This study is to investigate the incremental effect of using a high performance computer-aided detection (CAD) system
in detection of solitary pulmonary nodules in chest radiographs. The Kodak Chest CAD system was evaluated by a panel
of six radiologists at different levels of experience. The observer study consisted of two independent phases: readings
without CAD and readings with assistance of CAD. The study was conducted over a set of chest radiographs comprising
150 cancer cases and 150 cancer-free cases. The actual sensitivity of the CAD system is 72% with 3.7 false positives per
case. Receiver operating characteristic (ROC) analysis was used to assess the overall observer performance. The AUZ
(area under ROC curve) showed a significantly improvement (P=0.0001) from 0.844 to 0.884 after using CAD. The
ROC analysis was also applied for observer performances on nodules in different sizes and visibilities. The average
AUZs are improved from 0.798 to 0.835 (P=0.0003) for 5-10mm nodules, 0.853 to 0.907 (P=0.001) for 10-15mm
nodules, 0.864 to 0.897 (P=0.051) for 15-20 mm nodules and 0.859 to 0.896 (P=0.0342) for 20-30mm nodules,
respectively. For different visibilities, the average AUZs are improved from 0.886 to 0.915 (P=0.0337), 0.803 to 0.840
(P=0.063), 0.830 to 0.893 (P=0.0001), and 0.813 to 0.847 (P=0.152), for nodules clearly visible, hidden by ribs, partially
overlap with ribs, and overlap with other structures, respectively. These results showed that observer performance could
be greatly improved when the CAD system is employed as a second reader, especially for small nodules and nodules
occluded by ribs.
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