Effect of the number of cases in image database on the performance of computer-aided diagnosis (CAD) for the detection of pulmonary nodules in chest radiographs

We investigated the effect of the number of cases included in an image database on development of a computer-aided diagnosis (CAD) scheme for the detection of lung nodules, in terms of the performance of the CAD scheme. A total number of 1000 chest radiographs with nodules was used in this study. All images were divided randomly into subsets consisting of the same number of cases from different sources. The subsets we used in this study were 10 sets of 100 cases, 5 sets of 200 cases, and 2 sets of 500 cases. The entire database and all of the subsets were tested by use of the same CAD scheme, but with different parameter settings for consistency tests. When the sensitivities of the CAD scheme for each subset were kept at a level of 70.0%, the numbers of false positives per image were 0.1 for 100 cases, 0.6 for 200 cases, 2.9 for 500 cases, and 6.2 for 1000 cases. Therefore, the performance of the CAD scheme in detecting lung nodules was strongly affected by the number of cases used. We conclude that a large-scale image database is needed for reliable evaluation of the performance of CAD.