Can Computer-aided Detection Be Detrimental to Mammographic Interpretation?

In conclusion, CAD has some potential advantages but also some important and potentially serious limitations. Awareness of the limitations discussed in this article is important for optimal use. A few suggestions to protect oneself from experiencing detrimental effects from the use of CAD in screening interpretation are as follows: (a) Never use CAD as a pre-screener. The present sensitivity of CAD is not sufficient, and many cancers will be missed with this approach. (b) Never use CAD as an initial step in mammogram interpretation. Again, for the same reasons, if one concentrates primarily on areas that CAD has marked, many important findings may be missed. (c) Interpret mammograms as usual, and only use CAD as a last step in a reading protocol. Do not decide not to recall a patient for a finding just because it is not marked by CAD. It might be worth considering that if one finds that CAD is consistently marking findings that the reader had not recognized initially and that appear important (ie, potentially worthy of recall) that the reader should maybe step away from reading for a rest until his or her acuity has resumed. Understanding of the limitations of CAD is important for those interpreting mammograms; this cautious approach to the use of CAD should help optimize this presently imperfect system and minimize the possible detrimental effects. © RSNA, 2009.