Are Eye Movements a Window to the Radiologist's Expertise?

Hossein Jadvar, MD, PhD, MPH, MBA


January 24, 2017

The Study

An interesting report by Finnish investigators examined the relationship between the eye movements of radiologists and their interpretations of abdominal CT studies.[1] The cohort included 15 early residents with up to 1.5 years of experience in abdominal CT radiology, 14 advanced residents with 1.5-3.5 years of experience, and 12 specialists with 2-22 years of experience. Participants viewed 26 abdominal CT studies at either 3 or 5 frames per second while their eye movements were recorded using an eye tracking device.

The study found that the lesion detection rate among early residents decreased with the number of hours worked. Residents also detected fewer low visual contrast lesions than did advanced residents and specialists. Regardless of expertise level, high lesion detection rates were associated with greater reduction in saccade length in the presence of lesions. (Saccades are rapid eye movements between two fixation points.) Expertise in CT interpretation may be associated with eye movement patterns, according to the authors' conclusions.


The goal of this study was to establish a potential relationship between visual interpretative expertise in detecting abdominal CT lesions and level of radiologists' experience. It is known that eye fixation—that is, maintaining gaze in a single location—is associated with acquisition of visual information, probably as a result of accessibility to highest spatial resolution from the fovea visual acuity.[2] In contrast, no useful visual information is extracted during rapid saccadic eye movement.[2]

Given this evidence, the authors hypothesized that measurement of visual interpretative skills may be associated with eye movements and serve as potential tool for assessing professional development in radiology.[3]

The investigators found that decline in saccade length in the presence of a lesion and greater saccade length with faster image presentation was associated with higher detection rates, irrespective of expertise level. Also, compared with participants with more experience, lesion detection rates among early residents seemed to be more noticeably affected by fatigue: The early residents were more likely to detect lesions in the morning than in the afternoon.

This new report raises the possibility of quantitatively and independently assessing eye movements as a marker of expertise development in radiology trainees, which can in turn be used to optimize training.



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