Eye-Tracking as a Tool to Quantify the Effects of CAD Display on Radiologists' Interpretation of Chest Radiographs

TL;DR

This study used eye tracking to quantify how bounding-box highlights in chest radiograph interpretation influence radiologists' visual search behavior, revealing significant changes in search patterns and interpretation time.

Contribution

It demonstrates the feasibility of using eye tracking to measure the effects of CAD display features on radiologist search behavior in chest radiograph interpretation.

Findings

Bounding-box display increased interpretation time by 4.9 seconds.

Bounding-box display increased lesion dwell time by 1.3 seconds.

Bounding-box display increased lung-field coverage by 10.5%.

Abstract

Rationale and Objectives: Computer-aided detection systems for chest radiographs are widely used, and concurrent reader displays, such as bounding-box (BB) highlights, may influence the reading process. This pilot study used eye tracking to conduct a preliminary experiment to quantify which aspects of visual search were affected. Materials and Methods: We sampled 180 chest radiographs from the VinDR-CXR dataset: 120 with solitary pulmonary nodules or masses and 60 without. The BBs were configured to yield an overall display sensitivity and specificity of 80%. Three radiologists (with 11, 5, and 1 years of experience, respectively) interpreted each case twice - once with BBs visible and once without - after a washout of >= 2 weeks. Eye movements were recorded using an EyeTech VT3 Mini. Metrics included interpretation time, time to first fixation on the lesion, lesion dwell time, total gaze-path length, and lung-field coverage ratio. Outcomes were modeled using a linear mixed model, with reading condition as a fixed effect and case and reader as random intercepts. The primary analysis was restricted to true positives (n=96). Results: Concurrent BB display prolonged interpretation time by 4.9 s (p<0.001) and increased lesion dwell time by 1.3 s (p<0.001). Total gaze-path length increased by 2,076 pixels (p<0.001), and lung-field coverage ratio increased by 10.5% (p<0.001). Time to first fixation on the lesion was reduced by 1.3 s (p<0.001). Conclusion: Eye tracking captured measurable alterations in search behavior associated with concurrent BB displays during chest radiograph interpretation. These findings support the feasibility of this approach and highlight the need for larger studies to confirm effects and explore implications across modalities and clinical contexts.