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AI Algorithm As Good As Human Readers at Screening Mammograms

By MedImaging International staff writers
Posted on 06 Sep 2023

Image: AI performs comparably to human readers of mammograms (Photo courtesy of 123RF)

Mammographic screening, while valuable, may not detect all instances of breast cancer. False-positive results can lead to unnecessary imaging and biopsies for women without cancer. One approach to enhance the sensitivity and specificity of screening mammography is to have two readers interpret each mammogram. Double reading has been shown to increase cancer detection rates by 6 to 15% while maintaining low recall rates. However, implementing this strategy can be challenging during periods of reader shortages due to its labor-intensive nature. Now, a comparative study of the performance of an artificial intelligence (AI) algorithm with human readers of screening mammograms suggests that AI can provide comparable sensitivity and specificity to human readers, potentially serving as a valuable second reader in clinical practice.

Researchers at the University of Nottingham (Nottingham, UK) used a standardized assessment to evaluate the performance of a commercially available AI algorithm in comparison to human readers when interpreting screening mammograms. The evaluation utilized test sets from the Personal Performance in Mammographic Screening (PERFORMS) quality assurance assessment, a program employed by the UK's National Health Service Breast Screening Program (NHSBSP). PERFORMS test sets consist of 60 challenging mammographic exams, including cases with abnormal, benign, and normal findings. Each reader's evaluation of a test mammogram was compared to the AI's ground truth results. The study employed data from two consecutive PERFORMS test sets, totaling 120 screening mammograms, for the evaluation of both human readers and the AI algorithm.

The research team compared the performance of the AI algorithm with that of 552 human readers, comprising 315 (57%) board-certified radiologists and 237 non-radiologist readers, consisting of 206 radiographers and 31 breast clinicians. Each breast in the study was considered individually, with 67% categorized as normal (161/240), 29% as malignant (70/240), and 4% as benign (9/240). The most common malignant mammographic feature observed was masses (64.3%), followed by calcifications (12.9%), asymmetries (11.4%), and architectural distortions (11.4%). The average size of malignant lesions measured 15.5 mm. The study found that there was no significant difference in the performance of AI and human readers in detecting breast cancer in the 120 exams. Human readers demonstrated a mean sensitivity of 90% and specificity of 76%, while AI exhibited comparable sensitivity (91%) and specificity (77%) in comparison to human readers.

"The results of this study provide strong supporting evidence that AI for breast cancer screening can perform as well as human readers," said Yan Chen, Ph.D., professor of digital screening at the University of Nottingham. "It's vital that imaging centers have a process in place to provide ongoing monitoring of AI once it becomes part of clinical practice. There are no other studies to date that have compared such a large number of human reader performance in routine quality assurance test sets to AI, so this study may provide a model for assessing AI performance in a real-world setting."

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69 (70.095062255859): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (446.08116149902): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294798535 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 2771.1391448975): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294798535 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (546.93222045898): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (70.810317993164): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (88.930130004883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (241.04118347168): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294798535 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (61.988830566406): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294798535 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (56.982040405273): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

105 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

106 (70.810317993164): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294798535 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (53.882598876953): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294798535 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

109 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

110 (45.061111450195): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294798535 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (481.84394836426): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294798535 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 2285.0036621094): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (454.90264892578): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

115 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

116 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

117 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

118 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

119 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

120 (232.93495178223): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 141219.85435486): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (!!!!! 7418.155670166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

123 (!!!!! 8152.961730957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

124 (!!!!! 7746.9348907471): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294798535 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294798535 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1313969.1352844): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 1445950.0312805): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (458.0020904541): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (682.83081054688): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (243.18695068359): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (216.96090698242): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (329.01763916016): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (119.20928955078): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (485.89706420898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (263.92936706543): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (109.91096496582): SELECT name FROM jos_deeppockets WHERE id=211

136 (42.915344238281): SELECT name FROM jos_deeppockets WHERE id=211

137 (465.15464782715): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (375.03242492676): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (!!!!! 4445.0759887695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

140 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

141 (!!!!! 11654.853820801): TRUNCATE TABLE jos_trademed_module

142 (760.07843017578): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294798535 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (444.88906860352): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294798535 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (325.91819763184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (49.829483032227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

147 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

148 (!!!!! 1008.9874267578): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (779.15191650391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

150 (346.89903259277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

151 (!!!!! 4909.9922180176): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294798535 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294798535 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (301.83792114258): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

153 (34.093856811523): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

154 (494.95697021484): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (!!!!! 3045.0820922852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

156 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294798535 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294798535 AND published='1' LIMIT 1

157 (689.02969360352): select jos_twitters.link from jos_twitters where cat=10

158 (171.18453979492): select jos_facebook.link from jos_facebook where cat=10

159 (!!!!! 12624.979019165): select jos_google_plus.link from jos_google_plus where cat=10

160 (!!!!! 7811.0694885254): select jos_linkedin.link from jos_linkedin where cat=10

161 (!!!!! 9860.9924316406): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 10235.071182251): insert into jos_banners_delta values (14615,'2025-04-29 21:08:35','3.23.102.192','view'),(14202,'2025-04-29 21:08:35','3.23.102.192','view'),(14203,'2025-04-29 21:08:35','3.23.102.192','view')

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