Mammography has been the frontline screening tool for breast cancer for decades. However, high error rates in the form of false negatives (FNs) and false positives (FPs) have persisted despite technological improvements. Radiologists still miss between 10% and 30% of cancers while 80% of woman recalled for additional views have normal outcomes, with 40% of biopsied lesions being benign. Research show that the majority of cancers missed is actually visible and looked at, but either go unnoticed or are deemed to be benign. Causal agents for these errors include human related characteristics resulting in contributory search, perception and decision-making behaviours. Technical, patient and lesion factors are also important relating to positioning, compression, patient size, breast density and presence of breast implants as well as the nature and subtype of the cancer itself, where features such as architectural distortion and triple-negative cancers remain challenging to detect on screening. A better understanding of these causal agents as well as the adoption of technological and educational interventions, which audits reader performance and provide immediate perceptual feedback, should help. This paper reviews the current status of our knowledge around error rates in mammography and explores the factors impacting it. It also presents potential solutions for maximizing diagnostic efficacy thus benefiting the millions of women who undergo this procedure each year.

OBJECTIVE. The objective of the present study was to assess interradiologist agreement regarding mammographic breast density assessment performed using the rating scale outlined in the fifth edition of the BI-RADS atlas of the American College of Radiology. MATERIALS AND METHODS. Breast density assessments of 1000 cases were conducted by five radiologists from the same institution who together had recently undergone retraining in mammographic breast density classification based on the fifth edition of BI-RADS. The readers assigned breast density grades (A–D) on the basis of the BI-RADS classification scheme. Repeat assessment of 100 cases was performed by all readers 1 month after the initial assessment. A weighted kappa was used to calculate intrareader and interreader agreement. RESULTS. Intrareader agreement ranged from a kappa value of 0.86 (95% CI, 0.77–0.93) to 0.89 (95% CI, 0.81–0.95) on a four-category scale (categories A–D) and from 0.89 (95% CI, 0.86–0.92) to 0.94 (95% CI, 0.89–0.97) on a two-ca...

Radiologists can detect abnormality in mammograms at above-chance levels after a momentary glimpse of an image. The study investigated this instantaneous perception of an abnormality, known as a “gist” response, when 23 radiologists viewed prior mammograms of women that were reported as normal, but later diagnosed with breast cancer at subsequent screening. Five categories of cases were included: current cancer-containing mammograms, current mammograms of the normal breast contralateral to the cancer, prior mammograms of normal cases, prior mammograms with visible cancer signs in a breast from women who were initially reported as normal, but later diagnosed with breast cancer at subsequent screening in the same breast, and prior mammograms without any visible cancer signs from women labelled as initially normal but subsequently diagnosed with cancer. Our findings suggest that readers can distinguish patients who were diagnosed with cancer, from individuals without breast cancer (normal category), at above-chance levels based on a half-second glimpse of the mammogram even before any lesion becomes visible on the mammogram. Although 20 of the 23 radiologists demonstrated this ability, radiologists’ abilities for perceiving the gist of the abnormal varied between the readers and appeared to be linked to expertise. These results could have implications for identifying women of higher than average risk of a future malignancy event, thus impacting upon tailored screening strategies.

Purpose . To explore doses from common adult computed tomography (CT) examinations and propose national diagnostic reference levels (nDRLs) for Nigeria. Materials and Methods . This retrospective study was approved by the Nnamdi Azikiwe University and University Teaching Hospital Institutional Review Boards (IRB: NAUTH/CS/66/Vol8/84) and involved dose surveys of adult CT examinations across the six geographical regions of Nigeria and Abuja from January 2016 to August 2017. Dose data of adult head, chest and abdomen/pelvis CT examinations were extracted from patient folders. The median, 75th and 25th percentile CT dose index volume (CTDI _vol ) and dose-length-product (DLP) were computed for each of these procedures. Effective doses (E) for these examinations were estimated using the k conversion factor as described in the ICRP publication 103 (E _DLP = _{k × DLP} ). Results . The proposed 75th percentile CTDI _vol for head, chest, and abdomen/pelvis are 61 mGy, 17 mGy, and 20 mGy, respectively. The corresponding DLPs are 1310 mGy.cm, 735 mGy.cm, and 1486 mGy.cm respectively. The effective doses were 2.75 mSv (head), 10.29 mSv (chest), and 22.29 mSv (abdomen/pelvis). Conclusion . Findings demonstrate wide dose variations within and across centres in Nigeria. The results also show CTDI _vol comparable to international standards, but considerably higher DLP and effective doses.

Digital breast tomosynthesis (DBT) has gained acceptance as an adjunct to digital mammography in screening. Now that breast density reporting is mandated in several states in the USA, it is increasingly important that the methods of breast density measurement be robust, reliable and consistent. Breast density assessment with DBT needs some consideration since quantitative methods are modelled for two-dimensional (2D) mammography. A review of methods used for breast density assessment with DBT was performed. Existing evidence shows Cumulus has better reproducibility than that of the breast imaging reporting and data system (BI-RADS®) but still suffers from subjective variability; MedDensity is limited by image noise, whilst Volpara and Quantra are robust and consistent. The reported BI-RADs inter-reader breast density agreement (k) ranged from 0.65 to 0.91, with inter-reader correlation (r) ranging from 0.70 to 0.93. The correlation (r) between BI-RADS and Cumulus ranged from 0.54-0.94, whilst that of BI-RADs and MedDensity ranged from 0.48-0.78. The reported agreement (k) between BI-RADs and Volpara is 0.953. Breast density correlation between DBT and 2D mammography ranged from 0.73 to 0.97, with agreement (k) ranging from 0.56 to 0.96. To avoid variability and provide more reliable breast density information for clinicians, automated volumetric methods are preferred.

Introduction: Radiographer image evaluation methods such as the preliminary image evaluation (PIE), a formal comment describing radiographers’ findings in radiological images, are embedded in the contemporary radiographer role within Australia. However, perceptions surrounding both the capacity for Australian radiographers to adopt PIE and the barriers to its implementation are highly variable and seldom evidence‐based. This paper systematically reviews the literature to examine radiographic image interpretation by Australian radiographers and the barriers to implementation.Methods: The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses were used to systematically review articles via Scopus, Ovid MEDLINE, PubMed, ScienceDirect and Informit. Articles were deemed eligible for inclusion if they were English language, peer‐reviewed and explored radiographic image interpretation by radiographers in the context of the Australian healthcare system. Letters to the editor, opinion pieces, reviews and reports were excluded.Results: A total of 926 studies were screened for relevance, 19 articles met the inclusion criteria. The 19 articles consisted of 11 cohort studies, seven cross‐sectional surveys and one randomised control trial. Studies exploring radiographers’ image interpretation performance utilised a variety of methodological designs with accuracy, sensitivity and specificity values ranging from 57 to 98%, 45 to 98% and 68 to 98%, respectively. Primary barriers to radiographic image evaluation by radiographers included lack of accessible educational resources and support from both radiologists and radiographers.Conclusion: Australian radiographers can undertake PIE; however, educational and clinical support barriers limit implementation. Access to targeted education and a clear definition of radiographers’ image evaluation role may drive a wider acceptance of radiographer image evaluation in Australia.