The evaluations reviewed by the GDG demonstrated substantial variation in the diagnostic accuracy (sensitivity and specificity) of CAD programmes across settings, even when using the same technology set to the same threshold. Thus, it will be essential to calibrate the threshold to be used for any given software for each setting and population in which it will be used in order to ensure that the accuracy, predictive values, overall yield and requirements for further diagnostic testing are as expected. Further guidance on calibrating CAD in a new setting is provided in the operational handbook accompanying the guidelines, which links to a protocol for collecting the requisite data and a web-based tool to assist with the analysis of data and calculation of receiver operating characteristic curves and sensitivity and specificity values across a range of thresholds (7).
The feasibility of implementing CAD depends heavily on the setting, including ensuring access to the required equipment for conducting digital radiography, a stable internet connection and required maintenance for the hardware and software. The required resources and the cost–effectiveness will depend on the setting, including the availability and salaries of human readers.