## 4 Discussion
### Educational Tool Evaluation  
The use of eye-tracking in an educational role is a theme which was addressed in the literature. It must be noted that whilst synthesis may be difficult considering differing purpose and methodology, all articles provide important discourse to radiological discussion.  
The first article pertaining to training for radiographic interpretation via eye-tracking was that of [PERSON] et al. [13] in which eye-tracking was used as a tool to both inform production and assessment of the program. The program appeared to significantly improve diagnostic accuracy of the intervention group (with an increase in true positive and decrease in false positive diagnoses) as well as a significant increase in confidence. Gaze metrics were analysed, yet were more varied in results, as there was a decrease in fixation count, visit duration and interpretation time for the control group, the chest x-ray (CXR) reporting radiographers presented with a decrease in fixation duration and fixation count for both groups, but the intervention CXR reporting radiographer group made diagnostic decisions in significantly more time. Whilst these results may reflect themes from the competency assessment section of this review (Section 4.2), one must consider that a similar research team also produced the article by [PERSON] et al. [23] who posed similar questions about speed and gaze-metrics. This is important to consider in the overall review for sources of bias in result reporting. In other aspects, both articles were presented well with strong methodologies, samples, analysis, discussions and conclusions.  
A similar study by [PERSON] et al. [14] presented eye-tracking as a form of self-reflection and assessed performance post-intervention. Whilst there was no significance in regard to improved accuracy for the intervention group, there was an identification that interventional trainees shortened decision time [14]. There was also a subjective rating of the self-study system by the trainees and a senior radiologist mentor, who cohesively rated the program positively as it allowed for review into educational improvement [14]. This study had many limitations which impact quality, such as the lack of significance analysis,very small sample size (eight trainees only, which introduced error) and a lower-cost, lower efficiency system which can affect the feedback quality. Despite these study restraints, there is a benefit to the utilisation of such systems for educational purposes.  
The article by [PERSON] et al. (2015) focused on the manner in which interpretation is taught to professionals who interpret radiographs. Authors used interventions based on systematic training, non-systematic training or full coverage training. The results reflected that that systematic groups presented the most homogenous viewing technique, non-systematic and systematic training was best for sensitivity and that non-systematic training was the fastest for abnormality detection. The overall conclusion stated that students did not benefit from systematic training. Whilst this study conducted dual experiments, main focus remained on the second experiment which referenced educational styles. There was an adequate sample size of 64, with appropriate procedures and equipment for data collection. Limitations resided in the length of training, as longer training may provide further benefits in interpretation strategy.  
Overall thematic conclusions for these studies suggest that eye-tracking technologies may have a considerable role in the education of radiological professionals and the improvement of diagnostic skills.