Gaze responses to false-positive computer-aided detection prompts during colonoscopy: a paired-video and real-time eye-tracking study

Abstract

False-positive computer-aided detection (CADe) prompts may divert endoscopists'attention during colonoscopy, yet the attentional impact of individual prompts remains unclear. We used event-locked eye tracking to quantify gaze attraction and attention occupation in complementary retrospective and prospective studies. In a retrospective paired-video experiment, 3 senior and 2 novice endoscopists viewed 60 colonoscopy videos with and without CADe. The prospective study recorded gaze during 42 real-time CADe-assisted colonoscopies performed by 9 senior endoscopists. Screened CADe prompts outside expert-annotated lesion windows were classified as false-positive artifact events. False-positive prompts attracted gaze in 48.6% (68/140) of retrospective observations and 65.2% (533/817) of prospective events. Among attraction events with complete recovery, median attention occupation lasted 1000 ms in the retrospective study and 1100 ms in the prospective study. Corresponding median prompt durations were 33 ms and 267 ms, with median time amplifications of 17.55-fold and 5.15-fold, respectively. In paired retrospective comparisons, visible artifact prompts drew gaze closer to the prompted region than did the same-coordinate unassisted reference. Secondary retrospective analyses showed high lesion gaze recognition without and with CADe (98.0% versus 99.0%). First gaze entry into lesion regions occurred 147.8 ms earlier with CADe. Across controlled and real-time clinical settings, false-positive CADe prompts frequently captured gaze, with attention persisting beyond prompt visibility. These findings support considering prompt-related attentional burden in CADe evaluation and design.