{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:14:53Z","timestamp":1785420893094,"version":"3.56.0"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000923","name":"Macquarie University and an Australian Research Council (ARC) Future Fellowship","doi-asserted-by":"publisher","award":["FT190100623"],"award-info":[{"award-number":["FT190100623"]}],"id":[{"id":"10.13039\/501100000923","id-type":"DOI","asserted-by":"publisher"}]},{"award":["FT190100623"],"award-info":[{"award-number":["FT190100623"]}],"id":[{"id":"https:\/\/ror.org\/05mmh0f86","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JEMR"],"abstract":"<jats:p>Eye-tracking has been utilized to characterize visual behavior in medical image visualization and interpretation, yet neurosurgeons remain underrepresented. Characterizing neurosurgery-specific visual expertise is important for understanding expert search strategies, informing training, and developing computational models. This study examined gaze behavior in na\u00efve observers (Np = 29), neurosurgery registrars (Np = 16), and consultant neurosurgeons (Np = 24), viewing normal (Np = 20) and pathological (Np = 19) brain MR images under a free-viewing paradigm. To capture expertise-related characteristics, we analyzed two features at each fixation location: (i) fixation duration, reflecting temporal allocation of visual attention, and (ii) three-dimensional fractal dimension (3DFD) around each fixation location, quantifying local structural complexity. To assess pathological-type effects, we grouped similar pathologies into five stimulus groups. Linear mixed-effects modelling revealed systematic expertise-related differences, with experts exhibiting longer fixation durations in pathological stimulus groups and pathology-type-dependent complexity sampling. Combined fixation duration and 3DFD features captured complementary aspects of visual expertise, improving Random Forest classifier\u2019s accuracy (&gt;93%) compared to individual features, for all five stimulus groups. These findings highlight neurosurgery-specific markers of visual expertise and demonstrate that combining behavioral and image-derived features could underpin computational models and training tools that emulate expert-level strategies in neurosurgical image interpretation. Future work should evaluate its applicability to other medical domains.<\/jats:p>","DOI":"10.3390\/jemr19030062","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:17:31Z","timestamp":1780467451000},"page":"62","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing Visual Neurosurgical Expertise in Brain MRI Visualization Using Eye-Tracking and 3D Fractal Dimension Analysis"],"prefix":"10.3390","volume":"19","author":[{"given":"Poonam","family":"Kumari","sequence":"first","affiliation":[{"name":"Computational NeuroSurgery (CNS) Lab, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Road, Sydney, NSW 2109, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8675-6858","authenticated-orcid":false,"given":"Ghasem","family":"Azemi","sequence":"additional","affiliation":[{"name":"Computational NeuroSurgery (CNS) Lab, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Road, Sydney, NSW 2109, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8296-4345","authenticated-orcid":false,"given":"Carlo","family":"Russo","sequence":"additional","affiliation":[{"name":"Computational NeuroSurgery (CNS) Lab, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Road, Sydney, NSW 2109, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Di Ieva","sequence":"additional","affiliation":[{"name":"Computational NeuroSurgery (CNS) Lab, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Road, Sydney, NSW 2109, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/S0028-3932(01)00121-X","article-title":"Testing Cognitive Models of Visual Attention with FMRI and MEG","volume":"39","author":"Downing","year":"2001","journal-title":"Neuropsychologia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1038\/7280","article-title":"A Physiological Correlate of the \u201cspotlight\u201d of Visual Attention","volume":"2","author":"Brefczynski","year":"1999","journal-title":"Nat. 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