When Radiologists Perform Best: The Learning Curve in Screening Mammogram Interpretation
- 1 December 2009
- journal article
- Published by Radiological Society of North America (RSNA) in Radiology
- Vol. 253 (3), 632-640
- https://doi.org/10.1148/radiol.2533090070
Abstract
Purpose To examine changes in screening mammogram interpretation as radiologists with and radiologists without fellowship training in breast imaging gain clinical experience. Materials and Methods In an institutional review board—approved HIPAA-compliant study, the performance of 231 radiologists who interpreted screen-film screening mammograms from 1996 to 2005 at 280 facilities that contribute data to the Breast Cancer Surveillance Consortium was examined. Radiologists’ demographic data and clinical experience levels were collected by means of a mailed survey. Mammograms were grouped on the basis of how many years the interpreting radiologist had been practicing mammography, and the influence of increasing experience on performance was examined separately for radiologists with and those without fellowship training in breast imaging, taking into account case-mix and radiologist-level differences. Results A total of 1 599 610 mammograms were interpreted during the study period. Performance for radiologists without fellowship training improved most during their 1st 3 years of clinical practice, when the odds of a false-positive reading dropped 11%–15% per year (P < .015) with no associated decrease in sensitivity (P > .89). The number of women recalled per breast cancer detected decreased from 33 for radiologists in their 1st year of practice to 24 for radiologists with 3 years of experience to 19 for radiologists with 20 years of experience. Radiologists with fellowship training in breast imaging experienced no learning curve and reached desirable goals during their 1st year of practice. Conclusion Radiologists’ interpretations of screening mammograms improve during their first few years of practice and continue to improve throughout much of their careers. Additional residency training and targeted continuing medical education may help reduce the number of work-ups of benign lesions while maintaining high cancer detection rates. © RSNA, 2009Keywords
This publication has 27 references indexed in Scilit:
- Variability in Interpretive Performance at Screening Mammography and Radiologists’ Characteristics Associated with AccuracyRadiology, 2009
- Agreement of the Order of Overall Performance Levels Under Different Reading ParadigmsAcademic Radiology, 2008
- The “Laboratory” Effect: Comparing Radiologists' Performance and Variability during Prospective Clinical and Laboratory Mammography InterpretationsRadiology, 2008
- Association between Radiologists' Experience and Accuracy in Interpreting Screening MammogramsBMC Health Services Research, 2008
- Radiologist Characteristics Associated With Interpretive Performance of Diagnostic MammographyJNCI Journal of the National Cancer Institute, 2007
- Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessmentBreast Cancer Research and Treatment, 2006
- The ‘learning curve’ in surgery: what is it, how do we measure it and can we influence it?BJU International, 2004
- Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database.American Journal of Roentgenology, 1997
- A piece of my mind. The learning curvePublished by American Medical Association (AMA) ,1993
- Longitudinal data analysis using generalized linear modelsBiometrika, 1986