CT Colonography with Computer-aided Detection as a Second Reader: Observer Performance Study 1

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.
Radiology (Impact Factor: 6.87). 01/2008; 246(1):148-56. DOI: 10.1148/radiol.2453062161
Source: PubMed


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.

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    • "The standalone performance of CADe schemes was evaluated by a number of investigators [18] [19] [20] [21] [22]. Observer performance studies were performed to show the usefulness of CADe schemes [17] [23]. 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. "
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