Digital mammographic interpretation by UK radiographer mammographers: A JAFROC analysis of observer performance.

INTRODUCTION: Radiologists utilise mammography test sets to bench mark their performance against recognised standards. Using a validated test set, this study compares the performance of radiographer readers against previous test results for radiologists. METHODS: Under similar test conditions radiographer readers were given an established test set of 60 mammograms and tasked to identify breast cancer, they were measured against their ability to identify, locate and give a confidence level for cancer being present on a standard set of mammographic images. The results were then compared to previously published results for radiologists for similar or the same test sets. RESULTS: The 10 radiographer readers demonstrated similar results to radiologists and for lesion sensitivity were the highest scoring group. The study group score a sensitivity of 83; a specificity of 69.3 and lesion sensitivity of 74.8 with ROC and JAFROC scores of 0.86 and 0.74 respectively. CONCLUSION: Under test conditions radiographers are able to identify and accurately locate breast cancer in a range of complex mammographic backgrounds. IMPLICATIONS FOR PRACTICE: The study was performed under experimental conditions with results comparable to breast radiologists under similar conditions, translation of these findings into clinical practice will help address access and capacity issues in the timely identification and diagnosis of breast cancer.

The impact of age on the art of mammography and how to adapt accordingly.

INTRODUCTION: Breast cancer is increasingly a disease of the elderly, and combined with the NHS Breast Screening Extension means that more elderly patients are having mammography. Increasing age can make mammography more technically difficult. This is a technical note detailing the results of a local audit which may be of interest due to potential service implications. METHOD: A retrospective audit of the first year of screening extension of The Shropshire Breast Screening Programme. Aims to collect data on patient demographics and describe the technical adaptations developed in Shropshire. RESULTS: Breast screening extension has increased by 2.5 times the number of women aged 70-74 screened, and doubled the overall numbers of women over 70 screened. Significantly more older patients are being screened to present technical challenges to a screening programme. Data was obtained from a month of screening showed that 29% of patients over 70 needed extra time for positioning. Reasons included 22% difficulty in obtaining adequate positioning and 15% needed a relative to aid with consent. DISCUSSION: In the Shropshire screening programme different technical adaptations have been developed and are key to ensuring adequate images. These include double appointments, two radiographers, thorough assessment, steeper angles, seated examinations, from-below imaging and pre-planning for subsequent screen. CONCLUSION: Significantly more older women are having breast screening due to the increasing incidence of breast cancer and the Breast Screening Programme extension. Increasing age can significantly increase time taken for adequate imaging and present technical challenges. Development of technical adaptations to art of mammography is key to achieve adequate images.