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Gommers JJJ, Abbey CK, Strand F, Taylor-Phillips S, Jenkinson DJ, Larsen M, Hofvind S, Broeders MJM, Sechopoulos I. Modeling Radiologists' Assessments to Explore Pairing Strategies for Optimized Double Reading of Screening Mammograms. Med Decis Making 2024:272989X241264572. [PMID: 39077968 DOI: 10.1177/0272989x241264572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
PURPOSE To develop a model that simulates radiologist assessments and use it to explore whether pairing readers based on their individual performance characteristics could optimize screening performance. METHODS Logistic regression models were designed and used to model individual radiologist assessments. For model evaluation, model-predicted individual performance metrics and paired disagreement rates were compared against the observed data using Pearson correlation coefficients. The logistic regression models were subsequently used to simulate different screening programs with reader pairing based on individual true-positive rates (TPR) and/or false-positive rates (FPR). For this, retrospective results from breast cancer screening programs employing double reading in Sweden, England, and Norway were used. Outcomes of random pairing were compared against those composed of readers with similar and opposite TPRs/FPRs, with positive assessments defined by either reader flagging an examination as abnormal. RESULTS The analysis data sets consisted of 936,621 (Sweden), 435,281 (England), and 1,820,053 (Norway) examinations. There was good agreement between the model-predicted and observed radiologists' TPR and FPR (r ≥ 0.969). Model-predicted negative-case disagreement rates showed high correlations (r ≥ 0.709), whereas positive-case disagreement rates had lower correlation levels due to sparse data (r ≥ 0.532). Pairing radiologists with similar FPR characteristics (Sweden: 4.50% [95% confidence interval: 4.46%-4.54%], England: 5.51% [5.47%-5.56%], Norway: 8.03% [7.99%-8.07%]) resulted in significantly lower FPR than with random pairing (Sweden: 4.74% [4.70%-4.78%], England: 5.76% [5.71%-5.80%], Norway: 8.30% [8.26%-8.34%]), reducing examinations sent to consensus/arbitration while the TPR did not change significantly. Other pairing strategies resulted in equal or worse performance than random pairing. CONCLUSIONS Logistic regression models accurately predicted screening mammography assessments and helped explore different radiologist pairing strategies. Pairing readers with similar modeled FPR characteristics reduced the number of examinations unnecessarily sent to consensus/arbitration without significantly compromising the TPR. HIGHLIGHTS A logistic-regression model can be derived that accurately predicts individual and paired reader performance during mammography screening reading.Pairing screening mammography radiologists with similar false-positive characteristics reduced false-positive rates with no significant loss in true positives and may reduce the number of examinations unnecessarily sent to consensus/arbitration.
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Affiliation(s)
- Jessie J J Gommers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Craig K Abbey
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, CA, USA
| | - Fredrik Strand
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Breast Radiology, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mireille J M Broeders
- Dutch Expert Center for Screening (LRCB), Nijmegen, The Netherlands
- IQ Health Science Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Center for Screening (LRCB), Nijmegen, The Netherlands
- Technical Medicine Center, University of Twente, Enschede, The Netherlands
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Gommers JJJ, Abbey CK, Strand F, Taylor-Phillips S, Jenkinson DJ, Larsen M, Hofvind S, Sechopoulos I, Broeders MJM. Optimizing the Pairs of Radiologists That Double Read Screening Mammograms. Radiology 2023; 309:e222691. [PMID: 37874241 DOI: 10.1148/radiol.222691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Despite variation in performance characteristics among radiologists, the pairing of radiologists for the double reading of screening mammograms is performed randomly. It is unknown how to optimize pairing to improve screening performance. Purpose To investigate whether radiologist performance characteristics can be used to determine the optimal set of pairs of radiologists to double read screening mammograms for improved accuracy. Materials and Methods This retrospective study was performed with reading outcomes from breast cancer screening programs in Sweden (2008-2015), England (2012-2014), and Norway (2004-2018). Cancer detection rates (CDRs) and abnormal interpretation rates (AIRs) were calculated, with AIR defined as either reader flagging an examination as abnormal. Individual readers were divided into performance categories based on their high and low CDR and AIR. The performance of individuals determined the classification of pairs. Random pair performance, for which any type of pair was equally represented, was compared with the performance of specific pairing strategies, which consisted of pairs of readers who were either opposite or similar in AIR and/or CDR. Results Based on a minimum number of examinations per reader and per pair, the final study sample consisted of 3 592 414 examinations (Sweden, n = 965 263; England, n = 837 048; Norway, n = 1 790 103). The overall AIRs and CDRs for all specific pairing strategies (Sweden AIR range, 45.5-56.9 per 1000 examinations and CDR range, 3.1-3.6 per 1000; England AIR range, 68.2-70.5 per 1000 and CDR range, 8.9-9.4 per 1000; Norway AIR range, 81.6-88.1 per 1000 and CDR range, 6.1-6.8 per 1000) were not significantly different from the random pairing strategy (Sweden AIR, 54.1 per 1000 examinations and CDR, 3.3 per 1000; England AIR, 69.3 per 1000 and CDR, 9.1 per 1000; Norway AIR, 84.1 per 1000 and CDR, 6.3 per 1000). Conclusion Pairing a set of readers based on different pairing strategies did not show a significant difference in screening performance when compared with random pairing. © RSNA, 2023.
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Affiliation(s)
- Jessie J J Gommers
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
| | - Craig K Abbey
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
| | - Fredrik Strand
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
| | - Sian Taylor-Phillips
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
| | - David J Jenkinson
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
| | - Marthe Larsen
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
| | - Solveig Hofvind
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
| | - Ioannis Sechopoulos
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
| | - Mireille J M Broeders
- From the Department of Medical Imaging (J.J.J.G., I.S.) and Department for Health Evidence (M.J.M.B.), Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Post 766, Nijmegen, the Netherlands; Department of Psychological and Brain Sciences, University of California-Santa Barbara, Santa Barbara, Calif (C.K.A.); Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden (F.S.); Department of Breast Radiology, Karolinska University Hospital, Stockholm, Sweden (F.S.); Warwick Medical School, University of Warwick, Coventry, United Kingdom (S.T.P., D.J.J.); Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway (M.L., S.H.); Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway (S.H.); Dutch Expert Center for Screening (LRCB), Nijmegen, the Netherlands (I.S., M.J.M.B.); and Technical Medicine Center, University of Twente, Enschede, the Netherlands (I.S.)
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Suman AA, Russo C, Carrigan A, Nalepka P, Liquet-Weiland B, Newport RA, Kumari P, Di Ieva A. Spatial and time domain analysis of eye-tracking data during screening of brain magnetic resonance images. PLoS One 2021; 16:e0260717. [PMID: 34855867 PMCID: PMC8639086 DOI: 10.1371/journal.pone.0260717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/15/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Eye-tracking research has been widely used in radiology applications. Prior studies exclusively analysed either temporal or spatial eye-tracking features, both of which alone do not completely characterise the spatiotemporal dynamics of radiologists' gaze features. PURPOSE Our research aims to quantify human visual search dynamics in both domains during brain stimuli screening to explore the relationship between reader characteristics and stimuli complexity. The methodology can be used to discover strategies to aid trainee radiologists in identifying pathology, and to select regions of interest for machine vision applications. METHOD The study was performed using eye-tracking data 5 seconds in duration from 57 readers (15 Brain-experts, 11 Other-experts, 5 Registrars and 26 Naïves) for 40 neuroradiological images as stimuli (i.e., 20 normal and 20 pathological brain MRIs). The visual scanning patterns were analysed by calculating the fractal dimension (FD) and Hurst exponent (HE) using re-scaled range (R/S) and detrended fluctuation analysis (DFA) methods. The FD was used to measure the spatial geometrical complexity of the gaze patterns, and the HE analysis was used to measure participants' focusing skill. The focusing skill is referred to persistence/anti-persistence of the participants' gaze on the stimulus over time. Pathological and normal stimuli were analysed separately both at the "First Second" and full "Five Seconds" viewing duration. RESULTS All experts were more focused and a had higher visual search complexity compared to Registrars and Naïves. This was seen in both the pathological and normal stimuli in the first and five second analyses. The Brain-experts subgroup was shown to achieve better focusing skill than Other-experts due to their domain specific expertise. Indeed, the FDs found when viewing pathological stimuli were higher than those in normal ones. Viewing normal stimuli resulted in an increase of FD found in five second data, unlike pathological stimuli, which did not change. In contrast to the FDs, the scanpath HEs of pathological and normal stimuli were similar. However, participants' gaze was more focused for "Five Seconds" than "First Second" data. CONCLUSIONS The HE analysis of the scanpaths belonging to all experts showed that they have greater focus than Registrars and Naïves. This may be related to their higher visual search complexity than non-experts due to their training and expertise.
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Affiliation(s)
- Abdulla Al Suman
- Computational NeuroSurgery (CNS) Lab, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Carlo Russo
- Computational NeuroSurgery (CNS) Lab, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Ann Carrigan
- School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
- Centre for Elite Performance, Expertise and Training, Macquarie University, Sydney, Australia
| | - Patrick Nalepka
- School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
- Centre for Elite Performance, Expertise and Training, Macquarie University, Sydney, Australia
| | - Benoit Liquet-Weiland
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Robert Ahadizad Newport
- Computational NeuroSurgery (CNS) Lab, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Poonam Kumari
- Computational NeuroSurgery (CNS) Lab, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Antonio Di Ieva
- Computational NeuroSurgery (CNS) Lab, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
- Centre for Elite Performance, Expertise and Training, Macquarie University, Sydney, Australia
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