title: Exploring the potential of context-sensitive CADe in screening mammography.
abstract: OBJECTIVE
  Conventional computer-assisted detection (CADe) systems in screening mammography provide the same decision support to all users. The aim of this study was to investigate the potential of a context-sensitive CADe system which provides decision support guided by each user's focus of attention during visual search and reporting patterns for a specific case.
  
  
  METHODS
  An observer study for the detection of malignant masses in screening mammograms was conducted in which six radiologists evaluated 20 mammograms while wearing an eye-tracking device. Eye-position data and diagnostic decisions were collected for each radiologist and case they reviewed. These cases were subsequently analyzed with an in-house knowledge-based CADe system using two different modes: Conventional mode with a globally fixed decision threshold and context-sensitive mode with a location-variable decision threshold based on the radiologists' eye dwelling data and reporting information.
  
  
  RESULTS
  The CADe system operating in conventional mode had 85.7% per-image malignant mass sensitivity at 3.15 false positives per image (FPsI). The same system operating in context-sensitive mode provided personalized decision support at 85.7%-100% sensitivity and 0.35-0.40 FPsI to all six radiologists. Furthermore, context-sensitive CADe system could improve the radiologists' sensitivity and reduce their performance gap more effectively than conventional CADe.
  
  
  CONCLUSIONS
  Context-sensitive CADe support shows promise in delineating and reducing the radiologists' perceptual and cognitive errors in the diagnostic interpretation of screening mammograms more effectively than conventional CADe.
authors.affiliation: Department of Radiology, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina 27705, USA. georgia.tourassi@duke.edu
authors.forename: Georgia D
authors.initials: GD
authors.lastname: Tourassi
authors.forename: Maciej A
authors.initials: MA
authors.lastname: Mazurowski
authors.forename: Brian P
authors.initials: BP
authors.lastname: Harrawood
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Krupinski
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D003071:Cognition; D003657:Decision Making; D003661:Decision Support Techniques; D003936:Diagnosis, Computer-Assisted; D003951:Diagnostic Errors / Q000517:prevention & control; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D015588:Observer Variation; D010465:Perception; D011871:Radiology / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity