Objective: The aim of this study was to investigate a practical method for incorporating radiographers\u27 reports with radiologists\u27 readings of digital mammograms. Methods: This simulation study was conducted using data from a free-response receiver operating characteristic observer study obtained with 75 cases (25 malignant, 25 benign and 25 normal cases) of digital mammograms. Each of the rating scores obtained by six breast radiographers was utilized as a second opinion for four radiologists\u27 readings with the radiographers\u27 reports. A logical "OR" operation with various criteria settings was simulated for deciding an appropriate method to select a radiographer\u27s report in all combinations of radiologists and radiographers. The average figure of merit (FOM) of the radiologists\u27 performances was statistically analysed using a jackknife procedure (JAFROC) to verify the clinical utility of using radiographers\u27 reports. Results: Potential improvement of the average FOM of the radiologists\u27 performances for identifying malignant microcalcifications could be expected when using radiographers\u27 reports as a second opinion. When the threshold value of 2.6 in Breast Imaging-Reporting and Data System (BI-RADS®) assessment was applied to adopt/ reject a radiographer\u27s report, FOMs of radiologists\u27 performances were further improved. Conclusion: When using breast radiographers\u27 reports as a second opinion, radiologists\u27 performances potentially improved when reading digital mammograms. It could be anticipated that radiologists\u27 performances were improved further by setting a threshold value on the BIRADS assessment provided by the radiographers. Advances in knowledge: For the effective use of a radiographer\u27s report as a second opinion, radiographers\u27 rating scores and its criteria setting for adoption/ rejection would be necessary
