Fractal analysis of radiologists' visual scanning pattern in screening mammography

Several researchers have investigated radiologists™ visual scanning patterns with respect to features such as total time examining a case, time to initially hit true lesions, number of hits, etc. The purpose of this study was to examine the complexity of the radiologists™ visual scanning pattern when viewing 4-view mammographic cases, as they typically do in clinical practice. Gaze data were collected from 10 readers (3 breast imaging experts and 7 radiology residents) while reviewing 100 screening mammograms (24 normal, 26 benign, 50 malignant). The radiologists™ scanpaths across the 4 mammographic views were mapped to a single 2-D image plane. Then, fractal analysis was applied on the composite 4-view scanpaths. For each case, the complexity of each radiologist™s scanpath was measured using fractal dimension estimated with the box counting method. The association between the fractal dimension of the radiologists™ visual scanpath, case pathology, case density, and radiologist experience was evaluated using fixed effects ANOVA. ANOVA showed that the complexity of the radiologists™ visual search pattern in screening mammography is dependent on case specific attributes (breast parenchyma density and case pathology) as well as on reader attributes, namely experience level. Visual scanning patterns are significantly different for benign and malignant cases than for normal cases. There is also substantial inter-observer variability which cannot be explained only by experience level.