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QA of CAD is important so that end users can be made aware of changes in CAD performance both due to intentional or unintentional causes. In addition, end-user training is critical to prevent improper use of CAD, which could potentially result in lower overall clinical performance. The purpose of this paper is to bring attention to these issues, inform the readers of the opinions of the members of the American Association of Physicists in Medicine AAPM CAD subcommittee, and thus stimulate further discussion in the CAD community on these topics.
The work items may serve as a framework for the discussion Dating marlin rifles Frauen dating kostenlos eventual design of detailed QA and Best online dating sites free SLIDES: Carestream Health and Global Product Level Information Deploym procedures for physicists and users of CAD.
The eventual standardization of the requirements of QA procedures for CAD will have to be determined through consensus from members of the CAD community, and user training may require support of professional societies. It is expected that high-quality CAD and proper use of CAD could allow these systems to achieve their true potential, thus benefiting both the patients and the clinicians, and may bring about more widespread clinical use of CAD for many other diseases and applications.
It is hoped that the awareness of the need for appropriate CAD QA and user training will stimulate new ideas and approaches for implementing such procedures efficiently and effectively as well as funding opportunities to fulfill such critical efforts.
CAD is increasingly used for decision support by healthcare professionals for detection and interpretation of diseases occurring in various organs of the body. CAD is also rapidly expanding to provide additional functionalities such as estimates of the likelihood of a lesion being malignant or the risk of developing a disease, quantitative measurement tools e.
The acceptance of CAD by clinicians would lead to further improvement in the current CAD systems and opportunities for research and development of new applications. CAD products can be accepted in clinical use only if they can provide clinical benefit that outweighs the potential associated risks. There are many aspects of CAD that are important to meet this goal. All along the lifecycle of a CAD system i.
However, there is only limited training offered to the end Best online dating sites free SLIDES: Carestream Health and Global Product Level Information Deploym and limited quality assurance QA testing performed on the system. For example, no requirements or procedures have been developed to assure and analyze the quality of CAD and the use of CAD over time at clinical sites. Therefore, the end users may not be alerted to any unexpected changes in CAD performance and do not have the ability to easily identify any potential issue that may arise.
The purpose of this paper is to review the current status of the work done on the last two topics i. It is hoped that, by recognizing the need for appropriate CAD QA and user training to ensure the effectiveness of CAD in clinical practice, the community will begin to work on developing and implementing some of the procedures.
The potential benefits of improved quality and scientific rigor of CAD in clinical use may eventually outweigh the costs associated with QA requirements and regulations. Note that the proposed set of guidelines as contained in this paper has been established through discussions among a number of experts in CAD who worked through a series of questions see Sec.
Sections II B and II C present detailed procedures required to assure that a CAD system functions and performs according to vendor's specifications and to assure consistency of its performance over time, respectively. Note that Photos and profiles of Ukrainian women 40-60 years old for dating of the recommendations are considered by the subcommittee to Your dating site free messaging is empty. reasonably easy and practical and can be Best online dating sites free SLIDES: Carestream Health and Global Product Level Information Deploym immediately by the end users.
It should be noted that the testing procedures discussed in Sec. II do not cover all the testing that may be required for all possible CAD systems. For example, additional QA procedures may be required for CAD systems intended for determining the likelihood of malignancy for a suspicious abnormality, and estimating the risk Your dating site free messaging is empty. developing a disease or not responding to treatment.
These packages could potentially benefit from QA testing. Although the specifics and extent of the testing may vary from one application to another and we often use the more commonly used lesion detection CAD as examples, the general principles and considerations discussed herein should be applicable to the various types of computer-assisted diagnostic software tools.
Seven Examples of funny online dating profiles SLIDES: Carlisle Brake Frictions Aras PLM Implementation were used to guide development and recommendation of a set of general guidelines for CAD QA procedures.
Responses to these questions were not made specific to a particular CAD application and are detailed below. CAD QA should be performed by designated quality assurance personnel with adequate training to perform the QA procedures, e. For testing CAD system performance, the measures may include, for example:. The following data may be captured, tracked, and reported from either visual assessment or automated computer analysis:.
These data sets are usually small. Acceptance testing procedures ensure that the CAD or upgraded CAD is installed properly, functions correctly, and integrates properly with image acquisition and display hardware and software e. Such procedures should be adopted by all CAD manufacturers including those that market and deliver the CAD system through the Internet. The test results should be documented as a reference for future QA of consistency.
There are also situations where the clinical sites want to repeat such acceptance testing procedures using either the manufacturer's sample test set or their own independent data set s see requirements on data sets in Sec. It is therefore important that all clinical Best online dating sites free SLIDES: Carestream Health and Global Product Level Information Deploym be trained and encouraged to perform CAD acceptance testing.
Such QA procedures can be implemented immediately at clinical sites. Currently, results of such acceptance testing or QA procedures are not documented at clinical sites.
It is recommended that the test records should be kept for example, in the form of a log book or archived in a designated QA database to allow subsequent review and comparison. As recommended in general guidelines R5 see Sec. II Athese may include the CAD final output results as well as intermediate results, pertinent notes on the results obtained, and any relevant information on problems encountered during the installation or upgrades of the CAD system. QA personnel at the clinical sites should independently evaluate performance in accordance with the specifications given by the CAD manufacturer.
Adequate training and written instructions provided by the manufacturer are necessary to ensure that site personnel can perform QA tests correctly. For an upgrade of the CAD software, the manufacturer should inform the site personnel of any expected changes.
The site personnel should be advised to compare the CAD results before and after the upgrade and communicate any unexpected differences. It is important to understand whether or not the differences are intended by the upgrade. However, if the test set is small, one may not see the expected differences e. For some modalities such as mammography, only the software for display of the CAD output is provided on the workstation. However, if a clinical workstation is a part of the picture archiving and communication system PACSthe workstation may also offer software for display or analysis of other image modalities.
The different software may have unforeseen effects on one another, most likely resulting from changes in the system configurations when software is installed or upgraded.
Therefore, when other software either CAD or non-CAD is installed on a workstation or PACS system, it is important to perform QA procedures of all software including CAD that resides on the workstation in order to verify that it still functions correctly and in accordance with performance specifications.
The results of QA tests for CAD should be identical before and after installation of other software on the workstation. As such, comparison of previous and current CAD marks, or quantitative outputs for some CAD systems in a few test images, should suffice. Such QA procedures can be implemented immediately and encouraged at clinical sites.
A fixed set of test cases is recommended for acceptance testing at the first installation and subsequent upgrades of the CAD software. For convenient QA testing of consistency in performance, use of a CAD manufacturer-provided data set is appropriate.
This data set should represent the typical performance of the system, and the specific CAD behavior on those cases, including truth, locations of CAD marks, and resulting sensitivity and specificity or other quantitative output should be well documented.
Such test sets can be made available immediately to the end users. Because a manufacturer's sample is likely to be limited and thus cannot be considered representative of the patient population seen at individual clinical sites, clinical sites are also encouraged to collect their own sets of test cases for performance assessment.
It is advisable to collect a sufficient number of cases and use the automatic analysis tools to obtain a reliable estimate of the average performance. The data sets may come from existing databases at that site or third party sites, or they may be collected prospectively after installation of the CAD system. For a user-collected independent test set, the user Best online dating sites free SLIDES: Carestream Health and Global Product Level Information Deploym responsible for collecting Best online dating sites free SLIDES: Carestream Health and Global Product Level Information Deploym standards required to assess the CAD system performance, following instructions and using tools provided by the CAD manufacturer e.
The reference standard for each case has to be established by a clinician or other qualified personnel. It is recognized Best online dating sites free SLIDES: Carestream Health and Global Product Level Information Deploym collecting such independent test data sets will require both additional effort and Best online dating sites free SLIDES: Carestream Health and Global Product Level Information Deploym.
Visual assessment of individual cases allows users to review images along with CAD output. It provides users the opportunity to assess performance specific to lesion type and identify any quality issues related to the display of CAD results. For lesion detection CAD systems, for example, users can track the performance by counting and visually assessing the CAD marks. However, it will be impractical, if not impossible, to score manually the overall performance of the CAD system in a substantially large data set or compare the results quantitatively or statistically with some expected performance level.
Therefore, it is recommended that CAD system manufacturers provide built-in automatic scoring functionality.
This automatic QA will run the test cases in batch mode and report the resulting sensitivity and specificity relative to the collected reference standards. On the other hand, even with fully automatic QA, it is recommended that each clinical site performs visual checks to ensure that the output of the CAD system, such as lesion segmentation or CAD mark locations, is reasonable and consistent.
Automatic analysis would require proper evaluation software tools and validation of the reference standards used for scoring see details in Sec. II A responses and recommendations to Q3. Automatic assessment of CAD QA performance would be the best practice approach but may require significant effort from CAD manufacturers or any pertinent parties to implement or incorporate the functionality as QA tools. It is recognized that even with fully automatic scoring and reporting, the interpretation of test results for locally collected data may be more complex than testing with the manufacturer's data set.
For example, the local CAD performance may differ when compared against the manufacturer's claims or tests conducted at other sites. The difference may be attributed to many factors, such as a a true difference in the CAD performance if the test set is sufficiently large and representative of the local population, b difference in the image quality between the local data set and the manufacturer's data set, c statistical uncertainty due to the sample size of the independent test set, or d one or both of the test sets are biased.
As discussed elsewhere in this report, such variability may or may not necessarily indicate problems with the CAD system, and the interpretation of such test results in the absolute sense requires caution. Some guidelines on independent testing, sample size, and quality of the test data set, and statistical interpretation of test results may be found in a report to be published by the AAPM CADSC Groups 1 and 2 3 and in the literature. Tracking the performance of a CAD system over time is an important QA procedure to ensure that the CAD system is consistent within its performance specifications.
Tracking the performance after initial installation could help monitor, for example, whether variability that may occur in a component of the imaging chain affects the performance of the CAD system, or whether an upgrade by the CAD manufacturer actually improves the performance in the local patient population.
CAD systems for lesion detection are discussed below as an example. Tracking the number of CAD marks per image over time on routine clinical cases is the most efficient and effective way to detect any unusual behavior of a CAD detection system.
The QA procedure to track the running average number of CAD marks per image over N consecutive patients at any given time can be completely automated. The CAD mark rate monitor in the form of a graph giving the average number of CAD marks as a function of time may be inspected periodically by QA personnel. Visual inspection of the time-series plot could greatly inform the end users on the stability of the CAD system over time.
If the QA test on an archived data set does not show a change, but deleterious changes are observed with routine clinical cases, the imaging chain should be evaluated for changes in image acquisition and processing. Such a QA procedure is reasonably easy and practical to implement, but it requires development of an automated recording and storage capability for the number of CAD marks for each image as well as software to generate and display a graph of the QA results.
As described in Secs. However, additional effort is required to establish an independent database of abnormal cases and to perform automatic performance evaluation. It should be noted that once the database is established, the database can be used to check the sensitivity of the CAD system both for new installation and after subsequent upgrades. An alternative to accumulating consecutive abnormal cases by the end users is to use a third-party or public database, if available.
In addition, CAD manufacturers could provide software tools that allow users to collect the data set and reference truths and calculate the sensitivity as described in the general guidelines see Sec. II A to facilitate such evaluation in case the end users want to evaluate the sensitivity of the CAD system on their own patient population.
Whether the sensitivity assessment on a nonmanufacturer-provided data set should be included as an acceptance or a routine QA test will be a topic of discussion for the CAD community. However, best practices have not been established for CAD training. Radiologists have been anecdotally somewhat resistant to formal CAD training.
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