title: Computer Vision Tool and Technician as First Reader of Lung Cancer Screening CT Scans.
abstract: To implement a cost-effective low-dose computed tomography (LDCT) lung cancer screening program at the population level, accurate and efficient interpretation of a large volume of LDCT scans is needed. The objective of this study was to evaluate a workflow strategy to identify abnormal LDCT scans in which a technician assisted by computer vision (CV) software acts as a first reader with the aim to improve speed, consistency, and quality of scan interpretation.
  
  
  
  Without knowledge of the diagnosis, a technician reviewed 828 randomly batched scans (136 with lung cancers, 556 with benign nodules, and 136 without nodules) from the baseline Pan-Canadian Early Detection of Lung Cancer Study that had been annotated by the CV software CIRRUS Lung Screening (Diagnostic Image Analysis Group, Nijmegen, The Netherlands). The scans were classified as either normal (no nodules ≥1 mm or benign nodules) or abnormal (nodules or other abnormality). The results were compared with the diagnostic interpretation by Pan-Canadian Early Detection of Lung Cancer Study radiologists.
  
  
  
  The overall sensitivity and specificity of the technician in identifying an abnormal scan were 97.8% (95% confidence interval: 96.4-98.8) and 98.0% (95% confidence interval: 89.5-99.7), respectively. Of the 112 prevalent nodules that were found to be malignant in follow-up, 92.9% were correctly identified by the technician plus CV compared with 84.8% by the study radiologists. The average time taken by the technician to review a scan after CV processing was 208 ± 120 seconds.
  
  
  
  Prescreening CV software and a technician as first reader is a promising strategy for improving the consistency and quality of screening interpretation of LDCT scans.
authors.affiliation: Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, Canada; Royal Brisbane Hospital, Brisbane, Australia.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Ritchie
authors.affiliation: Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, Canada.
authors.forename: Calvin
authors.initials: C
authors.lastname: Sanghera
authors.affiliation: Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Colin
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, Canada; Peking University First Hospital, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Vancouver Coastal Health, Vancouver, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Mayo
authors.affiliation: Department of Radiology, University Health Network-Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Heidi
authors.initials: H
authors.lastname: Schmidt
authors.affiliation: Department of Radiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Gingras
authors.affiliation: Department of Radiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada.
authors.forename: Sergio
authors.initials: S
authors.lastname: Pasian
authors.affiliation: Department of Radiology, Juravinski Hospital and Cancer Center, Hamilton, Ontario, Canada.
authors.forename: Lori
authors.initials: L
authors.lastname: Stewart
authors.affiliation: Department of Radiology, Juravinski Hospital and Cancer Center, Hamilton, Ontario, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Department of Radiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Daria
authors.initials: D
authors.lastname: Manos
authors.affiliation: Department of Radiology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Seely
authors.affiliation: Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Burrowes
authors.affiliation: Department of Radiology, Memorial University, Newfoundland, Canada.
authors.forename: Rick
authors.initials: R
authors.lastname: Bhatia
authors.affiliation: Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, Canada.
authors.forename: Sukhinder
authors.initials: S
authors.lastname: Atkar-Khattra
authors.affiliation: Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Bram
authors.initials: B
authors.lastname: van Ginneken
authors.affiliation: Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Tammemagi
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada; Department of Pathology, University Health Network-Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Ming Sound
authors.initials: MS
authors.lastname: Tsao
authors.affiliation: Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, Canada. Electronic address: slam@bccancer.bc.ca.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lam
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D002170:Canada; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Early detection; Lung cancer; Screening