Are radiologists' goals for mammography accuracy consistent with published recommendations?

Abstract

Rationale and objectives: Mammography quality assurance programs have been in place for more than a decade. We studied radiologists' self-reported performance goals for accuracy in screening mammography and compared them to published recommendations.

Materials and methods: A mailed survey of radiologists at mammography registries in seven states within the Breast Cancer Surveillance Consortium (BCSC) assessed radiologists' performance goals for interpreting screening mammograms. Self-reported goals were compared to published American College of Radiology (ACR) recommended desirable ranges for recall rate, false-positive rate, positive predictive value of biopsy recommendation (PPV2), and cancer detection rate. Radiologists' goals for interpretive accuracy within desirable range were evaluated for associations with their demographic characteristics, clinical experience, and receipt of audit reports.

Results: The survey response rate was 71% (257 of 364 radiologists). The percentage of radiologists reporting goals within desirable ranges was 79% for recall rate, 22% for false-positive rate, 39% for PPV2, and 61% for cancer detection rate. The range of reported goals was 0%-100% for false-positive rate and PPV2. Primary academic affiliation, receiving more hours of breast imaging continuing medical education, and receiving audit reports at least annually were associated with desirable PPV2 goals. Radiologists reporting desirable cancer detection rate goals were more likely to have interpreted mammograms for 10 or more years, and >1000 mammograms per year.

Conclusion: Many radiologists report goals for their accuracy when interpreting screening mammograms that fall outside of published desirable benchmarks, particularly for false-positive rate and PPV2, indicating an opportunity for education.

Figure 1

Radiologists’ self-reported goals for performance measures: A) recall rate, B) false positive rate, C) positive predictive value of biopsy, and D) cancer detection rate per 1000 screening mammograms. Vertical lines indicate the desirable goal ranges.

Figure 2

A and B. Radiologists’ reported performance goals for recall, false positive rate, PPV2, and cancer detection rates (CDR) relative to desirable goal ranges and peer cohort benchmarks A. Radiologists’ performance goals relative to American College of Radiology desirable goal ranges categorized by no response, less than desirable range, greater than desirable range, and within desirable range. B. Radiologists’ performance goals relative to peer cohort benchmark quartiles, categorized by no response, lowest quartile (0-24%), average performance (25%-75%), and highest quartile (76-100%).

Figure 2

A and B. Radiologists’ reported performance goals for recall, false positive rate, PPV2, and cancer detection rates (CDR) relative to desirable goal ranges and peer cohort benchmarks A. Radiologists’ performance goals relative to American College of Radiology desirable goal ranges categorized by no response, less than desirable range, greater than desirable range, and within desirable range. B. Radiologists’ performance goals relative to peer cohort benchmark quartiles, categorized by no response, lowest quartile (0-24%), average performance (25%-75%), and highest quartile (76-100%).