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Published on: August 30, 2013
Enhancing Radiologist Reading Performance by Ordering Screening Mammograms Based on Characteristics That Promote
Jessie J J Gommers1, Sarah D Verboom1, Katya M Duvivier1
1From the Departments of Medical Imaging (J.J.J.G., S.D.V., I.S.) and IQ Health (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (K.M.D.); Department of Radiology and Nuclear Medicine, Haga Teaching Hospital, Den Haag, the Netherlands (J.K.v.R.); Department of Radiology, Gelre Hospitals, Apeldoorn, the Netherlands (A.F.v.R.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (J.B.H.); Department of Radiology, Diakonessenhuis, Utrecht, the Netherlands (D.B.N.); Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.); Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Psychology, University of Nevada, Reno, Nev (M.A.W.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., I.S.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.).
Abstract:
Background Mammographic background characteristics may stimulate human visual adaptation, allowing radiologists to detect abnormalities more effectively. However, it is unclear whether density, or another image characteristic, drives visual adaptation. Purpose To investigate whether screening performance improves when screening mammography examinations are ordered for batch reading according to mammographic characteristics that may promote visual adaptation. Materials and Methods This retrospective multireader multicase study was performed with mammograms obtained between September 2016 and May 2019. The screening examinations, each consisting of four mammograms, were interpreted by 13 radiologists in three distinct orders: randomly, by increasing volumetric breast density (VBD), and based on a self-supervised learning (SSL) encoding (examinations automatically grouped as "looking similar"). An eye tracker recorded radiologists' eye movements during interpretation. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of random-ordered readings were compared with those of VBD- and SSL-ordered readings using mixed-model analysis of variance. Reading time, fixation metrics, and perceived density were compared using Wilcoxon signed-rank tests. Results Mammography examinations (75 with breast cancer, 75 without breast cancer) from 150 women (median age, 55 years [IQR, 50-63]) were read. The examinations ordered by increasing VBD versus randomly had an increased AUC (0.93 [95% CI: 0.91, 0.96] vs 0.92 [95% CI: 0.89, 0.95]; P = .009), without evidence of a difference in specificity (89% [871 of 975] vs 86% [837 of 975], P = .04) and sensitivity (both 81% [794 of 975 vs 788 of 975], P = .78), and a reduced reading time (24.3 vs 27.9 seconds, P < .001), fixation count (47 vs 52, P < .001), and fixation time in malignant regions (3.7 vs 4.6 seconds, P < .001). For SSL-ordered readings, there was no evidence of differences in AUC (0.92 [95% CI: 0.89, 0.95]; P = .70), specificity (84% [820 of 975], P = .37), sensitivity (80% [784 of 975], P = .79), fixation count (54, P = .05), or fixation time in malignant regions (4.6 seconds, P > .99) compared with random-ordered readings. Reading times were significantly higher for SSL-ordered readings compared with random-ordered readings (28.4 seconds, P = .02). Conclusion Screening mammography examinations ordered from low to high VBD improved screening performance while reducing reading and fixation times. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grimm in this issue.
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