Sparse Bayesian mass-mapping with uncertainties: hypothesis testing of structure

A crucial aspect of mass-mapping, via weak lensing, is quantification of the uncertainty introduced during the reconstruction process. Properly accounting for these errors has been largely ignored to date. We present results from a new method that reconstructs maximum a posteriori (MAP) convergence maps by formulating an unconstrained Bayesian inference problem with Laplace-type $\ell_1$-norm sparsity-promoting priors, which we solve via convex optimization. Approaching mass-mapping in this manner allows us to exploit recent developments in probability concentration theory to infer theoretically conservative uncertainties for our MAP reconstructions, without relying on assumptions of Gaussianity. For the first time these methods allow us to perform hypothesis testing of structure, from which it is possible to distinguish between physical objects and artifacts of the reconstruction. Here we present this new formalism, demonstrate the method on illustrative examples, before applying the developed formalism to two observational datasets of the Abel-520 cluster. In our Bayesian framework it is found that neither Abel-520 dataset can conclusively determine the physicality of individual local massive substructure at significant confidence. However, in both cases the recovered MAP estimators are consistent with both sets of data

Mammography workstation design: effect on mammographer behaviour and the risk of musculoskeletal disorders

In the UK Breast Screening Programme there is a growing transition from film to digital mammography, and consequently a change in mammography workstation ergonomics. This paper investigates the effect of the change for radiologists including their comfort, likelihood of developing musculoskeletal disorders (MSD’s), and work practices. Three workstations types were investigated: one with all film mammograms; one with digital mammograms alongside film mammograms from the previous screening round, and one with digital mammograms alongside digitised film mammograms from the previous screening round. Mammographers were video-taped whilst conducting work sessions at each of the workstations. Event based Rapid Upper Limb Assessment (RULA) postural analysis showed no overall increase in MSD risk level in the switch from the film to digital workstation. Average number of visual glances at the prior mammograms per case measured by analysis of recorded video footage showed an increase if the prior mammograms were digitised, rather than displayed on a multi-viewer (p<.05). This finding has potential implications for mammographer performance in the transition to digital mammography in the UK

The human factors surrounding system change in breast cancer screening: a case study

Screening for breast cancer involves examination of mammograms. Conventional filmscreen mammography is being surpassed with the implementation of digital soft copy film reporting. However, little thought has been given to the human factors associated with the allied period of system changeover. This study considered the human factors implications with respect to comfort, performance and efficiency of work tasks. The purpose of this project was to examine the human factors issues surrounding the implementation of the new technology and prepare recommendations relevant to practitioners for improved implementation practice. A combination of techniques (expert walkthroughs, verbal protocol analysis, interviews, work station assessments) were applied to examine existing and revised working practices during mammography film reading. Eight Radiologists and Radiographer Advanced Practitioners within two Breast Screening Units participated to enable a thorough understanding to be gained of strategies adopted when using the different systems and the combination of systems. A variety of changes in working practices were recognised to have occurred with the new system (digital) implementation. There was an impact upon technique, comfort, performance and efficiency during digital soft copy reporting when viewing analogue priors. Subsequent recommendations for workstation design, working practices and training were produced to assist in improved implementation of digital processes in mammography. The project demonstrated that implementation of new technology needs to be thoroughly assessed to alleviate any potentially problematic human factors issues

A method for exploratory repeated-measures analysis applied to a breast-cancer screening study

When a model may be fitted separately to each individual statistical unit, inspection of the point estimates may help the statistician to understand between-individual variability and to identify possible relationships. However, some information will be lost in such an approach because estimation uncertainty is disregarded. We present a comparative method for exploratory repeated-measures analysis to complement the point estimates that was motivated by and is demonstrated by analysis of data from the CADET II breast-cancer screening study. The approach helped to flag up some unusual reader behavior, to assess differences in performance, and to identify potential random-effects models for further analysis.Comment: Published in at http://dx.doi.org/10.1214/11-AOAS481 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Influencing clinicians and healthcare managers: can ROC be more persuasive?

Receiver Operating Characteristic analysis provides a reliable and cost effective performance measurement tool, without using full clinical trials. However, when ROC analysis shows that performance is statistically superior in one condition than another it is difficult to relate this result to effects in practice, or even to determine whether it is clinically significant. In this paper we present two concurrent analyses: using ROC methods alongside single threshold recall rate data, and suggest that reporting both provides complimentary data. Four mammographers read 160 difficult cases (41% malignant) twice, with and without prior mammograms. Lesion location and probability of malignancy was reported for each case and analyzed using JAFROC. Concurrently each participant chose recall or return to screen for each case. JAFROC analysis showed that the presence of prior mammograms improved performance (p<.05). Single threshold data showed a trend towards a 26% increase in the number of false positive recalls without prior mammograms (p=.056). If this trend were present throughout the NHS Breast Screening Programme then discarding prior mammograms would correspond to an increase in recall rate from 4.6% to 5.3%, and 12,414 extra women recalled annually for assessment. Whilst ROC methods account for all possible thresholds of recall and have higher power, providing a single threshold example of false positive, false negative, and recall rates when reporting results could be more influential for clinicians. This paper discusses whether this is a useful additional method of presenting data, or whether it is misleading and inaccurat

Double reading in breast cancer screening : cohort evaluation in the CO-OPS trial

Purpose: To investigate the effect of double readings by a second radiologist on recall rates, cancer detection and characteristics of cancers detected in the National Health Service Breast Screening Program in England. Materials and Methods: In this retrospective analysis we evaluated 805,206 women through screening and diagnostic test results by extracting one year of routine data from 33 English breast screening centers. Centers used double reading of digital mammograms, with arbitration if there were discrepant reads. Information on reader decisions, with results of follow-up tests, were used to explore the effect of the second reader. The statistical tests used were the test for equality of proportions, the χ2 test for independence and the t-test. Results: The first reader recalled 4·76%, (38295/805206, 95% CI 4·71%-4·80%) of women. Two readers recalled 6·19% in total, (49857/805206, 95% CI 6·14%- 6·24%), but arbitration of discordant reads reduced recall rate to 4·08%, (32863/805206, 95% CI 4·04%-4·12%, p<0.001). 7055 cancers were detected of which 627 (8·89%, 95% CI 8·22%-9·55%, p<0.001) were detected by the second reader only. These additional cancers were more likely to be ductal carcinoma in situ, (30·5% (183/600) vs 22.0% (1344/6114), p<0.001); and additional invasive cancers were smaller (mean 14·2mm vs 16·7mm, p<0.001), had fewer involved nodes, and were likely to be lower grade. Conclusion: Double reading with arbitration reduces recall and increases cancer detection compared to single reading. Cancers detected only by the second reader were smaller, lower grade, and had less nodal involvement

Impact of Digital Mammography on Cancer Detection and Recall Rates: 11.3 Million Screening Episodes in the English National Health Service Breast Cancer Screening Program.

Purpose To report the impact of changing from screen-film mammography to digital mammography (DM) in a large organized national screening program. Materials and Methods A retrospective analysis of prospectively collected annual screening data from 2009-2010 to 2015-2016 for the 80 facilities of the English National Health Service Breast Cancer Screening Program, together with estimates of DM usage for three time periods, enabled the effect of DM to be measured in a study of 11.3 million screening episodes in women aged 45-70 years (mean age, 59 years). Regression models were used to estimate percentage and absolute change in detection rates due to DM. Results The overall cancer detection rate was 14% greater with DM (P < .001). There were higher rates of detection of grade 1 and 2 invasive cancers (both ductal and lobular), but no change in the detection of grade 3 invasive cancers. The recall rate was almost unchanged by the introduction of DM. At prevalent (first) screening episodes for women aged 45-52 years, DM increased the overall detection rate by 19% (P < .001) and for incident screening episodes in women aged 53-70 years by 13% (P < .001). Conclusion The overall cancer detection rate was 14% greater with digital mammography with no change in recall rates and without confounding by changes in other factors. There was a substantially higher detection of grade 1 and grade 2 invasive cancers, including both ductal and lobular cancers, but no change in the detection of grade 3 invasive cancers. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by C.I. Lee and J.M. Lee in this issue

The time course of cancer detection performance

The purpose of this study was to measure how mammography readers' performance varies with time of day and time spent reading. This was investigated in screening practice and when reading an enriched case set. In screening practice records of time and date that each case was read, along with outcome (whether the woman was recalled for further tests, and biopsy results where performed) was extracted from records from one breast screening centre in UK (4 readers). Patterns of performance with time spent reading was also measured using an enriched test set (160 cases, 41% malignant, read three times by eight radiologists). Recall rates varied with time of day, with different patterns for each reader. Recall rates decreased as the reading session progressed both when reading the enriched test set and in screening practice. Further work is needed to expand this work to a greater number of breast screening centres, and to determine whether these patterns of performance over time can be used to optimize overall performance