Physician Predictors of Mammographic Accuracy

Smith‐Bindman, Rebecca; Chu, Philip; Miglioretti, Diana L.; Quale, Chris; Rosenberg, Robert D.; Cutter, Gary; Geller, Berta M.; Bacchetti, Peter; Sickles, Edward A.; Kerlikowske, Karla

doi:10.1093/jnci/dji060

Cited by 134 publications

(110 citation statements)

References 29 publications

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“…Our study support findings from five studies showing volume to be of importance. [18][19][20][21][22] For example, Theberge et al 21 showed that radiologist who read more than 2,000 mammograms per year had higher sensitivity while maintaining low specificity. Our results are in contrast with those of previous studies finding that increased volume may not necessarily increase performance.…”

Section: Discussionmentioning

confidence: 99%

“…Radiologist training in general has been associated with increased performance. [12][13][14][15][16][17] Data on the relationship between volume read per radiologist and performance are, however, conflicting, 13,[18][19][20][21][22] whereas associations have been found between some other indicators of radiologists' experience and performance. [23][24][25] However, most studies focused on mammography screening, and no large community based study has evaluated the association between organisational factors and performance of diagnostic mammography.…”

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confidence: 99%

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Performance of clinical mammography: A nationwide study from Denmark

Jensen

Vejborg

Severinsen

et al. 2006

Intl Journal of Cancer

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Clinical mammography is the key tool for breast cancer diagnosis, but little is known about the impact of the organisational set-up on the performance. We evaluated whether organisatorial factors influence the performance of clinical mammography. Clinical mammography data from all clinics in Denmark in the year 2000 were collected and linked to cancer outcome. Use of the National Institute of Radiation Hygiene register for identification of radiology clinics ensured comprehensive nationwide registration. We used the final mammographic assessment at the end of the imaging work-up to determine sensitivity, specificity and accuracy, the latter using a receiver-operating characteristics (ROC) analysis. In 96,534 clinical mammography examinations, sensitivity was 75% and specificity 99%. The presence of at least one high volumereading radiologist in the clinic increased accuracy (AUC 5 0.91 for <1,000 examinations/year and 0.92 for >2,000 examinations/ year, p 5 0.017). The examination volume per clinic showed no clear effect on performance, as accuracy was significantly higher in clinics with a medium number of examinations (AUC 5 0.93 for 2,000-4,000 examinations/year and 0.90 for >6,000 examinations/year, p 5 0.003). Accuracy was significantly lower in regions with high annual utilisation rate of clinical mammography, which means the proportion of examined women in a region (AUC 5 0.90 for 3.0-5.0% annual utilisation rate and AUC 5 0.93 for 2.0-2.5% annual utilisation rate, and p 5 0.001), indicating that clinical mammography worked best in patient populations of purely symptomatic women. Our data indicate that to increase the accuracy of clinical mammography at the community level, the presence of an experienced radiologist should be prioritised ahead of raising the clinic size. ' 2006 Wiley-Liss, Inc.Key words: mammography; breast cancer; organization; sensitivity; specificity; accuracy Diagnostic mammography is the most commonly used tool for diagnosing breast cancers in women with signs or symptoms of this disease. It is most often undertaken in combination with a clinical examination and supplemented with ultrasound or other imaging techniques. 1 In contrast to mammography screening, performance of diagnostic mammography has been examined only in a few studies. In addition, the majority of these studies are singleclinic studies covering small populations, 1-5 and only two studies have evaluated the performance of diagnostic mammography at the community level. 6,7 Performance of mammography is known to be influenced by factors related to woman characteristics, such as age, breast density, history of previous breast lesions and presence of symptoms. 6,[8][9][10][11] However, performance of mammography may also be related to the organisational setup, such as the type of clinic, the number of examinations undertaken and the experience of the radiologists. Radiologist training in general has been associated with increased performance. 12-17 Data on the relationship between volume read per radiologist and performan...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Performance of clinical mammography: A nationwide study from Denmark

Jensen

Vejborg

Severinsen

et al. 2006

Intl Journal of Cancer

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“…Barlow et al report that more recently qualified radiologists have higher sensitivity but lower specificity which might suggest that years of experience lead to a change in the threshold for recalling a patient rather than improved accuracy [24]. However Smith-Bindeman et al have found that radiologists with more years of qualification had better specificity and slightly improved or at least equal sensitivity, suggesting that the improved specificity is the result of more accurate interpretation [25]. Their analysis is summarised in Figure 1.…”

Section: Studies Of Medical Decision-makingmentioning

confidence: 99%

“…It might be that radiologists who view more cases per annum are not being given sufficient feedback on performance, or adequate opportunity for reflection for the experience to be beneficial. Smith-Bindeman et al report radiologists reading 2500-4000 mammograms a year had improved specificity but that this effect was not found in radiologists reading more than 4000 per annum [25]. We need to ensure that all radiologists, but particularly recently qualified radiologists, are given not just experience but also the opportunity to learn from it.…”

Section: Implications For Radiological Trainingmentioning

confidence: 99%

A Review of Research Into the Development of Radiologic Expertise: Implications for Computer-Based Training

Taylor

2007

Academic Radiology

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Studies of radiological error reveal high levels of variation between radiologists.Although it is known that experts outperform novices, we have only limited knowledge about radiological expertise and how it is acquired. This review identifies three areas of research: studies of the impact of experience and related factors on the accuracy of decision-making; studies of the organisation of expert knowledge; and studies of radiologists' perceptual processes.Interpreting evidence from these three paradigms in the light of recent research into perceptual learning and studies of the visual pathway has a number of conclusions for the training of radiologists, particularly for the design of computer-based learning programs which are able to illustrate the similarities and differences between diagnoses, to give access to large numbers of cases and to help identify weaknesses in the way trainees build up a global representation from fixated regions.

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“…Screening accuracy could be enhanced by either improving image quality or by improving the accuracy of radiologists who interpret mammograms [1]. Differences in radiologists' training, experience and reading volume may affect their clinical recommendations and interpretations [2][3][4][5][6]. Regulations set forth by the Food and Drug Administration's (FDA) Mammography Quality Standards Act (MQSA) [7] require continuing medical education (CME) for all radiologists who interpret mammograms [8].…”

Section: Introductionmentioning

confidence: 99%

Computer-Assisted Mammography Feedback Program (CAMFP)

et al. 2007

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RATIONALE AND OBJECTIVES:Our goal was to develop and evaluate software to support a computer assisted mammography feedback program (CAMFP) to be used for continuing medical education (CME). MATERIALS AND METHODS:Thirty-five radiologists from our region signed consent to participate in an IRB-approved film-reading study. The radiologists primarily assessed digitized mammograms and received feedback in 5 film interpretation sessions. A bivariate analysis was used to evaluate the joint effects of the training on sensitivity and specificity, and the effects of image quality on reading performance were explored. RESULTS:Interpretation was influenced by the CAMFP intervention: Sensitivity increased (Δ sensitivity = 0.086, p <0.001) and specificity decreased (Δ specificity = −0.057, p=0.04). Variability in interpretation among radiologists also decreased after the training sessions (p = 0.035). CONCLUSION:The CAMFP intervention improved sensitivity and decreased variability among radiologist's interpretations. Although this improvement was partially offset by decreased specificity, the program is potentially useful as a component of continuing medical education of radiologists. Dissemination via the web may be possible using digital mammography.

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Physician Predictors of Mammographic Accuracy

Abstract: Raising the annual volume requirements in the Mammography Quality Standards Act might improve the overall quality of screening mammography in the United States.

Cited by 134 publications

References 29 publications

Performance of clinical mammography: A nationwide study from Denmark

Performance of clinical mammography: A nationwide study from Denmark

A Review of Research Into the Development of Radiologic Expertise: Implications for Computer-Based Training

Computer-Assisted Mammography Feedback Program (CAMFP)

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