The Influence of Mammographic Technologists on Radiologists' Ability to Interpret Screening Mammograms in Community Practice

Abstract

Purpose To determine whether the mammographic technologist has an effect on the radiologists’ interpretative performance of screening mammography in community practice. Materials and Methods In this institutional review board approved retrospective cohort study, we included Carolina Mammography Registry (CMR) data from 372 radiologists and 356 mammographic technologists from 1994 to 2009 who performed 1,003,276 screening mammograms. Measures of interpretative performance (recall rate, sensitivity, specificity, positive predictive value (PPV1), and cancer detection rate (CDR)) were ascertained prospectively with cancer outcomes collected from the state cancer registry and pathology reports. To determine if the mammographic technologist influenced the radiologists’ performance, we employed mixed effects logistic regression models, including a radiologist-specific random effect and taking into account the clustering of examinations across women, separately for screen-film mammography (SFM) and full field digital mammography (FFDM). Results Of the 356 mammographic technologists included, 343 performed 889,347 SFM examinations and 51 performed 113,929 FFDM examinations, and 38 performed both SFM and FFDM. A total of 4,328 cancers were reported for SFM and 564 cancers for FFDM. The technologists had a statistically significant effect on the radiologists’ recall rate, sensitivity, specificity and CDR for both SFM and FFDM (p-values<0.01). For PPV1, variability by technologist was observed for SFM (p-value<0.0001) but not for FFDM (p-value=0.088). Conclusion The interpretative performance of radiologists in screening mammography varies substantially by the technologist performing the examination. Additional studies should aim to identify technologist characteristics that may explain this variation.

Characterizing the Mammography Technologist Workforce in North Carolina

“…In our prior work, we found that technologists do in fact contribute to the observed variability of screening and diagnostic mammography performance. [13, 14] An important factor for mammography performance, specifically sensitivity, is breast positioning during the examination. [15] While the quality of the image is related to both the calibration of the mammography machine and the skill of the technologist, the technologist is ultimately responsible for obtaining correct positioning and sufficient compression to maximize image sharpness.…”

Interprofessional work in early detection of breast cancer: An integrative review

“…The advanced radiography practitioner is identified as someone who has progressed professionally to a higher level than colleagues through role extension, and has the ability to direct and encourage service delivery within their specialist area. 44 Mammography is a specialist area and in several studies professional growth 21,23e26 and shared responsibility 22,37,38 were mentioned as contributing to deliver high quality service in the chain of early detection of breast cancer. The wording of these descriptions appears to indicate an advanced role for the radiographer.…”

“…It strengthens each profession, since in the interprofessional context the uniqueness of each profession becomes more visible. 21,22,26,37,38 Also, work motivation and satisfaction increase when participating in shared decision-making, learning from other health-care professionals, sharing experience, and witnessing the improved quality of care and diagnostics. 22,27,30,34,35 For health-care teams, the benefits of the interprofessional work model include more flexibility in performing tasks, occasional opportunities to replace other professionals for certain tasks, the possibility to give and receive timely feedback, fewer errors and misunderstandings, as well as lower patient recall rate.…”

“…22,27,30,34,35 For health-care teams, the benefits of the interprofessional work model include more flexibility in performing tasks, occasional opportunities to replace other professionals for certain tasks, the possibility to give and receive timely feedback, fewer errors and misunderstandings, as well as lower patient recall rate. 21,32,37,38,40 However, in order to reach these benefits, all professionals involved must be motivated to work together, believe in the benefits of this model, receive support from the leaders, and have the necessary education and training. It is important to clarify staff members' roles, and continuously monitor that the processes lead to the goal.…”

Cardiovascular Ultrasound Combined With Non-invasive Screening for the Detection of Undiagnosed Cardiovascular Disease: A Literature Review

“…Radiology studies have indicated a significant effect in screening results due to variation in mammography technologists, but more research is required to explore what types of variation affect the results. 72 National recommendations suggest that personnel performing sonography have, at a minimum, obtained a national credential in the modality in which they are performing the image acquisition. 73 Utilization of staff performing the imaging who have limited training can reduce sensitivity of disease to 21% to 33% in cardiac valvular abnormalities requiring Doppler evaluation.…”