Better radiologist performance on own recalled screens
Diana S.M. Buist, Ph.D., M.P.H., from the Group Health Cooperative in Seattle, and colleagues examined the performance of screening mammography by linking 651,671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists to cancer registries. The correlation between the volume of recalled screening mammograms ("own" mammograms [interpretation of diagnostic image by same radiologist who interpreted screening image] and "any" mammograms) and screening performance was assessed.
The researchers found that the sensitivity, false-positive rate (FPR), and cancer detection rate (CDR) of screening mammography increased with increasing numbers of radiologist work-ups for their own recalled mammograms; there was 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. Significant increases were seen in FPR and CDR and a nonsignificant increase in sensitivity with increases in work-ups for any radiologist. A lower annual volume of any work-ups correlated with consistently lower FPR, sensitivity, and CDR.
"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," the authors write. "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."
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