Assessing mammography film-reader performance

Introduction

Mammography film-readers in the National Health Service Breast Screening Programme are required to read 5,000 screening mammograms per year, and to participate in Personal Performance in Mammographic Screening (PERFORMS). It is known that individual cancer detection rates are higher when individuals perform high volumes of breast imaging annually, and that poor performance may be identified by PERFORMS. We have looked more closely at details of reader performance to guide individuals on how practice may be improved.

Method

At our institution, films are double-read by radiologists and advanced practitioners, with arbitration by consensus of two readers. Information on 12 months of activity was obtained from the National Breast Screening Service, and data on individual workload, recall to arbitration rate, cancer detection rate and cancers detected by only one reader were compared.

Results

There is a weak association between the recall rate and the cancer detection rate, and in general readers with high recall rates miss fewer cancers. Overall the cancer detection rate is similar on both first and second reads, although some readers perform best on first read and others on second read. Feedback of these data and discussion of arbitrary levels of preferred recall rates and cancer detection rates is used to inform personal practice.