Where Do Clinicians Look When Viewing Videofluoroscopic Swallow Studies? A Pilot Eye-Tracking Study.

Purpose: This study aimed to explore how speech-language pathologists (SLPs) visually assess videofluoroscopic swallow studies (VFSS) as reflected in eye-tracking data and to discuss challenges and barriers when using eye-tracking methodology to better understand VFSS review.

Method: Thirteen SLPs reviewed two swallows of a 5-ml thin liquid swallow while their eye movements were recorded. Fixation counts were analyzed across anatomically relevant areas of interest (AOIs). Data were analyzed descriptively, and statistical comparisons were made between the two swallows using the Wilcoxon signed-ranks test.

Results: Key findings included an overall decline in fixation count rate in the second swallow, significant variability in eye-gaze behavior across participants, and AOI-specific changes. The bolus received the highest fixation count rate in both swallows, and visual attention shifted from anterior-superior structures in the first swallow to more posterior-inferior structures in the second swallow. Methodological challenges included but were not limited to drawing the constantly changing AOI boundary and the lack of guidelines for missing gaze data.

Conclusions: Eye tracking offers exploratory insights into SLPs' visual attention during VFSS review, revealing variable gaze patterns and methodological challenges. Future research should further explore the link between gaze behavior and VFSS interpretation, possibly revealing patterns that may influence clinical decision making about a patient's swallowing physiology and shape clinical training accordingly.

Supplemental material: https://doi.org/10.23641/asha.30104632.