Does it matter for the radiologists' performance whether they read short or long batches in organized mammographic...

To analyze the association between radiologists' performance and image position within a batch in screen reading of mammograms in Norway.

We described true and false positives and true and false negatives by groups of image positions and batch sizes for 2,937,312 screen readings performed from 2012 to 2018. Mixed-effects models were used to obtain adjusted proportions of true and false positive, true and false negative, sensitivity, and specificity for different image positions. We adjusted for time of day and weekday and included the individual variation between the radiologists as random effects. Time spent reading was included in an additional model to explore a possible mediation effect.

True and false positives were negatively associated with image position within the batch, while the rates of true and false negatives were positively associated. In the adjusted analyses, the rate of true positives was 4.0 per 1000 (95% CI: 3.8-4.2) readings for image position 10 and 3.9 (95% CI: 3.7-4.1) for image position 60. The rate of true negatives was 94.4% (95% CI: 94.0-94.8) for image position 10 and 94.8% (95% CI: 94.4-95.2) for image position 60. Per 1000 readings, the rate of false negative was 0.60 (95% CI: 0.53-0.67) for image position 10 and 0.62 (95% CI: 0.55-0.69) for image position 60.

There was a decrease in the radiologists' sensitivity throughout the batch, and although this effect was small, our results may be clinically relevant at a population level or when multiplying the differences with the number of screen readings for the individual radiologists.

• True and false positive reading scores were negatively associated with image position within a batch. • A decreasing trend of positive scores indicated a beneficial effect of a certain number of screen readings within a batch. • False negative scores increased throughout the batch but the association was not statistically significant.