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Materials and Methods: The contributing institutions performed the examinations under approval of their local institutional review board, with waiver of informed consent, for this HIPAA-compliant study. A cohort of 100 colonoscopy-proved cases was used: In 52 patients with findings positive for polyps, 74 polyps of 6 mm or larger were observed in 65 colonic segments; in 48 patients with findings negative for polyps, no polyps were found. Nineteen blinded readers interpreted each case at two different times, with and without the assistance of a commercial CAD system. The effect of CAD was assessed in segment-level and patient-level receiver operating characteristic (ROC) curve analyses. Results: Thirteen (68%) of 19 readers demonstrated higher accuracy with CAD, as measured with the segment-level area under the ROC curve (AUC).

The readers’ average segment-level AUC with CAD (0.758) was significantly greater ( P =.015) than the average AUC in the unassisted read (0.737). Readers’ per-segment, per-patient, and per-polyp sensitivity for all polyps of 6 mm or larger was higher ( P. Introduction Computed tomographic (CT) colonography is gaining acceptance as a method to screen the colon and rectum for polyps and masses, but there is a substantial learning curve (,), and sensitivity remains variable (). Computer-aided detection (CAD) has been proposed as a way to help readers (–)—particularly novice readers (–)—achieve a high sensitivity without unduly reducing specificity or adversely affecting reading time (,).

Because many polyps readers are often visible in retrospect (), CAD is expected to help readers improve sensitivity. In stand-alone studies (–), CAD has been shown to be sensitive for detection of polyps, but reader studies are critical to demonstrate the practical value of CAD because readers may accept or reject CAD marks, and there is a potential for sensitivity and specificity to improve or deteriorate. Multireader CAD trials, to date, have generally included either small patient cohorts or small numbers of readers, often addressing a specific narrow question (,,,–) such as cost-effectiveness of CAD (). Two trials have included low-prevalence cohorts () or large cohorts (). Furthermore, different CAD systems function differently, and only limited extrapolation can be made among fundamentally different software programs. This study was performed to assess the effect of the use of CAD in the second-read mode on readers’ accuracy in interpreting CT colonographic images.