title: CT colonography: investigation of the optimum reader paradigm by using computer-aided detection software.
abstract: OBJECTIVE
  To prospectively compare the diagnostic performance and time efficiency of both second and concurrent computer-aided detection (CAD) reading paradigms for retrospectively obtained computed tomographic (CT) colonography data sets by using consensus reading (three radiologists) of colonoscopic findings as a reference standard.
  
  
  METHODS
  Ethical permission, HIPAA compliance (for U.S. institutions), and patient consent were obtained from all institutions for use of CT colonography data sets in this study. Ten radiologists each read 25 CT colonography data sets (12 men, 13 women; mean age, 61 years) containing 69 polyps (28 were 1-5 mm, 41 were >or=6 mm) by using workstations integrated with CAD software. Reading was randomized to either "second read" CAD (applied only after initial unassisted assessment) or "concurrent read" CAD (applied at the start of assessment). Data sets were reread 6 weeks later by using the opposing paradigm. Polyp sensitivity and reading times were compared by using multilevel logistic and linear regression, respectively. Receiver operating characteristic (ROC) curves were generated.
  
  
  RESULTS
  Compared with the unassisted read, odds of improved polyp (>or=6 mm) detection were 1.5 (95% confidence interval [CI]: 1.0, 2.2) and 1.3 (95% CI: 0.9, 1.9) by using CAD as second and concurrent reader, respectively. Detection odds by using CAD concurrently were 0.87 (95% CI: 0.59, 1.3) and 0.76 (95% CI: 0.57, 1.01) those of second read CAD, excluding and including polyps 1-5 mm, respectively. The concurrent read took 2.9 minutes (95% CI: -3.8, -1.9) less than did second read. The mean areas under the ROC curve (95% CI) for the unassisted read, second read CAD, and concurrent read CAD were 0.83 (95% CI: 0.78, 0.87), 0.86 (95% CI: 0.82, 0.90), and 0.88 (95% CI: 0.83, 0.92), respectively.
  
  
  CONCLUSIONS
  CAD is more time efficient when used concurrently than when used as a second reader, with similar sensitivity for polyps 6 mm or larger. However, use of second read CAD maximizes sensitivity, particularly for smaller lesions.
authors: Department of Specialist X-Ray, University College Hospital, 235 Euston Rd, 2F Podium, London NW1 2BU, England. csytaylor@yahoo.co.uk
authors: Stuart A
authors: SA
authors: Taylor
authors: Susan C
authors: SC
authors: Charman
authors: Philippe
authors: P
authors: Lefere
authors: Elizabeth G
authors: EG
authors: McFarland
authors: Erik K
authors: EK
authors: Paulson
authors: Judy
authors: J
authors: Yee
authors: Rizwan
authors: R
authors: Aslam
authors: John M
authors: JM
authors: Barlow
authors: Arun
authors: A
authors: Gupta
authors: David H
authors: DH
authors: Kim
authors: Chad M
authors: CM
authors: Miller
authors: Steve
authors: S
authors: Halligan
mesh_terms: D000465:Algorithms; D001185:Artificial Intelligence; D003111:Colonic Polyps / Q000000981:diagnostic imaging*; D023881:Colonography, Computed Tomographic / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software