Aims: Videofluoroscopy swallow studies (VFSS) are often considered ‘gold standard’ in the assessment of dysphagia. However, VFSS interpretation requires expertise related to the ability to perceive and detect swallowing problems from dynamic x-ray images. Eye-tracker technology facilitates an in depth examination of how individuals view the images from the oral to laryngeal stages of deglutition, and how they interpret what they see to form a differential diagnosis. While studies have examined the eye tracking patterns of health professionals in their interpretation of medical images, such as mammograms, chest x-rays and skeletal fractures, no study has examined the interpretation of VFSS using this technology. This exploratory study aimed to (i) examine eye-gaze patterns of novice and expert SLT clinicians in their interpretation of dynamic x-ray images as they differentially diagnose dysphagia from a range of VFSS, (ii) compare inter-rater reliability between novice and expert SLTs, and (iii) explore if self-reported confidence in clinical judgements differs with experience.
Methods: A Tobii T120 eye-tracker was used to measure the participants’ eye-gaze patterns of five novice and four expert SLTs while differentially diagnosing dysphagia from VFSS. Inter-rater reliability measures were examined using the Dysphagia Outcome Severity Scale, the Penetration-Aspiration Scale and other Swallow Observation Parameters (SOP). Participants’ confidence in their clinical decisions was also recorded.
Results: Eye-tracking measures revealed that experts focused more on the laryngeal area compared to the novice group, who tended to focus on a wider area of the videofluoroscopy image. Expert SLTs demonstrated greater reliability and confidence in judgments of dysphagia severity than novice SLTs.
Discussion: Distinctive differences were observed between expert and novice groups in how they examined the VFSS clips, their diagnostic accuracy, and self-rated confidence in these clinical judgements.
Conclusion: In conclusion, eye-tracking technology provides in depth information into the process of interpreting VFSS and has the potential to become a useful educational tool for individuals interpreting VFSS.