title: Interpretation time of computer-aided detection at screening mammography.
abstract: OBJECTIVE
  To prospectively determine the interpretation time associated with computer-aided detection (CAD) and to analyze how CAD affected radiologists' decisions and their level of confidence in their interpretations of digital screening mammograms.
  
  
  METHODS
  An Institutional Review Board exemption was obtained, and patient consent was waived in this HIPAA compliant study. The participating radiologists gave informed consent. Five radiologists were prospectively studied as they interpreted 267 clinical digital screening mammograms. Interpretation times, recall decisions, and confidence levels were recorded without CAD and then with CAD. Software was used for linear regression fitting of interpretation times. P values less than .05 were considered to indicate statistically significant differences.
  
  
  RESULTS
  Mean interpretation time without CAD was 118 seconds ± 4.2 (standard error of the mean). Mean time for reviewing CAD images was 23 seconds ± 1.5. CAD identified additional findings in five cases, increased confidence in 38 cases, and decreased confidence in 21 cases. Interpretation time without CAD increased with the number of mammographic views (P < .0001). Mean times for interpretation without CAD and review of the CAD images both increased with the number of CAD marks (P < .0001). The interpreting radiologist was a significant variable for all interpretation times (P < .0001). Interpretation time with CAD increased by 3.2 seconds (95% confidence interval: 1.8, 4.6) for each calcification cluster marked and by 7.3 seconds (95% confidence interval: 4.7, 9.9) for each mass marked.
  
  
  CONCLUSIONS
  The additional time required to review CAD images represented a 19% increase in the mean interpretation time without CAD. CAD requires a considerable time investment for digital screening mammography but may provide less measureable benefits in terms of confidence of the radiologists.
authors.affiliation: Department of Imaging Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. pmtchou@gmail.com
authors.forename: Philip M
authors.initials: PM
authors.lastname: Tchou
authors.forename: Tamara Miner
authors.initials: TM
authors.lastname: Haygood
authors.forename: E Neely
authors.initials: EN
authors.lastname: Atkinson
authors.forename: Tanya W
authors.initials: TW
authors.lastname: Stephens
authors.forename: Paul L
authors.initials: PL
authors.lastname: Davis
authors.forename: Elsa M
authors.initials: EM
authors.lastname: Arribas
authors.forename: William R
authors.initials: WR
authors.lastname: Geiser
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Whitman
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D006801:Humans; D016014:Linear Models; D008327:Mammography; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D011873:Radiology Information Systems; D012984:Software; D013997:Time Factors