Purpose To compare radiologists’ performance during interpretation of screening mammograms in the clinic to their performance when reading the same examinations in a retrospective laboratory study. Materials and Methods This study was conducted under an Institutional Review Board approved HIPAA compliant protocol where informed consent was waived. Nine experienced radiologists rated an enriched set of examinations that they personally had read in the clinic (“reader-specific”) mixed with an enriched “common” set of examinations that none of the participants had read in the clinic, using a screening BI-RADS rating scale. The original clinical recommendations to recall the women for a diagnostic workup, or not, for both reader-specific and common sets were compared with their recommendations during the retrospective experiment. The results are presented in terms of reader-specific and group averaged “sensitivity” and “specificity” levels and the dispersion (spread) of reader-specific performance estimates. Results On average radiologists performed significantly better in the clinic as compared with their performance in the laboratory (p=0.035). Inter reader dispersion of the computed performance levels was significantly lower during the clinical interpretations (p<0.01). Conclusion Retrospective laboratory experiments may not represent well either expected performance levels or inter- reader variability during clinical interpretations of the same set of examinations in the clinical environment.

A substantial fraction of women in this study would have preferred the inconvenience of and anxiety associated with a higher recall rate if it resulted in the possibility of detecting breast cancer earlier.

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