title: Applying a decision support system in clinical practice: results from melanoma diagnosis.
abstract: The work reported in this paper investigates the use of a decision-support tool for the diagnosis of pigmented skin lesions in a real-world clinical trial with 511 patients and 3827 lesion evaluations. We analyzed a number of outcomes of the trial, such as direct comparison of system performance in laboratory and clinical setting, the performance of physicians using the system compared to a control dermatologist without the system, and repeatability of system recommendations. The results show that system performance was significantly less in the real-world setting compared to the laboratory setting (c-index of 0.87 vs. 0.94, p = 0.01). Dermatologists using the system achieved a combined sensitivity of 85% and combined specificity of 95%. We also show that the process of acquiring lesion images using digital dermoscopy devices needs to be standardized before sufficiently high repeatability of measurements can be assured.
authors.affiliation: Upper Austria University of Applied Sciences, Hagenberg, Austria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Dreiseitl
authors.forename: Michael
authors.initials: M
authors.lastname: Binder
authors.forename: Staal
authors.initials: S
authors.lastname: Vinterbo
authors.forename: Harald
authors.initials: H
authors.lastname: Kittler
mesh_terms: D020000:Decision Support Systems, Clinical; D046169:Dermoscopy / Q000379:methods*; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D008545:Melanoma / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis*