Educational Interventions to Improve Screening Mammography Interpretation: A Randomized Controlled Trial

Geller, Berta M.; Bogart, Andy; Carney, Patricia A.; Sickles, Edward A.; Smith, Robert A.; Monsees, Barbara; Bassett, Lawrence W.; Buist, Diana M.; Kerlikowske, Karla; Onega, Tracy; Yankaskas, Bonnie C.; Haneuse, Sebastien; Hill, Deirdre A.; Wallis, Matthew; Miglioretti, Diana L.

doi:10.2214/ajr.13.11147

Cited by 20 publications

(21 citation statements)

References 26 publications

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“…be reduced with use of other strategies to improve interpretative performance, such as interventions for radiologists to improve interpretative performance (21)(22)(23), application of performance thresholds (20), providing additional audit feedback by reviewing the lesion that was sampled for biopsy, or providing additional feedback related to improving specificity (24)(25)(26)(27). Some women who undergo screening mammography may regard the small increase in the FPR as an acceptable trade-off for improved sensitivity (28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Buist¹,

Anderson²,

Smith³

et al. 2014

Radiology

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Purpose:To examine radiologists' screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists. Materials andMethods:In an institutional review board-approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [FPR], and cancer detection rate [CDR]). Logistic regression was used to assess the association between the volume of recalled screening mammograms ("own" mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and "any" mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up. Results:Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% performed the work-up for 0-50, and 39% performed the work-up for more than 50. For the work-up of recalled screening mammograms from any radiologist, 24% of radiologists performed the work-up for 0-50 mammograms, 32% performed the work-up for 51-125, and 44% performed the work-up for more than 125. With increasing numbers of radiologist workups for their own recalled mammograms, the sensitivity (P = .039), FPR (P = .004), and CDR (P , .001) of screening mammography increased, yielding a stepped increase in women recalled per cancer detected from 17.4 for 25 or fewer mammograms to 24.6 for more than 50 mammograms. Increases in work-ups for any radiologist yielded significant increases in FPR (P = .011) and CDR (P = .001) and a nonsignificant increase in sensitivity (P = .15). Radiologists with a lower annual volume of any work-ups had consistently lower FPR, sensitivity, and CDR at all annual interpretive volumes. Conclusion:These findings support the hypothesis that radiologists may improve their screening performance by performing the diagnostic work-up for their own recalled screening mammograms and directly receiving feedback afforded by means of the outcomes associated with their initial decision to recall. Arranging for radiologists to work up a minimum number of their own recalled cases could improve screening performance but would need systems to facilitate this workflow.q RSNA, 2014

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Section: Discussionmentioning

confidence: 99%

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Buist¹,

Anderson²,

Smith³

et al. 2014

Radiology

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“…10 Participating BCSC registries included the Carolina Mammography Registry, Group Health Surveillance Registry in Washington State, New Hampshire Mammography Network, San Francisco Mammography Registry, New Mexico Mammography Project, and Vermont Breast Cancer Surveillance System. Because this study required an estimate of clinical performance, we only included radiologists with at least 10 screening mammograms with cancer for estimating sensitivity and/or 100 screening mammograms without cancer for estimating specificity in the BCSC database.…”

Section: Methodsmentioning

confidence: 99%

“…As part of the larger study, all radiologists who took one of the first four test sets were invited to participate in a randomized controlled trial of two educational interventions, either a live seminar or a DVD. 10 The intervention groups were invited to take test set 5 after the intervention was completed and the control group was sent the intervention DVD after completing test set 5.…”

Section: Methodsmentioning

confidence: 99%

Correlation Between Screening Mammography Interpretive Performance on a Test Set and Performance in Clinical Practice

et al. 2017

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Rationale and Objectives Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test-set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set. Materials and Methods This institutional review board–approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later. Test sets differed in number of cancer cases and difficulty of lesion detection. Test-set sensitivity and specificity were estimated using woman-level and breast-level recall with cancer status and expert opinion as gold standards. Clinical performance was estimated using women-level recall with cancer status as the gold standard. Spearman rank correlations between test-set and clinical performance with 95% confidence intervals (CI) were estimated. Results For test sets with fewer cancers (N=15) that were more difficult to detect, correlations were weak-to-moderate for sensitivity (woman-level=0.46, 95%CI=0.16, 0.69; breast-level=0.35, 95%CI=0.03, 0.61) and weak for specificity (0.24, 95%CI=0.01, 0.45) relative to expert recall. Correlations for test sets with more cancers (N=30) were close to zero and not statistically significant. Conclusions Correlations between screening performance on a test set and performance in clinical practice are not strong. Test set performance more accurately reflects performance in clinical practice if cancer prevalence is low and lesions are challenging to detect.

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“…The larger study is described in detail elsewhere (17, 18). Briefly, we developed four image-based test sets designed to assess interpretative performance at baseline, conducted a randomized controlled trial to evaluate two educational interventions designed to improve interpretation of screening mammography, and designed a single test-set to test performance post-intervention.…”

Section: Methodsmentioning

confidence: 99%

Feasibility and Acceptability of Conducting a Randomized Clinical Trial Designed to Improve Interpretation of Screening Mammography

et al. 2013

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Purpose To describe recruitment, enrollment and participation in a study of U.S. radiologists invited to participate in a randomized controlled trial of two continuing medical education interventions designed to improve interpretation of screening mammography. Methods We collected recruitment, consent, and intervention-completion information as part of a large study involving radiologists in California, Oregon, Washington, New Mexico, New Hampshire, North Carolina, and Vermont. Consenting radiologists were randomized to receive either a one-day live, expert-led educational session; a self-paced DVD with similar content; or to a control group (delayed intervention). The impact of the interventions was assessed using a pre- and post-intervention test set design. All activities were IRB-approved and HIPAA compliant. Results Of 403 eligible radiologists, 151/403 (37.5%) consented to participate in the trial and 119/151 (78.8%) completed the pre–intervention test set, leaving 119 available for randomization to one of the two intervention groups or to controls. Female radiologists were more likely than males to consent to and complete the study (p= 0.03). Consenting radiologists who completed all study activities were more likely to have been interpreting mammography for ≤10 years compared to radiologists who consented and did not complete all study activities or did not consent at all. The live intervention group was more likely to report their intent to change their clinical practice as a result of the intervention compared to those who received the DVD (50% versus 17.6%, p=0.02). The majority of participants in both interventions groups felt the interventions were a useful way to receive CME mammography credits Conclusions Community radiologists found interactive interventions designed to improve interpretative mammography performance acceptable and useful for clinical practice. This suggests CME credits for radiologists should, in part, be for examining practice skills.

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Educational Interventions to Improve Screening Mammography Interpretation: A Randomized Controlled Trial

Cited by 20 publications

References 26 publications

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Correlation Between Screening Mammography Interpretive Performance on a Test Set and Performance in Clinical Practice

Feasibility and Acceptability of Conducting a Randomized Clinical Trial Designed to Improve Interpretation of Screening Mammography

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