TY - JOUR
T1 - Reversal of the hanging protocol of Contrast Enhanced Mammography leads to similar diagnostic performance yet decreased reading times
AU - van Geel, Koos
AU - Kok, Ellen M.
AU - Krol, Jorian P.
AU - Houben, Ivo P. L.
AU - Thibault, Fabienne E.
AU - Pijnappel, Ruud M.
AU - van Merrienboer, Jeroen J. G.
AU - Lobbes, Marc B.
N1 - Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/8
Y1 - 2019/8
N2 - Objectives: Contrast-enhanced mammography (CEM) was found superior to Full-Field Digital Mammography (FFDM) for breast cancer detection. Current hanging protocols show low-energy (LE, similar to FFDM) images first, followed by recombined (RC) images. However, evidence regarding which hanging protocol leads to the most efficient reading process and highest diagnostic performance is lacking. This study investigates the effects of hanging-protocol ordering on the reading process and diagnostic performance of breast radiologists using eye-tracking methodology. Furthermore, it investigates differences in reading processes and diagnostic performance between LE, RC and FFDM images.Materials and methods: Twenty-seven breast radiologists were randomized into three reading groups: LE-RC (commonly used hangings), RC-LE (reversed hangings) and FFDM. Thirty cases (nine malignant) were used. Fixation count, net dwell time and time-to-first fixation on malignancies as visual search measures were registered by the eye-tracker. Reading time per image was measured. Participants clicked on suspicious lesions to determine sensitivity and specificity. Area-under-the-ROC-curve (AUC) values were calculated.Results: RC-LE scored identical on visual search measures, t(16) = -1.45, p = .17 or higher-p values, decreased reading time with 31%, t(16) = -2.20, p = .04, while scoring similar diagnostic performance compared to LE-RC, t(13.2) = -1.39, p - .20 or higher p-values. The reading process was more efficient on RC compared to LE. Diagnostic performance of CEM was superior to FFDM; F (2,26) = 16.1, p <.001. Average reading time did not differ between the three groups, F (2,25) = 3.15, p = .06.Conclusion: The reversed CEM hanging protocol (RC-LE) scored similar on diagnostic performance compared to LE-RC, while reading time was a third faster. Abnormalities were interpreted quicker on RC images. A RC-LE hanging protocol is therefore recommended for clinical practice and training. Diagnostic performance of CEM was (again) superior to FFDM.
AB - Objectives: Contrast-enhanced mammography (CEM) was found superior to Full-Field Digital Mammography (FFDM) for breast cancer detection. Current hanging protocols show low-energy (LE, similar to FFDM) images first, followed by recombined (RC) images. However, evidence regarding which hanging protocol leads to the most efficient reading process and highest diagnostic performance is lacking. This study investigates the effects of hanging-protocol ordering on the reading process and diagnostic performance of breast radiologists using eye-tracking methodology. Furthermore, it investigates differences in reading processes and diagnostic performance between LE, RC and FFDM images.Materials and methods: Twenty-seven breast radiologists were randomized into three reading groups: LE-RC (commonly used hangings), RC-LE (reversed hangings) and FFDM. Thirty cases (nine malignant) were used. Fixation count, net dwell time and time-to-first fixation on malignancies as visual search measures were registered by the eye-tracker. Reading time per image was measured. Participants clicked on suspicious lesions to determine sensitivity and specificity. Area-under-the-ROC-curve (AUC) values were calculated.Results: RC-LE scored identical on visual search measures, t(16) = -1.45, p = .17 or higher-p values, decreased reading time with 31%, t(16) = -2.20, p = .04, while scoring similar diagnostic performance compared to LE-RC, t(13.2) = -1.39, p - .20 or higher p-values. The reading process was more efficient on RC compared to LE. Diagnostic performance of CEM was superior to FFDM; F (2,26) = 16.1, p <.001. Average reading time did not differ between the three groups, F (2,25) = 3.15, p = .06.Conclusion: The reversed CEM hanging protocol (RC-LE) scored similar on diagnostic performance compared to LE-RC, while reading time was a third faster. Abnormalities were interpreted quicker on RC images. A RC-LE hanging protocol is therefore recommended for clinical practice and training. Diagnostic performance of CEM was (again) superior to FFDM.
KW - Contrast Enhanced Mammography
KW - Full-Field Digital Mammography
KW - Hanging protocols
KW - Eye-tracking methodology
KW - Visual expertise
KW - SPECTRAL MAMMOGRAPHY
KW - BREAST-CANCER
KW - CHALLENGES
KW - WOMEN
KW - RISK
KW - CEDM
KW - MRI
U2 - 10.1016/j.ejrad.2019.05.013
DO - 10.1016/j.ejrad.2019.05.013
M3 - Article
C2 - 31307654
SN - 0720-048X
VL - 117
SP - 62
EP - 68
JO - European Journal of Radiology
JF - European Journal of Radiology
ER -