通过根据促进视觉适应的特征排序筛查乳腺X线摄影，提高放射科医师的阅读表现

背景 乳腺X线摄影的背景特征可能刺激人体视觉适应，从而使放射科医师更有效地检测异常。然而，目前尚不清楚密度或其他影像特征是否驱动了视觉适应。目的 本研究旨在探讨当按可能促进视觉适应的乳腺X线摄影特征对筛查乳腺X线片进行排序时，筛查表现是否得到改善。材料与方法 本回顾性多读者多病例研究使用2016年9月至2019年5月期间获得的乳腺X线摄影进行。每份筛查检查由13名放射科医师以三种不同的顺序解读：随机顺序、按容积乳腺密度（VBD）递增顺序以及基于自我监督学习（SSL）编码（自动将检查归为“相似”）的顺序。使用眼动仪记录放射科医师在解读过程中的眼动。将随机排序的读取的受试者工作特性曲线下面积（AUC）、敏感性和特异性与VBD和SSL排序的结果进行混合模型方差分析比较。使用Wilcoxon符号秩检验比较阅读时间、注视次数和感知密度。结果 研究对象包括150名女性（中位年龄55岁[四分位数：50-63]），每人进行75例有乳腺癌和75例无乳腺癌的乳腺X线检查。按VBD递增排序的检查相比随机排序，AUC有所提高（0.93[95% CI: 0.91, 0.96]对比0.92[95% CI: 0.89, 0.95]；P = .009），而特异性（89%[871/975]对比86%[837/975]，P = .04）和敏感性（均为81%[794/975对比788/975]，P = .78）无显著差异，且阅读时间（24.3秒对比27.9秒，P < .001）、注视次数（47对比52，P < .001）以及在恶性区域的注视时间（3.7秒对比4.6秒，P < .001）均减少。SSL排序的阅读中，AUC（0.92[95% CI: 0.89, 0.95]；P = .70）、特异性（84%[820/975]，P = .37）、敏感性（80%[784/975]，P = .79）、注视次数（54，P = .05）和在恶性区域的注视时间（4.6秒，P > .99）与随机排序无显著差异。SSL排序的阅读时间明显长于随机排序（28.4秒，P = .02）。结论 按照低到高VBD排序的乳腺X线摄影能改善筛查表现，同时缩短阅读和注视时间。

Background Mammographic background characteristics may stimulate human visual adaptation, allowing radiologists to detect abnormalities more effectively. However, it is unclear whether density, or another image characteristic, drives visual adaptation. Purpose To investigate whether screening performance improves when screening mammography examinations are ordered for batch reading according to mammographic characteristics that may promote visual adaptation. Materials and Methods This retrospective multireader multicase study was performed with mammograms obtained between September 2016 and May 2019. The screening examinations, each consisting of four mammograms, were interpreted by 13 radiologists in three distinct orders: randomly, by increasing volumetric breast density (VBD), and based on a self-supervised learning (SSL) encoding (examinations automatically grouped as "looking similar"). An eye tracker recorded radiologists' eye movements during interpretation. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of random-ordered readings were compared with those of VBD- and SSL-ordered readings using mixed-model analysis of variance. Reading time, fixation metrics, and perceived density were compared using Wilcoxon signed-rank tests. Results Mammography examinations (75 with breast cancer, 75 without breast cancer) from 150 women (median age, 55 years [IQR, 50-63]) were read. The examinations ordered by increasing VBD versus randomly had an increased AUC (0.93 [95% CI: 0.91, 0.96] vs 0.92 [95% CI: 0.89, 0.95]; P = .009), without evidence of a difference in specificity (89% [871 of 975] vs 86% [837 of 975], P = .04) and sensitivity (both 81% [794 of 975 vs 788 of 975], P = .78), and a reduced reading time (24.3 vs 27.9 seconds, P < .001), fixation count (47 vs 52, P < .001), and fixation time in malignant regions (3.7 vs 4.6 seconds, P < .001). For SSL-ordered readings, there was no evidence of differences in AUC (0.92 [95% CI: 0.89, 0.95]; P = .70), specificity (84% [820 of 975], P = .37), sensitivity (80% [784 of 975], P = .79), fixation count (54, P = .05), or fixation time in malignant regions (4.6 seconds, P > .99) compared with random-ordered readings. Reading times were significantly higher for SSL-ordered readings compared with random-ordered readings (28.4 seconds, P = .02). Conclusion Screening mammography examinations ordered from low to high VBD improved screening performance while reducing reading and fixation times.