Representing and Inferring Visual Perceptual Skills in Dermatological Image Understanding

Experts have a remarkable capability of locating, perceptually organizing, identifying, and categorizing objects in images specific to their domains of expertise. Eliciting and representing their visual strategies and some aspects of domain knowledge will benefit a wide range of studies and applications. For example, image understanding may be improved through active learning frameworks by transferring human domain knowledge into image-based computational procedures, intelligent user interfaces enhanced by inferring dynamic informational needs in real time, and cognitive processing analyzed via unveiling the engaged underlying cognitive processes. An eye tracking experiment was conducted to collect both eye movement and verbal narrative data from three groups of subjects with different medical training levels or no medical training in order to study perceptual skill. Each subject examined and described 50 photographical dermatological images. One group comprised 11 board-certified dermatologists (attendings), another group was 4 dermatologists in training (residents), and the third group 13 novices (undergraduate students with no medical training). We develop a novel hierarchical probabilistic framework to discover the stereotypical and idiosyncratic viewing behaviors exhibited by the three expertise-specific groups. A hidden Markov model is used to describe each subject's eye movement sequence combined with hierarchical stochastic processes to capture and differentiate the discovered eye movement patterns shared by multiple subjects' eye movement sequences within and among the three expertise-specific groups. Through these patterned eye movement behaviors we are able to elicit some aspects of the domain-specific knowledge and perceptual skill from the subjects whose eye movements are recorded during diagnostic reasoning processes on medical images. Analyzing experts' eye movement patterns provides us insight into cognitive strategies exploited to solve complex perceptual reasoning tasks. Independent experts' annotations of diagnostic conceptual units of thought in the transcribed verbal narratives are time-aligned with discovered eye movement patterns to help interpret the patterns' meanings. By mapping eye movement patterns to thought units, we uncover the relationships between visual and linguistic elements of their reasoning and perceptual processes, and show the manner in which these subjects varied their behaviors while parsing the images. We further discover that inferred eye movement patterns characterize groups of similar temporal and spatial properties, and specify a subset of distinctive eye movement patterns which are commonly exhibited across multiple images. Based on the combinations of the occurrences of these eye movement patterns, we are able to categorize the images from the perspective of experts' viewing strategies in a novel way. In each category, images share similar lesion distributions and configurations. Our results show that modeling with multi-modal data, representative of physicians' diagnostic viewing behaviors and thought processes, is feasible and informative to gain insights into physicians' cognitive strategies, as well as medical image understanding. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]