Digital Breast Tomosynthesis and Digital Mammography Recall and False-Positive Rates by Time of Day and Reader Experience

Abstract

BREAST IMAGINGT he psychology literature shows that fatigue inhibits performance (1). For instance, test performance decreases over the course of the day among school children (2), and primary care physicians are more likely to prescribe antibiotics for an acute upper respiratory infection later versus earlier in a clinic session (3). Fatigue also affects the performance of radiologists (4,5). A series of reader experiments has examined radiologists' performance when images are read before versus during or after a clinical shift; generally, radiologists are more accurate during earlier sessions (6-10). Hanna et al (11) conducted a retrospective review of nearly 3 million studies double read by radiologists. There were 4294 major discrepancies between the two readers, and these discrepancies were more likely to occur when the first reader read the study later in the shift. In an experiment by Krupinski et al ( 12), in which radiologists and residents read CT chest images, a performance decrease later in the day was observed among radiology residents only; there was no time-ofday effect for attending radiologists. Overall, these studies suggest that radiologists' decision making is affected by time of day, consistent with findings from cognitive psychology (13). Although the focus on major discrepancies from Hanna and colleagues (11) is informative, another relevant outcome for health care costs is the recall rate. Furthermore, if time of day does affect recall, this effect may be more profound for imaging modalities that provide more detail and thus are more cognitively taxing than modalities that provide less detail. Moreover, this effect, if it exists, may be more notable among less-experienced radiologists. Digital breast tomosynthesis (DBT) provides much greater detail than digital mammography (DM) in breast cancer detection, with images of the breast reconstructed into sections 1 mm apart for the radiologist to review. This results in hundreds Background: Digital breast tomosynthesis (DBT) image interpretation might be more cognitively demanding than interpretation of digital mammography (DM) images. The time of day of interpretation might affect recall and false-positive (FP) rates, especially for DBT.Purpose: To determine whether recall and FP rates vary by time of day of interpretation for screening mammography for breast cancer performed with DM and DBT. Materials and Methods:This is a retrospective study examining 97 671 screening mammograms interpreted by 18 radiologists between January 2018 and December 2019 at one of 12 community radiology sites. The association between the time of day of interpretation, the type of image interpreted (DM vs DBT), and radiologist experience (≤5 posttraining years vs .5 posttraining years) and the likelihood of a patient being recalled from screening mammography and the likelihood of whether the interpretation was FP or true positive were analyzed. Analyses were conducted using generalized linear mixed modeling with a binary distribution and sandwich estimation where ob...

Women’s perceptions and attitudes to the use of AI in breast cancer screening: a survey in a cancer referral centre

“…4 Moreover, AI introduction in breast cancer screening mammogram interpretation could be essential even in high-income countries to face the current (and the expected) shortage of radiologists which is increasingly putting breast cancer screening under strain. 16 Finally, while radiologists' performance tends to decrease after 70 or 80 min of reading, 17 AI never gets tired and has consistent performance. Mammography screening supported by AI can help to reduce the radiologists' overload of work, decreasing the increasing burnout rate and making radiologists less anxious during their shifts.…”

Mammography in 2022, from Computer-Aided Detection to Artificial Intelligence Applications

“…Moreover, while performance of radiologists decreases after 70-80 minutes of reading [4], AI has consistent performance, never getting tired. Mammography screening supported with AI can help to reduce the radiologists' overload of work, decreasing the increasing burnout rate of physicians that was reported in the last few years, probably due also by COVID-19 pandemics [13][14][15].…”

“…The ability to appropriately find lesions by radiologists may be limited by some features indeed, like the suboptimal image quality of the exams, the extremely dense tissue of the breast, the inaccurate assessment of subtle or complex patterns [2,3]. Moreover, the fatigue or other radiologists' limitations may influence the detection of abnormalities [4].…”

Discordant and false-negative interpretations at digital breast tomosynthesis in the prospective Oslo Tomosynthesis Screening Trial (OTST) using independent double reading

“…Increased number of false-negatives throughout batch and reduced reading time for later image positions within batch was reported in DM screening [ 30 ]. High-volume DBT screening using batch reading requires greater cognitive resources than DM and might exacerbate association between fatigue and reader performance [ 31 ]. An experimental study found that readers were beginning to show signs of visual fatigue after 20 DBT cases [ 32 ].…”