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Interactive Computer Aided Detection Nico Karssemeijer Maurice Samulski, Michiel Kallenberg, Rianne Hupse Carla Boetes, Roel Mus, Ard den Heeten Radboud University Nijmegen Medical Centre Radiology / LRCB
Overview presentation ,[object Object],[object Object],[object Object],[object Object]
Breast Cancer Facts ,[object Object],[object Object],[object Object],[object Object],[object Object]
X-ray Mammography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
Cancer missed by  10 out of 15 in observer  study
 
Detection of masses
Detection of Masses: Effect of Training 940 TP mass regions and 38000 normal regions in training set 5 fold cross validation
Use of CAD prompts is intended to avoid oversights ImageChecker,  R2 Technology / Hologic
Mammography CAD in practice ,[object Object],[object Object],[object Object],[object Object],[object Object]
Limitations of CAD ,[object Object],[object Object],[object Object],[object Object],[object Object]
Manning et al., Categories of observer error from eye-tracking and AFROC data, SPIE Medical Imaging 2004, Proc SPIE Vol 5372 Why are cancers missed? Detection of lung nodules by 24 readers in 120 digitized chest radiographs
CAD (R2) and 10 experienced screening radiologists 115 visible mass priors, 250 normals Radiologists CAD
CAD performance on regions reported by readers 115 visible mass priors, 250 normals on regions marked by readers
Observer study with traditional CAD ,[object Object],[object Object],[object Object],[object Object],[object Object]
Results
Results
Effect of CAD on reader scores -1.26 (p=.54) -4.87 (p<.002) 48 +5.25 (p<.003) -3.05 (p<.05) +2.00 (p=.14) -3.96 (p<.001) 146 All TP marked by CAD (n=44) TP not marked by CAD (n=39) Training
Effect of CAD on reader scores  +6.37 (p<.001) -1.51 (p<.001) 48 +2.75 (p<.001) -0.93 (p<.001) +4.56 (p<.001) -1.22 (p<.001) 146 All FP marked by CAD (n=75) FP not marked by CAD (n=244) Training
Independent Combination of Reader Scores with CAD ,[object Object],Single Reading  Suspiciousness = S R Combined with CAD markers: Suspiciousness = (S R +S CAD  )/2 *
Independent Combination of Reader Scores with CAD 10 radiologists, 192 cases with cancers missed in screening
[object Object],[object Object],[object Object],[object Object],[object Object],Interactive use of CAD for decision support
Mammographic workstation design ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
 
 
 
Reader Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reader Study (2) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mean LROC performance of readers
Mean sensitivity in interval FPF < 10% non radiologists  radiologists
Mean reading time per case  non radiologists  radiologists seconds
Summary of results Non radiologists Radiologists Unaided CAD Unaided CAD TPF10  (%) 26.5 39.2 26.5 28.9 Reading time per case (s) 126 112 56 64
Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Future work ,[object Object],[object Object],[object Object],[object Object],[object Object]
Independent combination of reader scores
Future work: Other Modalities ,[object Object]
Mean number of regions probed for CAD per case  non radiologists  radiologists
Review of interval cancers in the Netherlands 2nd site visit (1999-2003) 0 20 40 60 80 100 120 A2 B2 C2 D2 E2 F2 G2 H2 I2 J2 K2 L2 M2 N2 O2 P2 Q2 R2 U2 V2 W2 X2 Z2 Mean no abnormality minimal signs sign lesion
CAD in digital environment  CAD server Mammography system PACS Review station Processed  (Raw)‏ CAD dicom SR  Processed  Raw
Breast Cancer ,[object Object],[object Object],[object Object],A: normal duct cells  B: basement membrane  C: lumen (centre of duct)‏

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Nico Karssemeijer

  • 1. Interactive Computer Aided Detection Nico Karssemeijer Maurice Samulski, Michiel Kallenberg, Rianne Hupse Carla Boetes, Roel Mus, Ard den Heeten Radboud University Nijmegen Medical Centre Radiology / LRCB
  • 2.
  • 3.
  • 4.
  • 5.  
  • 6.  
  • 7.  
  • 8.  
  • 9. Cancer missed by 10 out of 15 in observer study
  • 10.  
  • 12. Detection of Masses: Effect of Training 940 TP mass regions and 38000 normal regions in training set 5 fold cross validation
  • 13. Use of CAD prompts is intended to avoid oversights ImageChecker, R2 Technology / Hologic
  • 14.
  • 15.
  • 16. Manning et al., Categories of observer error from eye-tracking and AFROC data, SPIE Medical Imaging 2004, Proc SPIE Vol 5372 Why are cancers missed? Detection of lung nodules by 24 readers in 120 digitized chest radiographs
  • 17. CAD (R2) and 10 experienced screening radiologists 115 visible mass priors, 250 normals Radiologists CAD
  • 18. CAD performance on regions reported by readers 115 visible mass priors, 250 normals on regions marked by readers
  • 19.
  • 22. Effect of CAD on reader scores -1.26 (p=.54) -4.87 (p<.002) 48 +5.25 (p<.003) -3.05 (p<.05) +2.00 (p=.14) -3.96 (p<.001) 146 All TP marked by CAD (n=44) TP not marked by CAD (n=39) Training
  • 23. Effect of CAD on reader scores +6.37 (p<.001) -1.51 (p<.001) 48 +2.75 (p<.001) -0.93 (p<.001) +4.56 (p<.001) -1.22 (p<.001) 146 All FP marked by CAD (n=75) FP not marked by CAD (n=244) Training
  • 24.
  • 25. Independent Combination of Reader Scores with CAD 10 radiologists, 192 cases with cancers missed in screening
  • 26.
  • 27.
  • 28.  
  • 29.  
  • 30.  
  • 31.  
  • 32.  
  • 33.  
  • 34.  
  • 35.
  • 36.
  • 37. Mean LROC performance of readers
  • 38. Mean sensitivity in interval FPF < 10% non radiologists radiologists
  • 39. Mean reading time per case non radiologists radiologists seconds
  • 40. Summary of results Non radiologists Radiologists Unaided CAD Unaided CAD TPF10 (%) 26.5 39.2 26.5 28.9 Reading time per case (s) 126 112 56 64
  • 41.
  • 42.
  • 43. Independent combination of reader scores
  • 44.
  • 45. Mean number of regions probed for CAD per case non radiologists radiologists
  • 46. Review of interval cancers in the Netherlands 2nd site visit (1999-2003) 0 20 40 60 80 100 120 A2 B2 C2 D2 E2 F2 G2 H2 I2 J2 K2 L2 M2 N2 O2 P2 Q2 R2 U2 V2 W2 X2 Z2 Mean no abnormality minimal signs sign lesion
  • 47. CAD in digital environment CAD server Mammography system PACS Review station Processed (Raw)‏ CAD dicom SR Processed Raw
  • 48.