Fig. 1
Comparison between the standard screening workflow and the study scenarios
(A) The standard screening workflow in which the combined reading outcome of each mammogram is the result of independent, blinded double reading with arbitration for discordant readings. (B) The Standalone AI scenario in which the AI system replaces all readers, and the AI detection accuracy is compared to that of the first reader in the study sample. (C) The AI-integrated screening scenario in which AI replaces the first reader in the standard screening workflow, and the detection accuracy of the simulated screening setup is compared to that of the combined reading outcome from the study sample.
In both study scenarios (A) and (B), a binary AI score was defined by applying two different thresholds for the AI decision outcome. The cut-off points were chosen by matching at the mean sensitivity and specificity of the first reader outcome, AIsens and AIspec, respectively. If the AI and second reader decisions were discordant in the AI-integrated screening scenario and an arbitration decision was lacking in the original dataset, the arbitration decision outcome was simulated to match the same accuracy level of the original arbitrator from the study sample