Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists

BMC Cancer

Research Article

Robert A. Smith¹  María de la Luz Carranza-Flores²  Louis Martínez-Matsushita³  Mauricio Hernández-Ávila³  Angélica Angeles-Llerenas³  Gabriela Torres-Mejía³  Eduardo Lazcano-Ponce³  Carolina Ortega-Olvera³  Ernesto Montemayor-Varela³  Karla Kerlikowske⁴  Sergio Bautista-Arredondo⁵  Gilberto Sánchez-González⁵  Santos R. Uscanga-Sánchez⁶  Andy Bogart⁷  Diana L. Miglioretti⁸  Olga G. Martínez-Montañez⁹ 

[1] American Cancer Society, 250 Williams St., 30303, Atlanta, GA, USA;Centro de Diagnóstico Digital México-España, Secretaria de Salud Pública del Distrito Federal, Mariano Escobedo No. 148 col. Anáhuac, 11320, Ciudad de México D. F., Mexico;Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, 62100,, Cuernavaca, Morelos, Mexico;Department of Epidemiology and Biostatistics and the General Internal Medicine Section, University of California, 4150 Clement St, 94121, San Francisco, CA, USA;Department of Veterans Affairs, University of California, 4150 Clement St, 94121, San Francisco, CA, USA;Dirección de Economía de la Salud, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, CP. 62100, Cuernavaca, Morelos, Mexico;Federación Mexicana de Colegios de Ginecología y Obstetricia, Nueva York 38, Col. Nápoles, Benito Juárez, D.F. 03810, Ciudad de México, Mexico;Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave #1600, 98101, Seattle, WA, USA;Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave #1600, 98101, Seattle, WA, USA;Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, 1 Shields Ave, 95616, Davis, CA, USA;Hospital de Oncología, Centro Médico Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Cuauhtemoc Doctores, D.F. 06720, Ciudad de México, Mexico;

关键词: Radiographers;    Film readers;    Screening mammography;    BI-RADS system;   

DOI  :  10.1186/s12885-015-1399-2

 received in 2014-12-15, accepted in 2015-04-29,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundAn alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries.MethodsWe evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed.ResultsRadiographer’s sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7–86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7–57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6–0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms.ConclusionsGiven the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography.

【 授权许可】

CC BY   
© Torres-Mejía et al.; licensee BioMed Central. 2015