Effect of the EQUIP initiative on additional images performed at screening mammography: a pilot study

The Enhancing Quality Using the Inspection Program (EQUIP) initiative was launched to improve clinical image quality. The purpose of this study was to determine if the implementation of the EQUIP reporting system resulted in an increased number of extra views performed at the technologists' discretion during screening mammography.

Following IRB approval at a single comprehensive cancer center, patients who underwent screening mammography with combination full-field digital mammography plus digital breast tomosynthesis during a 6-month period before (January 2017 to June 2017) and after (January 2018 to June 2018) EQUIP implementation were identified. For each patient, both screening mammograms were retrospectively reviewed by 1 of 3 subspecialized breast radiologists (3-10 years of experience). The following data were recorded: demographics, breast density, surgical history, technologist, number and type of extra views, final BI-RADS assessment, radiologist-assigned indication for the view, and radiologist-assigned necessity of the view. McNemar's test for paired data was computed with p value of <0.05 considered statistically significant.

Of 820 patients, 370 (45%) had additional views in 2018 compared to 317 (39%) in 2017. After EQUIP, patients were 38% more likely to have additional views (OR = 1.38, 95% CI = 1.11-1.73). The total number of additional views in 2018 was 636 compared to 530 in 2017 (20% increase). Among patients with extra views in both years, the number of additional views per patient did not significantly increase post EQUIP implementation (OR = 1.18, 95% CI = 0.73-1.92). The most common extra view was exaggerated craniocaudal lateral, and the most common reason cited by the reviewing radiologist was lateral fibroglandular tissue at the edge of the images. Most of the extra views performed in 2018 were not performed in 2017 and over half were deemed unnecessary. Eight of eleven technologists demonstrated an increased frequency of screening mammograms with extra views performed post EQUIP.

Following EQUIP implementation, screening mammography patients were significantly more likely to have extra views performed at the technologists' discretion. Our findings emphasize the importance of ongoing technologist education and radiologist feedback.