Double reading.

Clearly, the cost of double reading varies with the approach used. The Massachusetts General Hospital method can only lead to an increase in recalls and the costs that these engender (anxiety for the women recalled, trauma from any biopsies obtained, and the actual monetary costs of additional imaging and interventions). It is of interest that one potential cost, the concern that women recalled may be reluctant to participate again in screening, does not seem to be the case. Women who are recalled appear to be more likely to participate in future screening. Double interpretation where there must be a consensus between the interpreting radiologists, and if this cannot be reached a third arbiter, is the most labor intensive, but can reduce the number of recalls in a double reading system. Computer systems have been developed to act as a second reader. The films must be digitized and then fed through the reader, but studies suggest that the computer can identify cancers that may be overlooked by a human reader. The challenge is to do this without too many false-positive calls. If the radiologist finds the false-positives are too numerous and distracting, then the system is not used. As digital mammographic systems proliferate, and computer algorithms become more sophisticated, the second human reader will likely be replaced by a computer-aided detection system and double reading will become the norm.