title: In the digital era, architectural distortion remains a challenging radiological task.
abstract: OBJECTIVE
  To compare readers' performance in detecting architectural distortion (AD) compared with other breast cancer types using digital mammography.
  
  
  METHODS
  Forty-one experienced breast screen readers (20 US and 21 Australian) were asked to read a single test set of 30 digitally acquired mammographic cases. Twenty cases had abnormal findings (10 with AD, 10 non-AD) and 10 cases were normal. Each reader was asked to locate and rate any abnormalities. Lesion and case-based performance was assessed. For each collection of readers (US; Australian; combined), jackknife free-response receiver operating characteristic (JAFROC), figure of merit (FOM), and inferred receiver operating characteristic (ROC), area under curve (Az) were calculated using JAFROC v.4.1 software. Readers' sensitivity, location sensitivity, JAFROC, FOM, ROC, Az scores were compared between cases groups using Wilcoxon's signed ranked test statistics.
  
  
  RESULTS
  For lesion-based analysis, significantly lower location sensitivity (p=0.001) was shown on AD cases compared with non-AD cases for all reader collections. The case-based analysis demonstrated significantly lower ROC Az values (p=0.02) for the first collection of readers, and lower sensitivity for the second collection of readers (p=0.04) and all-readers collection (p=0.008), for AD compared with non-AD cases.
  
  
  CONCLUSIONS
  The current work demonstrates that AD remains a challenging task for readers, even in the digital era.
authors.affiliation: Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Research Institute, The Faculty of Health Sciences, The University of Sydney, Australia. Electronic address: wsul5363@uni.sydney.edu.au.
authors.forename: W I
authors.initials: WI
authors.lastname: Suleiman
authors.affiliation: Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Research Institute, The Faculty of Health Sciences, The University of Sydney, Australia.
authors.forename: M F
authors.initials: MF
authors.lastname: McEntee
authors.affiliation: Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Research Institute, The Faculty of Health Sciences, The University of Sydney, Australia.
authors.forename: S J
authors.initials: SJ
authors.lastname: Lewis
authors.affiliation: Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Research Institute, The Faculty of Health Sciences, The University of Sydney, Australia; Faculty of Applied Medical Sciences, Jordan University of Science and Technology, P.O.Box 3030, Irbid 22110, Jordan.
authors.forename: M A
authors.initials: MA
authors.lastname: Rawashdeh
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, RA 020, Boston, MA 02115, USA.
authors.forename: D
authors.initials: D
authors.lastname: Georgian-Smith
authors.affiliation: Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Research Institute, The Faculty of Health Sciences, The University of Sydney, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Heard
authors.affiliation: Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Research Institute, The Faculty of Health Sciences, The University of Sydney, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Tapia
authors.affiliation: Medical Image Optimisation and Perception Group (MIOPeG), and the Brain and Mind Research Institute, The Faculty of Health Sciences, The University of Sydney, Australia.
authors.forename: P C
authors.initials: PC
authors.lastname: Brennan
mesh_terms: D000368:Aged; D001315:Australia; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity; D014481:United States