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Visualising scanning patterns of pathologists in the grading of cervical intraepithelial neoplasia
  1. E S M Tiersma1,
  2. A A W Peters1,
  3. H A Mooij2,
  4. G J Fleuren2
  1. 1Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Postbus 9600, 2300 RC Leiden, The Netherlands
  2. 2Department of Pathology, Leiden University Medical Centre
  1. Correspondence to:
 Dr E S M Tiersma, Leiden University Medical Centre, Department of Obstetrics and Gynaecology, Postbus 9600, 2300 RC Leiden, The Netherlands;


Aim: To investigate how effectively eye tracking devices can visualise the scanning patterns of pathologists, for application in studies on diagnostic decision making.

Methods: EyeCatcher, an eye tracking device, was used to visualise and compare the scanning patterns of five pathologists while they graded two projections of cervical intraepithelial neoplasia. Density cloud images were created from the scanning patterns. A questionnaire and interview provided information on the following steps in the diagnostic process.

Results: EyeCatcher successfully registered the scanning patterns of the pathologists. A “scanning style” and a “selective style” of visual search were distinguished. The scanning patterns, in addition to the interpretation and combination of the information ultimately leading to a diagnosis, varied between the various observers, resulting in a broad range of final diagnoses.

Conclusions: Eye gaze tracking devices provide an excellent basis for further discussion on the interpretation and grading criteria of lesions. As such, they may play an important role in studies on diagnostic decision making in pathology and in the development of training and quality control programmes for pathologists.

  • visual search
  • eye tracking
  • diagnostic decision making
  • cervical intraepithelial neoplasia
  • observer variation
  • AFIP, Armed Forces Institute of Pathology
  • CIN, cervical intraepithelial neoplasia
  • HPV, human papillomavirus

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