Changes in Radiologists' Gaze Patterns Against Lung X-rays with Different Abnormalities: a Randomized Experiment

The workload of some radiologists increased dramatically in the last several, which resulted in a potentially reduced quality of diagnosis. It was demonstrated that diagnostic accuracy of radiologists significantly reduces at the end of work shifts. The study aims to investigate how radiologists cover chest X-rays with their gaze in the presence of different chest abnormalities and high workload. We designed a randomized experiment to quantitatively assess how radiologists' image reading patterns change with the radiological workload. Four radiologists read chest X-rays on a radiological workstation equipped with an eye-tracker. The lung fields on the X-rays were automatically segmented with U-Net neural network allowing to measure the lung coverage with radiologists' gaze. The images were randomly split so that each image was shown at a different time to a different radiologist. Regression models were fit to the gaze data to calculate the treads in lung coverage for individual radiologists and chest abnormalities. For the study, a database of 400 chest X-rays with reference diagnoses was assembled. The average lung coverage with gaze ranged from 55 to 65% per radiologist. For every 100 X-rays read, the lung coverage reduced from 1.3 to 7.6% for the different radiologists. The coverage reduction trends were consistent for all abnormalities ranging from 3.4% per 100 X-rays for cardiomegaly to 4.1% per 100 X-rays for atelectasis. The more image radiologists read, the smaller part of the lung fields they cover with the gaze. This pattern is very stable for all abnormality types and is not affected by the exact order the abnormalities are viewed by radiologists. The proposed randomized experiment captured and quantified consistent changes in X-ray reading for different lung abnormalities that occur due to high workload.