How widely is computer-aided detection used in screening and diagnostic mammography?
ABSTRACT The aim of this study was to determine how widely computer-aided detection (CAD) is used in screening and diagnostic mammography and to see if there are differences between hospital facilities and private offices.
The nationwide Medicare Part B fee-for-service databases for 2004 to 2008 were used. The Current Procedural Terminology(®) codes for screening and diagnostic mammography (both digital and screen film) and the CAD add-on codes were selected. Procedure volume was compared for screening vs diagnostic mammography and for hospital facilities vs private offices.
From 2004 to 2008, Medicare screening mammography volume increased slightly from 5,728,419 to 5,827,326 (+2%), but the use of screening CAD increased from 2,257,434 to 4,305,595 (+91%). By 2008, CAD was used in 74% of all screening mammographic studies. During this same time period, the Medicare volume of diagnostic mammography declined slightly from 1,835,700 to 1,682,026 (-8%), but the use of diagnostic CAD increased from 360,483 to 845,461 (+135%). By 2008, CAD was used in 50% of all diagnostic mammographic studies. In hospital facilities in 2008, CAD was used in 70% of all screening mammographic studies, compared with 81% in private offices. For diagnostic mammography in 2008, CAD was used in 48% in hospitals, compared with 55% in private offices.
Despite some operational drawbacks to using CAD, radiologists have embraced it in an effort to improve cancer detection. Its use has grown rapidly, and in 2008, it was used in three-quarters of all screening mammographic studies and half of all diagnostic mammographic studies. Women undergoing either screening or diagnostic mammography are more likely to receive CAD if they go to a private office than if they go to a hospital facility, although the differences are not great.
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ABSTRACT: Current computer-aided detection (CAD) systems for mammography screening work as prompting devices that aim at drawing radiologists' attention to suspicious regions. In this paper, we investigate utilizing a CAD system based on a support vector machine classifier as a standalone tool for recalling additional abnormal cases missed at screening, while keeping the associated recall rate at low levels. We tested the system on a large database of 5800 cases containing abnormal instances (1%) corresponding to prior examinations missed at screening. The results showed that 26% of the missed cases could be detected with a low additional recall rate of 2%. Moreover, after extrapolating this result to a screening program, we determined that, with our system, 0.73 additional cancers per 20 additional recalls could be potentially detected. We also compared the proposed system with a regular CAD system intended for non-standalone operation. The performance of the proposed system was significantly better.Proceedings of the 11th international conference on Breast Imaging; 07/2012
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ABSTRACT: Objectives To assess the impact of shifting from a standard double reading plus arbitration protocol to a single reading by experienced radiologists assisted by computer-aided detection (CAD) in a breast cancer screening program. Methods This was a prospective study approved by the ethics committee. Data from 21,321 consecutive screening mammograms in incident rounds (2010–2012) were read following a single reading plus CAD protocol and compared with data from 47,462 consecutive screening mammograms in incident rounds (2004–2010) that were interpreted following a double reading plus arbitration protocol. For the single reading, radiologists were selected on the basis of the appraisement of their previous performance. Results Period 2010-2012 vs. period 2004-2010: Cancer detection rate (CDR): 6.1‰ (95% confidence interval: 5.1-7.2) vs. 5.25‰; Recall rate (RR): 7.02% (95% confidence interval: 6.7-7.4) vs. 7.24% (selected readers before arbitration) and vs 3.94 (all readers after arbitration); Predictive positive value of recall: 8.69% vs. 13.32%. Average size of invasive cancers: 14.6 + - 9.5 mm vs. 14.3 + - 9.5 mm. Stage: 0 (22.3/26.1%); I (59.2/50.8%); II (19.2/17.1%); III (3.1/3.3%); IV (0/1.9%). Specialized breast radiologists performed better than general radiologists. Conclusions The cancer detection rate of the screening program improved using a single reading protocol by experienced radiologists assisted by CAD, at the cost of a moderate increase of the recall rate mainly related to the lack of arbitration.European Journal of Radiology 11/2014; · 2.16 Impact Factor
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ABSTRACT: Evidence-based literature has confirmed the effectiveness of radiation therapy (RT) after breast-conserving surgery (BCS), especially for young women. However, women with young children may be less likely to be compliant. This study explores factors associated with noncompliance of RT among insured young patients. Using the MarketScan Database, we identified the study cohort as women aged 20 to 64 years who had a BCS between January 1, 2004, and December 31, 2009, and had continuous enrollment 12 months before and after the date of BCS. Patients who had any radiation claims within a year of BCS were considered compliant. Adjusted odds of compliance were estimated from logistic regressions for the full sample and age-stratified subgroups. Sensitivity analyses were performed to evaluate the robustness of study findings. All statistical tests were two-sided. Eighteen thousand one hundred twenty of 21 008 (86.25%) nonmetastatic BCS patients received RT. Among patients aged 20 to 64 years, those with children aged 7 to 12 years, those with children aged 13 to 17 years, and those with no children or children aged 18 years or older were more likely to receive RT than patients with at least one child aged less than 7 years (7-12 years: odds ratio (OR) =1.32, 95% confidence interval (CI) = 1.05 to 1.66, P = .02; 13-17 years: OR = 1.41, 95% CI = 1.13 to 1.75, P = .002; no children or ≥18 years: OR = 1.38, 95% CI = 1.13 to 1.68, P = .001). Stratified analyses showed that the above association was primarily driven by women in the youngest age group (aged 20-50). Other important factors included breast cancer quality of care measures, enrollment in health maintenance organizations or capitated preferred provider organizations, travelled to a Census division outside their residence for BCS, and whether patients were primary holders of the insurance policy. Competing demands from child care can constitute a barrier to complete guideline-concordant breast cancer therapy. Younger patients may be confronted by unique challenges that warrant more attention in future research.CancerSpectrum Knowledge Environment 12/2013; · 14.07 Impact Factor