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. 2023 Aug:135:104585.
doi: 10.1016/j.jdent.2023.104585. Epub 2023 Jun 8.

Gaze patterns of dentists while evaluating bitewing radiographs

Lubaina T Arsiwala-Scheppach  1 , Nora Castner  2 , Csaba Rohrer  3 , Sarah Mertens  3 , Enkelejda Kasneci  4 , Jose Eduardo Cejudo Grano de Oro  3 , Joachim Krois  5 , Falk Schwendicke  5
Affiliations

Gaze patterns of dentists while evaluating bitewing radiographs

Lubaina T Arsiwala-Scheppach et al. J Dent. 2023 Aug.

Abstract

Objectives: Understanding dentists' gaze patterns on radiographs may allow to unravel sources of their limited accuracy and develop strategies to mitigate them. We conducted an eye tracking experiment to characterize dentists' scanpaths and thus their gaze patterns when assessing bitewing radiographs to detect primary proximal carious lesions.

Methods: 22 dentists assessed a median of nine bitewing images each, resulting in 170 datasets after excluding data with poor quality of gaze recording. Fixation was defined as an area of attentional focus related to visual stimuli. We calculated time to first fixation, fixation count, average fixation duration, and fixation frequency. Analyses were performed for the entire image and stratified by (1) presence of carious lesions and/or restorations and (2) lesion depth (E1/2: outer/inner enamel; D1-3: outer-inner third of dentin). We also examined the transitional nature of the dentists' gaze.

Results: Dentists had more fixations on teeth with lesions and/or restorations (median=138 [interquartile range=87, 204]) than teeth without them (32 [15, 66]), p<0.001. Notably, teeth with lesions had longer fixation durations (407 milliseconds [242, 591]) than those with restorations (289 milliseconds [216, 337]), p<0.001. Time to first fixation was longer for teeth with E1 lesions (17,128 milliseconds [8813, 21,540]) than lesions of other depths (p = 0.049). The highest number of fixations were on teeth with D2 lesions (43 [20, 51]) and lowest on teeth with E1 lesions (5 [1, 37]), p<0.001. Generally, a systematic tooth-by-tooth gaze pattern was observed.

Conclusions: As hypothesized, while visually inspecting bitewing radiographic images, dentists employed a heightened focus on certain image features/areas, relevant to the assigned task. Also, they generally examined the entire image in a systematic tooth-by-tooth pattern.

Keywords: Dental radiography; Dentistry; Eye tracking; Medical image inspection; Scanpath; Visual search.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.