Improvement in mammography quality control: 1987-1995.

PURPOSE: To assess possible changes in quality control (QC) practices at mammography sites in the United States. MATERIALS AND METHODS: Mammography site surveys were conducted in 1990, 1992, and 1995 through the Colorado Mammography Advocacy Project (CMAP). Data from mammography sites applying for American College of Radiology (ACR) accreditation were collected between August 1987 and August 1993 through the ACR Mammography Accreditation Program. Data from both of these surveys were analyzed to assess temporal changes in mammography QC practices in the United States between 1987 and 1995. RESULTS: CMAP results indicated statistically significant improvement in medical physicist QC practices between 1990 and 1992 and in technologist QC practices between 1990 and 1995. Improvements in radiologic technologist QC practices coincided with increases in radiologic technologist continuing education in mammography. ACR results indicated statistically significant improvement in technologist QC practices between 1988 and 1992. CONCLUSION: There have been substantial improvements in QC practices at mammography sites in the United States during the past decade.

Status of mammography education and knowledge of radiology residents.

PURPOSE: To evaluate breast imaging training and knowledge of radiology residents over a 3-year period. MATERIALS AND METHODS: From 1992 through 1994, the American College of Radiology (ACR) sponsored a 1-day comprehensive breast imaging seminar, which was attended by 2,249 radiology residents at the 6-week radiologic-pathology course of the Armed Forces Institute of Pathology. At each course, the residents were asked to complete a demographics survey and identical pre- and post-tests to assess knowledge before and after the seminar. RESULTS: The majority of residents who attended the Armed Forces Institute of Pathology course were in their 2nd or 3rd year of radiology training, and 75% (1,682 of 2,249 residents) responded that they had training in breast imaging before the ACR seminar. There was an increase in the median residency training time devoted to mammography from 4-6 weeks in 1992 to 8-11 weeks in 1994. There was no statistically significant change in the pretest scores over the 3 years, with persistent weaknesses in knowledge about quality control and mammographic technique. There was improvement in short-term knowledge after the ACR seminar. CONCLUSION: Despite increased time spent in breast imaging training in radiology residency programs from 1992 through 1994, there was no statistically significant improvement in the baseline knowledge of residents who attended this course. This 1-day course improved short-term knowledge of breast imaging.

Mobile mammography: results of a national survey.

PURPOSE: to learn about mobile mammography in the United States. MATERIALS AND METHODS: A survey of 82 questions was designed, pilot tested, and sent to mobile mammography facilities. The questions addressed many aspects of mobile programs, including administrative, financial, equipment, personnel, film processing, quality assurance, and communication of results. RESULTS: Of the 367 facilities that were mailed surveys, 159 facilities completed the survey, and 30 (19%) of those had discontinued their mobile programs. Seventy-six of 158 (48%) mobile facilities had performed mobile mammography for 1-5 years, and 69 of 158 (44%) had performed mobile mammography for more than 5 years. Seventy-two of 156 (46%) facilities were hospital-owned, and 25 of 156 (16%) were radiologist-owned. One hundred seven of 159 (67%) mobile facilities performed screening only. One hundred fourteen of 152 (75%) facilities charged +80.00 or less for screening. Mobile facilities averaged 20 examinations per day and served diverse populations. Sixty-seven of 159 (42%) facilities accepted self-referred women. Thirty-one percent of the facilities performed on-board processing. Only 71 of 149 (47%) facilities were financially profitable or breaking even, but 112 of 154 (73%) facilities would undertake a mobile project again. CONCLUSION: Mobile programs provide an opportunity to increase access to screening mammography, but they face many obstacles.

Status of residency training in mammography.

OBJECTIVE: The purpose of this study was to survey the status of residency training in mammography, including mammography quality assurance, and to compare the results with previous surveys from 1990 and 1992. MATERIALS AND METHODS: A telephone interview was conducted with 213 chief residents and 11 other senior residents representing all 224 accredited residency programs in diagnostic radiology. RESULTS: Compared with 1990, more programs had exclusive mammography rotations (74% versus 40%). The number of fellowships in breast imaging increased from 17 to 76. More training programs differentiated screening from diagnostic examinations (50% versus 35%). Compared with 1992, the percentage of residents who knew recommended frequencies of quality control procedures increased by 30% and the percentage who knew the maximum allowable radiation dose increased by 50%. Residents lacked fundamental knowledge about conducting medical audits, such as calculating the positive predictive value for biopsies. CONCLUSION: More time is being devoted to breast imaging in diagnostic radiology residency training, and residents show greater knowledge about mammography quality assurance.

Demographic characteristics of physicists who evaluate mammographic units.

PURPOSE: To determine whether there will be an adequate number of physicists to meet the 1996 American College of Radiology (ACR) Mammography Accreditation Program requirements and assess the qualifications of physicists available to evaluate mammography units as required by the federal Mammography Quality Standards Act of 1992. MATERIALS AND METHODS: A 21-question survey prepared by the ACR was sent to most medical physicists who perform evaluations of mammographic units. Replies were received from 1,011 individuals. RESULTS: Survey results are based on the replies of 824 individuals who indicated a willingness to perform evaluations in the future. In 1996, there will be approximately 510 certified physicists to evaluate an estimated 14,000 mammography units in the United States. CONCLUSION: A sufficient number of certified diagnostic medical physicists will be available to provide required annual performance evaluations of all mammography units in the United States only if the number of units evaluated per physicist increases substantially over current levels.

Mammography film-labeling practices.

The labeling practices of 390 facilities that consecutively submitted screening mammography images (mediolateral oblique and craniocaudal views) to the American College of Radiology (ACR) Mammography Accreditation Program over a 2-month period were evaluated. Methods for identifying the patient and facility included a flash card at 333 facilities (85%), stick-on paper labels at 54 (14%), and handwriting directly on the film at three (1%). Identification labels included the patient's first and last name at 372 facilities (95%), the date at 370 (95%), the name of the facility at 349 (89%), a unique patient identification number at 328 (84%), the patient's age at 169 (43%), the name of the referring physician at 146 (37%), and the patient's date of birth at 129 (33%). Labeling practices, information provided, and methods used varied considerably from one site to another. Adoption of ACR guidelines for labeling mammography films is encouraged.

Quality assurance in mammography: status of residency education.

OBJECTIVE: The purpose of this study was to determine to what extent radiology residents are being trained in quality assurance procedures for mammography. MATERIALS AND METHODS: A telephone survey was conducted with 189 chief residents and 10 other senior residents from 199 of the 209 residency training programs in diagnostic radiology. RESULTS: Time spent on mammography rotations averaged 8 weeks. Only 10 residents (5%) were "very familiar" with the American College of Radiology (ACR) Mammography Accreditation Program; 72 (36%) were "not at all familiar" with it. Ninety-six (48%) knew that one technologist should be assigned quality control procedures. The majority did not know the recommended frequency for performing any of the five routine quality control procedures; only one knew the recommended frequencies for all five. Only twenty-seven (14%) knew the recommended maximum dose for a mammogram. Regarding biopsy yields and false-negative results: 92 residents (46%) sat in on outcome evaluation sessions; 54 (27%) played active roles, looking up and tabulating results; and 53 (27%) did not participate at all. CONCLUSION: Although time spent on mammography rotations has increased substantially, quality assurance issues are still largely neglected. It may not be reasonable for radiology residents to have detailed instruction in quality assurance procedures for mammography, but they should be more familiar with the general issues involved and the procedures intended to correct the problem of the variable quality of mammography in this country.