title: Computer-aided detection of masses at mammography: interactive decision support versus prompts.
abstract: OBJECTIVE
  To compare effectiveness of an interactive computer-aided detection (CAD) system, in which CAD marks and their associated suspiciousness scores remain hidden unless their location is queried by the reader, with the effect of traditional CAD prompts used in current clinical practice for the detection of malignant masses on full-field digital mammograms.
  
  
  METHODS
  The requirement for institutional review board approval was waived for this retrospective observer study. Nine certified screening radiologists and three residents who were trained in breast imaging read 200 studies (63 studies containing at least one screen-detected mass, 17 false-negative studies, 20 false-positive studies, and 100 normal studies) twice, once with CAD prompts and once with interactive CAD. Localized findings were reported and scored by the readers. In the prompted mode, findings were recorded before and after activation of CAD. The partial area under the location receiver operating characteristic (ROC) curve for an interval of low false-positive fractions typical for screening, from 0 to 0.2, was computed for each reader and each mode. Differences in reader performance were analyzed by using software.
  
  
  RESULTS
  The average partial area under the location ROC curve with unaided reading was 0.57, and it increased to 0.62 with interactive CAD, while it remained unaffected by prompts. The difference in reader performance for unaided reading versus interactive CAD was statistically significant (P = .009).
  
  
  CONCLUSIONS
  When used as decision support, interactive use of CAD for malignant masses on mammograms may be more effective than the current use of CAD, which is aimed at the prevention of perceptual oversights.
authors.affiliation: Department of Radiology, Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Zuid 10, Route 667, Postbus 9101, 6500 HB Nijmegen, The Netherlands. a.hupse@rad.umcn.nl
authors.forename: Rianne
authors.initials: R
authors.lastname: Hupse
authors.forename: Maurice
authors.initials: M
authors.lastname: Samulski
authors.forename: Marc B
authors.initials: MB
authors.lastname: Lobbes
authors.forename: Ritse M
authors.initials: RM
authors.lastname: Mann
authors.forename: Roel
authors.initials: R
authors.lastname: Mus
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: den Heeten
authors.forename: David
authors.initials: D
authors.lastname: Beijerinck
authors.forename: Ruud M
authors.initials: RM
authors.lastname: Pijnappel
authors.forename: Carla
authors.initials: C
authors.lastname: Boetes
authors.forename: Nico
authors.initials: N
authors.lastname: Karssemeijer
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014584:User-Computer Interface