背景 乳腺X线摄影背景特征可能会刺激人类视觉适应，使放射科医生能够更有效地检测异常情况。然而，尚不清楚密度或其他图像特征是否会驱动视觉适应。目的 调查根据可能促进视觉适应的乳房 X 线摄影特征，安排筛查性乳房 X 线摄影检查进行批量读取时，筛查性能是否会有所改善。材，并基于自我监督学习 (SSL) 编码（考试自动分组为“看起来相似”）。眼动仪记录了放射科医生在判读过程中的眼球运动。使用混合模型方差分析将随机排序读数的受试者工作特征曲线下面积 (AUC)、敏感性和特异性与 VBD 和 SSL 排序读数进行比较。使用 Wilcoxon 符号秩检验比较阅读时间、注视指标和感知密度。结果 读取了 150 名女性（中位年龄 55 岁 [IQR，50-63]）的乳房 X 光检查（75 名患有乳腺癌，75 名未患乳腺癌）。通过增加 VBD 进行的检查与随机进行的检查相比，AUC 有所增加（0.93 [95% CI: 0.91, 0.96] vs 0.92 [95% CI: 0.89, 0.95]；P = .009），但没有证据表明特异性存在差异（89 % [975 中的 871] 与 86% [975 中的 837]，P = .04）和灵敏度（均为 81% [975 中的 794 与 975 中的 788]，P = .78），以及缩短的读取时间（24.3 与27.9 秒，P < .001）、注视计数（47 与 52，P < .001）以及恶性区域的注视时间（3.7 与 4.6 秒，P < .001）。对于 SSL 排序读数，没有证据表明 AUC（0.92 [95% CI：0.89, 0.95]；P = .70）、特异性（84% [975 中的 820]，P = .37）、敏感性（与随机排序的读数相比，80% [784 of 975]，P = .79）、注视计数（54，P = .05）或恶性区域的注视时间（4.6 秒，P > .99）。与随机排序读数相比，SSL 排序读数的读取时间明显更长（28.4 秒，P = .02）。结论 按从低到高 VBD 顺序排列的筛查性乳房 X 光检查可提高筛查性能，同时减少读取和固定时间。 © RSNA，2024 本文提供补充材料。另请参阅本期格林的社论。

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. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grimm in this issue.