GazeRIB: Systematic Evaluation of Multi-Reader Gaze-Guided Chest X-ray Learning
Nattakorn Kittisut, Roy M. Gabriel, Marly van Assen, Mohammadreza Zandehshahvar, Carlo N. De Cecco, Elizabeth A. Krupinski, Ali Adibi
Abstract
Radiologists' visual attention can supervise medical image learning, but how reader panel composition affects its value remains untested. We evaluated GazeRIB (Gaze-guided Radiologist-Informed Blackout), which masks unviewed regions during training and uses unmasked images at inference. Eight experts repeatedly read the same 80 chest X-rays (CXRs). We compared individual readers with three-, five- and eight-reader panels across seven architectures and 10 seeds, evaluating 910 models on a separate 2,897-CXR cohort for four-class severity prediction. Every panel improved macro F1 over the no-gaze baseline by 5.33-7.47 percentage points (pp; Bonferroni-adjusted p < 0.007); no individual reader reached significance on this endpoint. Three readers captured 73-80% of the eight-reader gain in macro F1, the area under the receiver-operating-characteristic curve (ROC-AUC) and the area under the precision-recall curve (AU-PRC). On external validation without retraining, all four panels improved ROC-AUC on SIIM-FISABIO-RSNA by +1.93 to +4.24 pp (p <= 0.004); on MIMIC-Eye no panel differed significantly from baseline, whereas the single-reader average declined (-1.40 pp, p = 0.008). Reader composition therefore influenced performance, although transfer depended on the cohort.