National Institute of Biomedical Imaging and Bioengineering/Center for Devices and Radiological Health Joint Laboratory for the Assessment of Medical Imaging Systems, U.S. Food and Drug Administration, Rockville, MD, USA.
To evaluate the effect of computer-aided detection (CAD) as second reader on radiologists' diagnostic performance in interpreting computed tomographic (CT) colonographic examinations by using a primary two-dimensional (2D) approach, with segmental, unblinded optical colonoscopy as the reference standard.
This HIPAA-compliant study was IRB-approved with written informed consent. Four board-certified radiologists analyzed 60 CT examinations with a commercially available review system. Two-dimensional transverse views were used for initial polyp detection, while three-dimensional (3D) endoluminal and 2D multiplanar views were available for problem solving. After initial review without CAD, the reader was shown CAD-identified polyp candidates. The readers were then allowed to add to or modify their original diagnoses. Polyp location, CT Colonography Reporting and Data System categorization, and reader confidence as to the likelihood of a candidate being a polyp were recorded before and after CAD reading. The area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, and specificity were estimated for CT examinations with and without CAD readings by using multireader multicase analysis.
Use of CAD led to nonsignificant average reader AUC increases of 0.03, 0.03, and 0.04 for patients with adenomatous polyps 6 mm or larger, 6-9 mm, and 10 mm or larger, respectively (P > or = .25); likewise, CAD increased average reader sensitivity by 0.15, 0.16, and 0.14 for those respective groups, with a corresponding decrease in specificity of 0.14. These changes achieved significance for the 6 mm or larger group (P < .01), 6-9 mm group (P < .02), and for specificity (P < .01), but not for the 10 mm or larger group (P > .16). The average reading time was 5.1 minutes +/- 3.4 (standard deviation) without CAD. CAD added an average of 3.1 minutes +/- 4.3 (62%) to each reading (supine and prone positions combined); average total reading time, 8.2 minutes +/- 5.8.
Use of CAD led to a significant increase in sensitivity for detecting polyps in the 6 mm or larger and 6-9 mm groups at the expense of a similar significant reduction in specificity.
"The standalone performance of CADe schemes was evaluated by a number of investigators     . Observer performance studies were performed to show the usefulness of CADe schemes  . However, it has not yet been clear whether CADe would improve radiologists' performance in the detection of " difficult " polyps which were " missed " by radiologists in a multicenter clinical trial. "
[Show abstract][Hide abstract] ABSTRACT: To investigate the actual usefulness of computer-aided detection (CADe)
of polyps as a second reader, we conducted a free-response observer
performance study with radiologists in the detection of "difficult"
polyps in CT colonography (CTC) from a multicenter clinical trial. The
"difficult" polyps were defined as the ones that had been "missed" by
radiologists in the clinical trial or rated "difficult" in our
retrospective review. Our advanced CADe scheme utilizing
massive-training artificial neural networks (MTANNs) technology was
sensitive and specific to the "difficult" polyps. Four board-certified
abdominal radiologists participated in this observer study. They were
instructed, first without and then with our CADe, to indicate the
location of polyps and their confidence level regarding the presence of
polyps. Our database contains 20 patients with 23 polyps including 14
false-negative (FN) and 7 "difficult" polyps and 10 negative patients.
With CADe, the average by-polyp sensitivity of radiologists was improved
from 53 to 63% at a statistically significant level (P=0.037). Thus, our
CADe scheme utilizing the MTANN technology improved the diagnostic
performance of radiologists, including expert readers, in the detection
of "difficult" polyps in CTC.
Proceedings of SPIE - The International Society for Optical Engineering 03/2013; 8670. DOI:10.1117/12.2008284 · 0.20 Impact Factor
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