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Assessment of Radiologists’ Performance with CADe for Digital Mammography. Elodia B. Cole, MS Medical University of South Carolina Department of Radiology and Radiological Sciences ACRIN Fall Meeting 2010. Co-Authors. R. Edward Hendrick, PhD University of Colorado - Denver

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Assessment of radiologists performance with cade for digital mammography l.jpg

Assessment of Radiologists’ Performance with CADe for Digital Mammography

Elodia B. Cole, MS

Medical University of South Carolina

Department of Radiology and Radiological Sciences

ACRIN Fall Meeting 2010


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Co-Authors Digital Mammography

R. Edward Hendrick, PhD

University of Colorado - Denver

Department of Radiology

Emily Conant, MD

University of Pennsylvania

Department of Radiology

Constantine Gatsonis, PhD

Brown University

Center for Statistical Science

Laurie Fajardo, MD

University of Iowa

Department of Radiology

Janet Baum, MD

Harvard Medical School

Department of Radiology

Etta Pisano, MD

Medical University of South Carolina

Department of Radiology and Radiological Science

Zheng Zhang, PhD

Brown University

Center for Statistical Science

Helga Marques, MS

Brown University

Center for Statistical Science

Robert Nishikawa, PhD

University of Chicago

Department of Radiology

  • Martin Yaffe, PhD

  • Sunnybrook Health Sciences Center

  • Depts of Medical Physics and Medical Imaging


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Background Digital Mammography

  • The Digital Mammographic Imaging Screening Trial (DMIST) was conducted between 2001-2003. Study was comparison of two technologies screen-film and digital mammography.

  • Sensitivity for film-screen and digital mammography in DMIST was 0.41.

  • While CAD for mammography was available for screen-film mammography during this time it was not available for digital mammography and so CAD was not allowed in DMIST.


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Study Purpose Digital Mammography

  • Would CAD have made a difference in the performance of radiologists during DMIST for digital mammography had it been available?


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Study Aim Digital Mammography

  • To assess the performance of Radiologists in interpreting digital mammograms without and then with CAD for digital mammograms from DMIST.


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Methods & Materials Digital Mammography

  • CAD Systems Tested

    • R2 ImageChecker Cenova v1.0 (Hologic)

    • iCAD SecondLook v1.4 (iCAD)

  • Cases

    • Digital mammograms (“for processing” and “for presentation” states) acquired from digital mammography systems used in DMIST. 300 cases for each machine type: 150 cancers, 150 non-cancers.

      • R2 (Hologic – Selenia, GE 2000D, Fischer SenoScan, Fuji CR)

      • iCAD (Hologic-Selenia, GE 2000D, Fuji CR)


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Methods & Materials Digital Mammography

  • Readers

    • 15 Radiologists Readers with clinical R2 CAD experience in the R2 study.

    • 14 Radiologists Readers with clinical iCAD CAD experience in the iCAD study.

  • Image Preparation

    • DICOM headers for Fuji and Fischer cases were brought to current standards to allow for CAD processing using custom software.


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Methods & Materials Digital Mammography

  • The experiment

    • All reading sessions took place at UNC. Two dedicated CAD reading rooms were set up – one for the R2 readings, one for the iCAD.

    • Only one reader per CAD system at a time. Each reader session took about two days to complete.

    • Each reader first reviewed the case without CAD marks and provided BIRADS score for each breast.

    • The reader then applied CAD to the images by toggle button on mammography review workstation displaying the CAD structured report.

    • Reader then reviewed case with CAD marks and provided BIRADS score again for each breast.


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Case Characteristics Digital Mammography


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Case Characteristics Digital Mammography


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Case Characteristics Digital Mammography


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Case Characteristics Digital Mammography


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iCAD Results Digital Mammography


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Results R2 Digital Mammography


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iCAD Digital Mammography Impact on Reader Accuracy


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Impact of R2 on Reader Accuracy Digital Mammography


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Conclusions Digital Mammography

  • It is likely that CAD would not have improved radiologist performance (sensitivity, specificity, AUC) had it been available for the DMIST study

  • Radiologists are seldom if ever influenced by CAD marks in making their diagnostic decisions


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Acknowledgments Digital Mammography

  • CAD equipment provided by Hologic and iCAD

  • Softcopy review workstations provided by Hologic and Sectra


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