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Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment
Alai Tan1, Daniel H Freeman, James S Goodwin
1Department of Preventive Medicine and Community Health, Office of Epidemiology and Biostatistics, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-1148, USA. altan@utmb.edu
Background:
The accuracy of mammography reading varies among radiologists. We conducted a population-based assessment on radiologist variation in false- positive rates of screening mammography and its associated radiologist characteristics.
Methods:
About 27,394 screening mammograms interpreted by 1067 radiologists were identified from a 5% non-cancer sample of Medicare claims during 1998-1999. The data were linked to the American Medical Association Masterfile to obtain radiologist characteristics. Multilevel logistic regression models were used to examine the radiologist variation in false-positive rates of screening mammography and the associated radiologist characteristics.
Results:
Radiologists varied substantially in the false-positive rates of screening mammography (ranging from 1.5 to 24.1%, adjusting for patient characteristics). A longer time period since graduation is associated with lower false-positive rates (odds ratio [OR] for every 10 years increase: 0.87, 95% Confidence Interval [CI], 0.81-0.94) and female radiologists had higher false-positive rates than male radiologists (OR = 1.25, 95% CI, 1.05-1.49), adjusting for patient and other radiologist characteristics. The unmeasured factors contributed to about 90% of the between-radiologist variance.
Conclusions:
Radiologists varied greatly in accuracy of mammography reading. Female and more recently trained radiologists had higher false-positive rates. The variation among radiologists was largely due to unmeasured factors, especially unmeasured radiologist factors. If our results are confirmed in further studies, they suggest that system-level interventions would be required to reduce variation in mammography interpretation.
Insights
Radiologist accuracy in mammography varies significantly. Female and more recently trained radiologists showed higher false-positive rates, indicating a need for system-level interventions to improve screening mammography interpretation consistency.
Area of Science:
- Radiology
- Medical Imaging
- Public Health
Background:
- Mammography interpretation accuracy differs among radiologists.
- Population-based assessment of radiologist variation in false-positive rates for screening mammography is needed.
Purpose of the Study:
- To assess radiologist variation in false-positive rates for screening mammography.
- To identify radiologist characteristics associated with these variations.
Main Methods:
- Utilized a 5% non-cancer sample of Medicare claims (1998-1999) with 27,394 screening mammograms from 1067 radiologists.
- Linked claims data to the American Medical Association Masterfile for radiologist characteristics.
- Employed multilevel logistic regression models to analyze variations and associated factors.
Main Results:
- Substantial variation in false-positive rates (1.5% to 24.1%) was observed among radiologists.
- Longer time since graduation correlated with lower false-positive rates (OR=0.87 per 10 years).
- Female radiologists exhibited higher false-positive rates than male radiologists (OR=1.25).
Conclusions:
- Significant radiologist variation exists in mammography interpretation accuracy.
- Female and more recently trained radiologists had higher false-positive rates.
- Unmeasured factors accounted for approximately 90% of the observed variation, suggesting a need for system-level interventions.
