Evaluating Radiological Technologist's Ability to Detect Abnormalities in Film-Screen Mammographic Images: A Decision Analysis Pilot Project

The influence of breast density and key demographics of radiographers on mammography reporting performance - a pilot study

Introduction

A high demand has been placed on radiologists to perform screen reads due to higher number of women undergoing mammography. This study aims to examine radiographer performance in reporting low compared with high‐mammographic density (MD) images; and to assess the influence of key demographics of Jordanian radiographers on their performance.

Methods

Thirty mammograms with varied MD were reported by 12 radiographers using the Breast Imaging‐Reporting and Data System (BI‐RADS). Radiographer performance was measured using sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and area under the receiver operating characteristic curve (ROC AUC). Performance measures were compared between cases with low‐ and high‐MD and between subgroups of radiographers according to key demographics.

Results

All performance measures were significantly higher in low‐ compared to high‐MD cases (P value < 0.0). The mean sensitivity, specificity, PPV, NPV and ROC AUC were 0.58, 0.68, 0.67, 0.63 and 0.69 respectively. PPV was significantly different for readers who had different years of experience in mammography, hours and cases per week P value = 0.023, 0.01, 0.017 respectively. ROC AUC was significantly different for radiographers with different number of hours and cases performed per week (P value = 0.001 and 0.004 respectively).

Conclusions

The results of this pilot study are encouraging however a more extensive study is required to determine if Jordanian radiographers are capable of successfully taking part in breast screen reading. The lack of skills and knowledge required for correct and consistent reporting of high‐MD images highlights the need for any formal training in mammographic interpretation to focus on the dense breast.

Evaluating radiographers' diagnostic accuracy in screen-reading mammograms: what constitutes a quality study?

Introduction

The aim of this study was to first evaluate the quality of studies investigating the diagnostic accuracy of radiographers as mammogram screen-readers and then to develop an adapted tool for determining the quality of screen-reading studies.

Methods

A literature search was used to identify relevant studies and a quality evaluation tool constructed by combining the criteria for quality of Whiting, Rutjes, Dinnes et al. and Brealey and Westwood. This constructed tool was then applied to the studies and subsequently adapted specifically for use in evaluating quality in studies investigating diagnostic accuracy of screen-readers.

Results

Eleven studies were identified and the constructed tool applied to evaluate quality. This evaluation resulted in the identification of quality issues with the studies such as potential for bias, applicability of results, study conduct, reporting of the study and observer characteristics. An assessment of the applicability and relevance of the tool for this area of research resulted in adaptations to the criteria and the development of a tool specifically for evaluating diagnostic accuracy in screen-reading.

Conclusions

This tool, with further refinement and rigorous validation can make a significant contribution to promoting well-designed studies in this important area of research and practice.

Evaluation of radiographers' mammography screen-reading accuracy in Australia

Introduction

This study aimed to evaluate the accuracy of radiographers’ screen-reading mammograms. Currently, radiologist workforce shortages may be compromising the BreastScreen Australia screening program goal to detect early breast cancer. The solution to a similar problem in the United Kingdom has successfully encouraged radiographers to take on the role as one of two screen-readers. Prior to consideration of this strategy in Australia, educational and experiential differences between radiographers in the United Kingdom and Australia emphasise the need for an investigation of Australian radiographers’ screen-reading accuracy.

Methods

Ten radiographers employed by the Westmead Breast Cancer Institute with a range of radiographic (median = 28 years), mammographic (median = 13 years) and BreastScreen (median = 8 years) experience were recruited to blindly and independently screen-read an image test set of 500 mammograms, without formal training. The radiographers indicated the presence of an abnormality using BI-RADS®. Accuracy was determined by comparison with the gold standard of known outcomes of pathology results, interval matching and client 6-year follow-up.

Results

Individual sensitivity and specificity levels ranged between 76.0% and 92.0%, and 74.8% and 96.2% respectively. Pooled screen-reader accuracy across the radiographers estimated sensitivity as 82.2% and specificity as 89.5%. Areas under the reading operating characteristic curve ranged between 0.842 and 0.923.

Conclusions

This sample of radiographers in an Australian setting have adequate accuracy levels when screen-reading mammograms. It is expected that with formal screen-reading training, accuracy levels will improve, and with support, radiographers have the potential to be one of the two screen-readers in the BreastScreen Australia program, contributing to timeliness and improved program outcomes.