Improving the radiologist-CAD interaction: designing for appropriate trust
Open accessAbstract
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.
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The performance of the team of endoscopists and CADx is determined not only by the individual performances of endoscopists and CADx but also by the interaction between them.
“The performance of this”
From Appropriate trust in artificial intelligence for the optical diagnosis of colorectal polyps: the role of human/artificial intelligence interaction (2024) · cites this paper as [8]
The “Radiologist–CAD interaction” section (p. 3) says team performance depends on the individual performance of the radiologist and CAD system and the quality of their interaction. The cited paper concerns radiologists and CAD, not endoscopists and CADx, so it does not directly establish the claim for that team. (LLM, conf=0.88)
Experimental — accuracy not yet measuredHuman endoscopists' trust in algorithms is often not well calibrated.
“However, human endoscopists' trust in algorithms is often not well calibrated.8”
From Appropriate trust in artificial intelligence for the optical diagnosis of colorectal polyps: the role of human/artificial intelligence interaction (2024) · cites this paper as [8]
The review (p. 2) says radiologists often have an inappropriate level of trust in CAD, and the Radiologist–CAD interaction section (p. 3) describes inappropriate trust in automated aids more generally. It does not establish that this is often true specifically of human endoscopists. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAn important determinant for endoscopists whether or not to follow CADx predictions is endoscopists' trust in the validity of CADx predictions.
“An important determinant for endoscopists whether or not to follow CADx predictions is endoscopists' trust in the validity of CADx predictions.8”
From Appropriate trust in artificial intelligence for the optical diagnosis of colorectal polyps: the role of human/artificial intelligence interaction (2024) · cites this paper as [8]
The Radiologist–CAD interaction section (p. 3) says that people who trust an automated aid more are more likely to rely on its decisions. The Discussion (p. 7) applies this relationship to radiologists using CAD. The paper does not address endoscopists or CADx predictions, so the claim extends its conclusion to a different clinical setting. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAppropriate trust implies minimizing the negative performance outcomes through either overtrust or undertrust.
“Hence, appropriate trust implies minimizing the negative performance outcomes through either overtrust or undertrust.8,9”
From Appropriate trust in artificial intelligence for the optical diagnosis of colorectal polyps: the role of human/artificial intelligence interaction (2024) · cites this paper as [8]
Within radiology, it was suggested but not proven that higher levels of appropriate trust can be reached by adding confidence scores to predictions.
“Within radiology, it was suggested but not proven that higher levels of appropriate trust can be reached by adding confidence scores to predictions.8”
From Appropriate trust in artificial intelligence for the optical diagnosis of colorectal polyps: the role of human/artificial intelligence interaction (2024) · cites this paper as [8]
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Cites
Trust in Automation: Designing for Appropriate Reliance
Lee, J. D., & See, K. A. (2004) · Human Factors: The Journal of the Human Factors and Ergonomics Society · doi:10.1518/hfes.46.1.50_30392 · Cited by 6,605 · see citing works
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The role of trust in automation reliance
Dzindolet, M. T., Peterson, S. A., Pomranky, R. A., Pierce, L. G., & Beck, H. P. (2003) · International Journal of Human-Computer Studies · doi:10.1016/s1071-5819(03)00038-7 · Cited by 1,276 · see citing works
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Does automation bias decision-making?
SKITKA, L. J., MOSIER, K. L., & BURDICK, M. (1999) · International Journal of Human-Computer Studies · doi:10.1006/ijhc.1999.0252 · Cited by 694 · cited 1× · see citing works
“For example, Skitka et al. 44 found that participants performing a simulated fl ight task with an automated aid performed worse than unaided participants.”
MethodShortliffe, E. H., Davis, R., Axline, S. G., Buchanan, B. G., Green, C. C., & Cohen, S. N. (1975) · Computers and Biomedical Research · doi:10.1016/0010-4809(75)90009-9 · Cited by 493 · cited 1× · see citing works
“This local rationale approach has been implemented in automated aids from various domains (e.g., medical diagnosis, 68 fi nancial auditing, 69,70 and entertainment recommendation 71 e 73 ).”
MethodThe Perceived Utility of Human and Automated Aids in a Visual Detection Task
Dzindolet, M. T., Pierce, L. G., Beck, H. P., & Dawe, L. A. (2002) · Human Factors: The Journal of the Human Factors and Ergonomics Society · doi:10.1518/0018720024494856 · Cited by 386 · see citing works
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Integrity-based Explanations for Fostering Appropriate Trust in AI Agents
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Filice, R. W., & Ratwani, R. M. (2020) · Radiology: Artificial Intelligence · doi:10.1148/ryai.2020190095 · Cited by 30 · see citing works
van der Zander, Q. E. W., Roumans, R., Kusters, C. H. J., Dehghani, N., Masclee, A. A. M., de With, P. H. N., van der Sommen, F., Snijders, C. C. P., & Schoon, E. J. (2024) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2024.06.029 · Cited by 27 · see citing works
- Authors
- Jorritsma, W., Cnossen, F., & van Ooijen, P. M. A.
- Affiliations
- University Medical Center Groningen (NL)
- University of Groningen (NL)
- Corresponding author
- Jorritsma, W.
- ORCID
- Cnossen, F.
- Venue
- Clinical Radiology
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 70
- Issue
- 2
- Pages
- 115-122
- ISSN
- 0009-9260 (ISSN-L)
- OpenAlex
- W2158646765
- Cited by
- 61
- References
- 8
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 11 · 2023: 3 · 2022: 5 · 2021: 8 · 2020: 8 · 2019: 6 · 2018: 6 · 2017: 2 · 2016: 3
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Clinical Radiology (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Social Sciences › Psychology › Social Psychology › Human-Automation Interaction and Safety
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Keywords
- computer-aided diagnosis, trust in automation, human-automation interaction, CAD system design, diagnostic performance, observer study, diagnostic errors, trust calibration
- MeSH terms
- Attitude to Computers, Humans, Radiographic Image Interpretation, Computer-Assisted, Radiology, Reproducibility of Results, Trust
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