Predicting Radiologist Expertise from 3D Gaze Patterns During CT Interpretation

Abstract

Accurate interpretation of volumetric CT requires efficient navigation of 3D image volumes and attention to diagnostically relevant regions. While eye-tracking has been widely studied in 2D medical imaging, its use for expertise assessment in CT settings remains limited. We propose a gaze-informed transformer framework for expertise classification in thoracic CT. Using a DINOv2 backbone, radiologist fixation patterns are integrated into volumetric feature learning through (1) a learnable log-space bias in self-attention and (2) gaze-weighted pooling of patch embeddings. We trained and evaluated our approach on 182 CT reading sessions from five radiologists with varying levels of experience. On a held-out test set, the model achieves an ROC-AUC of 0.91 and F1 score of 0.86, outperforming adapted methods. These findings suggest that incorporating visual search behavior into transformers may support objective, process-based expertise assessment in radiology. Code is available via https://github.com/leiluk1/GazeToSkill.