Use of clinical history affects accuracy of interpretive performance of screening mammography

Abstract

Objective To examine how use of clinical history affects radiologist's interpretation of screening mammography. Study Design and Setting Using a self-administered survey and actual interpretive performance, we examined associations between use of clinical history and sensitivity, false-positive rate, recall rate, positive predictive value, after adjusting for relevant covariates using conditional logistic regression. Results The majority of radiologists the 216 radiologists surveyed (63.4%) reported usually or always using clinical history when interpreting screening mammography. Compared to radiologists who rarely use clinical history, radiologists who usually/always use it had a higher false-positive rate with younger women (10.7 vs. 9.7), denser breast tissue (10.1 for heterogeneously dense to 10.9 for extremely dense versus 8.9 for fatty tissue), or longer screening intervals (> prior 5 years) (12.5 vs. 10.5). Effect of current hormone therapy (HT) use on false-positive rate was weaker among radiologists who use clinical history compared to those who did not (p=0.01), resulting in fewer false-positive exams and a non-significant lower sensitivity (79.2 vs. 85.2) among HT users Conclusions Interpretive performance appears to be influenced by patient age, breast density, screening interval and hormone therapy use. This influence does not always result in improved interpretive performance.

Radiology Malpractice Claims in the United States From 2008 to 2012: Characteristics and Implications

“…For instance, collateral clinical information may not be available for out-of-network patients whose medical data do not reside in the institutional electronic health record. Studies have demonstrated that insufficient clinical data available to the interpreting radiologist (ie, either cryptic or incorrect information) at the point of care increases the likelihood of a diagnostic miss [16][17][18][19][20].…”

The Influence of Mammographic Technologists on Radiologists' Ability to Interpret Screening Mammograms in Community Practice

“…Interpretive performance of screening mammography is known to vary by patient (4, 23–25), radiologist (4–7, 9, 11, 24–30) , and facility level characteristics. (30, 31) However, the extent to which screening mammography performance varies by the radiologic technologist has yet to be investigated.…”

“…(4, 23, 24) Radiologist level factors found to affect performance include time since graduation from residency, breast-imaging fellowship/training, annual interpretative volume, years of mammographic imaging and interpretation, and primary affiliation with an academic medical center. (4–7, 9, 24–26, 28–30) Facility level characteristics that may affect performance include volume, screening versus diagnostic mammography mix, having breast imaging specialists interpreting the examinations, and having audits two or more times per year.…”

Influences of Radiology Trainees on Screening Mammography Interpretation

“…There are established variables affecting mammography recall rates (RRs) and cancer detection rates (CDRs). These include patient factors such as breast density [2], age [3,4], use of hormone replacement therapy [2,5], interval since prior mammographic study [3], family history [6], and prior biopsy results [6]. Interpreting physician factors may include radiologist's sex [7], experience [7,8], practice setting [9], annual case volume [10], and fellowship training [7,11].…”