While mammography computer-aided detection (CAD) software has been proliferating in the U.S., double reading is thought to be in decline. Even so, many radiologists still believe that double reading yields a higher cancer detection rate than CAD, according to a study in the October issue of Academic Radiology.
In a survey involving 257 community radiologists, a research team led by Tracy Onega, PhD, of Dartmouth Hitchcock Medical Center in Lebanon, NH, found that nearly three out of four respondents believed that double reading improved cancer detection rates, while only slightly more than half thought CAD did. However, only half of respondents believed that double reading decreased recall rates; nearly two-thirds perceived that benefit from CAD.
"This study suggests that radiologists have a more positive view of obtaining help from a colleague versus a computer algorithm, but that computer-based input may have more efficiencies and cost advantages," Onega told AuntMinnie.com.
The multi-institutional research team set out to explore the perceived effects of CAD's diffusion into clinical practice to try and understand how radiologists viewed the use of computer-aided interpretation in relation to its pros and cons, Onega said. A 10-page survey was mailed in 2006 and 2007 to 364 community radiologists who had participated in the U.S. Breast Cancer Surveillance Consortium from January 2005 to December 2006 (Acad Radiol, October 2010, Vol. 17:10, pp. 1217-1226).
The survey, which achieved a 71% response rate, aimed to gather radiologists' demographic and clinical practice information, as well as their perceptions of screening and diagnostic mammograms interpreted with CAD and double reading. The researchers then analyzed the data to classify overall perceptions toward CAD and double reading based on responses to statements about the two techniques.
Of the respondents, 74% believed that double reading improved cancer detection rates, while only 55% thought CAD did. Only 50% of respondents, though, believed that double reading decreased recall rates, compared with 65% who perceived that CAD led to lower recall rates.
Compared to radiologists who had the most unfavorable perceptions of the technology, those radiologists with the most favorable perceptions of CAD were more likely to believe that CAD improved cancer detection rates without taking too much time, according to the researchers.
Sixty-four percent of radiologists said they used CAD for more than half of the screening mammograms they interpret, while less than 5% utilized double reading that much, the group found.
Factors that led to an overall favorable perception of CAD included:
- Use of CAD (81%)
- A higher percentage of workload in screening mammography (80%)
- Academic affiliation (71%)
- Fellowship training (58%)
A surprising finding was that radiologists with primary affiliations with academic medical centers (AMCs) were significantly less likely (17%) to have the most favorable perceptions about CAD, Onega said. They were also significantly more likely to have the most favorable perceptions toward double reading (98%).
In comparison, 36% of radiologists without a primary affiliation with an AMC and 70% of those with an adjunct appointment had a favorable perception of CAD. Also, 59% of radiologists without a primary affiliation with an AMC and 69% of those with an adjunct appointment had the most favorable perceptions toward double reading.
"In the U.S., CAD has diffused rapidly, apparently without formal assessment of radiologists' perceptions, at the same time that double reading has declined," Onega said. "Ultimately, perceptions of these two interpretive practices may influence how they are used, more than whether they are used."
By Erik L. Ridley
AuntMinnie.com staff writer
September 23, 2010
Related Reading
Breast CAD helps find lobular carcinoma in situ lesions, August 20, 2010
Double readers top CAD in finding breast tissue deformities, July 26, 2010
U.K. study finds mammo CAD can save money, November 9, 2009
Why are correct CAD marks ignored? It's anybody's guess, November 9, 2009
CAD finds breast cancers missed at CR mammography, July 31, 2009
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