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Determining Thresholds for Computer-Aided Detection for Silicosis-An Analytic Approach.

Stephen Barker1, Annalee Yassi1, Jerry Spiegel1

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Summary

Choosing the right threshold for computer-aided detection (CAD) of silicosis is crucial. This study presents an analytic approach to selecting CAD thresholds, considering disease prevalence and definitions for accurate silicosis screening.

Keywords:
South Africachest X‐rayscomputer aided detectionminerssilicosisthresholdstuberculosis

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Area of Science:

  • Medical Imaging
  • Occupational Health
  • Pulmonary Medicine

Background:

  • Computer-aided detection (CAD) is increasingly used for pulmonary tuberculosis (TB) screening via chest X-ray (CXR).
  • CAD for silicosis, a significant TB risk factor, is less developed and requires expert validation.
  • Selecting appropriate thresholds for CAD classification is critical for disease detection accuracy.

Purpose of the Study:

  • To present an analytic approach for selecting thresholds in computer-aided detection (CAD) systems for silicosis.
  • To explore the impact of different criteria, definitions, and reader variability on threshold selection.
  • To introduce a novel two-threshold technique for improved classification of uncertain cases.

Main Methods:

  • Compared Youden Index and minimum 90% sensitivity criteria using receiver operating curve data from a published study.
  • Analyzed the influence of silicosis definition, expert reader, and disease prevalence on threshold choice and interpretation.
  • Developed a novel method using two CAD thresholds to differentiate positive, negative, and uncertain cases.

Main Results:

  • Thresholds varied significantly based on the chosen criterion, silicosis definition, and expert reader.
  • Disease prevalence substantially impacted positive predictive value (PPV) and false positive rates.
  • The study outlines implications for screening active miners, former miners, and compensation claims.

Conclusions:

  • Users must define the use case, sensitivity/specificity preferences, and silicosis definition when applying CAD.
  • System developers should account for and transparently report inter-reader variability in validation.
  • A two-threshold model offers potential benefits for high-volume screening with high referral costs.