AI Timing in Chest X-ray Interpretation Using Eye-Tracking

NCT07675694 | Recruiting

• 3 other identifiers: 20426934792026/EE/0111
• Study Type: interventional
• Target: 24
• Locations: 1 country
• Sites: 1

Brief Summary

Chest X-rays are commonly used to help diagnose and manage chest conditions. Artificial intelligence (AI) tools are increasingly being used to support chest X-ray interpretation. However, it is not yet clear whether the timing of AI information affects how clinicians review images, make decisions, and use AI support. This study will look at whether showing AI information before or after a clinician first reviews a chest X-ray changes how they look at the image, how long they take, their interpretation decisions, their confidence, and their trust in AI support. Healthcare professional participants will complete two chest X-ray interpretation sessions in a controlled NHS research setting. During each session, participants will review de-identified chest X-ray images while wearing eye-tracking equipment. Eye-tracking will record where a participant looks on the image and how long they spend looking at different areas. In one session, AI information will be shown before the participant reviews the chest X-ray. In the other session, AI information will be shown after the participant has first reviewed the chest X-ray. The order of these two sessions will be balanced across participants. The study uses de-identified chest X-ray images from existing examinations. It does not involve patients directly, does not change clinical care, and no clinical decisions will be made from the study readings. Participants will also complete a short questionnaire about their experience of using AI support. A separate anonymous survey will collect wider views from clinicians, patients, members of the public, and healthcare staff about the use of AI in chest X-ray interpretation.

Conditions

Diagnostic Imaging; Eye Tracking; Artificial Intelligence (AI)

Keywords

Artificial intelligence timing; Chest X-ray interpretation; Visual search behaviour; Diagnostic accuracy; Trust in automation; Automation bias; Clinician confidence; Decision support systems; Human-AI interaction

Outcome Measures

Primary Outcomes (4)

• Change in Chest X-ray Case Interpretation Time

  Case interpretation time is the duration, in seconds, from initial case display to final structured report submission. Change in case interpretation time will be measured between Session 1 and Session 2, displaying either original chest X-ray first or AI output first.

  Session 1 at enrolment and Session 2 at least 4 weeks later, anticipated average 5 weeks

• Change in Chest X-ray Case Diagnostic Accuracy

  Diagnostic accuracy will be assessed using structured report outcomes compared with clinician-verified chest X-ray ground truth. Each participant's final structured interpretation for each chest X-ray case will be compared with the verified study ground truth for that case. Change in diagnostic accuracy will be measured between Session 1 and Session 2, displaying either original chest X-ray first or AI output first.

  Session 1 at enrolment and Session 2 at least 4 weeks later, anticipated average 5 weeks

• Change in Chest X-ray Case Visual Search Behaviour

  Visual search behaviour will be assessed using predefined eye-tracking metrics that capture gaze location and search behaviour during chest X-ray interpretation. Metrics include time to first fixation, hit time, dwell time within abnormal case areas of interest, fixation count, mean fixation duration, revisit count, and fixation dispersion. Change in visual search behaviour will be measured between Session 1 and Session 2, displaying either original chest X-ray first or AI output first.

  Session 1 at enrolment and Session 2 at least 4 weeks later, anticipated average 5 weeks

• Trust in AI Support After Reader-Study Completion

  Trust in AI support will be assessed using structured questionnaire ratings after participants have completed both Session 1 and Session 2. This measure captures participants' overall perceived usefulness, reliance on AI support, and willingness to revise decisions after reviewing AI information.

  Immediately after Session 2, anticipated average 5 weeks after enrolment

Secondary Outcomes (5)

• Change in Chest X-ray Case Clinical Management Recommendations

  Session 1 at enrolment and Session 2 at least 4 weeks later, anticipated average 5 weeks

• Change in Chet X-ray Case Decision Confidence

  Session 1 at enrolment and Session 2 at least 4 weeks later, anticipated average 5 weeks

• Overall Reflective Confidence After Reader-Study Completion

  Immediately after Session 2, anticipated average 5 weeks after enrolment

• Participant Perceptions of AI Support After Reader-Study Completion

  Immediately after Session 2, anticipated average 5 weeks after enrolment

• Broader Attitudes Toward AI in Chest X-ray Interpretation

  2 months

Other Outcomes (5)

• Differences in Chest X-ray Case Diagnostic Accuracy, Visual Search Behaviour, and Trust in AI Support by Clinical Background and Experience

  Session 1 at enrolment and Session 2 at least 4 weeks later, anticipated average 5 weeks

• Association Between Chest X-ray Case Visual Search Behaviour and Diagnostic Accuracy

  Session 1 at enrolment and Session 2 at least 4 weeks later, anticipated average 5 weeks

• Association Between Chest X-ray Case Visual Search Behaviour and Case Complexity

  Session 1 at enrolment and Session 2 at least 4 weeks later, anticipated average 5 weeks

Study Arms (2)

Original CXR First Sequence

EXPERIMENTAL

Participants complete the original chest X-ray first timing condition in Session 1, followed by the AI output first timing condition in Session 2. Sessions are separated by at least four weeks.

Behavioral: Original CXR First Timing; Behavioral: AI Output First Timing

AI Output First Sequence

EXPERIMENTAL

Participants complete the AI output first timing condition in Session 1, followed by the original chest X-ray first timing condition in Session 2. Sessions are separated by at least four weeks.

Behavioral: Original CXR First Timing; Behavioral: AI Output First Timing

Interventions

Original CXR First Timing BEHAVIORAL

Participants first review the original chest X-ray without AI output and complete an initial structured interpretation response. AI output is then introduced, and participants may review or revise their response before submitting the final response for that case.

AI Output First Sequence; Original CXR First Sequence

AI Output First Timing BEHAVIORAL

Participants first view AI output before reviewing the original chest X-ray. The original chest X-ray is then introduced, and participants complete or revise their structured interpretation response before submitting the final response for that case.

AI Output First Sequence; Original CXR First Sequence

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Main reader study:
• Healthcare professionals aged 18 years or over
• Registered to practise in the UK
• Employed by the NHS or another healthcare service operating in the UK
• Current or recent, within the last 3 years, clinical experience involving chest X-ray interpretation, review, or use in clinical practice
• Able to attend two onsite study sessions at University Hospitals of Leicester NHS Trust at mutually agreed times
• Able and willing to provide written informed consent
• Compatible with the eye-tracking equipment
• Supplementary survey:
• Adults aged 18 years or over
• Live in the UK or have used the NHS or another UK healthcare service within the last 5 years
• Able to provide informed electronic consent
• Belong to one of the following respondent groups: healthcare professionals or healthcare staff, patients or carers, or members of the public
• Healthcare professional respondents may include adults involved in requesting, interpreting, checking, or acting on chest X-ray findings in clinical practice

You may not qualify if:

• Main reader study:
• Inability to attend both onsite study sessions at University Hospitals of Leicester NHS Trust
• Eye-tracking incompatibility, such as visual, neurological, or physical conditions preventing adequate gaze tracking or participant comfort
• Direct involvement in selection, adjudication, or preparation of the chest X-rays used in the study
• Conflicts of interest, including direct involvement in development of the AI system under evaluation
• Prior participation in a closely related AI chest X-ray study where overlap in image sets or study procedures may compromise validity, assessed on a case-by-case basis
• Supplementary survey:
• Aged under 18 years
• Does not live in the UK and has not used the NHS or another UK healthcare service within the last 5 years
• Unable to provide informed electronic consent
• Does not meet one of the eligible respondent groups for the survey

Sponsors & Collaborators

• University Hospitals, Leicester: lead

Study Sites (1)

University Hospitals of Leicester NHS Trust

Leicester, Leicestershire, LE1 5WW, United Kingdom

RECRUITING

Central Study Contacts

Richard Farley

CONTACT

+44116258 6237; richard.farley1@nhs.net

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: No masking is used. It is clear to participants and study staff whether the chest X-ray or the AI information is shown first during each session.
• Purpose: DIAGNOSTIC
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Participants are randomly assigned to one of two session orders. In one order, participants review the chest X-ray first in Session 1 and the AI information first in Session 2. In the other order, participants review the AI information first in Session 1 and the chest X-ray first in Session 2. Sessions are separated by at least four weeks.

Study Record Dates

• First Submitted: June 10, 2026
• First Posted: June 30, 2026
• Study Start: June 30, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026
• Last Updated: July 6, 2026

Record last verified: 2026-07

Locations

GB (1)