Abstract
ObjectiveTo analyze the association between radiologists’ performance and image position within a batch in screen reading of mammograms in Norway.MethodWe described true and false positives and true and false negatives by groups of image positions and batch sizes for 2,937,312 screen readings performed from 2012 to 2018. Mixed-effects models were used to obtain adjusted proportions of true and false positive, true and false negative, sensitivity, and specificity for different image positions. We adjusted for time of day and weekday and included the individual variation between the radiologists as random effects. Time spent reading was included in an additional model to explore a possible mediation effect.ResultTrue and false positives were negatively associated with image position within the batch, while the rates of true and false negatives were positively associated. In the adjusted analyses, the rate of true positives was 4.0 per 1000 (95% CI: 3.8–4.2) readings for image position 10 and 3.9 (95% CI: 3.7–4.1) for image position 60. The rate of true negatives was 94.4% (95% CI: 94.0–94.8) for image position 10 and 94.8% (95% CI: 94.4–95.2) for image position 60. Per 1000 readings, the rate of false negative was 0.60 (95% CI: 0.53–0.67) for image position 10 and 0.62 (95% CI: 0.55–0.69) for image position 60.ConclusionThere was a decrease in the radiologists’ sensitivity throughout the batch, and although this effect was small, our results may be clinically relevant at a population level or when multiplying the differences with the number of screen readings for the individual radiologists.Key Points• True and false positive reading scores were negatively associated with image position within a batch.• A decreasing trend of positive scores indicated a beneficial effect of a certain number of screen readings within a batch.• False negative scores increased throughout the batch but the association was not statistically significant.
Highlights
The aim of mammographic screening is to detect breast cancer in an early stage and reduce breast cancer mortality among asymptomatic women at average risk of breast cancer [1]
The decreasing trend of positive scores and increasing trend of negative scores by image position within the batch were observed for both radiologists
We observed a lower proportion of true positives for reader 1 compared to reader 2 for the first readings, while the proportions did not differ for higher image positions (Fig. 3)
Summary
The aim of mammographic screening is to detect breast cancer in an early stage and reduce breast cancer mortality among asymptomatic women at average risk of breast cancer [1]. The rate of screen-detected cancer can be influenced by the women’s individual risk of the disease, how the program is organized, and the performance of the radiologists. Menopausal status, use of hormonal treatment, and mammographic density are examples of risk factors [2,3,4,5], while screening interval, age range of the target population, and availability to prior mammograms are examples of organizational factors [6]. Eur Radiol of the batches are examples of factors expected to be of influence for the radiologists’ performance [6,7,8,9,10,11]. The evidence concerning the relative importance of these factors is sparse and the studies are often performed in a test or educational setting
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