A study of whether automated XXXX Image Assessment could replace manual grading steps in the English National Screening Programme.

@entity1 @entity1020 @entity6 @entity989
OBJECTIVES: @entity6 screening in England involves labour intensive manual grading of digital retinal images. We present the plan for an observational retrospective study of whether automated systems could replace one or more steps of @entity1 grading. METHODS: @entity1 aged 12 or older who attended the @entity6 Eye Screening programme, Homerton University Hospital (London) between 1 June 2012 and 4 November 2013 had macular and disc-centred retinal images taken. All screening episodes were manually graded and will additionally be graded by three automated systems. Each system will process all screening episodes, and screening performance (sensitivity, false positive rate, likelihood ratios) and diagnostic accuracy (95% confidence intervals of screening performance measures) will be quantified. A sub-set of gradings will be validated by an approved Reading Centre. Additional analyses will explore the effect of altering thresholds for disease detection within each automated system on screening performance. RESULTS: 2,782/20,258 @entity6 @entity1 were referred to ophthalmologists for further examination. Prevalence of @entity1020 (M1), @entity989 (R2), and @entity989 (R3) were 7.9%, 3.1% and 1.2%, respectively; 4749 (23%) @entity1 were diagnosed with background @entity989 (R1); 1.5% were considered ungradable by @entity1 graders. CONCLUSIONS: @entity989 prevalence was similar to other English diabetic screening programmes, so findings should be generalizable. The study population size will allow the detection of differences in screening performance between the @entity1 and automated grading systems as small as 2%. The project will compare performance and economic costs of manual versus automated systems.
