Ultrasound (US) is a valuable imaging modality used to detect primary breast malignancy. However, radiologists have a limited ability to distinguish between benign and malignant lesions on US, leading to false-positive and false-negative results, which limit the positive predictive value of lesions sent for biopsy (PPV3) and specificity. A recent study demonstrated that incorporating an AI-based decision support (DS) system into US image analysis could help improve US diagnostic performance. While the DS system is promising, its efficacy in terms of its impact also needs to be measured when integrated into existing clinical workflows. The current study evaluates workflow schemas for DS integration and its impact on diagnostic accuracy. The impact on two different reading methodologies, sequential and independent, was assessed. This study demonstrates significant accuracy differences between the two workflow schemas as measured by area under the receiver operating curve (AUC), as well as inter-operator variability differences as measured by Kendall’s tau-b. This evaluation has practical implications on the utilization of such technologies in diagnostic environments as compared to previous studies.
Medical Ultrasonography is a valuable imaging technology for medical diagnostics and to guide interventional procedures. Ultrasound imaging is particularly useful in breast cancer detection and diagnosis for women with dense breast tissue where traditional mammography may fail to detect suspicious areas. However, ultrasound imaging suffers from speckle noise, an inherent characteristic of all coherent imaging techniques due to the presence of sub-resolution scatterers. Speckle noise produces a reduction in contrast resolution which is responsible for the overall lower effective resolution of ultrasound compared to x-ray or MRI imaging. In the case of breast imaging, ultrasound speckle can mask small details such as low contrast tumors or micro-calcifications, which may be an early indication of breast cancer. This limitation prevents ultrasound from displacing mammography as the gold standard for breast cancer screening. In conventional pulsed ultrasound imaging systems, de-noising techniques are used to minimize the effect of speckle noise. However, research shows that there is a tradeoff between the effectiveness of speckle reduction techniques and image resolution. We introduce stepped-frequency continuous wave ultrasound imaging which provides a framework where speckle reduction techniques are particularly effective, resulting in higher quality images with an improved SNR and significantly lower speckle noise while maintaining the spatial resolution of the original scan so that small lesions of interest are visible to the radiologist.
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