Korean J Radiol.  2014 Oct;15(5):578-585. 10.3348/kjr.2014.15.5.578.

The Efficacy of Mammography Boot Camp to Improve the Performance of Radiologists

• Lee EH
• Jun JK
• Jung SE
• Kim YM
• Choi N

• KMID: 1734942
• DOI: http://doi.org/10.3348/kjr.2014.15.5.578

Abstract

OBJECTIVE
To evaluate the efficacy of a mammography boot camp (MBC) to improve radiologists' performance in interpreting mammograms in the National Cancer Screening Program (NCSP) in Korea.
MATERIALS AND METHODS
Between January and July of 2013, 141 radiologists were invited to a 3-day educational program composed of lectures and group practice readings using 250 digital mammography cases. The radiologists' performance in interpreting mammograms were evaluated using a pre- and post-camp test set of 25 cases validated prior to the camp by experienced breast radiologists. Factors affecting the radiologists' performance, including age, type of attending institution, and type of test set cases, were analyzed.
RESULTS
The average scores of the pre- and post-camp tests were 56.0 +/- 12.2 and 78.3 +/- 9.2, respectively (p < 0.001). The post-camp test scores were higher than the pre-camp test scores for all age groups and all types of attending institutions (p < 0.001). The rate of incorrect answers in the post-camp test decreased compared to the pre-camp test for all suspicious cases, but not for negative cases (p > 0.05).
CONCLUSION
The MBC improves radiologists' performance in interpreting mammograms irrespective of age and type of attending institution. Improved interpretation is observed for suspicious cases, but not for negative cases.

Keyword

Breast; Breast neoplasms; Mammography; Education; Mass screening

MeSH Terms

Adult
Aged
Breast Neoplasms/*radiography
Education, Medical, Continuing/*standards
Education, Professional, Retraining
Female
Humans
Male
*Mammography
Middle Aged

Figure

• 

  Fig. 1 Example case of choice 1 in group practice reading. Both craniocaudal views (A, B) show negative findings. Follow-up mammogram after 3 years (not shown) shows negative findings confirming case as truly negative.

• 

  Fig. 2 Example case of choice 2 in group practice reading. Right mediolateral oblique view shows small lobular microlobulated isodense mass in upper portion that was confirmed to be invasive ductal carcinoma.

• 

  Fig. 3 Example case of choice 3 in group practice reading. Left craniocaudal view shows asymmetry (arrow) in inner portion that was confirmed to be invasive ductal carcinoma.

• 

  Fig. 4 Example case of choice 4 in group practice reading. Right mediolateral oblique (MLO) view (A) shows clustered fine pleomorphic calcifications in upper portion and left MLO view (B) shows round, obscured hyperdense mass (arrow) in upper portion. These were confirmed to be ductal carcinoma in situ in right breast and invasive ductal carcinoma in left breast.

• 

  Fig. 5 Attendees' pre- and post-camp test scores. Average score of attendees in each mammography boot camp as well as those of all attendees showed significant improvement when pre- and post-camp test scores were compared. *P value based on Wilcoxon signed-rank test (otherwise, p value according to paired t test). Score = average score of attendees

Reference

1. Suh M, Choi KS, Lee YY, Jun JK. Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey, 2004-2012. Cancer Res Treat. 2013; 45:86–94.

2. Park B, Choi KS, Lee YY, Jun JK, Seo HG. Cancer screening status in Korea, 2011: results from the Korean National Cancer Screening Survey. Asian Pac J Cancer Prev. 2012; 13:1187–1191.

3. Kim Y, Jun JK, Choi KS, Lee HY, Park EC. Overview of the National Cancer screening programme and the cancer screening status in Korea. Asian Pac J Cancer Prev. 2011; 12:725–730.

4. Kang MH, Park EC, Choi KS, Suh M, Jun JK, Cho E. The National Cancer Screening Program for breast cancer in the Republic of Korea: is it cost-effective? Asian Pac J Cancer Prev. 2013; 14:2059–2065.

5. Sickles EA, D'Orsi CJ. ACR BI-RADS® Follow-up and outcome monitoring. In : D'Orsi CJ, Sickles EA, Mendelson EB , Morris EA , editors. ACR BI-RADS® Atlas Breast Imaging Reporting and Data System. 5th ed. Reston: ACR;2013. p. 21–31.

6. Ministry of health and welfare regulation 386 (2007.02.20). Web site. Accessed March 28, 2014. http://www.mw.go.kr/front_new/al/sal0101vw.jsp?PAR_MENU_ID=04&MENU_ID=040101&page=1&CONT_SEQ=40424&SEARCHKEY=TITLE&SEARCHVALUE=특수의료장비의 설치 및 운영에 관한 규칙.

7. Ministry of health and welfare notice 2006-5. Web site. Accessed March 28, 2014. http://www.bokjiro.go.kr/policy/legislationView.do?board_sid=300&data_sid=151815&searchGroup=AR01&searchSort=REG_DESC&pageIndex=1&searchWrd=%EA%B2%80%EC%A7%84&searchCont=&pageUnit=10&searchProgrYn=.

8. History of Korean Society of Breast Imaging. Web site. Accessed March 28, 2014. http://ksbi.radiology.or.kr/.

9. Ministry of health and welfare notice 2002-23. Web site. Accessed March 28, 2014. http://www.mw.go.kr/front_new/jb/sjb0402vw.jsp?PAR_MENU_ID=03&MENU_ID=030402&BOARD_ID=220&BOARD_FLAG=03&CONT_SEQ=22366&page=1.

10. Breast Imaging Boot Camp. Web site. Accessed March 28, 2014. http://www.acr.org/Meetings-Events/EC-BIBC.

11. Lee EH, Jun JK, Kim YM, Bae K, Hwang KW, Choi BB, et al. Mammography boot camp to improve a quality of national cancer screening program in Korea: a report about a test run in 2012. J Korean Soc Breast Screen. 2013; 10:162–168.

12. ACR BI-RADS® Committee. BI-RADS® breast imaging and reporting data system: breast imaging atlas. 4th ed. Reston: American College of Radiology;2003.

13. American College of Radiology. Mammography Accreditation Program Requirements. Accessed March 28, 2014. http://www.acr.org/~/media/ACR/Documents/Accreditation/Mammography/Requirements.pdf.

14. National Accreditation Committee. BreastScreen Australia National Accreditation Standards. Accessed March 28, 2014. http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/A03653118215815BCA257B41000409E9/$File/standards.pdf.

15. NHS Breast Cancer Screening Program. Accessed March 28, 2014. http://www.cancerscreening.nhs.uk/breastscreen/index.html.

16. Lee EH, Lyou CY. Radiology residents' performance in screening mammography interpretation. J Korean Soc Radiol. 2013; 68:333–341.

17. National Cancer Center. Annual report of cancer statistics in Korea in 2010. Accessed March 28, 2014. http://ncc.re.kr/manage/manage03_033_list.jsp.

18. DeSantis C, Ma J, Bryan L, Jemal A. Breast cancer statistics, 2013. CA Cancer J Clin. 2014; 64:52–62.

19. Kundel HL, Nodine CF, Carmody D. Visual scanning, pattern recognition and decision-making in pulmonary nodule detection. Invest Radiol. 1978; 13:175–181.

20. Brem RF, Baum J, Lechner M, Kaplan S, Souders S, Naul LG, et al. Improvement in sensitivity of screening mammography with computer-aided detection: a multiinstitutional trial. AJR Am J Roentgenol. 2003; 181:687–693.

21. Lee EH, Cha JH, Han D, Ryu DS, Choi YH, Hwang KT, et al. Analysis of previous screening examinations for patients with breast cancer. J Korean Radiol Soc. 2007; 56:191–202.

22. Rawashdeh MA, Lee WB, Bourne RM, Ryan EA, Pietrzyk MW, Reed WM, et al. Markers of good performance in mammography depend on number of annual readings. Radiology. 2013; 269:61–67.

23. Soh BP, Lee W, McEntee MF, Kench PL, Reed WM, Heard R, et al. Screening mammography: test set data can reasonably describe actual clinical reporting. Radiology. 2013; 268:46–53.

24. Tohno E, Takahashi H, Tamada T, Fujimoto Y, Yasuda H, Ohuchi N. Educational program and testing using images for the standardization of breast cancer screening by ultrasonography. Breast Cancer. 2012; 19:138–146.