Factors influencing University of Papua New Guinea medical imaging science students considering rural radiography careers.

INTRODUCTION: The aim of this research was to explore factors influencing students at the University of Papua New Guinea (UPNG) Bachelor of Medical Imaging Science (BMIS) choice to pursue rural radiography careers. METHODS: A survey and focus groups of BMIS students at the UPNG were undertaken. The survey included questions related to sociodemographic variables including gender, age, education, rural background and previous employment; and Likert-type scale questions exploring motivation for rural practice, the promotion of radiography through rural practice and the influence of birthplace and incentives to practice. Focus groups comprising convenience samples of six students each from the second, third and fourth years of study explored the promotion of rural radiography, community-based training internships, the benefits of rural practice and the influence of undergraduate training on future rural practice. RESULTS: There were 54 responses (94.7%) to the survey with strong interest (88.9%) in rural radiography practice; 96.3% (n=52) agreed that undergraduate rural training would also act as a motivator. Rural training was a stronger incentive for females than for males (p=0.02). Not being trained in conventional non-digital film screen imaging at UPNG was a strong barrier to rural practice; while being able to give back to the community, increased professional responsibility, cheaper living, job satisfaction and cultural exchange were all viewed as positive aspects of rural practice. Most students reported a benefit to rural practice, while acknowledging a lack of contemporary imaging equipment in rural facilities. CONCLUSION: The study demonstrated that UPNG BMIS students would contemplate careers in rural practice and provides evidence to support dedicated undergraduate rural radiography placement. It also highlights the dichotomy in urban and rural services, which suggests the need for greater emphasis on conventional non-digital film screen radiography in the undergraduate program to best support graduates to work and, importantly, work effectively in rural communities. As most students were from rural areas these results must be tempered by the fact that students may simply be wanting to return home rather than reporting explicit rural intent. A more comprehensive study of the medical imaging profession in PNG should be undertaken to validate this study.

The influence of breast density and key demographics of radiographers on mammography reporting performance - a pilot study.

INTRODUCTION: A high demand has been placed on radiologists to perform screen reads due to higher number of women undergoing mammography. This study aims to examine radiographer performance in reporting low compared with high-mammographic density (MD) images; and to assess the influence of key demographics of Jordanian radiographers on their performance. METHODS: Thirty mammograms with varied MD were reported by 12 radiographers using the Breast Imaging-Reporting and Data System (BI-RADS). Radiographer performance was measured using sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and area under the receiver operating characteristic curve (ROC AUC). Performance measures were compared between cases with low- and high-MD and between subgroups of radiographers according to key demographics. RESULTS: All performance measures were significantly higher in low- compared to high-MD cases (P value < 0.0). The mean sensitivity, specificity, PPV, NPV and ROC AUC were 0.58, 0.68, 0.67, 0.63 and 0.69 respectively. PPV was significantly different for readers who had different years of experience in mammography, hours and cases per week P value = 0.023, 0.01, 0.017 respectively. ROC AUC was significantly different for radiographers with different number of hours and cases performed per week (P value = 0.001 and 0.004 respectively). CONCLUSIONS: The results of this pilot study are encouraging however a more extensive study is required to determine if Jordanian radiographers are capable of successfully taking part in breast screen reading. The lack of skills and knowledge required for correct and consistent reporting of high-MD images highlights the need for any formal training in mammographic interpretation to focus on the dense breast.

Does mammographic density remain a radiological challenge in the digital era?

BACKGROUND: The low subject contrast between cancerous and fibroglandular tissue could obscure breast abnormalities. PURPOSE: To investigate radiologists' performance for detection of breast cancer in low and high mammographic density (MD) when cases are digitally acquired. MATERIAL AND METHODS: A test set of 60 digital mammography cases, of which 20 were cancerous, were examined by 17 radiologists. Mammograms were categorized as low (≤50%) or high (>50%) MD and rated for suspicion of malignancy using the Royal Australian and New Zealand College of Radiology (RANZCR) classification system. Radiologist demographics including cases read per year, age, subspecialty, and years of reporting were recorded. Radiologist performance was analyzed by the following metrics: sensitivity; specificity; area under the receiver operating characteristic (ROC) curve (AUC), location sensitivity, and jackknife free-response ROC (JAFROC) figure of merit (FOM). RESULTS: Comparing high to low MD cases, radiologists showed a significantly higher sensitivity (P = 0.015), AUC (P = 0.003), location sensitivity (P = 0.002), and JAFROC FOM (P = 0.001). In high compared to low MD cases, radiologists with <1000 annual reads and radiologists with no mammographic subspecialty had significantly higher AUC, location sensitivity, and JAFROC FOM. Radiologists with ≥1000 annual reads and radiologists with mammography subspecialty demonstrated a significant increase in location sensitivity in high compared to low MD cases. CONCLUSION: In this experimental situation, radiologists' performance was higher when reading cases with high compared to low MD. Experienced radiologists were able to precisely localize lesions in breasts with higher MD. Further studies in unselected screening materials are needed to verify the results.

Mammographic Breast Density Profile of Jordanian Women With Normal and Breast Cancer Findings.

PURPOSE: To document the mammographic breast density (MBD) distribution of Jordanian women and the relationship with MBD with age. Correlation between breast cancer diagnosis and density was also explored. METHODS: A retrospective review of 660 screening mammograms from King Abdullah University Hospital was conducted. Mammograms were classified into 2 groups: normal (return to routine screening) and breast cancer and rated using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) 5th edition for MBD. The association between MBD and age was assessed by descriptive analyses and Kruskal-Wallis test. To compare between normal and breast cancer groups, chi-square post hoc tests with Bonferroni adjustment was used. RESULTS: Groups consisted of 73.9% (n = 488) normal group and 26.1% (n = 172) breast cancer group. A significant inverse relationship was demonstrated between age and MBD among the normal (r = -.319, P < .01) and breast cancer group (r = -.569, P < .01). In total, 69% (n = 336) of women in the normal group and 71% (n = 122) in the breast cancer group and 79.1% (n = 159) of the normal group and 100% (n = 48) of the breast cancer group aged 40 to 49 years reported high MBD (ACR BI-RADS c or d). CONCLUSIONS: Most of women in both the normal and breast cancer groups evidenced increased MBD. Increased MBD was inversely proportional to age. As MBD has a known link to increased breast cancer risk and the decreased sensitivity of mammography and it is vital that future screening guidelines for Jordanian women consider the unique breast density distribution of this population.

The implications of increased mammographic breast density for breast screening in Jordan.

INTRODUCTION: Mammographic breast density is associated with a four to six times increased risk for breast cancer. Mammographic breast density varies by ethnicity, geographical region and age. The aim of this study was to document for the first time the mammographic breast density of Jordanian women and to explore its relationship with age. METHODS: Mammograms completed at King Abdullah University Hospital (Irbid, Jordan) between January 2016 and August 2018 were retrospectively reviewed and classified for breast density using the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS). Descriptive analyses and Kurskal-Wallis test were used to examine the association between age and mammographic breast density. RESULTS: A total of 659 mammograms were reviewed. A significant inverse relationship was observed between age and breast density (P < 0.001). In women aged 40-49 years, 83.2% had dense breasts (ACR BI-RADS (c) and (d)). This percentage decreased to 59.8% of women aged 50-59 years; 38.4% of women in their 60s and 37.9% of women aged 70 years or older (ACR BI-RADS (c) only). CONCLUSION: The mammographic breast density of Jordanian women has been shown to be high across all age groups. Increased mammographic breast density is associated with increased breast cancer risk and renders mammography a less effective technique for the early detection of breast cancer. Breast cancer screening of Jordanian women should be individualised to develop screening protocols and include additional adjunct imaging to best manage women at high risk.