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Factors affecting radiologist inconsistency in screening mammography
Craig A Beam1, Emily F Conant, Edward A Sickles
1Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
Academic Radiology
|December 3, 2002
Summary
Radiologist disagreement in mammogram interpretation stems more from difficult cases than individual reader variability. Focusing training on challenging mammography cases, rather than reader inconsistency, can improve diagnostic accuracy.
Area of Science:
- Radiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Mammogram interpretation exhibits variability among radiologists.
- The primary drivers of this disagreement (case complexity vs. reader inconsistency) remain unclear.
- Targeted training requires understanding the main sources of interpretation variability.
Purpose of the Study:
- To determine the relative contributions of case-specific features and interpreter differences to mammogram interpretation variability.
- To identify factors influencing disagreement in mammographic findings.
Main Methods:
- 110 radiologists independently interpreted 148 screening mammography cases.
- Evaluated findings included calcifications, mass, architectural distortion, and asymmetric density.
- Radiologists were blinded to biopsy-proven disease status.
Main Results:
- Case-related differences were a larger source of interpretation disagreement than interpreter differences.
- The presence of cancer and patient age were associated with increased disagreement.
- Disagreement was higher for cases with multiple findings.
Conclusions:
- Reducing disagreement in difficult mammography cases is key to improving consistency.
- A population-based method can objectively measure case difficulty for targeted training.
- Current training often relies on intuitive or experiential definitions of difficult cases.