Abstract
The aim of this study was to examine how dental students vary their viewing patterns of panoramic radiographs during different levels of dental education. Two groups of students (total number = 48, n = 24) in different grades (second and fifth clinical semester) were compared. The second clinical semester participated twice, as during the second clinical semester a specific lecture on dental radiology and diagnosis is held. The first viewing took place at the beginning of the semester (2a), the second at the end of it (2e). The fifth semester (5e) represents students shortly before graduation. While viewing 20 panoramic radiographs showing specific pathologies, the eye movement was captured by an eye-tracker. After a maximum of 60 s per image, the students had to report a suspected diagnosis. Every panoramic radiograph included a pathological lesion which was diagnosed by an expert observer who also defined the areas of interest (AOI). The images were presented in the same order to each participant. The metric data recorded by the tracking-system included total time to first fixation, total fixation count, total gaze duration and coordinates of the fixation in and outside an area of interest. In addition, parameters like the completeness of scanning and the suspected diagnosis were analysed. Differences between the groups were assessed for statistical significance and associations between level of different grades, viewing time, completeness of scanning and correctness of diagnosis were computed. 2e was significantly faster (p < 0,001), whereas 5e was significantly (p < 0.001) more likely to diagnose correctly and also to scan more completely. Scanning duration did not significantly influence the correctness of diagnosis. The lower edges of the panoramic radiographs were not scanned as often as the centre of the image. Bony lesions were generally found to be difficult to interpret and significant findings located in the sinus were overlooked the most. The higher semester had a more complete viewing pattern and diagnosed correctly with a higher percentage. After hearing the mentioned lecture, the second semester scanned faster and mentioned the AOI more often but could not make a right diagnosis.
Highlights
In Germany, 40% of radiologic examinations of all healthcare disciplines between 2007 and 2015 were used for dental reasons.[1]
Radiology is fundamental for dental diagnostics and records, especially panoramic radiographs (PAN) are commonly used as they represent a large overview of the dentition, the temporomandibular joint, the lower jaw and parts of the upper jaw including the maxillary sinus.[2]
Temporal viewing behaviour All PAN assessments were ended before the 60 s time limit
Summary
In Germany, 40% of radiologic examinations of all healthcare disciplines between 2007 and 2015 were used for dental reasons.[1] Radiology is fundamental for dental diagnostics and records, especially panoramic radiographs (PAN) are commonly used as they represent a large overview of the dentition, the temporomandibular joint, the lower jaw and parts of the upper jaw including the maxillary sinus.[2] The broad anatomical coverage of PANs is useful as initial baseline examination, for searching inflammatory focuses, as check-ups of the wisdom teeth, sinus illnesses, traumata, planning and reporting of prosthetic and surgical procedures as well as teeth development and other pathologies.[2,3,4,5] It is essential that dentists know the anatomy and the variables of the projected structures to understand and interpret such images in total and to decide on the right treatment.[6] Many German dental textbooks describe what aspects and areas on PANs are to evaluate but do not recommend a standardized order to view the image.[6,7] On the other hand, there are publications that propose a certain search strategy.[8] In general medicine for instance scanning patterns of radiologists viewing mammograms and computer tomographic images (CT) have been investigated.[9,10] In dentistry, only a few studies of radiographic images such as PANs or CTs in combination with eye-tracking have been published.[11,12,13,14,15,16,17] In general, it appears that experienced clinicians scanned faster and in a more systematic way but incompletely whereas unexperienced clinicians and students did not seem to follow a viewing scheme.[10,12,13,18] Bahazig et al[14] recently published that the expert group needed longer examination times on PANs than the group of novices
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