title: Improved classifications of planar whole-body bone scans using a computer-assisted diagnosis system: a multicenter, multiple-reader, multiple-case study.
abstract: The aim of this multicenter study was to investigate whether a computer-assisted diagnosis (CAD) system could improve performance and reduce interobserver variation in bone-scan interpretations of the presence or absence of bone metastases.
  
  
  METHODS
  The whole-body bone scans (anterior and posterior views) of 59 patients with breast or prostate cancer who had undergone scintigraphy for suspected bone metastatic disease were studied. The patients were selected to reflect the spectrum of pathology found in everyday clinical work. Thirty-five physicians working at 18 of the 30 nuclear medicine departments in Sweden agreed to participate. The physicians were asked to classify each case for the presence or absence of bone metastasis, without (baseline) and with the aid of the CAD system (1 y later), using a 4-point scale. The final clinical assessments, based on follow-up scans and other clinical data including the results of laboratory tests and available diagnostic images (such as MRI, CT, and radiographs from a mean follow-up period of 4.8 y), were used as the gold standard. Each physician's classification was pairwise compared with the classifications made by all the other physicians, resulting in 595 pairs of comparisons, both at baseline and after using the CAD system.
  
  
  RESULTS
  The physicians increased their sensitivity from 78% without to 88% with the aid of the CAD system (P < 0.001). The specificity did not change significantly with CAD. Percentage agreement and kappa-values between paired physicians on average increased from 64% to 70% and from 0.48 to 0.55, respectively, with the CAD system.
  
  
  CONCLUSIONS
  A CAD system improved physicians' sensitivity in detecting metastases and reduced interobserver variation in planar whole-body bone scans. The CAD system appears to have significant potential in assisting physicians in their clinical routine.
authors.affiliation: Department of Molecular and Clinical Medicine, Clinical Physiology, Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. may.sadik@vgregion.se
authors.forename: May
authors.initials: M
authors.lastname: Sadik
authors.forename: Madis
authors.initials: M
authors.lastname: Suurkula
authors.forename: Peter
authors.initials: P
authors.lastname: Höglund
authors.forename: Andreas
authors.initials: A
authors.lastname: Järund
authors.forename: Lars
authors.initials: L
authors.lastname: Edenbrandt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology*; D003936:Diagnosis, Computer-Assisted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011471:Prostatic Neoplasms / Q000473:pathology*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate