Effect of radiologists' diagnostic work-up volume on interpretive performance

Area of Science:

• Radiology
• Medical Imaging
• Cancer Screening

Background:

• Screening mammography is crucial for early breast cancer detection.
• Radiologist performance in interpreting mammograms can be influenced by various factors, including feedback mechanisms.
• The impact of a radiologist performing diagnostic work-ups on their own screening interpretations is not fully understood.

Purpose of the Study:

• To investigate the relationship between the number of diagnostic work-ups performed by radiologists and their screening mammography performance.
• To determine if performing diagnostic work-ups for their own recalled cases impacts radiologist sensitivity, false-positive rate (FPR), and cancer detection rate (CDR).

Main Methods:

• A retrospective study analyzed 651,671 screening mammograms interpreted by 96 radiologists between 2002 and 2006.
• Data were linked to cancer registries to evaluate screening performance metrics (sensitivity, FPR, CDR).
• Logistic regression assessed the association between the volume of diagnostic work-ups (own vs. any radiologist) and screening performance.

Main Results:

• Radiologists performing more diagnostic work-ups for their own recalled mammograms showed significant improvements in sensitivity, FPR, and CDR.
• Increased work-ups for any radiologist also correlated with higher FPR and CDR, but not significantly with sensitivity.
• Radiologists with lower annual work-up volumes consistently demonstrated lower performance across all metrics.

Conclusions:

• Performing diagnostic work-ups for their own recalled screening mammograms may enhance radiologist performance through direct feedback.
• Implementing systems to encourage radiologists to work up a minimum number of their own recalled cases could improve overall screening accuracy.
• This feedback loop is essential for refining diagnostic decision-making in mammography.