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An evaluation of the impact of computer-based prompts on screen readers' interpretation of mammograms

¹ Centre for Health Informatics and Multiprofessional Education, University College London, Archway Campus, Highgate Hill, London² Duchess of Kent Screening Unit, Blackshaw Road, London, ³ School of Public Policy, University College London, 29/30 Tavistock Square, London and ⁴ Health Economics Research Centre, Institute of Health Sciences, University of Oxford, Oxford, UK

The NHS Breast Screening Programme is changing working practices in response to increased workload and manpower shortages. Radiographers are being trained as film readers. Computer aids are being considered. We have evaluated the impact of prompts placed by the R2 ImageChecker 1000 on the sensitivity and specificity of film readers, including non-radiologist film readers. 30 radiologists, 5 breast clinicians and 15 radiographers each read 180 films, including 60 cancers (20 false negative interval cases and 40 screen detected cancers). Each reader read each case twice, once with and once without computer prompts. The order in which the reading sessions were carried out was randomized separately for each reader. 36 out of 40 screen-detected cases were prompted by the ImageChecker, a sensitivity of 90%. Eight out of 20 interval cases were prompted, a sensitivity of 40%. No significant difference was found for readers' sensitivity or specificity between the prompted and unprompted conditions. No significant difference was found between the sensitivity and specificity of the different groups of film reader. No difference in impact of prompts was found for well or poorly performing film readers. The result suggests that this version of the ImageChecker would not have a significant impact on the UK screening programme.

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