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Results for “Double reading”

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PubMed1996

Effect of human variability on independent double reading in screening mammography.

RATIONALE AND OBJECTIVES: To demonstrate the range of gains and losses that radiologists might experience from independent double reading in screening mammography. METHODS: From a national random sample of radiologists, the authors formed 131 pairs. For each radiologist, the authors analyzed the increase relative to his or her individual true-positive rate (TPR) or false-positive rate (FPR), number of additional cancers detected, and change to negative biopsy rate that would result from independent double reading after pairing. RESULTS: The average radiologist can expect an 8%-14% gain in TPR and a 4%-10% increase in FPR with pairing. For some radiologists, double reading increased the TPR with a small concomitant increase in FPR. Other radiologists, however, realized small gains in TPR with large increases in FPR. Adding the reading from a more experienced radiologist did not necessarily improve the TPR of a radiologist with less experience. CONCLUSION: Radiologists can form complementary and noncomplementary pairs for double reading. Use of this procedure must be decided on an individual basis.

Breast Neoplasms↗

PubMed1994

Benefit of independent double reading in a population-based mammography screening program.

PURPOSE: To evaluate independent double reading in mammography screening and, specifically, the effect on breast cancer detection. MATERIALS AND METHODS: Mammographic studies of 11,343 women, aged 41-75 years, who participated in a population-based screening program were independently screened by two experienced radiologists. A retrospective analysis also was performed from notations made for patient recalls. RESULTS: Including follow-up of recalled women, 131 surgical biopsies were performed, which resulted in 76 histologically proved breast cancers. Fifty-six cancerous lesions were detected by both screeners. One screener detected 14 cancerous lesions alone, and the other detected six alone. Of the cancerous lesions detected by only one screener, 85% were stage 0 or 1, compared with 59% of those detected by both screeners. Double reading detected 15% (95% confidence interval, +/- 7%) more cancer cases with an almost unchanged positive predictive value of 0.6. CONCLUSION: Independent double reading does significantly increase sensitivity of mammography screening.

Adult↗

PubMed1998

Methodological issues in mammography double reading studies.

OBJECTIVES: An examination of the methods used in assessing cancer detection rates in double reading studies to obtain a clear interpretation of the disparate results from differing studies. SETTING: National breast screening programmes. METHODS: Critical appraisal of methodologies used in the comparison of cancer detection rates with single or double reading. RESULTS: The reported improvement in cancer detection rate with double reading varies greatly between studies, depending upon whether the study is blinded and the statistic used. A method of calculating the increase in cancer detection rate due to a second reader is proposed.

Breast Neoplasms↗

PubMed2004

Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT.

The purpose of this study was to assess the effectiveness of double reading to increase the sensitivity of lung nodule detection at standard-dose (SDCT) and low-dose multirow-detector CT (LDCT). SDCT (100 mAs effective tube current) and LDCT (20 mAs) of nine patients with pulmonary metastases were obtained within 5 min using four-row detector CT. Softcopy images reconstructed with 5-mm slice thickness were read by three radiologists independently. Images with 1.25-mm slice thickness served as the gold standard. Sensitivity was assessed for single readers and combinations. The effectiveness of double reading was expressed as the increase of sensitivity. Average sensitivity for detection of 390 nodules (size 3.9+/-3.2 mm) for single readers was 0.63 (SDCT) and 0.64 (LDCT). Double reading significantly increased sensitivity to 0.74 and 0.79, respectively. No significant difference between sensitivity at SDCT and LDCT was observed. The percentage of nodules detected by all three readers concordantly was 52% for SDCT and 47% for LDCT. Although double reading increased the detection rate of pulmonary nodules from 63% to 74-79%, a considerable proportion of nodules remained undetected. No difference between sensitivities at LDCT and SDCT for detection of small nodules was observed.

Adult↗

PubMed2003

Computer-aided detection versus independent double reading of masses on mammograms.

PURPOSE: To evaluate the use of a computer-aided detection (CAD) system (designed for mammographic mass detection) to help improve mass interpretation and to compare CAD results with independent double-reading results. MATERIALS AND METHODS: Screening mammograms from 500 cases were collected; 125 of these cases were screening-detected cancers, and 125 were interval cancers. Previously obtained screening mammograms (ie, prior mammograms) were available in all cases. All mammograms were analyzed by a CAD system, which detected mass regions and assigned a level of (cancer) suspicion to each mass. Ten experienced screening radiologists read the prior mammograms. For independent interpretation with CAD, the suspicion rating assigned to each finding by the radiologist was weighted with the CAD output at the area of the finding. CAD markers on areas that were not reported by the radiologist were not used. Independent double reading was implemented by using a rule to combine the levels of suspicion assigned to findings by two radiologists. Results were evaluated by using localized-response receiver operating characteristic analysis. RESULTS: In a total of 141 cases, there was a visible abnormality at the location of the cancer on the prior mammogram, and 115 of these were classified as mass cases. For prior mammograms that depicted masses, the mean sensitivity of the radiologists, as averaged among the false-positive rates lower than 10%, was 39.4%; this increased by 7.0% with CAD and by 10.5% with double reading. Differences among single, double, and CAD readings were statistically significant (P <.001). CONCLUSION: Although independent double reading yields the best detection performance, the presence and probability of CAD mass markers can improve mammogram interpretation.

Aged↗

PubMed2004

Can computer-aided detection with double reading of screening mammograms help decrease the false-negative rate? Initial experience.

PURPOSE: To retrospectively evaluate the role of computer-aided detection (CAD) in reducing the rate of false-negative (FN) findings on screening mammograms considered normal at initial double reading. MATERIALS AND METHODS: At the authors' institution, independent prospective double readings in which the second reader is not blinded to results of the first reading are performed routinely for all mammograms. When cancer is diagnosed, prior mammograms also are reviewed with double reading to determine cancer visibility. Findings are categorized as (a) no evidence of cancer on any prior screening mammogram and patient presents more than 1 year after prior screening, (b) no evidence of cancer on any prior screening mammogram and patient presents with symptoms within 1 year after prior screening (year-interval occult false-negative), or (c) cancer visible. The clinical director separately evaluates each case in the same way. In 2000, 519 histologically proved breast cancers were diagnosed, including 132 for which patients sought a second opinion and FN findings were not tracked. Prior screening mammograms were available in 318 of the other 387 cases. Five radiologists in two reading sessions independently reviewed current and prior mammograms to categorize visible cancers as either threshold or actionable FN findings. Visible cancers deemed actionable by at least three of five readers were analyzed with a commercially available CAD system. FN rates were calculated prior to and after CAD analysis. RESULTS: Twenty-seven occult and 71 visible cancers were found (total FN findings, 98). Three of five readers considered 52 (73%) of 71 visible cancers actionable. The CAD system correctly marked 37 (71%) of these 52 on prior screening mammograms (19 [65%] of 29 masses, seven [88%] of eight microcalcifications, seven [78%] of nine architectural distortions, and four [67%] of six masses with microcalcifications). The FN rate was 98 (31%) of 318 before CAD and 61 (19%) of 318 after CAD. CONCLUSION: In this retrospective review of this small subset of cancers, it appears that CAD has the potential to decrease the FN rate at double reading by more than one-third (from 31% to 19%). The CAD system correctly marked 37 (71%) of 52 actionable findings read as negative in previous screening years.

Adult↗

PubMed2003

Double reading of barium enemas: is it necessary?

OBJECTIVE: The purpose of our study was to determine the effectiveness, clinical impact, and feasibility of double reading barium enemas. MATERIALS AND METHODS: Independent double readings of 1,003 consecutive barium enemas (822 double- and 181 single-contrast examinations) were prospectively performed. From this pool of 1,003 examinations, 994 were included in our study. Examinations showing at least one polyp or carcinoma 5 mm or larger were considered to have positive results. For combined readings, results were considered positive if either of the two interpreters reported finding a polyp or carcinoma. A McNemar test was used to compare the first reader's results with the combined results of the first and second readers. Results were retrospectively correlated with endoscopic or surgical results in 360 patients, and agreement between first and combined readings and endoscopic results was determined. RESULTS: Adding a second reader increased the number of positive results on examinations from 249 to 315 (p < 0.0001) and resulted in potential alteration of clinical treatment in 98 patients (9.9%). Sensitivity of the first and combined readings for detection of all lesions was identical, 76.3% (95% CI, 65.4-87.1%). Specificity decreased from 91.0% (95% CI, 87.9-94.3%) for the first reading to 86.4% (95% CI, 82.2-90.0%) for the combined reading. The overall measurement of agreement decreased from a kappa value of 61.8 (95% CI, 51.2-72.4%) for the first reading to 52.9 (95% CI, 42.2-63.6%) for the combined reading. The second reading required an average of 3.3 min. Sensitivity for the detection of adenocarcinomas was 100%. CONCLUSION: Although feasible, double reading of barium enemas does not improve sensitivity for detection of polyps and produces a higher false-positive rate.

Adult↗

PubMed2026

Artificial intelligence-supported double reading in European population breast cancer screening: A systematic review and meta-analysis of prospective programs.

BACKGROUND: Most European population mammography screening programs rely on double reading with arbitration, a model that delivers mortality benefit but is increasingly challenged by radiologist workload, variable specificity, and interval cancers. Artificial intelligence (AI) is being evaluated to support or optimize these established European screening pathways. PURPOSE: To synthesize prospective or program-embedded evaluations of AI conducted within European-style population screening programs and to estimate exploratory program-level absolute risk differences (RDs) per 1000 examinations for cancer detection rate (CDR) and recall. MATERIALS AND METHODS: We performed a prespecified, focused evidence synthesis of three large studies embedded within routine population screening programs operating under European-relevant workflows: MASAI (randomized AI-supported risk triage within a national program), ScreenTrustCAD (prospective paired-reader evaluation with AI as an independent reader in a double-reading framework), and PRAIM (nationwide decision-referral implementation). Outcomes were harmonized as AI-control RDs per 1000 examinations. Random-effects pooling used Hartung-Knapp-Sidik-Jonkman models. For the paired-reader design, sensitivity analyses applied a Kish effective sample-size approach across plausible within-examination correlations (ρ = 0.3-0.8). Positive predictive value (PPV) and workflow/time outcomes were summarized descriptively. RESULTS: Across 597,419 examinations, the pooled CDR RD was +0.9 per 1000 (95% CI -0.0 to +1.8; I2 ≈ 12%), consistent with a modest directional increase with borderline statistical uncertainty. The pooled recall RD was -0.6 per 1000 (95% CI -3.1 to +2.1; I2 ≈ 41-43%), indicating no consistent recall increase across screening programs. Where reported, PPV was higher with AI-supported screening. Efficiency signals included 44.3% fewer total readings in MASAI and shorter reading times for AI-normal examinations in PRAIM; in PRAIM, a program-level safety-net mechanism recovered 204 cancers that would otherwise have been missed. CONCLUSION: In European population screening programs characterized by double reading and arbitration, prospective program-embedded evidence suggests that AI integration may yield a small absolute increase in cancer detection (≈1/1000) without a consistent increase in recall, alongside improved PPV and efficiency signals. These findings suggestAI primarily as a complementary reader within European screening workflows, with implementation requiring explicit quality assurance and monitoring of interval cancers and stage distribution.

Humans↗

PubMed2003

Can the NHS Breast Screening Programme afford not to double read screening mammograms?

AIM: Rapid expansion of the National Health Service (UK) Breast Screening Programme (NHSBSP) to routinely invite women aged 50-70 years will result in many new readers undertaking screen reading. A timely method for assessing performance and preferably one that facilitates a steep learning curve will be required. MATERIALS AND METHODS: This unit screens a population of 88000 women aged 50-64 years and double reads >90% films. A record is kept of proven screen-detected cancers not recalled for assessment by either the first or second reader but correctly recalled following third-reader arbitration. Individual readers' workload and recall rates are obtained by running an annual co-writer report. The results of this 7 year prospective audit are presented. RESULTS: In total 177167 women were screened between 1/4/95 and 31/3/02 resulting in the detection of 1072 cancers. Eighty-seven cancers (8.1%) were detected after arbitration. Individual readers recall to assessment rates and percentage of cases incorrectly returned to routine recall varied. Prompt feedback of missed/misinterpreted cases allowed both experienced and inexperienced readers to modify their recall thresholds for particular mammographic abnormalities. CONCLUSION: It is recommended this audit method is adopted by all units in the NHSBSP and that the Advisory Committee for Breast Cancer Screening review the policy of single versus double reading.

Breast Neoplasms↗

PubMed2004

Double-reading of plain radiographs--no benefit with regard to earliness of diagnosis of cancer recurrence: a randomised follow-up study.

The aim of this study was to estimate the effect of the radiologist's interpretation of plain radiographs on the earliness of diagnosis of cancer recurrences. Data consisted of patients who had undergone primary treatment and were resident in the Tampere University Hospital Area in Finland during 1991-1997. Consecutive patients were randomised in a double-reading arm (an oncologist and a radiologist independently interpreting radiographs), and in a single-reading arm (interpretation by an oncologist only; if necessary, a radiologist's clinical report was obtained following a separate request). The time of diagnosis of recurrence and death were estimated by the cumulative probabilities of actuarial method with the Wilcoxon (Gehan) test. There were 869 eligible participants, mostly breast cancer patients (n = 516). In total, 227 recurrences were diagnosed, and of these 55 on plain radiographs, which is 24.2% of the total number of recurrences. There was no statistically significant difference between the arms in the number of recurrences (P = 0.85) or in the time of detecting the recurrence (P = 0.64). Altogether, 225 (25.9%) died from cancer and 38 (4.4%) from other causes. There was no statistically significant difference (P = 0.34) in survival between the two arms during the follow-up to 5 years. Double-reading of plain radiographs does not offer any extra benefit for the detection of recurrences or for patient's survival compared with single-reading.

Adult↗

PubMed2005

Computer-aided detection (CAD) of cancers detected on double reading by one reader only.

We evaluated the role of computer-aided detection (CAD) in cancers undergoing double reading and detected by one reader only. A series of 33 cancers, originally missed by the first reader and detected by the second reader, and 75 negative controls were processed to assess CAD sensitivity, and was read by the six radiologists who originally missed the cancers with the help of CAD printouts. CAD case-based sensitivity, specificity and positive predictive value were 51.5%, 18.6% and 21.7%, respectively. Average sensitivity of all radiologists in all cancers in the series was 74.7%, being higher for CAD+ (86.2%) than for CAD- (62.5%) cancers (P<0.01). When reading cancer cases that they had originally missed, radiologists had a sensitivity of 75.8%, which was higher for CAD+ (100.0%) than for CAD- (58.3%) cancers. The average recall rate was 14.2%, the majority of recalls (45 out of 64) occurring for lesions marked by CAD. CAD may help in detecting at most half of cancers missed at a single reading but detected by a second reader.

Breast Neoplasms↗

PubMedDate not supplied

Independent double reading system. Application of digital image management database.

The most important role in a radiologist's work is communicating his findings to the attending physician. This is difficult when the radiologic examinations are performed with portable X-ray units because the attending physician wishes to read the images as soon as possible. To resolve this problem, we have developed an independent double reading system. The hardware consists of a magnetic card reader, a display station, a personal computer and a mouse, all linked with the digital image database and a communication network between HIS and RIS. We also present the software of this system and evaluate the results of the implementation to establish the accuracy of the technique. It was concluded that this system could expand the contribution of the radiologist to portable radiographic examinations and to improve the quality of the RIS database.

Computer Systems↗

PubMed1994

Mammography screening. One versus two views and independent double reading.

Five experienced screeners independently and blindly reviewed mammograms from the first screening round of 46 healthy women, and of 74 women who had histologically proven breast cancers in the first screening round or later. The films were reviewed first as one-view screening and later as two-view screening. Fifty-one breast cancers were detected by at least one of the screeners on either one-view or two-view screening. The mean increase in sensitivity by using two views, instead of one, was 2%. The median of the proportional increase in detected cancers as the result of independent double reading was 14.5% with one-view screening and 12% with two-view screening. Two screeners using one-view screening detected about 10% more cancers than one screener using two-view screening.

Adult↗

PubMed1994

The efficacy of double reading mammograms in breast screening.

The effect of double reporting the screening mammograms of 31,146 women attending as part of the UK National Health Service Breast Screening Programme was analysed. Ninety per cent had their mammograms read by two of three experienced radiologists. Overall 1846 (5.9%) women were recalled for further assessment. Two hundred and sixty-one patients (0.8%) underwent surgical intervention resulting in the detection of 191 cancers (6.1/1000 women screened). The benign-to-malignant ratio was 1:3.6 (PPV 73.2%). Of the invasive cancers detected 72% had no histological evidence of axillary lymph node metastases. Twenty-one of the 191 cancers detected (10.4%) were missed by one of the two reporters. Six of these were invasive cancers < or = 1 cm in diameter. Comparison of those lesions detected by both readers to those detected by only one, showed readers were more likely to detect those lesions appearing as an opacity (65% vs 38%), but less likely to detect significant microcalcification (15% vs 33%). The difference between the two groups when taken as a whole, however, failed to reach statistical significance (chi 2 = 6.76, d.f. = 3, P = 0.08). In summary, double reporting resulted in an increase in sensitivity of 10%. However, there was a decrease in specificity of 1.8% with 569 women being recalled unnecessarily for assessment and biopsy of 13 benign lesions. The estimated resultant additional financial cost was 13773 pounds.

Aged↗

PubMed1994