Study: Many rads' goals for breast imaging misaligned

Mammography quality assurance programs are intended to help physicians get a sense of where their performance stands in relation to national benchmarks. A national survey of radiologists’ personal goals, however, showed that many radiologists have goals that fall outside of published desirable benchmarks, according to a study published in the March issue of Academic Radiology.

Sara L. Jackson, MD, MPH, of the department of internal medicine at the University of Washington in Seattle, and colleagues sent surveys to 364 community-based radiologists working in breast imaging in seven states to determine the proportion of radiologists’ personal goals that fall within published benchmarks from the American College of Radiology. They specifically looked at goals for recall rate, false-positive rate, positive predictive value of biopsy recommendation (PPV2) and cancer detection rate.

Of the 257 radiologists who responded, the percentage of radiologists reporting goals within desirable ranges was 79 percent for recall rate, 22 percent for false-positive rate, 39 percent for PPV2 and 61 percent for cancer detection rate.

“Self-reported goals for recall rate and cancer detection rate, two measures well-understood by interpreting radiologists, were most closely aligned with published goal ranges,” wrote the authors. “For [false-positive rate] and PPV2, a majority of radiologists reported goals that fell outside of desirable ranges, with relatively even dispersion of reported goals between 0 percent and 100 percent. This indicates that many radiologists are not familiar with [false-positive rate] and PPV2 or they have unrealistic goals for these measures.”

While a high percentage of overall PPV2 goals fell outside the guidelines, certain groups of physicians fared better than others. Radiologists with a primary academic affiliation, those receiving more hours of breast imaging continuing education and those receiving audit reports at least annually were more likely to have desirable PPV2 goals. Radiologists with detection rate goals aligned with national guidelines were more likely to have interpreted mammograms for 10 years or more, with an interpretive volume of more than 1,000 mammograms per year.

Jackson et al noted that false-positive rates are important to understand in order to reduce harms from overdiagnosis.

“It is possible that clearly defining [false-positive rate] in future guidelines and explicitly reporting this rate in audit data could improve radiologists’ awareness and understanding of this commonly used measure. In conceptual terms, it is important for radiologists to understand their [false-positive rates], because while working toward maximizing cancer detection, they should attempt to minimize the burden of false-positive workups,” they wrote.