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Title: Implications of unchanged detection criteria with CAD as second reader of mammograms

Abstract

In this paper we address the use of computer-aided detection (CAD) systems as second readers in mammography. The approach is based on Bayesian decision theory and its implication for the choice of optimal operating points. The choice of a certain operating point along an ROC curve corresponds to a particular tradeoff between false positives and missed cancers. By minimizing a total risk function given this tradeoff, we determine optimal decision thresholds for the radiologist and CAD system when CAD is used as a second reader. We show that under very general circumstances, the performance of the sequential system is improved if the decision threshold of the latent human decision variable is increased compared to what it would have been in the absence of the CAD system. This means that an initial stricter decision criterion should be applied by the radiologist when CAD is used as a second reader than otherwise. First and foremost, the results in this paper should be interpreted qualitatively, but an attempt is made at quantifying the effect by tuning the model to a prospective study evaluating the use of CAD as a second reader. By making some necessary and plausible assumptions, we are able to estimatemore » the effect of the resulting suboptimal operating point. In this study of 12 860 women, we estimate that a 15% reduction in callbacks for masses could have been achieved with only about a 1.5% relative decrease in sensitivity compared to that without using a stricter initial criterion by the radiologist. For microcalcifications the corresponding values are 7% and 0.2%.« less

Authors:
 [1]
  1. Department of Physics, KTH, Stockholm (Sweden)
Publication Date:
OSTI Identifier:
20775129
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 33; Journal Issue: 4; Other Information: DOI: 10.1118/1.2179148; (c) 2006 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; CARCINOMAS; MAMMARY GLANDS; PERFORMANCE; SENSITIVITY; SENSITIVITY ANALYSIS; WOMEN

Citation Formats

Bornefalk, Hans. Implications of unchanged detection criteria with CAD as second reader of mammograms. United States: N. p., 2006. Web. doi:10.1118/1.2179148.
Bornefalk, Hans. Implications of unchanged detection criteria with CAD as second reader of mammograms. United States. doi:10.1118/1.2179148.
Bornefalk, Hans. Sat . "Implications of unchanged detection criteria with CAD as second reader of mammograms". United States. doi:10.1118/1.2179148.
@article{osti_20775129,
title = {Implications of unchanged detection criteria with CAD as second reader of mammograms},
author = {Bornefalk, Hans},
abstractNote = {In this paper we address the use of computer-aided detection (CAD) systems as second readers in mammography. The approach is based on Bayesian decision theory and its implication for the choice of optimal operating points. The choice of a certain operating point along an ROC curve corresponds to a particular tradeoff between false positives and missed cancers. By minimizing a total risk function given this tradeoff, we determine optimal decision thresholds for the radiologist and CAD system when CAD is used as a second reader. We show that under very general circumstances, the performance of the sequential system is improved if the decision threshold of the latent human decision variable is increased compared to what it would have been in the absence of the CAD system. This means that an initial stricter decision criterion should be applied by the radiologist when CAD is used as a second reader than otherwise. First and foremost, the results in this paper should be interpreted qualitatively, but an attempt is made at quantifying the effect by tuning the model to a prospective study evaluating the use of CAD as a second reader. By making some necessary and plausible assumptions, we are able to estimate the effect of the resulting suboptimal operating point. In this study of 12 860 women, we estimate that a 15% reduction in callbacks for masses could have been achieved with only about a 1.5% relative decrease in sensitivity compared to that without using a stricter initial criterion by the radiologist. For microcalcifications the corresponding values are 7% and 0.2%.},
doi = {10.1118/1.2179148},
journal = {Medical Physics},
number = 4,
volume = 33,
place = {United States},
year = {Sat Apr 15 00:00:00 EDT 2006},
month = {Sat Apr 15 00:00:00 EDT 2006}
}
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  • The purpose of this study is to develop a new method for assessment of the reproducibility of computer-aided detection (CAD) schemes for digitized mammograms and to evaluate the possibility of using the implemented approach for improving CAD performance. Two thousand digitized mammograms (representing 500 cases) with 300 depicted verified masses were selected in the study. Series of images were generated for each digitized image by resampling after a series of slight image rotations. A CAD scheme developed in our laboratory was applied to all images to detect suspicious mass regions. We evaluated the reproducibility of the scheme using the detectionmore » sensitivity and false-positive rates for the original and resampled images. We also explored the possibility of improving CAD performance using three methods of combining results from the original and resampled images, including simple grouping, averaging output scores, and averaging output scores after grouping. The CAD scheme generated a detection score (from 0 to 1) for each identified suspicious region. A region with a detection score >0.5 was considered as positive. The CAD scheme detected 238 masses (79.3% case-based sensitivity) and identified 1093 false-positive regions (average 0.55 per image) in the original image dataset. In eleven repeated tests using original and ten sets of rotated and resampled images, the scheme detected a maximum of 271 masses and identified as many as 2359 false-positive regions. Two hundred and eighteen masses (80.4%) and 618 false-positive regions (26.2%) were detected in all 11 sets of images. Combining detection results improved reproducibility and the overall CAD performance. In the range of an average false-positive detection rate between 0.5 and 1 per image, the sensitivity of the scheme could be increased approximately 5% after averaging the scores of the regions detected in at least four images. At low false-positive rate (e.g., {<=}average 0.3 per image), the grouping method alone could increase CAD sensitivity by 7%. The study demonstrated that reproducibility of a CAD scheme can be tested using a set of slightly rotated and resampled images. Because the reproducibility of true-positive detections is generally higher than that of false-positive detections, combining detection results generated from subsets of rotated and resampled images could improve both reproducibility and overall performance of CAD schemes.« less
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