Mammography image quality evaluation in breast cancer screening: The Saudi experience

Abstract

ObjectiveTo evaluate the mammographic image quality carried out within the Saudi breast cancer screening program. MethodsTwo radiologists reviewed 956 mammograms using the American College of Radiology (ACR) quality standard. Each quality criterion was rated on a 5-point ordinal scale (1 = best to 5 = severe deficiency). A score of 5 or 4 for any category or a score of 3 for multiple categories led to failure. When disagreement occurred in the overall quality or positioning score, the mammograms were further evaluated by a third radiologist. Inter-rater agreement was tested using Cohen's kappa. ResultsInter-rater agreement ranged from slight (kappa 0.18, p=<0.0001) for positioning to low (kappa = 0.02, p = 0.002) for contrast. Positioning was the most frequently reported issue that led to failure in image quality (n = 324). When the set of images sent to the third reviewers, only 25.5% were deemed deficient in positioning. Of the 324 mammograms that failed due to positioning, the most common problems reported by all three reviewers were inadequate pectoralis major muscle on a mediolateral oblique view, a posterior nipple line on craniocaudal view exceeding 1 cm, other body parts projecting over the breast and poor visualization of posterior tissue on MLO. ConclusionPositioning was the major contributor to failures associated with mammography image quality. Considerable room for improvement exists through ongoing education and training, with particular emphasis on breast positioning. Radiologists are encouraged to be actively involved in this development process.