{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:00:30Z","timestamp":1790359230468,"version":"4.1.0"},"reference-count":68,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004484","name":"Tehran University of Medical Sciences and Health Services","doi-asserted-by":"publisher","award":["1403-102-73-352"],"award-info":[{"award-number":["1403-102-73-352"]}],"id":[{"id":"10.13039\/501100004484","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Breast cancer is a malignant tumor that mostly stems from ductal or lobular epithelial tissues. Each year, over two million people suffer from this disease and over half a million pass away globally, ranking breast cancer the most prevalent cancer type in women and the second cause of cancer-related deaths. Periodic screening programs such as mammography have significantly improved survival via early detection. Therefore, facilitating the interpretation for this modality through Computer-Aided Diagnosis (CAD) systems can accelerate specialists\u2019 decision-making and further raise the survival rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>A CAD web-based system was designed through Unified Modeling Language (UML) according to the three-tier architecture. The design was implemented using C# programming language and the ASP.NET 8 framework along with the Microsoft Structured Query Language (MSSQL) database. The ViTGEMC deep ensemble model with Incremental Learning (IL) capabilities was incorporated as the prediction engine. Moreover, the system evaluation was conducted in two phases: a multi-reader and multi-case experiment to appraise the system\u2019s assistance effect, and the user experience assessment via the User Experience Questionnaire (UEQ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The impact of software predictions was evaluated in an interventional test with the participation of four radiology specialists and 40 dual-view examinations, which yielded a 19.5% reduction in interpretation time (404.9 \u00b1 104.2 vs. 325.8 \u00b1 80.3 seconds,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0203) while maintaining accuracy (0.769 \u00b1 0.024 vs. 0.800 \u00b1 0.147,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.6560). The usability assessment was further conducted by 10 experts in medicine, radiology, and health information technology fields, in which the system achieved scores of 1.4 to 2.3 across the six UEQ aspects of user experience.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The CAD software provides a convenient and enhanced environment which can aid radiologists in quicker diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358861","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:28:22Z","timestamp":1790357302000},"page":"e0358861","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and evaluation of a deep incremental learning system for mammography image analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0244-1198","authenticated-orcid":true,"given":"Mohammad Hadi","family":"Ghahroudi","sequence":"first","affiliation":[{"name":"Tehran University of Medical Sciences","place":["Tehran, Iran"],"department":["Health Information Management and Medical Informatics Department, School of Allied Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasrin","family":"Ahmadinejad","sequence":"additional","affiliation":[{"name":"Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahid","family":"Changizi","sequence":"additional","affiliation":[{"name":"Tehran University of Medical Sciences","place":["Tehran, Iran"],"department":["Technology of Radiology and Radiotherapy Department, School of Allied Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elahe","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Mohammadmirzaei","sequence":"additional","affiliation":[{"name":"Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Shayegh","sequence":"additional","affiliation":[{"name":"Advanced Diagnostic and Interventional Radiology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences","place":["Tehran, Iran"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8450-7818","authenticated-orcid":true,"given":"Seyed Mohammad","family":"Ayyoubzadeh","sequence":"additional","affiliation":[{"name":"Tehran University of Medical Sciences","place":["Tehran, Iran"],"department":["Health Information Management and Medical Informatics Department, School of Allied Medical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"pone.0358861.ref001","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1002\/cncr.32887","article-title":"Breast cancer early detection: A phased approach to implementation","author":"O Ginsburg","year":"2020","journal-title":"Cancer"},{"issue":"3","key":"pone.0358861.ref002","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"F Bray","year":"2024","journal-title":"CA: A Cancer Journal for Clinicians"},{"issue":"1","key":"pone.0358861.ref003","first-page":"12","article-title":"Cancer statistics, 2024","volume":"74","author":"RL Siegel","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"pone.0358861.ref004","doi-asserted-by":"crossref","first-page":"101537","DOI":"10.1016\/j.cegh.2024.101537","article-title":"Epidemiologic profile of breast cancer in Iran: A systematic review and meta-analysis","volume":"26","author":"Z Sanaat","year":"2024","journal-title":"Clinical Epidemiology and Global Health"},{"issue":"1","key":"pone.0358861.ref005","doi-asserted-by":"crossref","DOI":"10.1007\/s40944-022-00613-4","article-title":"The Prevalence of breast cancer in Iranian women: A systematic review and meta-analysis","volume":"20","author":"M Kazeminia","year":"2022","journal-title":"Indian J Gynecol Oncolog"},{"key":"pone.0358861.ref006","unstructured":"Iran, Islamic Republic of - Global Cancer Observatory: GLOBOCAN; 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