The Application of Eye-Tracking Technology in the Assessment of Radiology Practices: A Systematic Review

The aim of this review is to provide an in-depth analysis of literature pertaining to the use of eye-tracking equipment in the evaluation of radiological image interpretation by professionals in clinical practice. A systematic search of current literature was conducted through the databases of CINAHL, Medline, ProQuest, PubMed, Scopus, Web of Science and Wiley Online Library. A total of 25 articles were included in the final analysis. The literature gathered referenced four main discussions, which were competency assessment, educational tools, visual search behaviour and assistive aid evaluations. The majority of articles (68%) referenced to the competency assessment of professional groups yet appeared to have conflicting results within the categories of speed and eye-metrics. Significant conclusions could be made pertaining to confidence (100%) and accuracy measurements (56%), which suggested a background of higher experience correlates to a higher rate of accuracy and a higher confidence level. Other findings regarding the main themes focused on eye-tracking as an educational tool, where the literature suggests that such equipment may be useful in improving educational repertoire and interpretation technique. Literature pertaining to the visual search behaviour analysis and the evaluation of assistive aids did not provide strong conclusions due to research limitations. Whilst the use of eye-tracking in the analysis of radiological practices is a promising new venture to quantify the interpretation patterns of professionals, undertaking future research is recommended to solidify conclusions and provide greater insight

Designing Clinical Data Presentation Using Cognitive Task Analysis Methods

Despite the many decades of research on effective use of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practicing dentists in the United States. One critical reason is the poor usability of clinical systems, which makes it difficult for providers to navigate through the system and obtain an integrated view of patient data during patient care. Cognitive science methods have shown significant promise to meaningfully inform and formulate the design, development and assessment of clinical information systems. Most of these methods were applied to evaluate the design of systems after they have been developed. Very few studies, on the other hand, have used cognitive engineering methods to inform the design process for a system itself. It is this gap in knowledge – how cognitive engineering methods can be optimally applied to inform the system design process – that this research seeks to address through this project proposal. This project examined the cognitive processes and information management strategies used by dentists during a typical patient exam and used the results to inform the design of an electronic dental record interface. The resulting 'proof of concept' was evaluated to determine the effectiveness and efficiency of such a cognitively engineered and application flow design. The results of this study contribute to designing clinical systems that provide clinicians with better cognitive support during patient care. Such a system will contribute to enhancing the quality and safety of patient care, and potentially to reducing healthcare costs

Doctor of Philosophy

dissertationUsing eye-tracking technology to capture the visual scanpaths of a sample of laypersons (N = 92), the current study employed a 2 (training condition: ABCDE vs. Ugly Duckling Sign) Ã- 2 (visual condition: photorealistic images vs. illustrations) factorial design to assess whether SSE training succeeds or fails in facilitating increases in sensitivity and specificity. Self-efficacy and perceived importance were tested as moderators, and eye-tracking fixation metrics as mediators, within the framework of Visual Skill Acquisition Theory (VSAT). For sensitivity, results indicated a significant main effect for visual condition, F(1,88) = 7.102, p = .009, wherein illustrations (M = .524, SD = .197) resulted in greater sensitivity than photos (M = .425, SD = .159, d = .55). For specificity, the main effect for training was not significant, F(1,88) = 2.120, p = .149; however, results indicated a significant main effect for visual condition, F(1,88) = 4.079, p = .046, wherein photos (M = .821, SD = .108) resulted in greater specificity than illustrations (M = .770, SD = .137, d = .41). The interaction for training Ã- visual condition, F(1,88) = 3.554, p = .063, was significant within a 90% confidence interval, such that those within the UDS Photo condition displayed greater specificity than all other combinations of training and visual condition. No significant moderated mediation manifested for sensitivity, but for specificity, the model was significant, r = .59, R2 = .34, F(9,82) = 4.7783, p =.001, with Percent of Time in Lookzone serving as a significant mediator, and both self-efficacy and visual condition significantly moderating the mediation. For those in the photo condition with very high self-efficacy, UDS increased specificity directly. For those in the photo condition with self-efficacy levels at the mean or lower, there was a conditional indirect effect through Percent of Time in Lookzoneâ€"which is to say that these individuals spent a larger amount of their viewing time on target (observing the atypical nevi)â€"and time on target is positively related to specificity. Findings suggest that existing SSE training techniques may be enhanced by maximizing visual processing efficiency

Dental Hygiene Students\u27 Matching Accuracy When Comparing Antemortem Dental Radiographs and Oral Photographs to Simulated Postmortem WinID3\u3csup\u3e®\u3c/sup\u3e Odontograms

Matching dental antemortem (AM) and postmortem (PM) data for human identification is especially challenging when the workforce is limited. Dental hygienists have served mass fatality incidents (MFIs) due to dental-related expertise. However, forensics within dental hygiene education and research on transferable skills is limited. This qualitative balance design study assessed senior dental hygiene students\u27 match accuracy of simulated cases varying in dental identifiers based on AM full mouth series (FMS) radiographs and oral photographs to PM WinID3® odontograms to demonstrate possible disaster victim identification (DVI) transferable skills gained during formal education. A convenience sample of senior dental hygiene students (n = 31) was presented information on WinID3® interpretation, then presented with 5 mismatched cases and asked to visually interpret each to make 10 total matches; five based on AM FMS with simulated PM WinID3® odontograms and five based on AM photographs with PM WinID3® odontograms. Match accuracy scores ranged from 41.9% to 58.1% for cases with 1–10 identifiers, and 77.4% to 93.5% for cases with 11–40 identifiers. Accuracy when matching AM radiographs to PM odontograms versus AM photographs to PM odontograms was compared and revealed no statistical differences in match accuracy depending on image type (p = 0.388 to 1.000). Results of this pilot study suggests transferable match accuracy skills resulted from the participants\u27 dental hygiene formal education. These baseline skills with additional specialized training support the rationale for dental hygienists serving on DVI teams. More research is needed in education and practice when preparing dental hygienists for forensic-based service

Detection of Dental Apical Lesions Using CNNs on Periapical Radiograph

Apical lesions, the general term for chronic infectious diseases, are very common dental diseases in modern life, and are caused by various factors. The current prevailing endodontic treatment makes use of X-ray photography taken from patients where the lesion area is marked manually, which is therefore time consuming. Additionally, for some images the significant details might not be recognizable due to the different shooting angles or doses. To make the diagnosis process shorter and efficient, repetitive tasks should be performed automatically to allow the dentists to focus more on the technical and medical diagnosis, such as treatment, tooth cleaning, or medical communication. To realize the automatic diagnosis, this article proposes and establishes a lesion area analysis model based on convolutional neural networks (CNN). For establishing a standardized database for clinical application, the Institutional Review Board (IRB) with application number 202002030B0 has been approved with the database established by dentists who provided the practical clinical data. In this study, the image data is preprocessed by a Gaussian high-pass filter. Then, an iterative thresholding is applied to slice the X-ray image into several individual tooth sample images. The collection of individual tooth images that comprises the image database are used as input into the CNN migration learning model for training. Seventy percent (70%) of the image database is used for training and validating the model while the remaining 30% is used for testing and estimating the accuracy of the model. The practical diagnosis accuracy of the proposed CNN model is 92.5%. The proposed model successfully facilitated the automatic diagnosis of the apical lesion

Fluorescence devices for the detection of dental caries

BACKGROUND: Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non‐invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection is a visual and tactile dental examination, however alternative methods of detection are available, and these include fluorescence‐based devices. There are three categories of fluorescence‐based device each primarily defined by the different wavelengths they exploit; we have labelled these groups as red, blue, and green fluorescence. These devices could support the visual examination for the detection and diagnosis of caries at an early stage of decay. OBJECTIVES: Our primary objectives were to estimate the diagnostic test accuracy of fluorescence‐based devices for the detection and diagnosis of enamel caries in children or adults. We planned to investigate the following potential sources of heterogeneity: tooth surface (occlusal, proximal, smooth surface or adjacent to a restoration); single point measurement devices versus imaging or surface assessment devices; and the prevalence of more severe disease in each study sample, at the level of caries into dentine. SEARCH METHODS: Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 May 2019); Embase Ovid (1980 to 30 May 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 May 2019); and the World Health Organization International Clinical Trials Registry Platform (to 30 May 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA: We included diagnostic accuracy study designs that compared a fluorescence‐based device with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information has been displayed as coupled forest plots and summary receiver operating characteristic (SROC) plots, displaying the sensitivity‐specificity points for each study. We estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. We reported sensitivities at fixed values of specificity (median 0.78, upper quartile 0.90). MAIN RESULTS: We included a total of 133 studies, 55 did not report data in the 2 x 2 format and could not be included in the meta‐analysis. 79 studies which provided 114 datasets and evaluated 21,283 tooth surfaces were included in the meta‐analysis. There was a high risk of bias for the participant selection domain. The index test, reference standard, and flow and timing domains all showed a high proportion of studies to be at low risk of bias. Concerns regarding the applicability of the evidence were high or unclear for all domains, the highest proportion being seen in participant selection. Selective participant recruitment, poorly defined diagnostic thresholds, and in vitro studies being non‐generalisable to the clinical scenario of a routine dental examination were the main reasons for these findings. The dominance of in vitro studies also means that the information on how the results of these devices are used to support diagnosis, as opposed to pure detection, was extremely limited. There was substantial variability in the results which could not be explained by the different devices or dentition or other sources of heterogeneity that we investigated. The diagnostic odds ratio (DOR) was 14.12 (95% CI 11.17 to 17.84). The estimated sensitivity, at a fixed median specificity of 0.78, was 0.70 (95% CI 0.64 to 0.75). In a hypothetical cohort of 1000 tooth sites or surfaces, with a prevalence of enamel caries of 57%, obtained from the included studies, the estimated sensitivity of 0.70 and specificity of 0.78 would result in 171 missed tooth sites or surfaces with enamel caries (false negatives) and 95 incorrectly classed as having early caries (false positives). We used meta‐regression to compare the accuracy of the different devices for red fluorescence (84 datasets, 14,514 tooth sites), blue fluorescence (21 datasets, 3429 tooth sites), and green fluorescence (9 datasets, 3340 tooth sites) devices. Initially, we allowed threshold, shape, and accuracy to vary according to device type by including covariates in the model. Allowing consistency of shape, removal of the covariates for accuracy had only a negligible effect (Chi(2) = 3.91, degrees of freedom (df) = 2, P = 0.14). Despite the relatively large volume of evidence we rated the certainty of the evidence as low, downgraded two levels in total, for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the high number of in vitro studies, and inconsistency due to the substantial variability of results. AUTHORS' CONCLUSIONS: There is considerable variation in the performance of these fluorescence‐based devices that could not be explained by the different wavelengths of the devices assessed, participant, or study characteristics. Blue and green fluorescence‐based devices appeared to outperform red fluorescence‐based devices but this difference was not supported by the results of a formal statistical comparison. The evidence base was considerable, but we were only able to include 79 studies out of 133 in the meta‐analysis as estimates of sensitivity or specificity values or both could not be extracted or derived. In terms of applicability, any future studies should be carried out in a clinical setting, where difficulties of caries assessment within the oral cavity include plaque, staining, and restorations. Other considerations include the potential of fluorescence devices to be used in combination with other technologies and comparative diagnostic accuracy studies

Fit to be Tied: Social Network Structures and Evaluation Apprehension

In everyday life, people are typically connected to others, and these variably strong connections facilitate social influence related to a range of phenomena, from shaping body image and, impacting self-esteem to shaping behaviors through exhibiting social norms. Although the strongest ties (those most intimate and influential) can be very important to a person, there can also be a fear of judgement (i.e., evaluation apprehension) in those relationships. In online social networks, the relationship between tie strength and evaluation apprehension may emerge differently than in offline spaces due to affordances of social media, the asynchronous nature of computer-mediated communication, and the networked audience on social media; the potential influences of discrete ties may be additive because groups of strong ties may also exert a similar normative influence. In order to explore the possible links between evaluation apprehension and online social network structures (i.e., cumulative tie strength and network density), a study was conducted in which participants ( N = 96) first completed an initial online survey (assessing online evaluation apprehension and demographics), then viewed an in-lab visualization of their Twitter network (to capture social network structure characteristics), and finally completed a second survey (to capture network use habits). Analysis revealed associations between evaluation apprehension and tie strength as well as evaluation apprehension and network density with a moderate effect size. Results are interpreted to suggest that evaluation apprehension may be digitally contextual, predictors of tie strength may serve as affirmation, social network features may influence evaluation apprehension, and digital social networks may function as a conglomerate discipline-mechanism similar to that of the panopticon

Issues in Contemporary Orthodontics

Issues in Contemporary Orthodontics is a contribution to the ongoing debate in orthodontics, a discipline of continuous evolution, drawing from new technology and collective experience, to better meet the needs of students, residents, and practitioners of orthodontics. The book provides a comprehensive view of the major issues in orthodontics that have featured in recent debates. Abroad variety of topics is covered, including the impact of malocclusion, risk management and treatment, and innovation in orthodontics

Delineating Phenotypes of Rare Disease

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