Prototype
50 radiological anatomy images were annotated with labels and programmed into the Facebook messenger chatbot to automatically quiz users for correct answers when prompted.
Users are able to access this chatbot with any desktop or mobile device that has a working internet connection.
They are able to connect via the web link 
https://m.me/anatomyhero and through the Facebook Messenger app on their phone after first connecting via the web link (Fig.4,
Fig.5).
Fig. 4: Screenshot of the anatomy chatbot being used on an Apple iPhone.
References: P. Marsh
Fig. 5: Screenshot of the desktop version of chatbot
References: P. Marsh
Benefits
(1) Accessibility
Given its accessibility,
the platform provides the ability for users to revise anatomy at any location by using their phone.
The quiz can be stopped and continued at anytime,
and if programmed,
a daily push notification can be triggered to remind the user to complete questions for the day,
the same way a friend may message them on the platform.
Unlike a didactic lecture,
chatbots require user involvement to continue.
(2) Personalisation & spaced repetition
Spaced repetition - where questions are repeatedly asked - improves retention by flattening the forgetting curve (Fig.
6) [3].
A meta-analysis review in 1999 suggested that by using spaced repetition,
students are able to outperform 67% of those who learn by mass presentation [4].
This is made possible by using computer software algorithms to ensure questions are re-exposed to improve long-term retention rates.
The personalisation of the questions provides a more focused revision process by allowing students to focus on areas they are less competent in [5].
Fig. 6: Projected forgetting curves are improved when spaced repetition is used, in turn providing better long-term retention of information
References: NEJM
(3) Data & feedback
When the chatbots are controlled by teachers or directors of training (DOT),
real-time data can provide anonymous insight to target particular areas which require more attention by pinpointing areas of weakness.
The ability for users to add their own questions to the pool will help continue to grow the database of useable questions.
A chatbot can also be a tool to advise its users which areas they need work on based on their previous answers and quiz results.
(4) Always up to date
The benefit of a chatbot over an app is the ability to access the data without installing any additional apps.
Depending on how an app was created,
its information may only be up to date based on the data from the most recent version installed.
A chatbot would remain up to date in real time.
Version 2.0
The next version of the chatbot is still a work in progress with many additional features to be incorporated including spaced repetition for incorrect answers - whereby questions answered incorrectly will be repeated a few questions later until the correct response is given.
And,
the ability of the chatbot to learn variations of answers as there are often common variations in spelling and terminology.
Keywords and template matching will be used to determine accurate answers within the chatbot.
In additional to randomised mock exams,
other quizzes will also be divided into body regions and have multiple choice and typed answer options available.
Additional questions will be added including attachments,
nerves and normal variants as reflected in the RANZCR anatomy syllabus.
The ability to demonstrate correct answers via animated diagrams (GIFs),
audio and video will enhance the learning experience and engagement.
Other Uses
Although chatbots are now widely used in customer service and information acquisition,
its use in medicine has only just begun.
Others have started to use chatbots to target a younger demographic,
such as screening for sexually transmitted diseases or providing safe sex education.
A chatbot's only constraint is it’s designer's creativity or ability.
There are numerous other future use cases for a chatbot in radiology including:
- Remote journal club - crowdsourced chatbot outlining a summary of recent journal articles and surveying users their opinion
- Diagnostic imaging pathway - imaging guideline advice for referring doctors
- Voice controlled quiz - with the introduction of Alexa and Google Home,
the ability to incorporate voice activated quizzes for revision become a possibility
