Time to Diagnosis and Performance Levels during Repeat Interpretations of Digital Breast Tomosynthesis: Preliminary Observations

Zuley, Margarita L.; Bandos, Andriy I.; Abrams, Gordon S.; Cohen, Cathy; Hakim, Christiane M.; Sumkin, Jules H.; Drescher, John; Rockette, Howard E.; Gur, David

doi:10.1016/j.acra.2009.11.011

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Volume 17, Issue 4 , Pages 450-455, April 2010

Time to Diagnosis and Performance Levels during Repeat Interpretations of Digital Breast Tomosynthesis:

Preliminary Observations

Margarita L. Zuley, MD
- Department of Radiology, Magee-Womens Hospital, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213
- Address correspondence to: M.L.Z.
Andriy I. Bandos, PhD
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213
Gordon S. Abrams, MD
- Department of Radiology, Magee-Womens Hospital, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213
Cathy Cohen, MD
- Department of Radiology, Magee-Womens Hospital, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213
Christiane M. Hakim, MD
- Department of Radiology, Magee-Womens Hospital, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213
Jules H. Sumkin, DO
- Department of Radiology, Magee-Womens Hospital, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213
John Drescher, BS
- Department of Radiology, Radiology Imaging Research, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213
Howard E. Rockette, PhD
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213
David Gur, ScD
- Department of Radiology, Radiology Imaging Research, University of Pittsburgh, 3362 Fifth Avenue, Pittsburgh, PA 15213

Received 18 September 2009; accepted 8 November 2009. published online 28 December 2009.

Rationale and Objectives

To compare time to interpretation and diagnostic performance levels during repeat readings of full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in a retrospective study.

Materials and Methods

Three experienced radiologists twice interpreted 125 selected examinations, 35 with verified cancers and 90 negative for cancer during a period of 22 months using FFDM alone followed by a combined FFDM + DBT mode. Changes in time to “review and rate” these examinations as well as in diagnostic performance levels where assessed. A fixed-effect analysis accounting for cross-correlation due to the review of the same examinations by the same readers was performed.

Results

The total (combined) time to review and rate an examination increased on average by 33% between the first and second readings of the same examinations (P < .001). Radiologists reduced their time to review FFDM before making the DBT available for viewing. However, they spent more time reviewing the combined FFDM + DBT mode. The recall rates for examinations depicting cancer remained largely unchanged. Among the groups of examinations with concordant and discordant recall recommendations during the two readings only the group examinations that were “newly recalled” during repeat reading, took significantly longer (P < .01).

Conclusion

DBT-based breast imaging may ultimately result in a substantial increase in performance; however, without efficiency improvements DBT may take longer to interpret. Addition of “false-positive recalls” was most strongly associated with increase in interpretation time while elimination of “false-positive recalls” did not require longer interpretation time.

Key Words: Observer performance, digital mammography, repeat readings, digital breast tomosynthesis