Qualidade da interpretação do diagnóstico mamográfico

Abstract

OBJECTIVE: To demonstrate the knowledge of mammogram readers working in the public healthcare system in the State of Rio de Janeiro, RJ, Brazil, and to evaluate their progress in the early diagnosis of breast cancer after a training course specifically developed for medical professionals . MATERIALS AND METHODS: A group of 53 physicians with experience in mammography reports were invited. A pre-test was given to assess their initial knowledge level. Afterwards, they were trained by experts mammographers, and for final conclusion, requested to take a post-test for comparison and evaluation of gained knowledge. RESULTS: The course, with emphasis on theoretical classes, has not resulted in a significant improvement on the quality of mammogram reading, highlighting the persistence of errors in morphological description of fundamental lesions of the breast, in the classification of such lesions according to the BI-RADS®, besides the lack of coherence between the BI-RADS classification and follow-up recommendation as observed in both the pre-and posttest. CONCLUSION: The authors conclude that the mammogram readers have demonstrated insufficient knowledge in relation to early imaging diagnosis of breast cancer, and that the theoretical training has not resulted in a significant improvement on the quality of mammogram reading.OBJETIVO: Demonstrar o conhecimento mamográfico dos médicos interpretadores que trabalham na rede de saúde pública do Estado do Rio de Janeiro e avaliar o conhecimento adquirido após um curso elaborado com o objetivo de capacitar profissionais médicos no diagnóstico precoce do câncer de mama. MATERIAIS E MÉTODOS: Foram convidados 53 médicos que laudam exames mamográficos para o treinamento. Esses médicos eram submetidos a um pré-teste, no qual se avaliava o grau de conhecimento inicial. Depois, foram lecionadas aulas previamente elaboradas por mamografistas experientes, e para conclusão do curso esses médicos eram submetidos a um pós-teste para avaliação do conhecimento adquirido. RESULTADOS: O curso de capacitação de profissionais médicos, com ênfase em aulas teóricas, não mostrou aumento significativo na qualidade da interpretação mamográfica, destacando-se a persistência do erro na descrição morfológica das lesões fundamentais da mama, erro da classificação pelo sistema de padronização das lesões mamárias (BI-RADS®), falta de coerência entre a classificação BI-RADS adotada e a recomendação de conduta, tanto no pré-teste como no pós-teste. CONCLUSÃO: Concluiu-se que os médicos interpretadores mostram conhecimento insuficiente em relação ao diagnóstico precoce por imagem do câncer de mama e que o curso teórico não mostrou aumento significativo na qualidade da interpretação mamográfica. Unitermos: Qualidade; Diagnóstico mamográfico; Parâmetros técnicos. AbstractResumo

Evolution of mammographic image quality in the state of Rio de Janeiro

“…The implementation of a mammography quality control program should include human resources training and capacitation as a key factor to strengthen and improve the program outcomes ( 3 , 7 ) .…”

“…Considering the academic and clinical consensus about mammography being the imaging method of choice for breast cancer screening ( 5 ) , it is expected that such a procedure produces good-quality images with the use of the lowest possible radiation dose. In Brazil, the initiatives aimed at mammography quality assurance started in 1991, with the Mammography Quality Control Program implemented by Colégio Brasileiro de Radiologia, whose adhesion was voluntary ( 6 , 7 ) . In the same decade, the Federal Ordinance 453/98 established the guidelines for protection in medical and odontological radiodiagnosis ( 6 , 8 , 9 ) .…”

Perfil Das Mulheres Diagnosticadas Com Câncer De Mama No Município De Maringá-Pr

“…A população-alvo do estudo não foge à regra, com diagnóstico tardio e necessidade de instituição de tratamento agressivo. A detecção precoce do câncer de mama em sua fase inicial é a forma mais eficaz de controle da doença (KOCH, 2010). sendo assim, é necessário que o equipamento mamográfico seja adequado, assim como uma equipe médica e técnica preparada para a realização e execução da mesma (GOTO, 2013).…”

Construction of an index of information from clinical practice in Radiology and Imaging Diagnosis based on text mining and thesaurus

“…Most of such lexical systems and vocabularies designed for communication are available only in English. Studies (10)(11)(12)(13) demonstrate that the application of such systems directly into the medical practice results in positive changes in the medical assistance quality, but, in certain circumstances, the application of a closed model of knowledge may bring difficulties to the use by specialists and even problems for the developer in the programming of technological solutions. The difficulty in the transposition of a closed terminology into the practice results fundamentally from the distancing between the theoretical perspective of using the developed terminology (how to use it, with which purpose, and who should/can use it), and the actual conditions of local use where such terminology will be utilized (which involves the institutional culture and the proper formalisms of each individual physician) (14) .…”