Improving the radiologist-CAD interaction: designing for appropriate trust.

Computer-aided diagnosis (CAD) has great potential to improve radiologists' diagnostic performance. However, the reported performance of the radiologist-CAD team is lower than what might be expected based on the performance of the radiologist and the CAD system in isolation. This indicates that the interaction between radiologists and the CAD system is not optimal. An important factor in the interaction between humans and automated aids (such as CAD) is trust. Suboptimal performance of the human-automation team is often caused by an inappropriate level of trust in the automation. In this review, we examine the role of trust in the radiologist-CAD interaction and suggest ways to improve the output of the CAD system so that it allows radiologists to calibrate their trust in the CAD system more effectively. Observer studies of the CAD systems show that radiologists often have an inappropriate level of trust in the CAD system. They sometimes under-trust CAD, thereby reducing its potential benefits, and sometimes over-trust it, leading to diagnostic errors they would not have made without CAD. Based on the literature on trust in human-automation interaction and the results of CAD observer studies, we have identified four ways to improve the output of CAD so that it allows radiologists to form a more appropriate level of trust in CAD. Designing CAD systems for appropriate trust is important and can improve the performance of the radiologist-CAD team. Future CAD research and development should acknowledge the importance of the radiologist-CAD interaction, and specifically the role of trust therein, in order to create the perfect artificial partner for the radiologist. This review focuses on the role of trust in the radiologist-CAD interaction. The aim of the review is to encourage CAD developers to design for appropriate trust and thereby improve the performance of the radiologist-CAD team.

Responsiveness of the Roland-Morris Disability Questionnaire: consequences of using different external criteria.

OBJECTIVE: To determine the consequences of using different external criteria on responsiveness of the Roland-Morris Disability Questionnaire (RMDQ) in patients with chronic low back pain. DESIGN: Questionnaire measures before and after rehabilitation treatment. SETTING: Rehabilitation centre. SUBJECTS: Patients with nonspecific chronic low back pain, referred for treatment. MAIN MEASURES: The RMDQ was used to assess self-reported functional status. The used external criteria were: (1) global perceived effect of change in complaints; (2) global perceived effect of change in ability to take care of oneself; (3) change in rating of pain intensity; (4) smallest real difference. Standardized response means, pooled effect sizes and receiver operating curves were calculated to determine responsiveness and to enable comparison of effect sizes with the thresholds of Cohen. RESULTS: Standardized response means ranged from 1.33 to 3.45, pooled effect sizes ranged from 1.50 to 2.81, and areas under curves ranged from 0.76 to 1.00, dependent on the used external criterion. CONCLUSIONS: All pooled effect sizes were well above 0.80, and all other statistics were high, indicating good responsiveness of the RMDQ. However, considerable differences were found in responsiveness, when using different external criteria in a same study population. Therefore, it can be concluded that the magnitude of the responsiveness statistic depends on the used external criteria.

Assessment and treatment of chronic work-related pain disorders in an outpatient university rehabilitation setting in The Netherlands.

Points of view of the assessment and treatment of chronic work-related disorders in a Dutch university rehabilitation setting are described. After a general introduction in which the basic philosophy is outlined, medical issues as well as issues regarding two treatment programs and the evaluation of functional capacity are described. The article ends with a brief description of current and future research programs.