# Eye‐Tracking Analysis in Surface‐Guided Radiation Therapy Positioning: A Comparative Study of Experienced and Novice Radiation Therapists

## TL;DR

This study used eye tracking to compare how experienced and novice radiation therapists perform patient setup using surface-guided radiation therapy, finding that experts are more efficient in identifying key points.

## Contribution

The study introduces eye-tracking analysis to evaluate and compare the visual strategies of experienced and novice radiation therapists during SGRT setup.

## Key findings

- Experienced therapists had fewer gaze fixations per positioning session.
- Experts focused more on specific screens during the latter half of positioning.
- Eye tracking could help standardize SGRT setup procedures by revealing efficient visual strategies.

## Abstract

The patient setup using the surface‐guided radiation therapy (SGRT) system differs from conventional surface marker procedures. Owing to the abundance of three‐dimensional information, there may be operator variability in where to focus during the patient setup. This study aimed to clarify the differences between expert and novice operators in SGRT positioning for head and neck cases by tracking their eye movements, thereby providing data for developing efficient patient setup procedures. Six radiation therapists set up a simulated patient on the SGRT system while recording eye movements on the screen using the QG‐PLUS eye‐tracking system. The positioning time and number of gaze fixations on the screen were analysed, and the relationship between years of experience with SGRT, positioning time and number of gaze fixations was evaluated. No significant correlation was found between SGRT experience and positioning time (r = −0.67, p = 0.15). However, more experienced radiation therapists exhibited fewer gaze fixations per positioning session (r = −0.81, p < 0.05), indicating that they efficiently identified key positioning points. Additionally, experienced radiation therapists focused more intently on a specific screen during the latter half of positioning, suggesting a refined approach for final patient alignment verification. More experienced radiation therapists showed fewer gaze fixations and demonstrated increased attention to a specific screen during the latter half of the patient setup process, suggesting that eye‐tracking technology may provide useful data for standardising patient setup procedures in SGRT patient setups.

This study compared expert and novice radiation therapists during surface‐guided radiation therapy (SGRT) setup for head and neck cases using eye tracking. Experts exhibited fewer gaze fixations and concentrated on specific screens during the latter half of positioning, suggesting that they efficiently identified key positioning points. Eye tracking may facilitate the optimization and standardisation of SGRT setup procedures by revealing expert visual strategies.