ACR Members Weigh In on CAD Debate
The recent report in the New England Journal of Medicine that questioned the efficacy of computer-aided detection in interpreting mammograms has received wide-ranging responses from ACR members around the country. The report goes so far as to suggest that CAD technology can actually harm the patient because it tends to identify more suspicious lumps and leads to more biopsies without a corresponding increase in the detection of actual breast cancers.
In an accompanying NEJM editorial, ACR Fellow Ferris M. Hall, M.D., a professor of radiology at Harvard Medical School, noted that the results would certainly surprise a lot of radiologists. “I was surprised,” Hall said in an April 5 article in the New York Times. “A lot of people will be amazed.”
“[CAD] was questioned from time to time,” noted ACR Fellow Leonard Berlin, M.D., head of radiology at Rush North Shore Medical Center in Skokie, Ill., in an April 5 article in the Chicago Tribune. “But nobody suggested that CAD could be harmful – until now.”
ACR member Michael J. Ulissey, M.D., director of breast imaging at the University of Texas Southwestern Medical Center in Dallas told the Philadelphia Inquirer that he used to give lectures claiming that CAD would become the standard of care and that, after reading the report, his “head was kind of spinning.”
“With these data, I have to reconsider,” he said in the April 5 article. “We have an obligation to analyze whether CAD is really useful. I wonder if too many general radiologists are over-relying on CAD.”
Other ACR members say that the study simply means that, like most technology, there are positives and negatives.
“With less experienced readers, it can help because it draws their eye to something that might not otherwise have stopped them,” noted ACR member Gene R. Solmos, M.D., a breast imaging specialist at Rush Breast Imaging Center in Chicago, in the Tribune article. “But there’s less benefit for those who do it full time. It can mark a whole bunch of things that are nothing, which adds an extra step that may or may not be a benefit.”
Ultimately, however, no one expects radiologists to disregard CAD technology completely, but instead will refine the process as breast cancer screening technologies continue to evolve.
“The primary reasons we got CAD are that it was financially good for us and that everyone else was getting it,” Hall told the New York Times. “It was a competitive thing; there is no way CAD is dead.”
ACR member Edward J. Petrella, M.D., president of South Jersey Radiology Associates, and ACR Fellow Vijay M. Rao, M.D., chair of radiology at Thomas Jefferson Medical College, were also cited in the Philadelphia Inquirer article.
To read the Reuters news story on the NEJM article, please click here. The various newspaper stories can be reached at Chicago Tribune, Philadelphia Inquirer, and New York Times.