As more clinical studies tout the benefits of deploying computer-assisted detection (CAD) systems for breast MRI and mammography, the few lingering impediments to widespread adoption seem to be environmental. Low reimbursement rates, unfamiliarity with the technology and the troubled economy remain as potential barriers. However, most radiologists currently using the technology concur that both types of CAD systems add to the accuracy of detecting breast cancer, and therefore, allow for better patient care and almost immediate return on investment.
CAD proves its worth
Huong Carisa Le-Petross, MD, assistant professor of breast and body imaging in the department of radiology at M.D. Anderson Cancer Center in Houston, has been using Invivo’s Breast MRI CAD, in addition to R2 Technology’s Mammography CAD system, for several years.
Mammography CAD is particularly beneficial in an all-digital environment, Le-Petross says. She explains that currently, when the technologist performs the exam, the CAD application is already activated, so when the radiologist assesses the image at the reading station, the mammo CAD images are already present.
“The CAD images now simply serve as additional images at the end of the exam—the last image that the radiologist views to double-check his or her assessment. For us, the CAD tools have become part of our daily routine,” Le-Petross says.
M.D. Anderson was using a breast MR system in the body imaging department, and upon her arrival at the facility, Le-Petross developed a protocol to utilize the systems for breast-specific imaging. “I’ve always used CAD, along with breast MR [CAD], because you need some kind of enhancement [rate of contrast agent uptake] of the lesion, as well as the rate that it leaves the lesion,” she says.
“Nowadays, CAD for breast MRI is becoming a vital part of breast MRI interpretation. This post-processing software allows more efficient interpretation of breast MRI cases, by providing functional color maps and time-intensity curve almost instantly after an exam is sent to the workstation. The colorized maps allow the radiologist to quickly identify suspicious lesions or lesions that have suspicious enhancing pattern, in a background of multiple enhancing lesions with more benign enhancing pattern. Prior to the era of breast MRI CAD, the same information can be obtained but requires several steps by the radiologists or technologists. Now, those steps are bypassed because the CAD software automatically processes the necessary final images for the radiologists to review and interpret the study. This improves the workflow and throughput of breast MRI interpretation,” Le-Petross suggests. “You also can customize the products to your preferences.”
Practice makes perfect
While Le-Petross has not witnessed a resistance to CAD’s adoption, especially with the newer, more “user-friendly versions,” she acknowledges there is a learning curve associated with any technology.
Due to the much-publicized reports of false-positive rates particularly associated with mammography CAD, some radiologists were initially hesitant. However, Le-Petross suggests those distractions can be quickly overcome, as the user becomes more experienced with the application. “The higher the volume of images that a person reads, the less likely he or she is going to rely solely on CAD,” she notes.
Marcela Böhm-Vélez, MD, radiologist at Weinstein Imaging Associates and clinical assistant professor of radiology at the University of Pittsburgh in Pennsylvania concurs with Le-Petross that once the learning curve is overcome, problems with false-positive rates quickly decline. In fact, she believes that the remaining attitudinal impediments about “CAD, as with any new technology, are mainly rooted in a lack of comfort and understanding of its benefits.”
Böhm-Vélez and her colleagues all specialize in breast imaging. “We use iCAD’s mammography CAD tools to confirm our suspicions, and will study areas that [the system] marks, but don’t depend on it as a decision maker. However, for the majority of radiologists, who read multiple modalities, CAD can give them tremendous confidence by offering them the advantage of a second reader,” she says.
Despite solely reading mammograms in her practice, Böhm-Vélez says that CAD helps with large workloads. “It draws