Effect of a computer-aided diagnosis scheme on radiologists' performance in detection of lung nodules on radiographs

PURPOSE: To evaluate the effect of a computer-aided diagnosis (CAD) scheme on radiologists' performance in the detection of lung nodules, and to examine a new method of receiver operating characteristic (ROC) analysis. MATERIALS AND METHODS: One hundred twenty radiographs (60 normal and 60 abnormal with lung nodules of varying subtlety) were used. Sixteen radiologists (two thoracic, six general, and eight residents) participated in an observer study in which they read both conventional radiographs and digitized radiographs. The radiologists' performance was evaluated with ROC analysis with two different methods (independent testing and sequential testing) and a continuous rating scale. RESULTS: A(z) (area under the best fit binormal ROC curve when it is plotted in the unit square) values obtained from ROC analysis with and without CAD output were 0.940 and 0.894, respectively, in the independent test and 0.948 and 0.906, respectively, in the sequential test. Findings with both methods indicated that the CAD scheme statistically significantly improved diagnostic accuracy, particularly for radiologists with less experience (P < .001). Reading time was not increased when CAD was used. CONCLUSION: The CAD scheme can assist radiologists in the detection of lung nodules on chest radiographs.