The Concept
MQSA requires mammographers to read a minimum of 480 mammograms per year, although there is plenty of published data, that those who read more mammograms, have a better performance and subsequently patient outcome than those who read small numbers (1,2). In Europe, the minimum number of mammograms read by radiologists is about a factor 10 times more. Most European countries have a requirement of 5000 screening mammograms per year for a Radiologist to participate in the screening program.
Also, in most European countries, screening mammogram cases are read by two independent readers and if there is discordant reading a "super reader" or arbitrator will discuss the cases and make the final decision if the patient is being called back. This results in a continuous teaching and quality control effort of the participants reading screening mammograms.
A recently conducted study by Elizabeth S. Burnside et al. (3) revealed that an annual interpretive volume of 2770 screening mammograms, above the United States’ (US) mandatory (480) and average (1777) annual volumes but below England’s mandatory (5000) annual volume is necessary to confidently assert that a physician performed adequately. In their analyzed US practice, a single year of data uniformly allowed confident assertion of adequate performance in terms of recall rate (RR) but not cancer detection rate (CDR), which required aggregation of data across more than one year. They concluded that for individual physician quality assessment in cancer screening programs that target low incidence populations, considering imprecision in observed performance metrics due to small numbers of patients with cancer is important.
In an effort to address this issue, where it is general radiologists who do the majority of mammography in the USA, we sought to devise a simple tool that could be used to increase a reader’s experience to more than 1000 mammograms.
MammoCoach is an online teaching product where participants can earn CME and can improve their screening mammography skills. To achieve that goal, a team of Experts from different backgrounds in Academia, Private Practice, Industry, and Public Health, worked together to make this possible.
MammoCoach includes 1000 screening mammograms, including 2 year prior studies, among which there will be 100 recalls, including diagnostic work up and a final amount of 5 malignancies - as well as access to a large electronic case collection to further retrain certain aspects of breast imaging.
(1) Rawashdeh MA, Lee WB, Bourne RM et al. Markers of good performance in mammography depends on number of annual readings. Radiology 2013; 269(1):54-60
(2) Sickles, EA, Wolverton DE, Dee KE. Performance Parameters for Screening and Diagnostic Mammography: Specialist and General Radiologist. Radiology 2002;224(3):861-869
(3) Burnside ES, Lin Y, Munoz del Rio A et al. Addressing the challenge of assessing physician-level screening performance: mammography as an example. PLoS One. 2014 Feb 21;9(2):e89418.
