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Fig. 2A —Malignancy detected by human second reviewer: 73-year-old woman with ductal carcinoma who was called back by human second reviewer for possible architectural distortion versus summation shadows. Abnormality was suspected on only mediolateral oblique projection of screening mammographic images. Of note is that computer-aided detection (CAD) system had marked this same image, but mark had been dismissed by "CAD reviewer." At time of diagnostic evaluation, many additional views were obtained, and finding was considered to be superimposition of shadows. However, short-term follow-up was recommended in 6 months based only on radiologist's "gut" feeling, even though mammogram was considered to be negative for abnormal findings. At that follow-up, finding was now thought to be architectural distortion in two views but was best seen in craniocaudal projection. Whether this change represented progression in malignancy versus differences in projection is not known. Pathology showed ductal carcinoma in situ. Mediolateral oblique (A) and craniocaudal (B) mammograms. Photographic enlargements show area considered to be overlapping shadows (arrows) after diagnostic workup.