kanagawa, Japan
| | | | | | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan
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Guzmán-García C, Sánchez-González P, Margallo JAS, Snoriguzzi N, Rabazo JC, Margallo FMS, Gómez EJ, Oropesa I. Correlating Personal Resourcefulness and Psychomotor Skills: An Analysis of Stress, Visual Attention and Technical Metrics. SENSORS 2022; 22:s22030837. [PMID: 35161582 PMCID: PMC8838092 DOI: 10.3390/s22030837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
Modern surgical education is focused on making use of the available technologies in order to train and assess surgical skill acquisition. Innovative technologies for the automatic, objective assessment of nontechnical skills are currently under research. The main aim of this study is to determine whether personal resourcefulness can be assessed by monitoring parameters that are related to stress and visual attention and whether there is a relation between these and psychomotor skills in surgical education. For this purpose, we implemented an application in order to monitor the electrocardiogram (ECG), galvanic skin response (GSR), gaze and performance of surgeons-in-training while performing a laparoscopic box-trainer task so as to obtain technical and personal resourcefulness' metrics. Eight surgeons (6 nonexperts and 2 experts) completed the experiment. A total of 22 metrics were calculated (7 technical and 15 related to personal resourcefulness) per subject. The average values of these metrics in the presence of stressors were compared with those in their absence and depending on the participants' expertise. The results show that both the mean normalized GSR signal and average surgical instrument's acceleration change significantly when stressors are present. Additionally, the GSR and acceleration were found to be correlated, which indicates that there is a relation between psychomotor skills and personal resourcefulness.
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Affiliation(s)
- Carmen Guzmán-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Juan A. Sánchez Margallo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | - Nicola Snoriguzzi
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
| | - José Castillo Rabazo
- Centro de Cirugía de Mínima Invasión Jesús Usón, 10071 Cáceres, Spain; (J.A.S.M.); (J.C.R.); (F.M.S.M.)
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Ignacio Oropesa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centre for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.G.-G.); (P.S.-G.); (N.S.); (E.J.G.)
- Correspondence: ; Tel.: +34-910-672-458
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Koskinen J, Torkamani-Azar M, Hussein A, Huotarinen A, Bednarik R. Automated tool detection with deep learning for monitoring kinematics and eye-hand coordination in microsurgery. Comput Biol Med 2021; 141:105121. [PMID: 34968859 DOI: 10.1016/j.compbiomed.2021.105121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/03/2022]
Abstract
In microsurgical procedures, surgeons use micro-instruments under high magnifications to handle delicate tissues. These procedures require highly skilled attentional and motor control for planning and implementing eye-hand coordination strategies. Eye-hand coordination in surgery has mostly been studied in open, laparoscopic, and robot-assisted surgeries, as there are no available tools to perform automatic tool detection in microsurgery. We introduce and investigate a method for simultaneous detection and processing of micro-instruments and gaze during microsurgery. We train and evaluate a convolutional neural network for detecting 17 microsurgical tools with a dataset of 7500 frames from 20 videos of simulated and real surgical procedures. Model evaluations result in mean average precision at the 0.5 threshold of 89.5-91.4% for validation and 69.7-73.2% for testing over partially unseen surgical settings, and the average inference time of 39.90 ± 1.2 frames/second. While prior research has mostly evaluated surgical tool detection on homogeneous datasets with limited number of tools, we demonstrate the feasibility of transfer learning, and conclude that detectors that generalize reliably to new settings require data from several different surgical procedures. In a case study, we apply the detector with a microscope eye tracker to investigate tool use and eye-hand coordination during an intracranial vessel dissection task. The results show that tool kinematics differentiate microsurgical actions. The gaze-to-microscissors distances are also smaller during dissection than other actions when the surgeon has more space to maneuver. The presented detection pipeline provides the clinical and research communities with a valuable resource for automatic content extraction and objective skill assessment in various microsurgical environments.
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Affiliation(s)
- Jani Koskinen
- School of Computing, University of Eastern Finland, Länsikatu 15, Joensuu, 80100, Pohjois-Karjala, Finland.
| | - Mastaneh Torkamani-Azar
- School of Computing, University of Eastern Finland, Länsikatu 15, Joensuu, 80100, Pohjois-Karjala, Finland
| | - Ahmed Hussein
- Microsurgery Center, Kuopio University Hospital, Kuopio, 70211, Pohjois-Savo, Finland; Department of Neurosurgery, Faculty of Medicine, Assiut University, Assiut, 71111, Egypt
| | - Antti Huotarinen
- Microsurgery Center, Kuopio University Hospital, Kuopio, 70211, Pohjois-Savo, Finland; Department of Neurosurgery, Institute of Clinical Medicine, Kuopio University Hospital, Kuopio, 70211, Pohjois-Savo, Finland
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Länsikatu 15, Joensuu, 80100, Pohjois-Karjala, Finland
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Maeda Y, Oiwa K, Matsumoto S, Nozawa A, Kawahira H. Years of experience is more effective in defining experts in the gaze analysis of laparoscopic suturing task than task duration. APPLIED ERGONOMICS 2021; 96:103474. [PMID: 34098406 DOI: 10.1016/j.apergo.2021.103474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
In this study, the relationship between gaze patterns, task duration, and years of experience, which are commonly used to define and evaluate expert surgeons in laparoscopic surgery, was identified. Ten surgeons with 1-28 years of experience and six inexperienced students were included. Subjects used forceps to repeat the task of suturing a suture pad. Each subject wore an eye-marking recorder, and gaze points were recorded and analyzed. No significant relationship between task duration and gaze pattern was observed. However, there was a significant relationship between a surgeon's years of experience and the percentage of time spent gazing at the forceps. Subjects with more years of experience operated without looking at the forceps and fixed their gaze on the operational target. Therefore, when analyzing laparoscopic gazing patterns, it may be more appropriate to define an "expert" based on the years of experience rather than task duration.
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Affiliation(s)
- Yoshitaka Maeda
- Medical Simulation Center, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Kosuke Oiwa
- Department of Electrical Engineering and Electronics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, 252-5258, Japan.
| | - Shiro Matsumoto
- The Departments of Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Akio Nozawa
- Department of Electrical Engineering and Electronics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, 252-5258, Japan.
| | - Hiroshi Kawahira
- Medical Simulation Center, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
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22
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Chainey J, Elomaa AP, O'Kelly CJ, Kim MJ, Bednarik R, Zheng B. Eye-Hand Coordination of Neurosurgeons: Evidence of Action-Related Fixation in Microsuturing. World Neurosurg 2021; 155:e196-e202. [PMID: 34400325 DOI: 10.1016/j.wneu.2021.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We examined performance differences between expert and novice neurosurgeons under a surgical microscope with the goal to evaluate surgical expertise. METHODS The Tobii eye-tracker was used to record surgeons' eye movements while they performed a microsuturing task. A total of 19 expert and 18 novice trials were recorded under the microscope. Surgical videos were annotated to label subtasks and critical actions. Total suturing time and subtask times were also compared between novice and expert surgeons. At 3 critical and discrete surgical actions (needle piercing into tissue, exiting, and thread cutting) we examined eye fixation that was directly coupled to each of these actions. RESULTS Compared with novices, expert surgeons completed the suture with shorter total time (258.52 ± 102.14 seconds vs. 330.02 ± 96.52 seconds, P = 0.038), penetration time (17.15 ± 3.50 seconds vs. 26.26 ± 18.58 seconds, P = 0.043), and knot-tying time (194.63 ± 94.55 seconds vs. 262.52 ± 79.05 seconds, P = 0.025). On average, experts displayed longer fixation (1.62 seconds) and preaction fixation time (1.3 seconds) than novices (fixation time = 1.24 seconds, P = 0.048; preaction fixation = 0.82 seconds, P = 0.005)). Experts maintained their visual engagement constantly over the 3 levels of subtasks while novices required a longer fixation time for the challenging piercing action than for the exiting and cutting action. CONCLUSIONS The action-related fixation can be used to evaluate microsurgeons' level of expertise and in surgical education for gaze training.
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Affiliation(s)
- Jonathan Chainey
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, University of Eastern Finland, Kuopio, Finland
| | - Cian J O'Kelly
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Michael J Kim
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Roman Bednarik
- School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Bin Zheng
- Department of Surgery, University of Alberta, Edmonton, Canada.
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Chainey J, O'Kelly CJ, Kim MJ, Zheng B. Neurosurgical performance between experts and trainees: Evidence from drilling task. Int J Med Robot 2021; 17:e2313. [PMID: 34288358 DOI: 10.1002/rcs.2313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Lumbar laminectomy is a common neurosurgery that requires precise manipulation of power drills. We examined the fine movement controls of novice neurosurgeons in drilling tasks and compared its accuracy to expert surgeons' performance. METHODS Four experts and three novice neurosurgeons performed a lumbar laminectomy on a three-dimensional printed spine model. Scene video and surgeons' eye movements were recorded. Independent sample t-Tests were conducted on the number of jump, total fixation durations, pre-jump fixation durations, post-jump fixation durations and jump distances over novice and expert surgeons. RESULTS No statistically significant differences were recorded in terms of total fixations and pre-jump fixation durations. However, novices had more jumping events, greater jump distances and longer post-jump fixation durations when compared to expert neurosurgeons. CONCLUSION Differences in movement accuracy and eye measures were found between expert and novice neurosurgeons during a simulated microscopic lumbar laminectomy. A more comprehensive understanding of surgeon's fine movement control mechanism and eye-hand coordination in microsurgery is essential for us before building an enhanced training protocol for surgical residents in neurosurgery.
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Affiliation(s)
- Jonathan Chainey
- Department of Surgery, Division of Neurosurgery, University of Alberta, Edmonton, Canada
| | - Cian J O'Kelly
- Department of Surgery, Division of Neurosurgery, University of Alberta, Edmonton, Canada
| | - Michael J Kim
- Department of Surgery, Division of General Surgery, University of Alberta Hospital, Edmonton, Canada
| | - Bin Zheng
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Zheng B, Jiang X, Bednarik R, Atkins MS. Action-related eye measures to assess surgical expertise. BJS Open 2021; 5:6363075. [PMID: 34476467 PMCID: PMC8413367 DOI: 10.1093/bjsopen/zrab068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Eye-tracking offers a new list of performance measures for surgeons. Previous studies of eye-tracking have reported that action-related fixation is a good measuring tool for elite task performers. Other measures, including early eye engagement to target and early eye disengagement from the previous subtask, were also reported to distinguish between different expertise levels. These parameters were examined during laparoscopic surgery simulations in the present study, with a goal to identify the most useful measures for distinguishing surgical expertise. Methods Surgical operators, including experienced surgeons (expert), residents (intermediate), and university students (novice), were required to perform a laparoscopic task involving reaching, grasping, and loading, while their eye movements and performance videos were recorded. Spatiotemporal features of eye–hand coordination and action-related fixation were calculated and compared among the groups. Results The study included five experienced surgeons, seven residents, and 14 novices. Overall, experts performed tasks faster than novices. Examining eye–hand coordination on each subtask, it was found that experts managed to disengage their eyes earlier from the previous subtask, whereas novices disengaged their eyes from previous subtask with a significant delay. Early eye engagement to the current subtask was observed for all operators. There was no difference in action-related fixation between experienced surgeons and novices. Disengage time was strongly associated with the surgical experience score of the operators, better than both early-engage time and action-related fixation. Conclusion The spatiotemporal features of surgeons’ eye–hand coordination can be used to assess level of surgical experience.
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Affiliation(s)
- B Zheng
- Department of Surgery, University of Alberta, Canada
| | - X Jiang
- Computing Science, Memorial University of Newfoundland, Newfoundland, Canada
| | - R Bednarik
- School of Computing, University of Eastern Finland, Joensuu, Finland
| | - M S Atkins
- Computing Science, Simon Fraser University, British Columbia, Canada
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Dalton K. Review: The Quiet Eye in Sports Performance-Is the Quiet Eye the Ultimate Explanation or Only the Beginning? Optom Vis Sci 2021; 98:732-737. [PMID: 34267083 DOI: 10.1097/opx.0000000000001728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The quiet eye is a gaze behavior that seems to differentiate both expert-novice performance and successful and unsuccessful performance in experts; however, the quiet eye may only represent one aspect of the perceptual-cognitive expertise differences that exist between athletes and nonathletes.Research suggests that expert-novice differences in vision and visual-motor coordination skills exist between athletes and nonathletes, although the underlying mechanisms driving these differences are not well understood. The quiet eye is the final fixation or tracking gaze made before the initiation of the action of importance in a motor coordination task and is quite possibly the most well-studied vision strategy variable in sport. The quiet eye has been shown to be a key component of both expert ability and successful performance. However, the quiet eye is not without its criticisms, and the perceptual mechanisms underlying this unique gaze behavior are not yet well understood. The question that remains to be answered is whether the differences in vision and visual-motor coordination skills that exist between athletes and nonathletes can be explained by the quiet eye alone or if the explanation is more complicated.
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Marín-Conesa E, Sánchez-Ferrer F, Grima-Murcia MD, Sánchez-Ferrer ML. The Application of a System of Eye Tracking in Laparoscopic Surgery: A New Didactic Tool to Visual Instructions. Front Surg 2021; 8:643611. [PMID: 34179065 PMCID: PMC8219847 DOI: 10.3389/fsurg.2021.643611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/29/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Laparoscopic surgery is an increasingly used technique, but it requires a high degree of learning, and communication between the operating room crew is considerably difficult. The use of eye tracking has been proposed as a didactic and evaluation tool in several settings, including in laparoscopy in simulators. Objectives: This study aimed to evaluate the usefulness of the use of eye tracking systems (Tobii glasses 2) in laparoscopic surgery as a didactic and assessment tool to improve communication in the operating room and improve patients' security. Methodology: An anonymous survey was sent to the students and medical teachers of a faculty of medicine and practicing doctors and residents. The message contained an explanation about the use of the Tobii glasses, a link to watch the video showing its use in a laparoscopic surgery, and the survey to complete after watching the video. Results: The survey was answered by 113 participants (51.3% medical students, 27.4% medical teachers, 18.6% practicing doctors, and 2.7% medicine residents). Eighty-three percent agreed with the usefulness of the “Tobii glasses” in the operating room for improving communication between the main surgeon and the assistant, for learning complex surgery techniques, for obtaining didactic videos, and for indicating anatomical structures. The item scored worst was the price of the glasses. Conclusions: It is possible to record and project expert gaze patterns in the operating room in real time using the Tobii glasses. This device allows improving communication among the surgical crew and the learning of residents and also improving the security of surgical patients.
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Affiliation(s)
- Ester Marín-Conesa
- Department of Neurology, 'Reina Sofía' University Hospital of Murcia, Murcia, Spain
| | - Francisco Sánchez-Ferrer
- Department of Pediatrics, "San Juan" University Hospital, Miguel Hernandez University, Alicante, Spain
| | | | - María Luisa Sánchez-Ferrer
- Department of Obstetrics and Gynecology of the University Hospital "Virgen de la Arrixaca", Institute for Biomedical Research of Murcia, IMIB-Arrixaca, University of Murcia, Murcia, Spain
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Xiao Y, Shen Z. Umbilical two-port laparoscopic percutaneous extraperitoneal closure for patent processus vaginalis in boys: incision-hiding and solo-like surgery. BMC Surg 2021; 21:275. [PMID: 34078336 PMCID: PMC8173889 DOI: 10.1186/s12893-021-01277-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Transumbilical two-port laparoscopic percutaneous extraperitoneal closure for the treatment of processus vaginalis patency in boys has been practising recent years. The applicable instruments and skills are still evolving. In this study, we used a self-made needle assisted by a disposable dissecting forceps to practise this minimal invasive method for patent processus vaginalis in boys. Its safety and effectiveness were studied. The methods for depth and orientation perceptions were analyzed. Methods From January 2020 to November 2020, boys characteristic of symtomatic patency of processus vaginalis were performed open surgery consecutively. From December 2020, the authors begun to propose transumbilical two-port laparoscopic percutaneous extraperitoneal closure for this kind of boy patients. The open group included fifteen boys and the laparoscopic group included ten ones. The data of the patients age, constituent ratios of unilateral and bilateral patency, operating time, postoperative stay in hospital, follow-up time, conversion, postoperative complications were assessed. Throughout the laparoscopic process, the parallel and synchronous movements of lens pole and dissecting forceps were maintained. Vas deferens protrude was imagined as one of the point to form the triangular manipulation plane. Results There were no statistically significant difference between the laparoscopic group and the open group for the following items: age, operating time, the constituent ratios of unilateral or bilateral patency of processus vaginalis (P > 0.05). Postoperative stay in hospital and follow-up time of the laparoscopic group was significantly shorter than that of the open group (P = 0.0000). No laparoscopic case was converted to open surgery. After 10 cases of laparoscopic practice, orientation perception was established. There were no postoperative complications for all the patients. Conclusion Our preliminary experience suggested that umbilical two-port laparoscopic percutaneous extraperitoneal closure is safe and convenient for patent processus vaginalis treatment in boys. It has the advantage of incision-hiding and can be manipulated like a solo-like surgery.
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Affiliation(s)
- Yuanhong Xiao
- Department of Pediatric Surgery, Faculty of Pediatrics, the Seventh Medical Center, Chinese PLA General Hospital, Nan Men Cang 5th, Dongcheng District, Beijing, 100700, China.
| | - Zhou Shen
- Department of Pediatric Surgery, Faculty of Pediatrics, the Seventh Medical Center, Chinese PLA General Hospital, Nan Men Cang 5th, Dongcheng District, Beijing, 100700, China
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van Montfort D, Kok E, Vincken K, van der Schaaf M, van der Gijp A, Ravesloot C, Rutgers D. Expertise development in volumetric image interpretation of radiology residents: what do longitudinal scroll data reveal? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:437-466. [PMID: 33030627 PMCID: PMC8041671 DOI: 10.1007/s10459-020-09995-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
The current study used theories on expertise development (the holistic model of image perception and the information reduction hypothesis) as a starting point to identify and explore potentially relevant process measures to monitor and evaluate expertise development in radiology residency training. It is the first to examine expertise development in volumetric image interpretation (i.e., CT scans) within radiology residents using scroll data collected longitudinally over five years of residency training. Consistent with the holistic model of image perception, the percentage of time spent on full runs, i.e. scrolling through more than 50% of the CT-scan slices (global search), decreased within residents over residency training years. Furthermore, the percentage of time spent on question-relevant areas in the CT scans increased within residents over residency training years, consistent with the information reduction hypothesis. Second, we examined if scroll patterns can predict diagnostic accuracy. The percentage of time spent on full runs and the percentage of time spent on question-relevant areas did not predict diagnostic accuracy. Thus, although scroll patterns over training years are consistent with visual expertise theories, they could not be used as predictors of diagnostic accuracy in the current study. Therefore, the relation between scroll patterns and performance needs to be further examined, before process measures can be used to monitor and evaluate expertise development in radiology residency training.
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Affiliation(s)
- Dorien van Montfort
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands
| | - Ellen Kok
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands.
| | - Koen Vincken
- Image Sciences Institute, Imaging Dept, University Medical Center, Utrecht, The Netherlands
| | - Marieke van der Schaaf
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk van der Gijp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cécile Ravesloot
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk Rutgers
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Comparing the Visual Perception According to the Performance Using the Eye-Tracking Technology in High-Fidelity Simulation Settings. Behav Sci (Basel) 2021; 11:bs11030031. [PMID: 33807673 PMCID: PMC7998119 DOI: 10.3390/bs11030031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: We used eye-tracking technology to explore the visual perception of clinicians during a high-fidelity simulation scenario. We hypothesized that physicians who were able to successfully manage a critical situation would have a different visual focus compared to those who failed. Methods: A convenience sample of 18 first-year emergency medicine residents were enrolled voluntarily to participate in a high-fidelity scenario involving a patient in shock with a 3rd degree atrioventricular block. Their performance was rated as pass or fail and depended on the proper use of the pacing unit. Participants were wearing pre-calibrated eye-tracking glasses throughout the 9-min scenario and infrared (IR) markers installed in the simulator were used to define various Areas of Interest (AOI). Total View Duration (TVD) and Time to First Fixation (TFF) by the participants were recorded for each AOI and the results were used to produce heat maps. Results: Twelve residents succeeded while six failed the scenario. The TVD for the AOI containing the pacing unit was significantly shorter (median [quartile]) for those who succeeded compared to the ones who failed (42 [31–52] sec vs. 70 [61–90] sec, p = 0.0097). The TFF for the AOI containing the ECG and vital signs monitor was also shorter for the participants who succeeded than for those who failed (22 [6–28] sec vs. 30 [27–77] sec, p = 0.0182). Discussion: There seemed to be a connection between the gaze pattern of residents in a high-fidelity bradycardia simulation and their performance. The participants who succeeded looked at the monitor earlier (diagnosis). They also spent less time fixating the pacing unit, using it promptly to address the bradycardia. This study suggests that eye-tracking technology could be used to explore how visual perception, a key information-gathering element, is tied to decision-making and clinical performance.
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Melnyk R, Campbell T, Holler T, Cameron K, Saba P, Witthaus MW, Joseph J, Ghazi A. See Like an Expert: Gaze-Augmented Training Enhances Skill Acquisition in a Virtual Reality Robotic Suturing Task. J Endourol 2021; 35:376-382. [PMID: 32967467 DOI: 10.1089/end.2020.0445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: The da Vinci Skills Simulator (DVSS) is an effective platform for robotic skills training. Novel training methods using expert gaze patterns to guide trainees have demonstrated superiority to traditional instruction. Portable head-mounted eye-trackers (HMET) offer the opportunity for eye tracking technology to enhance surgical robotic simulation training. Objective: To evaluate if training guided by expert gaze patterns can improve trainee performance over standard movement training techniques during robotic simulation. Methods: Medical students were recruited and randomized into gaze training (GT, n = 9) and movement training (MT, n = 8) groups. First, the participants reviewed an instructional video, with the GT group emulating expert gaze patterns and the MT group (n = 8) standard movement-based instruction. Training consisted of 10 repetitions of "Suture Sponge 3" on the DVSS while wearing HMET; the first three repetitions were followed by group-appropriate video coaching (gaze vs movement feedback), while the remaining repetitions were without feedback. Finally, two multitasking repetitions with a secondary bell-counting task were completed. Primary outcomes included DVSS scores during training and multitasking. Secondary outcomes included metrics collected from the HMET (gaze patterns and gaze entropy). Results: Total score, efficiency, and penalties improved significantly over the training in both groups; the GT group achieved higher scores on every attempt. Total scores in the GT group were higher than the MT group postvideo review (20.3 ± 21.8 vs 3.0 ± 6.2, p = 0.047), after coaching repetitions (61.8 ± 18.8 vs 30.1 ± 26.2, p = 0.01), and at the last training attempt (73.0 ± 16.5 vs 63.1 ± 17.4, p = 0.247). During multitasking, the GT group maintained higher total scores (75 ± 10.1 vs 63.3 ± 15.3, p = 0.01), efficiency (86.3 ± 7.4 vs 77.4 ± 11.2, p = 0.009), and superior secondary task performance (error: 6.3% ± 0.06 vs 10.7% ± 0.11, p = 0.20). Gaze entropy (cognitive-load indicator) and gaze pattern analysis showed similar trends. Conclusion: Gaze-augmented training leads to more efficient movements through adoption of expert gaze patterns that withstand additional stressors.
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Affiliation(s)
- Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Timothy Campbell
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Tyler Holler
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Katherine Cameron
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael W Witthaus
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed Ghazi
- Simulation Innovation Laboratory, Department of Urology, University of Rochester Medical Center, Rochester, New York, USA.,Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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de Brouwer AJ, Flanagan JR, Spering M. Functional Use of Eye Movements for an Acting System. Trends Cogn Sci 2021; 25:252-263. [PMID: 33436307 DOI: 10.1016/j.tics.2020.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
Movements of the eyes assist vision and support hand and body movements in a cooperative way. Despite their strong functional coupling, different types of movements are usually studied independently. We integrate knowledge from behavioral, neurophysiological, and clinical studies on how eye movements are coordinated with goal-directed hand movements and how they facilitate motor learning. Understanding the coordinated control of eye and hand movements can provide important insights into brain functions that are essential for performing or learning daily tasks in health and disease. This knowledge can also inform applications such as robotic manipulation and clinical rehabilitation.
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Affiliation(s)
- Anouk J de Brouwer
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.
| | - J Randall Flanagan
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada; Department of Psychology, Queen's University, Kingston, Canada
| | - Miriam Spering
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
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Is Experience in Hemodialysis Cannulation Related to Expertise? A Metrics-based Investigation for Skills Assessment. Ann Biomed Eng 2021; 49:1688-1700. [PMID: 33417054 DOI: 10.1007/s10439-020-02708-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/08/2020] [Indexed: 12/19/2022]
Abstract
Cannulation is not only one of the most common medical procedures but also fraught with complications. The skill of the clinician performing cannulation directly impacts cannulation outcomes. However, current methods of teaching this skill are deficient, relying on subjective demonstrations and unrealistic manikins that have limited utility for skills training. Furthermore, of the factors that hinders effective continuing medical education is the assumption that clinical experience results in expertise. In this work, we examine if objective metrics acquired from a novel cannulation simulator are able to distinguish between experienced clinicians and established experts, enabling the measurement of true expertise. Twenty-two healthcare professionals, who practiced cannulation with varying experience, performed a simulated arteriovenous fistula cannulation task on the simulator. Four clinicians were peer-identified as experts while the others were designated to the experienced group. The simulator tracked the motion of the needle (via an electromagnetic sensor), rendered blood flashback function (via an infrared light sensor), and recorded pinch forces exerted on the needle (via force sensing elements). Metrics were computed based on motion, force, and other sensor data. Results indicated that, with near 80% of accuracy using both logistic regression and linear discriminant analysis, the objective metrics differentiated between experts and the experienced, including identifying needle motion and finger force as two prominent features that distinguished between the groups. Furthermore, results indicated that expertise was not correlated with years of experience, validating the central hypothesis of the study. These insights contribute to structured and standardized medical skills training by enabling a meaningful definition of expertise and could potentially lead to more effective skills training methods.
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Wu C, Cha J, Sulek J, Zhou T, Sundaram CP, Wachs J, Yu D. Eye-Tracking Metrics Predict Perceived Workload in Robotic Surgical Skills Training. HUMAN FACTORS 2020; 62:1365-1386. [PMID: 31560573 PMCID: PMC7672675 DOI: 10.1177/0018720819874544] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/05/2019] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of this study is to assess the relationship between eye-tracking measures and perceived workload in robotic surgical tasks. BACKGROUND Robotic techniques provide improved dexterity, stereoscopic vision, and ergonomic control system over laparoscopic surgery, but the complexity of the interfaces and operations may pose new challenges to surgeons and compromise patient safety. Limited studies have objectively quantified workload and its impact on performance in robotic surgery. Although not yet implemented in robotic surgery, minimally intrusive and continuous eye-tracking metrics have been shown to be sensitive to changes in workload in other domains. METHODS Eight surgical trainees participated in 15 robotic skills simulation sessions. In each session, participants performed up to 12 simulated exercises. Correlation and mixed-effects analyses were conducted to explore the relationships between eye-tracking metrics and perceived workload. Machine learning classifiers were used to determine the sensitivity of differentiating between low and high workload with eye-tracking features. RESULTS Gaze entropy increased as perceived workload increased, with a correlation of .51. Pupil diameter and gaze entropy distinguished differences in workload between task difficulty levels, and both metrics increased as task level difficulty increased. The classification model using eye-tracking features achieved an accuracy of 84.7% in predicting workload levels. CONCLUSION Eye-tracking measures can detect perceived workload during robotic tasks. They can potentially be used to identify task contributors to high workload and provide measures for robotic surgery training. APPLICATION Workload assessment can be used for real-time monitoring of workload in robotic surgical training and provide assessments for performance and learning.
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Affiliation(s)
| | - Jackie Cha
- Purdue University, West Lafayette, Indiana, USA
| | - Jay Sulek
- Indiana University, Indianapolis, USA
| | - Tian Zhou
- Purdue University, West Lafayette, Indiana, USA
| | | | | | - Denny Yu
- Purdue University, West Lafayette, Indiana, USA
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Menekse Dalveren GG, Cagiltay NE. Distinguishing Intermediate and Novice Surgeons by Eye Movements. Front Psychol 2020; 11:542752. [PMID: 33013592 PMCID: PMC7511664 DOI: 10.3389/fpsyg.2020.542752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/17/2020] [Indexed: 02/05/2023] Open
Abstract
Surgical skill-level assessment is key to collecting the required feedback and adapting the educational programs accordingly. Currently, these assessments for the minimal invasive surgery programs are primarily based on subjective methods, and there is no consensus on skill level classifications. One of the most detailed of these classifications categorize skill levels as beginner, novice, intermediate, sub-expert, and expert. To properly integrate skill assessment into minimal invasive surgical education programs and provide skill-based training alternatives, it is necessary to classify the skill levels in as detailed a way as possible and identify the differences between all skill levels in an objective manner. Yet, despite the existence of very encouraging results in the literature, most of the studies have been conducted to better understand the differences between novice and expert surgical skill levels leaving out the other crucial skill levels between them. Additionally, there are very limited studies by considering the eye-movement behaviors of surgical residents. To this end, the present study attempted to distinguish novice- and intermediate-level surgical residents based on their eye movements. The eye-movement data was recorded from 23 volunteer surgical residents while they were performing four computer-based simulated surgical tasks under different hand conditions. The data was analyzed using logistic regression to estimate the skill levels of both groups. The best results of the estimation revealing a 91.3% recognition rate of predicting novice and intermediate surgical residents on one scenario were selected from four under the dominant hand condition. These results show that the eye-movements can be potentially used to identify surgeons with intermediate and novice skills. However, the results also indicate that the order in which the scenarios are provided, and the design of the scenario, the tasks, and their appropriateness with the skill levels of the participants are all critical factors to be considered in improving the estimation ratio, and hence require thorough assessment for future research.
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Affiliation(s)
- Gonca Gokce Menekse Dalveren
- Department of Computer Science, Norwegian University of Science and Technology, Gjøvik, Norway.,Department of Information Systems Engineering, Atılım University, Ankara, Turkey
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Evans-Harvey K, Erridge S, Karamchandani U, Abdalla S, Beatty JW, Darzi A, Purkayastha S, Sodergren MH. Comparison of surgeon gaze behaviour against objective skill assessment in laparoscopic cholecystectomy-a prospective cohort study. Int J Surg 2020; 82:149-155. [DOI: 10.1016/j.ijsu.2020.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 01/06/2023]
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Capogna E, Salvi F, Delvino L, Di Giacinto A, Velardo M. Novice and Expert Anesthesiologists' Eye-Tracking Metrics During Simulated Epidural Block: A Preliminary, Brief Observational Report. Local Reg Anesth 2020; 13:105-109. [PMID: 32922069 PMCID: PMC7457852 DOI: 10.2147/lra.s267879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/06/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Eye tracking is the process of measuring an individual’s eye movements to register their attentional behavior by using a device called an eye-tracker. Studies conducted using eye-tracking techniques have demonstrated a number of differences in eye movement parameters and patterns between experts and novices. The aim of this preliminary study was to evaluate if there are any differences in eye-tracking metrics between novice and expert anesthesiologists during the performance of an epidural block using an epidural simulator. Methods Seven experts and seven novices who gave their consent to this preliminary study were asked to perform an epidural technique using an epidural simulator while wearing a pair of Tobii Pro glasses. Number of fixations, fixation duration, heat maps and scan-paths were examined by Tobii Pro Lab Software. Duration of the procedure was also recorded. Results The observation of the attentional heat map and gaze plot showed different gaze dispersion between experts and novices. The mean total duration of fixations during needle insertion and advancement and catheter introduction was lower in experts than trainees (respectively, 0.18 vs 3.56 sec; P<0.05 and 0.73 vs 2.48 sec; P<0.05). The mean fixation count was greater in experts vs trainees (5 vs 2; P<0.05). The mean duration of the epidural procedure was 104.16 (41) (trainees) vs 65.3 (32.6) seconds (experts) (P<0.05). Expert anesthesiologists spent more time fixating a more specific target location (eg, the point of the epidural needle rather than the syringe’s barrel) whilst novices split their attention between tracking their tools and the target location. Discussion Eye tracking may have interesting implications for the creation of assessment programs, which distinguish skill level through the use of gaze behavior, and may be a promising tool for monitoring training progress towards the development of expertise.
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Affiliation(s)
- Emanuele Capogna
- EESOA Maternal Neonatal Simulation Center, European School of Obstetric Anesthesia, Rome, Italy
| | - Francesco Salvi
- EESOA Maternal Neonatal Simulation Center, European School of Obstetric Anesthesia, Rome, Italy
| | | | | | - Matteo Velardo
- EESOA Maternal Neonatal Simulation Center, European School of Obstetric Anesthesia, Rome, Italy
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Liu Z, Bible J, Wells J, Vadivalagan D, Singapogu R. Examining the Effect of Haptic Factors for Vascular Palpation Skill Assessment Using an Affordable Simulator. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2020; 1:228-234. [PMID: 33681817 PMCID: PMC7932134 DOI: 10.1109/ojemb.2020.3017156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Goal: Simulators that incorporate haptic feedback for clinical skills training are increasingly used in medical education. This study addresses the neglected aspect of rendering simulated feedback for vascular palpation skills training by systematically examining the effect of haptic factors on performance. Methods: A simulator-based approach to examine palpation skill is presented. Novice participants with and without minimal previous palpation training performed a palpation task on a simulator that rendered controlled vibratory feedback under various conditions. Results: Five objective metrics were employed to analyze participants’ performance that yielded key findings in quantifying palpation performance. Participants’ palpation accuracy was influenced by all three haptic factors, ranging from moderate to statistically significant. Duration, Total Path Length and Ratio of Correct Movement also demonstrated utility for quantifying performance. Conclusions: We demonstrate that our affordable simulator is capable of rendering controlled haptic feedback suitable for skills training. Further, metrics presented in this study can be used for structured palpation skills assessment and training, potentially improving healthcare delivery.
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Affiliation(s)
- Zhanhe Liu
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
| | - Joseph Bible
- Department of Mathematical and Statistical Sciences, Clemson University, SC 29634, USA
| | - Jared Wells
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
| | - Deepak Vadivalagan
- Department of Electrical and Computer Engineering, Clemson University, Clemson, SC 29634, USA
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Feasibility and Utility of an Eye-Tracking Device for Assessing Teachers of Invasive Bedside Procedures. Mayo Clin Proc Innov Qual Outcomes 2020; 4:339-344. [PMID: 32542224 PMCID: PMC7283964 DOI: 10.1016/j.mayocpiqo.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/21/2020] [Indexed: 01/22/2023] Open
Abstract
Patient-related complications from invasive bedside procedures (IBPs) are attributed to the experience and proficiency of the operator. Furthermore, IBP complications by trainees may be due to practice variability and competency among IBP teachers. The use of gaze metrics technology to better understand the behaviors of IBP teachers may aid in the creation of faculty development checklists and, ultimately, reduce procedural complications. Prior research on gaze patterns has focused on the individual performing the procedure, but the goal of this pilot study was to assess gaze behaviors of supervising teachers of IBPs, which is a paradigm shift within procedural education. In this study, pulmonary and critical care medicine fellows placed a central venous catheter on a simulated task trainer as pulmonary and critical care medicine faculty supervised while wearing an eye-tracking device. Both quantitative and qualitative data were obtained. Gaze analysis was divided into 2 areas of interest (ultrasonography and procedure site) and 3 procedural tasks (venous puncture, dilation, and flushing the line). Study findings included the following: (1) calibration was easy and took seconds to complete, (2) the device is relatively comfortable and did not interfere with tasks, (3) a trend toward a higher fixation frequency and dwell time on the ultrasound images during the puncture segment, and (4) variations in fixation frequency on the ultrasound images among supervising IBP teachers. This study documents the feasibility of the eye-tracking device for assessing behaviors of supervisory IBP teachers. There may be a signal suggesting differences in gaze patterns among supervisory teachers, which warrants further study.
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Harris DJ, Wilson MR, Crowe EM, Vine SJ. Examining the roles of working memory and visual attention in multiple object tracking expertise. Cogn Process 2020; 21:209-222. [PMID: 32016685 PMCID: PMC7203592 DOI: 10.1007/s10339-020-00954-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/25/2020] [Indexed: 01/04/2023]
Abstract
When tracking multiple moving targets among visually similar distractors, human observers are capable of distributing attention over several spatial locations. It is unclear, however, whether capacity limitations or perceptual-cognitive abilities are responsible for the development of expertise in multiple object tracking. Across two experiments, we examined the role of working memory and visual attention in tracking expertise. In Experiment 1, individuals who regularly engaged in object tracking sports (soccer and rugby) displayed improved tracking performance, relative to non-tracking sports (swimming, rowing, running) (p = 0.02, ηp2 = 0.163), but no differences in gaze strategy (ps > 0.31). In Experiment 2, participants trained on an adaptive object tracking task showed improved tracking performance (p = 0.005, d = 0.817), but no changes in gaze strategy (ps > 0.07). They did, however, show significant improvement in a working memory transfer task (p < 0.001, d = 0.970). These findings indicate that the development of tracking expertise is more closely linked to processing capacity limits than perceptual-cognitive strategies.
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Affiliation(s)
- David J. Harris
- School of Sport and Health Sciences, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Mark R. Wilson
- School of Sport and Health Sciences, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
| | - Emily M. Crowe
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Samuel J. Vine
- School of Sport and Health Sciences, University of Exeter, St Luke’s Campus, Exeter, EX1 2LU UK
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Hayashi K, Aono S, Fujiwara M, Shiro Y, Ushida T. Difference in eye movements during gait analysis between professionals and trainees. PLoS One 2020; 15:e0232246. [PMID: 32353030 PMCID: PMC7192381 DOI: 10.1371/journal.pone.0232246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/11/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Observational gait analysis is a widely used skill in physical therapy. Meanwhile, the skill has not been investigated using objective assessments. The present study investigated the differences in eye movement between professionals and trainees, while observing gait analysis. METHODS The participants included in this study were 26 professional physical therapists and 26 physical therapist trainees. The participants, wearing eye tracker systems, were asked to describe gait abnormalities of a patient as much as possible. The eye movement parameters of interest were fixation count, average fixation duration, and total fixation duration. RESULTS The number of gait abnormalities described was significantly higher in professionals than in trainees, overall and in limbs of the patient. The fixation count was significantly higher in professionals when compared to trainees. Additionally, the average fixation duration and total fixation duration were significantly shorter in professionals. Conversely, in trunks, the number of gait abnormalities and eye movements showed no significant differences between groups. CONCLUSIONS Professionals require shorter fixation durations on areas of interest than trainees, while describing a higher number of gait abnormalities.
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Affiliation(s)
- Kazuhiro Hayashi
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
- Department of Rehabilitation, Aichi Medical University Hospital, Nagakute, Japan
| | - Shuichi Aono
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
- Department of Pain Data Management, Aichi Medical University, Nagakute, Japan
| | - Mitsuhiro Fujiwara
- Department of Rehabilitation, Kamiiida Rehabilitation Hospital, Nagoya, Japan
| | - Yukiko Shiro
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya, Japan
| | - Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
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Marshall B, Wright DJ, Holmes PS, Williams J, Wood G. Combined action observation and motor imagery facilitates visuomotor adaptation in children with developmental coordination disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 98:103570. [PMID: 31918039 DOI: 10.1016/j.ridd.2019.103570] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/28/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
The internal modelling deficit (IMD) hypothesis suggests that motor control issues associated with Developmental Coordination Disorder (DCD) are the result of impaired predictive motor control. In this study, we examined the benefits of a combined action observation and motor imagery (AO + MI) intervention designed to alleviate deficits in internal modelling and improve eye-hand coordination during a visuomotor rotation task. Twenty children with DCD were randomly assigned to either an AO + MI group (who watched a video of a performer completing the task whilst simultaneously imagining the kinaesthetic sensations associated with action execution) or a control group (who watched unrelated videos involving no motor content). Each group then attempted to learn a 90° visuomotor rotation while measurements of completion time, eye-movement behaviour and movement kinematics were recorded. As predicted, after training, the AO + MI group exhibited quicker completion times, more target-focused eye-movement behaviour and smoother movement kinematics compared to the control group. No significant after-effects were present. These results offer further support for the IMD hypothesis and suggest that AO + MI interventions may help to alleviate such deficits and improve motor performance in children with DCD.
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Affiliation(s)
- B Marshall
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - D J Wright
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - P S Holmes
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - J Williams
- Institute for Sport and Health, College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - G Wood
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
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Nakhaeizadeh S, Morgan RM, Olsson V, Arvidsson M, Thompson T. The value of eye-tracking technology in the analysis and interpretations of skeletal remains: A pilot study. Sci Justice 2020; 60:36-42. [PMID: 31924287 DOI: 10.1016/j.scijus.2019.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/29/2019] [Accepted: 08/11/2019] [Indexed: 11/26/2022]
Abstract
This initial study is the first to use eye-trackers as a tool in order to study gaze pattern strategies and decision making processes involved in the assessment of skeletal remains. Three experienced participants were asked to wear eye-tracking glasses (Tobii Pro Glasses 2) when estimating sex and age-at-death of one set of skeletal remains from a known archeological sample. The study assessed participants' fixation points (the features of the skeleton focused on), fixation duration (the total time spent on each assessment and feature) as well as visit count and duration (the total number of visits and the duration of visits to particular areas). The preliminary results of this study identified differences in gaze "strategies" with regards to fixation points, visit duration, and visit counts between the participants. The data generated provide a starting point for assessing how such technologies could be used in order to more fully understand the decision making processes involved in forensic anthropological interpretations and their role in forensic reconstructions.
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Affiliation(s)
- Sherry Nakhaeizadeh
- UCL Centre for the Forensic Sciences, University College London, 35 Tavistock Square, London, WC1H 9EZ, United Kingdom; UCL Department of Security and Crime Science, 35 Tavistock Square, London, WC1H 9EZ, United Kingdom.
| | - Ruth M Morgan
- UCL Centre for the Forensic Sciences, University College London, 35 Tavistock Square, London, WC1H 9EZ, United Kingdom; UCL Department of Security and Crime Science, 35 Tavistock Square, London, WC1H 9EZ, United Kingdom
| | - Viktor Olsson
- Tobii Pro Insight, Karlsrovägen 2D, 182 53 Danderyd, Stockholm, Sweden
| | - Martin Arvidsson
- Tobii Pro Insight, Karlsrovägen 2D, 182 53 Danderyd, Stockholm, Sweden
| | - Tim Thompson
- Teesside University School of Science, Engineering & Design, Stephenson Street, Tees Valley, TS1 3BX Teesside, United Kingdom
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Chatelain P, Sharma H, Drukker L, Papageorghiou AT, Noble JA. Evaluation of Gaze Tracking Calibration for Longitudinal Biomedical Imaging Studies. IEEE TRANSACTIONS ON CYBERNETICS 2020; 50:153-163. [PMID: 30188843 DOI: 10.1109/tcyb.2018.2866274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Gaze tracking is a promising technology for studying the visual perception of clinicians during image-based medical exams. It could be used in longitudinal studies to analyze their perceptive process, explore human-machine interactions, and develop innovative computer-aided imaging systems. However, using a remote eye tracker in an unconstrained environment and over time periods of weeks requires a certain guarantee of performance to ensure that collected gaze data are fit for purpose. We report the results of evaluating eye tracking calibration for longitudinal studies. First, we tested the performance of an eye tracker on a cohort of 13 users over a period of one month. For each participant, the eye tracker was calibrated during the first session. The participants were asked to sit in front of a monitor equipped with the eye tracker, but their position was not constrained. Second, we tested the performance of the eye tracker on sonographers positioned in front of a cart-based ultrasound scanner. Experimental results show a decrease of accuracy between calibration and later testing of 0.30° and a further degradation over time at a rate of 0.13°. month-1. The overall median accuracy was 1.00° (50.9 pixels) and the overall median precision was 0.16° (8.3 pixels). The results from the ultrasonography setting show a decrease of accuracy of 0.16° between calibration and later testing. This slow degradation of gaze tracking accuracy could impact the data quality in long-term studies. Therefore, the results we present here can help in planning such long-term gaze tracking studies.
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Engelbrecht H, Lindeman RW, Hoermann S. A SWOT Analysis of the Field of Virtual Reality for Firefighter Training. Front Robot AI 2019; 6:101. [PMID: 33501116 PMCID: PMC7805897 DOI: 10.3389/frobt.2019.00101] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/30/2019] [Indexed: 11/13/2022] Open
Abstract
Virtual reality (VR) research has gone through rapid advances and the technology has established itself as a valuable training tool in many domains. While research in the field of emergency response, and more specifically in the field of firefighting, is still catching up, the future potential of VR technology for training is promising. This paper uses the SWOT framework to analyse the strengths, weaknesses, opportunities, and threats immersive VR technology faces in the field of firefighter training. While using VR for training is cost-effective, safe to use and provides the ability to prepare trainees with a large variety of high fidelity training environments, the lack in specialization of the applications for the fire-service sector and issues with technology acceptance and limitations need to be addressed. Looking to current research, there are promising findings that might be directly transferable, creating affective, and multi-sensory experiences for more effective mental and physical training of firefighters in the future. More research is needed to establish methods of skills transfer from VR to real life scenarios and to evaluate the potential risk of frequent training in engaging and physiologically stimulating virtual environments.
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Affiliation(s)
- Hendrik Engelbrecht
- HIT Lab NZ, College of Engineering, University of Canterbury, Christchurch, New Zealand
| | - Robert W. Lindeman
- HIT Lab NZ, College of Engineering, University of Canterbury, Christchurch, New Zealand
| | - Simon Hoermann
- HIT Lab NZ, College of Engineering, University of Canterbury, Christchurch, New Zealand
- School of Product Design, College of Engineering, University of Canterbury, Christchurch, New Zealand
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Feng Y, McGowan H, Semsar A, Zahiri HR, George IM, Park A, Kleinsmith A, Mentis H. Virtual pointer for gaze guidance in laparoscopic surgery. Surg Endosc 2019; 34:3533-3539. [PMID: 31586251 DOI: 10.1007/s00464-019-07141-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/20/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND A challenge of laparoscopic surgery is learning how to interpret the indirect view of the operative field. Acquiring professional vision-understanding what to see and which information to attend to, is thereby an essential part of laparoscopic training and one in which trainers exert great effort to convey. We designed a virtual pointer (VP) that enables experts to point or draw free-hand sketches over an intraoperative laparoscopic video for a novice to see. This study aimed to investigate the efficacy of the virtual pointer in guiding novices' gaze patterns. METHODS We conducted a counter-balanced, within-subject trial to compare the novices' gaze behaviors in laparoscopic training with the virtual pointer compared to a standard training condition, i.e., verbal instruction with un-mediated gestures. In the study, seven trainees performed four simulated laparoscopic tasks guided by an experienced surgeon as the trainer. A Tobii Pro X3-120 eye-tracker was used to capture the trainees' eye movements. The measures include fixation rate, i.e., the frequency of trainees' fixations, saccade amplitude, and fixation concentration, i.e., the closeness of trainees' fixations. RESULTS No significant difference in fixation rate or saccade amplitude was found between the virtual pointer condition and the standard condition. In the virtual pointer condition, trainees' fixations were more concentrated (p = 0.039) and longer fixations were more clustered, compared to the Standard condition (p = 0.008). CONCLUSIONS The virtual pointer effectively improved surgical trainees' in-the-moment gaze focus during the laparoscopic training by reducing their gaze dispersion and concentrating their attention on the anatomical target. These results suggest that technologies which support gaze training should be expert-driven and intraoperative to efficiently modify novices' gaze behaviors.
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Affiliation(s)
- Yuanyuan Feng
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, USA.
| | - Hannah McGowan
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Azin Semsar
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Hamid R Zahiri
- Department of Surgery, Anna Arundel Medical Center, Annapolis, MD, USA
| | - Ivan M George
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Adrian Park
- Department of Surgery, Anna Arundel Medical Center, Annapolis, MD, USA
| | - Andrea Kleinsmith
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Helena Mentis
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, MD, USA
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Loth S, Cote AC, Shaafi Kabiri N, Bhangu JS, Zumwalt A, Moss M, Thomas K. Improving Triage Accuracy in First Responders: Measurement of Short Structured Protocols to Improve Identification of Salient Triage Features. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cagiltay NE, Menekse Dalveren GG. Are Left- and Right-Eye Pupil Sizes Always Equal? J Eye Mov Res 2019; 12:10.16910/jemr.12.2.1. [PMID: 33828724 PMCID: PMC7881883 DOI: 10.16910/jemr.12.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Eye movements provide very critical information about the cognitive load and behaviors of human beings. Earlier studies report that under normal conditions, the left- and right-eye pupil sizes are equal. For this reason, most studies undertaking eye-movement analysis are conducted by only considering the pupil size of a single eye or taking the average size of both eye pupils. This study attempts to offer a better understanding concerning whether there are any differences between the left- and right-eye pupil sizes of the right-handed surgical residents while performing surgical tasks in a computer-based simulation environment under different conditions (left-hand, right-hand and both hands). According to the results, in many cases, the right-eye pupil sizes of the participants were larger than their left-eye pupil sizes while performing the tasks under right-hand and both hands conditions. However, no significant difference was found in relation to the tasks performed under left-hand condition in all scenarios. These results are very critical to shed further light on the cognitive load of the surgical residents by analyzing their left-eye and right-eye pupil sizes. Further research is required to investigate the effect of the difficulty level of each scenario, its appropriateness with the skill level of the participants, and handedness on the differences between the leftand right-eye pupil sizes.
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Affiliation(s)
- Nergiz Ercil Cagiltay
- Atilim University, Faculty of Engineering, Department of Software Engineering, Ankara, Turkey
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Marshall B, Wright DJ, Holmes PS, Wood G. Combining Action Observation and Motor Imagery Improves Eye–Hand Coordination during Novel Visuomotor Task Performance. J Mot Behav 2019; 52:333-341. [DOI: 10.1080/00222895.2019.1626337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Ben Marshall
- Department of Sport and Exercise Science, Faculty of Science and Engineering, Research Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, UK
| | - David J. Wright
- Department of Sport and Exercise Science, Faculty of Science and Engineering, Research Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, UK
| | - Paul S. Holmes
- Department of Sport and Exercise Science, Faculty of Science and Engineering, Research Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, UK
| | - Greg Wood
- Department of Sport and Exercise Science, Faculty of Science and Engineering, Research Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, UK
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Sinitsky DM, Fernando B, Potts H, Lykoudis P, Hamilton G, Berlingieri P. Development of a structured virtual reality curriculum for laparoscopic appendicectomy. Am J Surg 2019; 219:613-621. [PMID: 31122678 DOI: 10.1016/j.amjsurg.2019.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 04/29/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laparoscopic appendicectomy (LA) is a common surgical emergency procedure mainly performed by trainees. The aim was to develop a step-wise structured virtual reality (VR) curriculum for LA to allow junior surgeons to hone their skills in a safe and controlled environment. METHODS A prospective randomized study was designed using a high-fidelity VR simulator. Thirty-five novices and 25 experts participated in the assessment and their performances were compared to assess construct validity. Learning curve analysis was performed. RESULTS Five of the psychomotor tasks and all appendicectomy tasks showed construct validity. Learning was demonstrated in the majority of construct-valid tasks. A novel goal-directed VR curriculum for LA was constructed. CONCLUSIONS A step-wise structured VR curriculum for LA is proposed with a framework which includes computer generated metrics and supports deliberate practice, spacing intervals, human instruction/feedback and assessment. Future study should test the feasibility of its implementation and transferability of acquired skill.
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Affiliation(s)
- Daniel M Sinitsky
- Division of Surgery & Interventional Science, Royal Free Campus, UCL, London, UK
| | - Bimbi Fernando
- Division of Surgery & Interventional Science, Royal Free Campus, UCL, London, UK
| | - Henry Potts
- Institute of Health Informatics, UCL, London, UK
| | - Panagis Lykoudis
- Division of Surgery & Interventional Science, Royal Free Campus, UCL, London, UK
| | - George Hamilton
- Division of Surgery & Interventional Science, Royal Free Campus, UCL, London, UK
| | - Pasquale Berlingieri
- Division of Surgery & Interventional Science, Royal Free Campus, UCL, London, UK; Centre for Screen-Based Medical Simulation, Royal Free Hospital, London, UK.
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Merkle F, Kurtovic D, Starck C, Pawelke C, Gierig S, Falk V. Evaluation of attention, perception, and stress levels of clinical cardiovascular perfusionists during cardiac operations: a pilot study. Perfusion 2019; 34:544-551. [PMID: 30868941 DOI: 10.1177/0267659119828563] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Performing cardiopulmonary bypass is a complex task which involves evaluating visual input from patient monitors and technical parameters displayed at the heart-lung machine console as well as reacting to other sensory input. Only few studies are available concerning the competency requirements for clinical cardiovascular perfusionists, including attention, perception, and coping with mental stress. This study aims at evaluating attention, perception, and stress levels of clinical cardiovascular perfusionists during cardiopulmonary bypass. METHODS Nine clinical cardiovascular perfusionists voluntarily offered to participate in the study. Participants were asked to wear Tobii 2 eye-tracking glasses throughout the procedures. Specific time points were analyzed (cardiopulmonary bypass on, initial cardioplegia delivery, steady state, cross-clamp off, and weaning from cardiopulmonary bypass). Data acquisition was supplemented by participants' self-evaluation regarding their stress levels and by National Aeronautics and Space Administration Task Load Index (NASA TLX) questionnaires. RESULTS Seven datasets were sufficient to be evaluated. The clinical cardiovascular perfusionists' professional experience ranged from 0.5 to 24 years. Evaluation of eye-tracking data revealed large variations in areas of interest hits, fixation, and dwell times. Across all phases, the venous reservoir, mean arterial pressure, arterial pump display, cardioplegia control, and data management system received the highest levels of attention. Pupil diameter measurements increased at start of cardiopulmonary bypass, cardioplegia delivery, and weaning off, but returned to base level during steady state. Clinical cardiovascular perfusionists' self-evaluation showed that subjective stress level was highest at the start and the end of the procedure. NASA TLX questionnaires revealed medium-to-high mental and temporal workloads, but low physical workloads. Performance, effort, and frustration indices showed medium workloads. CONCLUSION During cardiopulmonary bypass, perfusionists are subjected to stress. Peak stress levels were highest during start and end of cardiopulmonary bypass. Furthermore, visual attention and perception varied between the operative phases. Further studies are indicated to evaluate the design of heart-lung machines and stress-coping strategies during cardiopulmonary bypass.
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Affiliation(s)
| | | | | | | | - Sina Gierig
- Berlin Institute of Technology, Berlin, Germany
| | - Volkmar Falk
- German Heart Center Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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