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Pulmonary Nodules: Estimation of Malignancy at Thin-Section Helical CT—Effect of Computer-aided Diagnosis on Performance of Radiologists¹

¹ From the Department of Diagnostic Radiology, Graduate School of Medical Sciences (K.A., Y.N., T.N., D.L., K.K., S.M., Y.Y.), and Department of Radiological Technology, School of Health Sciences (Y.F.), Kumamoto University, 1-1-1 Honjyo, Kumamoto 860-8556, Japan; and Bio-IT Business Development Group, Fujitsu, Chiba, Japan (K.M., A.O.). Received February 6, 2005; revision requested April 6; revision received May 10; final version accepted June 13. Address correspondence to K.A.

Purpose: To evaluate the effect of a computer-aided diagnosis (CAD) system on the diagnostic performance of radiologists for the estimation of the malignancy of pulmonary nodules on thin-section helical computed tomographic (CT) scans.

Materials and Methods: The institutional review board approved use of the CT database; informed specific study-related consent was waived. The institutional review board approved participation of radiologists; informed consent was obtained from all observers. Thirty-three (18 malignant, 15 benign) pulmonary nodules of less than 3.0 cm in maximal diameter were evaluated. Receiver operating characteristic (ROC) analysis with a continuous rating scale was used to compare observer performance for the estimation of the likelihood of malignancy first without and then with the CAD system. The participants were 10 board-certified radiologists and nine radiology residents.

Results: For all 19 participants, the mean area under the best-fit ROC curve (A_z) values achieved without and with the CAD system were 0.843 ± 0.097 (standard deviation) and 0.924 ± 0.043, respectively. The difference was significant (P = .021). The mean A_z values achieved without and with the CAD system were 0.910 ± 0.052 and 0.944 ± 0.040, respectively, for the 10 board-certified radiologists (P = .190) and 0.768 ± 0.078 and 0.901 ± 0.036, respectively, for the nine radiology residents (P = .009).

Conclusion: Use of the CAD system significantly (P = .009) improved the diagnostic performance of radiology residents for assessment of the malignancy of pulmonary nodules; however, it did not improve that of board-certified radiologists.

© RSNA, 2006

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