Evaluation of novice reader diagnostic performance in coronary CT angiography using an advanced cardiac software package

Abstract

PurposeThe purpose of this research was to evaluate whether a commercially available advanced cardiac software package for coronary CT angiography (CTA) interpretation may reliably assist inexperienced readers to screen for significant coronary artery stenoses.MethodsCoronary CTA data sets of 61 consecutive patients with suspected coronary artery disease were evaluated by three novice readers with no experience in cardiac CT interpretation. In the first 15 patients, the novice readers were trained to use the advanced cardiac software package (includes automatic detection of coronary vessels, curved MPR and VRT reconstructions and a measurement too) knowing the results of an expert read. In the next 46 patients, the novice readers had to state whether there is a significant coronary artery stenosis (50 %) and if they are confident with their diagnosis. The results of the novice readers were compared to the expert read.ResultsThe 46 coronary CTA data sets contained 184 vessels with 15 stenoses in 9 patients. On a per-vessel analysis, novice reader 1/2/3 demonstrated 60 %/100 %/ 93% sensitivity, and 98 %/90 %/86 % specificity. Per patient, the readers diagnosed 36/28/29 cases correctly as free of stenoses, 6/9/8 correctly as having at least one stenosis, missed 3/0/1 cases with a stenosis and overdiagnosed 1/9/8 patients. Cohen’s kappa values for the three readers versus the expert were 0.60, 0.61 and 0.54. The three novice readers felt confident in the diagnosis of 36/33/30 patients. In these patients, they missed one significant stenosis, showed a sensitivity of 100 %/100 %/75 % and a specificity of 100 %/92 %/88 %.ConclusionsThe evaluated advanced cardiac software package successfully assists novice readers in interpreting coronary CTA data sets especially in ruling out significant coronary artery stenosis.

Automated Identification of Coronary Arteries in Assisting Inexperienced Readers: Comparison between Two Commercial Vendors

“…Correct interpretation of cardiac imaging requires extensive training and experience, needed to reduce inter-observer variability [ 21 ]. Inexperienced readers, at the beginning of their learning curve, benefit from the assistance of dedicated software in the identification of coronary arteries and segments [ 17 , 22 , 23 ]. A thorough evaluation of the coronary tree is fundamental for the CCTA to achieve high diagnostic yield.…”

“…The application of such tools are more convenient than semi-automated methods and may theoretically further facilitate coronary vessels’ evaluation, favoring the trend towards less reader dependency [ 15 ]. It has been demonstrated that advanced cardiac software packages have a NPV similar to high experience readers while their positive predictive value is comparable to novice CCTA readers [ 16 ]; additionally, they may assist novice readers in ruling out significant CAD [ 17 ]. Nevertheless, to the best of our knowledge, previous investigations were focused on diagnostic performances rather than the identification of coronary vessels and segments as an aiding tool for inexperienced CCTA readers.…”

Evaluation of a Novel Content-Based Image Retrieval System for the Differentiation of Interstitial Lung Diseases in CT Examinations

“…In the present however, AI-like CAD systems are only used as a supplementary aid for the radiologists' subjective image assessment [19]. Therefore, the performance of CADs is depending on the users' knowledge and experience and has been shown to successfully assist even novice readers [20]. Regarding ILDs, while CADs have shown promising results such as good accuracy in detecting fibrosis on a quantitative level [21] and good performance in distinguishing between specific diseases such as UIP and non-specific interstitial pneumonia (NSIP) [22], current systems are usually limited in the number of different ILDs they comprise of and patterns they recognize.…”