Evaluation of a surgical interface for robotic cryoablation task using an eye-tracking system

Computer-assisted navigation systems coupled with surgical interfaces (SIs) are providing doctors with tools that are safer for patients compared to traditional methods. Usability analysis of the SIs that guides their development is hence important. In this study, we record the eye movements of doctors and other people with no medical expertise during interaction with an SI that directs a simulated cryoablation task. There are two different arrangements for the layout of the same SI, and the goal is to evaluate whether one of these arrangements is ergonomically better than the other. We use several gaze related statistics some of which are employed in an SI design context for the first time. Even though the performance and gaze related analysis reveals that the two arrangements are comparable in many respects, there are also differences. Specifically, one arrangement leads to more saccades along the vertical and horizontal directions, lower saccade amplitudes in the crucial phase of the task, more locally clustered and yet globally spread viewing. Accordingly, that arrangement is selected for future use. The present study provides a proof of concept for the integration of novel gaze analysis tools developed for scene perception studies into the interface development process. Two arrangements for a surgical interface (SI) are developed using design principles.Doctors & laypeople perform SI-guided simulated cryoablation while gaze is recorded.Saccades in cardinal directions are more likely with one arrangement.Spatial fixation distributions at different temporal scales support the same arrangement.Design and evaluation with eye movements measures produce better SIs.

[1]  Tom Foulsham,et al.  Asymmetries in the direction of saccades during perception of scenes and fractals: Effects of image type and image features , 2010, Vision Research.

[2]  Gavriel Salvendy,et al.  Handbook of Human Factors and Ergonomics , 2005 .

[3]  B. Velichkovsky,et al.  Eye typing in application: A comparison of two interfacing systems with ALS patients , 2008 .

[4]  P. König,et al.  The Contributions of Image Content and Behavioral Relevancy to Overt Attention , 2014, PloS one.

[5]  Joseph H. Goldberg,et al.  Eye tracking in web search tasks: design implications , 2002, ETRA.

[6]  G Schneider,et al.  Eye tracking for assessment of workload: a pilot study in an anaesthesia simulator environment. , 2011, British journal of anaesthesia.

[7]  D. Sparks The brainstem control of saccadic eye movements , 2002, Nature Reviews Neuroscience.

[8]  Ann Blandford,et al.  Integration of human factors and ergonomics during medical device design and development: it's all about communication. , 2014, Applied ergonomics.

[9]  Tommy Strandvall,et al.  Eye Tracking in Human-Computer Interaction and Usability Research , 2009, INTERACT.

[10]  Thomas Martinetz,et al.  Variability of eye movements when viewing dynamic natural scenes. , 2010, Journal of vision.

[11]  Linden J. Ball,et al.  Eye Tracking in Human-Computer Interaction and Usability Research : Current Status and Future Prospects , 2004 .

[12]  Yushi Yang,et al.  Using Eye Trackers for Usability Evaluation of Health Information Technology: A Systematic Literature Review , 2015, JMIR human factors.

[13]  M. Rolfs Microsaccades: Small steps on a long way , 2009, Vision Research.

[14]  Marcus Nyström,et al.  Discrimination of fixations and smooth pursuit movements in high-speed eye-tracking data , 2014, 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[15]  B. Velichkovsky,et al.  Eye tracking and usability research: An introduction to the special issue , 2008 .

[16]  C. Baur,et al.  A navigation system for open liver surgery: design, workflow and first clinical applications , 2011, The international journal of medical robotics + computer assisted surgery : MRCAS.

[17]  Claudia Mello-Thoms,et al.  What attracts the eye to the location of missed and reported breast cancers? , 2002, ETRA.

[18]  Ann Blandford,et al.  The challenges of delivering validated personas for medical equipment design. , 2014, Applied ergonomics.

[19]  Sonja Engmann,et al.  Integration of Luminance Contrast and Colour Contrast in Directing the Human Gaze , 2006 .

[20]  Anthony J. Hornof,et al.  A Computational Model of “Active Vision” for Visual Search in Human–Computer Interaction , 2011, Hum. Comput. Interact..

[21]  J. Henderson,et al.  Facilitation of return during scene viewing , 2009 .

[22]  Jakob Nielsen,et al.  Heuristic evaluation of user interfaces , 1990, CHI '90.

[23]  Mary Beth Privitera,et al.  Applied ergonomics: Determining user needs in medical device design , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[24]  Ricardo Matos,et al.  Identifying parameter values for an I-VT fixation filter suitable for handling data sampled with various sampling frequencies , 2012, ETRA.

[25]  Tania Schlatter,et al.  Visual Usability: Principles and Practices for Designing Digital Applications , 2013 .

[26]  Duygun Erol Barkana,et al.  Improvement of design of a surgical interface using an eye tracking device , 2014, Theoretical Biology and Medical Modelling.

[27]  Riccardo Muradore,et al.  Development of a Cognitive Robotic System for Simple Surgical Tasks , 2015 .

[28]  Stefano Zaffagnini,et al.  Description and validation of a navigation system for intra-operative evaluation of knee laxity. , 2007, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[29]  U. Mezger,et al.  Navigation in surgery , 2013, Langenbeck's Archives of Surgery.

[30]  Peter König,et al.  Saccadic Momentum and Facilitation of Return Saccades Contribute to an Optimal Foraging Strategy , 2013, PLoS Comput. Biol..

[31]  Ahamed AlTaboli,et al.  Investigating Effects of Screen Layout Elements on Interface and Screen Design Aesthetics , 2011, Adv. Hum. Comput. Interact..

[32]  A. L. Yarbus Eye Movements During Perception of Complex Objects , 1967 .

[33]  Eileen Kowler Eye movements: The past 25years , 2011, Vision Research.

[34]  Nancy Kober,et al.  Safe, Comfortable, Attractive, and Easy to Use: Improving the Usability of Home Medical Devices , 1996 .

[35]  T. Donovan,et al.  Performance changes in lung nodule detection following perceptual feedback of eye movements , 2008, SPIE Medical Imaging.

[36]  Robert J. K. Jacob,et al.  Eye tracking in human-computer interaction and usability research : Ready to deliver the promises , 2002 .

[37]  A. Torralba,et al.  Fixations on low-resolution images. , 2010, Journal of vision.

[38]  Kristen Wegner,et al.  Surgical navigation system and method using audio feedback , 1998 .

[39]  Ivan Burmistrov,et al.  Flat Design vs Traditional Design: Comparative Experimental Study , 2015, INTERACT.

[40]  Michael Wiklund,et al.  Handbook of Human Factors in Medical Device Design , 2010 .

[41]  Heecheon You,et al.  Development of A User-Centered Virtual Liver Surgery Planning System , 2012 .

[42]  Tom Foulsham,et al.  Turning the world around: Patterns in saccade direction vary with picture orientation , 2008, Vision Research.

[43]  Maximilian Schwalm,et al.  Computer-assisted navigation and the acquisition of route and survey knowledge , 2006 .

[44]  Joseph H. Goldberg,et al.  Chapter 23 – Eye Tracking in Usability Evaluation: A Practitioner's Guide , 2003 .

[45]  Joseph H. Goldberg,et al.  Computer interface evaluation using eye movements: methods and constructs , 1999 .

[46]  Bruce Hanington,et al.  Methods in the Making: A Perspective on the State of Human Research in Design , 2003, Design Issues.

[47]  David A Jaffray,et al.  Applying usability heuristics to radiotherapy systems. , 2012, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[48]  M. Stella Atkins,et al.  Eye gaze patterns differentiate novice and experts in a virtual laparoscopic surgery training environment , 2004, ETRA.

[49]  Matteo Valsecchi,et al.  Saccadic and smooth-pursuit eye movements during reading of drifting texts. , 2013, Journal of vision.

[50]  H L Kundel,et al.  Nature of expertise in searching mammograms for breast masses , 1996, Medical Imaging.

[51]  Jennifer C. Romano Bergstrom,et al.  Eye tracking in user experience design , 2014 .

[52]  E. Reingold,et al.  Eye movements and visual expertise in chess and medicine , 2011 .

[53]  Peter König,et al.  Measures and Limits of Models of Fixation Selection , 2011, PloS one.

[54]  Peter König,et al.  Real and implied motion at the center of gaze. , 2014, Journal of vision.

[55]  Philipp Berens,et al.  CircStat: AMATLABToolbox for Circular Statistics , 2009, Journal of Statistical Software.

[56]  Colin Swindells,et al.  Surgeon's vigilance in the operating room. , 2011, American journal of surgery.

[57]  P. König,et al.  Does luminance‐contrast contribute to a saliency map for overt visual attention? , 2003, The European journal of neuroscience.

[58]  Andrew J Anderson,et al.  Small samples: does size matter? , 2001, Investigative ophthalmology & visual science.

[59]  Derrick J. Parkhurst,et al.  Scene content selected by active vision. , 2003, Spatial vision.

[60]  Elizabeth Murphy,et al.  Medical device development: the challenge for ergonomics. , 2008, Applied ergonomics.

[61]  Mark R. Wilson,et al.  Perceptual impairment and psychomotor control in virtual laparoscopic surgery , 2011, Surgical Endoscopy.

[62]  P. Perona,et al.  Objects predict fixations better than early saliency. , 2008, Journal of vision.