Breast US: Assessment of Technical Quality and Image Interpretation

Abstract

To determine whether ultrasonography (US) of the breast performed at a wide range of clinical practices conforms to the American College of Radiology (ACR) standards for quality and to assess the interpretations of breast sonograms. Static images from 152 breast US examinations performed at 86 institutions were evaluated for compliance with ACR guidelines for breast US hardware, technical factors, imaging protocol, and image annotation. Official interpretations submitted by the referring facilities were compared with static images submitted by the facility. Discrepancies were confirmed by two dedicated breast radiologists after repeat imaging, short-interval follow-up imaging, or biopsy. A total of 60.5% of cases did not comply with at least one ACR guideline on breast US and included 9.2% of cases with inadequate equipment, 14.7% of cases with inappropriate focal zone placement, at least 14% of cases with static images in only one imaging plane, and 25% of cases with incomplete patient identifiers. Clinically relevant interpretation errors and interpretation discrepancies were confirmed in 23 (15.1%) of 152 cases. The majority of breast US examinations did not comply with at least some of the standards for quality set forth by the ACR. Attention to these basic standards could substantially improve image quality.