September 7, 2022 – When double-reading screening mammograms, radiographers (technologists) trained on the task perform as well as radiologists in key areas, according to a study published in Radiologya journal of the Radiological Society of North America (RSNA).
Double reading, the process of interpreting an X-ray image with two or more pairs of eyes, is the standard of care across Europe and has been shown to improve cancer detection rates while keeping recall rates low. The National Health Service Breast Screening Program (NHSBSP) in the UK has over 80 screening centers in England, where over 2 million women are screened each year.
To alleviate pressures on the healthcare system due to increasing workloads and shortages of radiologists, the NHSBSP has been using non-radiologists as part of double reading since the 1990s. While the The traditional role of radiographers is to perform mammography, the NHSBSP recruits radiographers who undergo additional extensive postgraduate training to interpret mammograms. They also participate in the same quality assurance standards as radiologists.
“Through the production of reliable data on the performance of individual readers over recent years, it has been possible to produce a robust comparison of the performance of our radiologist and non-radiologist readers in England,” said the study’s lead author. , Yan Chen, Ph.D., Associate Professor of Cancer Screening at the University of Nottingham School of Medicine in the UK
For this study, the researchers analyzed one year of performance data collected from 224 radiologists and 177 radiographers from the NHSBSP. Readers who also participated in the external quality assurance (EQA) program known as Personal Performance in Mammographic Screening (PERFORMS) were eligible for this study, and they also provided consent for their individual performance data to be real-life breast screening are accessible from the breast cancer screening information system.
The performance parameters that were analyzed were the cancer detection rate, the recall rate – the percentage of patients called back for follow-up testing – and the positive predictive value of recall based on biopsy-proven pathology findings. The positive predictive value reflects the percentage of cancers found among the examinations for which a biopsy was recommended or performed.
Each metric was analyzed based on reader profession, years of experience, and any interaction between them using analysis of variance. Analysis of variance is a statistical formula used to compare the variances between means (or mean) of different groups.
The researchers found no significant difference in the performance of readers from either professional group. The cancer detection rate among radiologists was 7.84 per 1,000 exams, while the cancer detection rate among radiologists was 7.53 per 1,000 exams. In addition, the average recall rate for radiologists and radiographers was 5% and 5.2%, respectively. The final performance measure, the positive predictive value of recall, also showed no variation. The positive predictive value of recall was 17.1% for radiologists and 16.1% for radiographers.
“It was very gratifying to show that there was little difference in the performance of readers from either professional group when we looked at key performance indicators for breast cancer screening, namely cancer detection rates, recall rates, and the positive predictive value of recall,” the co-author said. Jonathan J. James, FRCR, Consultant Radiologist and Director of Education and Training at Nottingham Breast Institute at Nottingham University Hospitals NHS Trust.
The results of this study also showed that reading performance was based on readers’ years of experience. This suggests that proper targeted training, participation in EQA programs like PERFORMS, and experience are all factors that contribute to a reader’s performance, rather than just having a medical degree and the broad training in radiology followed by all radiologists.
“Many countries are experiencing a shortage of radiologists, and this is compounded by growing demands and growing screening backlogs,” Dr. Chen said. The results of this study could lead
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