RESUMEN
OBJECTIVE: This paper describes a high-quality, multisite telemammography system to enable "almost real-time" remote patient management while the patient remains in the clinic. One goal is to reduce the number of women who would physically need to return to the clinic for additional imaging procedures (termed "recall") to supplement "routine" imaging of screening mammography. MATERIALS AND METHODS: Mammography films from current and prior (when available) examinations are digitized at three remote sites and transmitted along with other pertinent information across low-level communication systems to the central site. Images are automatically cropped, wavelet compressed, and encrypted prior to transmission to the central site. At the central site, radiologists review and rate examinations on a high-resolution workstation that displays the images, computer-assisted detection results, and the technologist's communication. Intersite communication is provided instantly via a messaging "chat" window. RESULTS: The technologists recommended additional procedures at 2.7 times the actual clinical recall rate for the same cases. Using the telemammography system during a series of "off-line" clinically simulated studies, radiologists recommended additional procedures at 1.3 times the actual clinical recall rate. Percent agreement and kappa between the study and actual clinical interpretations were 66.1% and 0.315, respectively. For every physical recall potentially avoided using the telemammography system, approximately one presumed "unnecessary" imaging procedure was recommended. CONCLUSION: Remote patient management can reduce the number of women recalled by as much as 50% without performing an unreasonable number of presumed "unnecessary" procedures.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Mamografía , Tamizaje Masivo , Telerradiología , Instituciones de Atención Ambulatoria , Neoplasias de la Mama/epidemiología , Redes de Comunicación de Computadores , Simulación por Computador , Computadores , Sistemas de Administración de Bases de Datos , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Variaciones Dependientes del Observador , Interpretación de Imagen Radiográfica Asistida por Computador , Sistemas de Información Radiológica , Proyectos de Investigación , Programas InformáticosRESUMEN
RATIONALE AND OBJECTIVE: To evaluate breast radiologists' recognition of mammograms showing cancers that they correctly detected or "missed" during clinical interpretations. MATERIALS AND METHODS: Two similar experiments were conducted. In the first, 33 bilateral screening mammograms were reviewed by four breast imagers. These included five cancers that each radiologist had detected, two cancers that each radiologist had "missed," and five mammograms recalled by other radiologists that were not cancer. Radiologists were asked if they had interpreted the mammogram in clinic and if the mammogram was suspicious for cancer. In the second experiment, four different breast imagers reviewed 48 mammograms that included five cancers that each radiologist had detected, two cancers that each radiologist had "missed," and five mammograms that were recalled by each radiologist but were not cancer. Using chi-square analysis, the performance of the radiologists on screening mammograms they had read in clinic was compared with their performance on mammograms read in clinic by other radiologists. RESULTS: Seven of eight radiologists did not remember interpreting any of the mammograms in clinic. One radiologist correctly remembered interpreting one mammogram in clinic, but interpreted it incorrectly. Average performance showed no significant difference (P = .60) between mammograms they had interpreted in clinic and those interpreted by others. CONCLUSION: Radiologists do not remember most mammograms showing cancer that they have interpreted, either correctly or incorrectly, after they are mixed with mammograms showing cancer that were interpreted by other radiologists. Screening mammograms can be used in observer performance studies in which the interpreting radiologist participates as an observer.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Mamografía , Memoria , Radiología/normas , Errores Diagnósticos , Evaluación del Rendimiento de Empleados , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Mamografía/normas , Variaciones Dependientes del Observador , Proyectos de Investigación , Estudios RetrospectivosRESUMEN
BACKGROUND: The authors investigated the correlation between recall and detection rates in a group of 10 radiologists who had read a high volume of screening mammograms in an academic institution. METHODS: Practice-related and outcome-related databases of verified cases were used to compute recall rates and tumor detection rates for a group of 10 Mammography Quality Standard Act (MQSA)-certified radiologists who interpreted a total of 98,668 screening mammograms during the years 2000, 2001, and 2002. The relation between recall and detection rates for these individuals was investigated using parametric Pearson (r) and nonparametric Spearman (rho) correlation coefficients. The effect of the volume of mammograms interpreted by individual radiologists was assessed using partial correlations controlling for total reading volumes. RESULTS: A wide variability of recall rates (range, 7.7-17.2%) and detection rates (range, 2.6-5.4 per 1000 mammograms) was observed in the current study. A statistically significant correlation (P < 0.05) between recall and detection rates was observed in this group of 10 experienced radiologists. The results remained significant (P < 0.05) after accounting for the volume of mammograms interpreted by each radiologist. CONCLUSIONS: Optimal performance in screening mammography should be evaluated quantitatively. The general pressure to reduce recall rates through "practice guidelines" to below a fixed level for all radiologists should be assessed carefully.