Mammography Positioning Improvement Results and Unique Challenges in a Safety-Net Health System

Poor mammography positioning can result in missed or delayed cancer diagnoses. The authors' safety-net breast imaging practice experienced an increase in technical repeats due to poor screening mammography quality, potentially worsening socioeconomic and racial disparities in breast cancer outcomes. The aim of this article is to share the authors' safety-net breast imaging practice challenges and the results of participating in a structured improvement program to improve screening mammography positioning.

In collaboration with the ACR Learning Network, the authors' center joined cohort 3 of the ACR Mammography Positioning Improvement Collaborative. A project team was formed, and A3 thinking was applied to improve adherence to established positioning criteria. After conducting a current-state analysis and process mapping, root causes of poor image quality, key drivers for improvement, and interventions were identified. Throughout the program, positioning was assessed on 1,639 four-view screening mammograms, interventions were implemented, and changes in the percentage of screening mammograms meeting positioning criteria were tracked.

Root causes included variable technologist skill levels, inconsistent onboarding, high technologist turnover, understaffing, language barriers, challenging patient body habitus, and mobility issues. Interventions included daily positioning tips, one-on-one training for technologists, and a Spanish-language document for technologists. The percentage of screening mammograms meeting positioning criteria was significantly increased from 45% to 58% overall (P = .02), with an average weekly pass rate of 75% for the final 7 weeks of the project.

Through a structured improvement program, the authors identified challenges to mammography positioning faced by a safety-net breast imaging practice and developed and implemented interventions to significantly improve overall image quality.