Comparison of Radiographer/Radiologist Double Film Reading with Single Reading in Breast Cancer Screening

Pauli, Regina; Hammond, Seán; Cooke, Julie; Ansell, Janet

doi:10.1177/096914139600300106

Cited by 39 publications

(41 citation statements)

References 6 publications

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“…In the setting of an increased workload for radiologists, this alternative working practice, known as skill mixing, has been explored in many studies [16][17][18][19][20][21]. A systematic review showed that technologists could be as sensitive as radiologists in detecting breast malignancies, but with higher false-positive rates [22].…”

Section: Introductionmentioning

confidence: 99%

Computer-aided detection in full-field digital mammography in a clinical population: performance of radiologist and technologists

Biggelaar

Kessels

Engelshoven

et al. 2009

Breast Cancer Res Treat

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The purpose of the study was to evaluate the impact of a computer-aided detection (CAD) system on the performance of mammogram readers in interpreting digital mammograms in a clinical population. Furthermore, the ability of a CAD system to detect breast cancer in digital mammography was studied in comparison to the performance of radiologists and technologists as mammogram readers. Digital mammograms of 1,048 consecutive patients were evaluated by a radiologist and three technologists. Abnormalities were recorded and an imaging conclusion was given as a BI-RADS score before and after CAD analysis. Pathology results during 12 months follow up were used as a reference standard for breast cancer. Fifty-one malignancies were found in 50 patients. Sensitivity and specificity were computed before and after CAD analysis and provided with 95% CIs. In order to assess the detection rate of malignancies by CAD and the observers, the pathological locations of these 51 breast cancers were matched with the locations of the CAD marks and the mammographic locations that were considered to be suspicious by the observers. For all observers, the sensitivity rates did not change after application of CAD. A mean sensitivity of 92% was found for all technologists and 84% for the radiologist. For two technologists, the specificity decreased (from 84 to 83% and from 77 to 75%). For the radiologist and one technologist, the application of CAD did not have any impact on the specificity rates (95 and 83%, respectively). CAD detected 78% of all malignancies. Five malignancies were indicated by CAD without being noticed as suspicious by the observers. In conclusion, the results show that systematic application of CAD in a clinical patient population failed to improve the overall sensitivity of mammogram interpretation by the readers and was associated with an increase in false-positive results. However, CAD marked five malignancies that were missed by the different readers.

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Section: Introductionmentioning

confidence: 99%

Computer-aided detection in full-field digital mammography in a clinical population: performance of radiologist and technologists

Biggelaar

Kessels

Engelshoven

et al. 2009

Breast Cancer Res Treat

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“…Alternatives for double interpretation by a second radiologist include second reading by a mammography radiographer or computer-aided detection devices (Pauli et al, 1996;Tonita et al, 1999;Gilbert et al, 2006Gilbert et al, , 2008.…”

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confidence: 99%

Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome

et al. 2009

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We prospectively determined the variability in radiologists' interpretation of screening mammograms and assessed the influence of type and number of readers on screening outcome. Twenty-one screening mammography radiographers and eight screening radiologists participated. A total of 106 093 screening mammograms were double-read by two radiographers and, in turn, by two radiologists. Initially, radiologists were blinded to the referral opinion of the radiographers. A woman was referred if she was considered positive at radiologist double-reading with consensus interpretation or referred after radiologist review of positive cases at radiographer double-reading. During 2-year follow-up, clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result from any reader. Single radiologist reading (I) resulted in a mean cancer detection rate of 4.64 per 1000 screens (95% confidence intervals (CI) ¼ 4.23 -5.05) with individual variations from 3.44 (95% CI ¼ 2.30 -4.58) to 5.04 (95% CI ¼ 3.81 -6.27), and a sensitivity of 63.9% (95% CI ¼ 60.5 -67.3), ranging from 51.5% (95% CI ¼ 39.6 -63.3) to 75.0% (95% CI ¼ 65.3 -84.7). Sensitivity at non-blinded, radiologist double-reading (II), radiologist double-reading followed by radiologist review of positive cases at radiographer double-reading (III), triple reading by one radiologist and two radiographers with referral of all positive readings (IV) and quadruple reading by two radiologists and two radiographers with referral of all positive readings (V) were as follows: 68.6% (95% CI ¼ 65.3 -71.9) (II); 73.2% (95% CI ¼ 70.1 -76.4) (III); 75.2% (95% CI ¼ 72.1 -78.2) (IV), and 76.9% (95% CI ¼ 73.9 -79.9) (V). We conclude that screener performance significantly varied at singlereading. Double-reading increased sensitivity by a relative 7.3%. When there is a shortage of screening radiologists, triple reading by one radiologist and two radiographers may replace radiologist double-reading.

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“…In a study by Haiart and Henderson, the sensitivity and specificity of the radiologists, radiographers and breast clinicians involved in the screening program of the UK were compared, showing similar sensitivities for all three groups, but significantly differing specificities were highest for the radiologists [49]. Other studies support less obvious differences [50], but document the influence of training on the diagnostic outcome. It can, however, be assumed that CAD offers opportunities for rather inexperienced colleagues, mainly for two reasons: 1) the basis for the decision whether the lesion is malignant or not is a bit weaker for inexperienced colleagues and thus 2) they are more influenced by a positive or negative CAD result.…”

Section: Impact Of Cad On Human Reader Performancementioning

confidence: 98%

CAD for mammography: the technique, results, current role and further developments

2006

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CAD systems, developed to assist the radiologist in the detection of suspicious lesions on mammograms, are currently controversially discussed. The highly sensitive detection of malignant structures including priors by CAD is linked with a low specific performance and a high rate of falsely positive markings. This causes controversial results regarding the effect of CAD systems for the diagnosing radiologist. This review aims to give an overview of the current literature, to state the currently discussed controversial results of CAD and to give an outlook on the next developments, which are not limited to senology, but include many other applications of CAD systems in radiology.

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Comparison of Radiographer/Radiologist Double Film Reading with Single Reading in Breast Cancer Screening

Cited by 39 publications

References 6 publications

Computer-aided detection in full-field digital mammography in a clinical population: performance of radiologist and technologists

Computer-aided detection in full-field digital mammography in a clinical population: performance of radiologist and technologists

Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome

CAD for mammography: the technique, results, current role and further developments

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