Abstract
A change is underway, with conventional film-screen mammography being surpassed by the implementation of digital mammography and the associated soft-copy digital film reporting. However, there is an allied period of changeover with implementation that requires careful consideration to ensure optimal performance and efficiency of work tasks. To examine the human factors implications, a combination of techniques (expert walkthroughs, verbal protocol analysis, workstation assessment) was applied to examine existing working practices during the implementation of digital mammography film reading. Radiologists and advanced practitioners within a UK NHS Breast Screening Unit participated to enable a thorough understanding to be gained of strategies adopted when using: routine conventional roller viewing of analogue (film) cases with analogue priors; routine soft-copy reporting with full-field digital mammography (FFDM) priors; trial FFDM with analogue priors viewed on a multiviewer; and trial FFDM with digitised analogue cases viewed digitally. A variety of changes in working practices were recognised to have occurred with digital implementation. There was an impact upon performance and efficiency of digital soft-copy reporting when viewing analogue priors. Subsequent recommendations for workstation design, working practices and training were produced to assist in improved implementation of digital processes in mammography.
Highlights
Axillary lymph node dissection has been standard practice for staging invasive breast cancer
Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography
Full field digital mammography (FFDM) had a higher detection rate for ductal carcinoma in situ (DCIS) but no difference was observed for invasive tumours
Summary
Axillary lymph node dissection has been standard practice for staging invasive breast cancer. Aim To assess the feasibility of surgeons performing breast US in symptomatic breast clinics either as an adjunct to triple assessment or on their own for diagnostic and therapeutic purposes. The performance of individual units is monitored to ensure all women have access to an excellent service Aim This project aims to demonstrate how the Liverpool Breast Unit addressed failure to meet the national quality standard for the benign. Method A retrospective review of the records of patients who had undergone benign biopsy (2001–2002) was conducted to establish reasons for surgical referral and suggest corrective measures to enable the unit to meet the standard in the future. Columnar cell change (CCC) is diagnosed on core biopsies performed for indeterminate microcalcification. Method Mammograms of 33 cases with established CCC on core biopsy were reviewed and the radiological features, follow-up imaging and surgical excision histology (if performed) were collated. The results were completed when all units were undergoing assimilation onto the new banding procedures
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