Investigation of viewing procedures for interpretation of breast tomosynthesis image volumes: a detection-task study with eye tracking

OBJECTIVES: To evaluate the efficiency of different methods of reading breast tomosynthesis (BT) image volumes. METHODS: All viewing procedures consisted of free scroll volume browsing and three were combined with initial cine loops at three different frame rates (9, 14 and 25 fps). The presentation modes consisted of vertically and horizontally orientated BT image volumes. Fifty-five normal BT image volumes in mediolateral oblique view were collected. In these, simulated lesions were inserted, creating four unique image sets, one for each viewing procedure. Four observers interpreted the cases in a free-response task. Time efficiency, visual attention and search were investigated using eye tracking. RESULTS: Horizontally orientated BT image volumes were read faster than vertically when using free scroll browsing only and when combined with fast cine loop. Cine loops at slow frame rates were ruled out as inefficient. CONCLUSIONS: In general, horizontally oriented BT image volumes were read more efficiently. All viewing procedures except for slow frame rates were promising when assuming equivalent detection performance. KEY POINTS: • Breast tomosynthesis is increasingly used for breast cancer detection • There is a benefit in reading breast tomosynthesis image volumes presented horizontally • Align image content to visual field, especially for dynamic 3D images • Reading at slow frame rates was considered inefficient