Open Access Research article

Is single reading with computer-aided detection (CAD) as good as double reading in mammography screening? A systematic review

Edward Azavedo14, Sophia Zackrisson2*, Ingegerd Mejàre3 and Marianne Heibert Arnlind34

Author affiliations

1 Department of Diagnostic Radiology, Karolinska Institutet, Stockholm, Sweden

2 Department of Clinical Sciences in Malmö, Diagnostic Radiology, Lund University, Skåne University Hospital Malmö, Malmö, SE-205 02, Sweden

3 Swedish Council on Health Technology Assessment (SBU), Stockholm, Sweden

4 LIME/MMC, Karolinska Institutet, Stockholm, Sweden

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Citation and License

BMC Medical Imaging 2012, 12:22  doi:10.1186/1471-2342-12-22

Published: 24 July 2012



In accordance with European guidelines, mammography screening comprises independent readings by two breast radiologists (double reading). CAD (computer-aided detection) has been suggested to complement or replace one of the two readers (single reading + CAD).

The aim of this systematic review is to address the following question: Is the reading of mammographic x-ray images by a single breast radiologist together with CAD at least as accurate as double reading?


The electronic literature search included the databases Pub Med, EMBASE and The Cochrane Library. Two independent reviewers assessed abstracts and full-text articles.


1049 abstracts were identified, of which 996 were excluded with reference to inclusion and exclusion criteria; 53 full-text articles were assessed for eligibility. Finally, four articles were included in the qualitative analysis, and one in a GRADE synthesis.


The scientific evidence is insufficient to determine whether the accuracy of single reading + CAD is at least equivalent to that obtained in standard practice, i.e. double reading where two breast radiologists independently read the mammographic images.

CAD; Mammography; Screening; Breast; Cancer; Single reading; Double reading