How to support dental students in reading radiographs: effects of a gaze-based compare-and-contrast intervention

Abstract

In dental medicine, interpreting radiographs (i.e., orthopantomograms, OPTs) is an error-prone process, even in experts. Effective intervention methods are therefore needed to support students in improving their image reading skills for OPTs. To this end, we developed a compare-and-contrast intervention, which aimed at supporting students in achieving full coverage when visually inspecting OPTs and, consequently, obtaining a better diagnostic performance. The comparison entailed a static eye movement visualization (heat map) on an OPT showing full gaze coverage from a peer-model (other student) and another heat map showing a student's own gaze behavior. The intervention group (N = 38) compared five such heat map combinations, whereas the control group (N = 23) diagnosed five OPTs. Prior to the experimental variation (pre-test) and after it (post-test), students in both conditions searched for anomalies in OPTs while their gaze was recorded. Results showed that students in the intervention group covered more areas of the OPTs and looked less often and for a shorter amount of time at anomalies after the intervention. Furthermore, they fixated on low-prevalence anomalies earlier and high-prevalence anomalies later during the inspection. However, the students in the intervention group did not show any meaningful improvement in detection rate and made more false positive errors compared to the control group. Thus, the intervention guided visual attention but did not improve diagnostic performance substantially. Exploratory analyses indicated that further interventions should teach knowledge about anomalies rather than focusing on full coverage of radiographs.

Keywords: Dental medicine; Eye movement visualization; Gaze behavior; Gaze-based intervention; Medical image interpretation; Radiology; Visual expertise.

Fig. 1

OPT displayed on a laptop (left panel) and compare-and-contrast training intervention for one OPT (right panel)

Fig. 2

Means and standard errors of number of fixations (left panel), fixation time (middle panel) and time to first fixation of anomalies (right panel) for groups (intervention vs. control), time (pre-test vs. post-test) and location (central vs. peripheral anomalies)

Fig. 3

Means and standard errors of detection rate (left panel) and false positive markings per OPT (right panel) for groups (intervention vs. control), time (pre-test vs. post-test) and location (central vs. peripheral anomalies)