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The effect of computer-aided detection markers on visual search and reader performance during concurrent reading of CT colonography

  • Gastrointestinal
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Abstract

Objective

We aimed to identify the effect of computer-aided detection (CAD) on visual search and performance in CT Colonography (CTC) of inexperienced and experienced readers.

Methods

Fifteen endoluminal CTC examinations were recorded, each with one polyp, and two videos were generated, one with and one without a CAD mark. Forty-two readers (17 experienced, 25 inexperienced) interpreted the videos during infrared visual search recording. CAD markers and polyps were treated as regions of interest in data processing. This multi-reader, multi-case study was analysed using multilevel modelling.

Results

CAD drew readers’ attention to polyps faster, accelerating identification times: median ‘time to first pursuit’ was 0.48 s (IQR 0.27 to 0.87 s) with CAD, versus 0.58 s (IQR 0.35 to 1.06 s) without. For inexperienced readers, CAD also held visual attention for longer. All visual search metrics used to assess visual gaze behaviour demonstrated statistically significant differences when “with” and “without” CAD were compared. A significant increase in the number of correct polyp identifications across all readers was seen with CAD (74 % without CAD, 87 % with CAD; p < 0.001).

Conclusions

CAD significantly alters visual search and polyp identification in readers viewing three-dimensional endoluminal CTC. For polyp and CAD marker pursuit times, CAD generally exerted a larger effect on inexperienced readers.

Key Points

• Visual gaze is attracted by computer-assisted detection (CAD) marks on polyps

• Inexperienced readers’ gaze is affected more by CAD than experienced readers.

• CAD marks could mean that the unannotated endoluminal surface is relatively neglected.

• Correct polyp identification is increased significantly by CAD.

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References

  1. Gilbert FJ, Astley SM, Gillan MG et al (2008) Single reading with computer-aided detection for screening mammography. N Engl J Med 359:1675–1684

    Article  CAS  PubMed  Google Scholar 

  2. Mazzone PJ, Obuchowski N, Phillips M, Risius B, Bazerbashi B, Meziane M (2013) Lung cancer screening with computer aided detection chest radiography: design and results of a randomized, controlled trial. PLoS One 8:e59650

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Halligan S, Mallett S, Altman DG et al (2011) Incremental benefit of computer-aided detection when used as a second and concurrent reader of CT colonographic data: multiobserver study. Radiology 258:469–476

    Article  PubMed  Google Scholar 

  4. Dachman AH, Obuchowski NA, Hoffmeister JW et al (2010) Effect of computer-aided detection for CT colonography in a multireader, multicase trial. Radiology 256:827–835

    Article  PubMed Central  PubMed  Google Scholar 

  5. Halligan S, Altman DG, Mallett S et al (2006) Computed tomographic colonography: assessment of radiologist performance with and without computer-aided detection. Gastroenterology 131:1690–1699

    Article  PubMed  Google Scholar 

  6. Taylor SA, Halligan S, Burling D et al (2006) Computer-assisted reader software versus expert reviewers for polyp detection on CT colonography. AJR Am J Roentgenol 186:696–702

    Article  PubMed  Google Scholar 

  7. Lawrence EM, Pickhardt PJ, Kim DH, Robbins JB (2010) Colorectal polyps: stand-alone performance of computer-aided detection in a large asymptomatic screening population. Radiology 256:791–798

    Article  PubMed  Google Scholar 

  8. Taylor SA, Greenhalgh R, Ilangovan R et al (2008) CT colonography and computer-aided detection: effect of false-positive results on reader specificity and reading efficiency in a low-prevalence screening population. Radiology 247:133–140

    Article  PubMed  Google Scholar 

  9. Phillips P, Boone D, Mallett S et al (2013) Method for tracking eye gaze during interpretation of endoluminal 3D CT colonography: technical description and proposed metrics for analysis. Radiology 267:924–931

    Article  PubMed  Google Scholar 

  10. Krupinski EA, Berbaum KS (2009) The Medical Image Perception Society update on key issues for image perception research. Radiology 253:230–233

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kundel HL, Nodine CF, Krupinski EA (1990) Computer-displayed eye position as a visual aid to pulmonary nodule interpretation. Invest Radiol 25:890–896

    Article  CAS  PubMed  Google Scholar 

  12. Tourassi GD, Mazurowski MA, Harrawood BP, Krupinski EA (2010) Exploring the potential of context-sensitive CADe in screening mammography. Med Phys 37:5728–5736

    Article  PubMed Central  PubMed  Google Scholar 

  13. Krupinski EA, Nodine CF, Kundel HL (1993) A perceptually based method for enhancing pulmonary nodule recognition. Invest Radiol 28:289–294

    Article  CAS  PubMed  Google Scholar 

  14. Drew T, Cunningham C, Wolfe JM (2012) When and why might a computer-aided detection (CAD) system interfere with visual search? An eye-tracking study. Acad Radiol 19:1260–1267

    Article  PubMed Central  PubMed  Google Scholar 

  15. Helbren E, Halligan S, Phillips P et al. (2014) Towards a framework for analysis of eye-tracking studies in the three-dimensional environment: A study of visual search by experienced readers of endoluminal CT Colonography. Br J Radiol. doi:10.1259/bjr.20130614

  16. Hock D, Ouhadi R, Materne R et al (2008) Virtual dissection CT colonography: evaluation of learning curves and reading times with and without computer-aided detection. Radiology 248:860–868

    Article  PubMed  Google Scholar 

  17. Regge D, Della Monica P, Galatola G et al (2013) Efficacy of computer-aided detection as a second reader for 6-9-mm lesions at CT colonography: multicenter prospective trial. Radiology 266:168–176

    Article  PubMed  Google Scholar 

  18. Iussich G, Correale L, Senore C et al (2014) Computer-aided detection for computed tomographic colonography screening: a prospective comparison of a double-reading paradigm with first-reader computer-aided detection against second-reader computer-aided detection. Invest Radiol 49:173–182

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Prof. Steve Halligan. The authors of this manuscript declare relationships with the following companies: Vital Images (Vital Images Inc., Minnetonka, Minnesota, USA) and iCAD (iCAD Inc., Fairborn, Ohio, USA) provided a medical image workstation used for this research. This study was funded by the National Institute for Health (NIHR) Research under its Programme Grants for Applied Research funding scheme (RP-PG-0407-10338). Three of the authors are statisticians. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (observers) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, experimental, multicenter study.

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Authors and Affiliations

  1. Centre for Medical Imaging, University College London, London, UK

    Emma Helbren, Stuart A. Taylor & Steve Halligan

  2. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

    Thomas R. Fanshawe & Susan Mallett

  3. Health and Medical Sciences Group, University of Cumbria, Lancaster, UK

    Peter Phillips

  4. Colchester Hospital University NHS Foundation Trust and Anglia University, Colchester, UK

    Darren Boone

  5. Applied Vision Research Centre, Loughborough University, Loughborough, UK

    Alastair Gale

  6. Centre for Statistics in Medicine, University of Oxford, Oxford, UK

    Douglas G. Altman

  7. Lancaster Medical School, Faculty of Health & Medicine, Lancaster University, Lancaster, UK

    David Manning

  8. Gastrointestinal Radiology, University College London, Centre for Medical Imaging, Podium Level 2, University College Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom

    Steve Halligan

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  1. Emma Helbren
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  2. Thomas R. Fanshawe
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  3. Peter Phillips
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  4. Susan Mallett
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  6. Alastair Gale
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  7. Douglas G. Altman
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  8. Stuart A. Taylor
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  10. Steve Halligan
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Correspondence to Steve Halligan.

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Helbren, E., Fanshawe, T.R., Phillips, P. et al. The effect of computer-aided detection markers on visual search and reader performance during concurrent reading of CT colonography. Eur Radiol 25, 1570–1578 (2015). https://doi.org/10.1007/s00330-014-3569-z

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  • DOI: https://doi.org/10.1007/s00330-014-3569-z

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