Mammography quality assurance. Current issues

Some of the issues being addressed in mammography quality assurance are 1) that image quality is the most important technical aspect of mammography; 2) that image quality has improved steadily over the past two decades and will continue to improve at most mammography sites in the United States; 3) that the American College of Radiology's Mammography Accreditation Program is the best way to ensure high quality mammogram; 4) that access to high quality mammography is not geographically restricted, with over half the mammography sites in the United States now ACR accredited and another 30% participating in the accreditation process; 5) that regular and effective quality assurance, as described in the ACR Mammography Quality Control Manuals and as required of ACR accredited sites, is the only way to ensure that superior mammography image quality is maintained; and 6) that sites with higher mammography volume have better quality assurance practices and lower failure rates than others within the ACR Mammography Accreditation Program. Two bills passed by the United States Congress, the Medicare Coverage of Screening Mammography (1990) and the Mammography Quality Standards Act (1992), contain mammography quality assurance provisions. As a result of the 1990 Medicare bill, on-site inspections of Medicare screening sites began in the fall of 1992. The Mammography Quality Standards Act is scheduled to go into effect on October 1, 1994. The current challenges to mammography are to improve and maintain high image quality at every mammography site, to improve imaging of the dense breast, to implement patient-tracking and follow-up mechanisms to improve compliance and assess the efficacy of screening, and to ensure that federal mammography quality standards are effectively and appropriately implemented.