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BMC Cancer. 2015 May 16;15:410. doi: 10.1186/s12885-015-1399-2.

Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

Author information

1
Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico. gtorres@insp.mx.
2
American Cancer Society, 250 Williams St., Atlanta, GA, 30303, USA. robert.Smith@cancer.org.
3
Centro de Diagnóstico Digital México-España, Secretaria de Salud Pública del Distrito Federal, Mariano Escobedo No. 148 col. Anáhuac, Ciudad de México D. F., 11320, Mexico. mlcf_13@yahoo.com.mx.
4
Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave #1600, Seattle, WA, 98101, USA. bogart.t@ghc.org.
5
Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico. mat_pichu@hotmail.com.
6
Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave #1600, Seattle, WA, 98101, USA. dmiglioretti@phs.ucdavis.edu.
7
Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, 1 Shields Ave, Davis, CA, 95616, USA. dmiglioretti@phs.ucdavis.edu.
8
Department of Epidemiology and Biostatistics and the General Internal Medicine Section, University of California, 4150 Clement St, San Francisco, CA, 94121, USA. karla.Kerlikowske@ucsf.edu.
9
Department of Veterans Affairs, University of California, 4150 Clement St, San Francisco, CA, 94121, USA. karla.Kerlikowske@ucsf.edu.
10
Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico. ortega.caro@gmail.com.
11
Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico. agersomnia@gmail.com.
12
Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico. aangelica@insp.mx.
13
Dirección de Economía de la Salud, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, CP. 62100, Cuernavaca, Morelos, Mexico. sbautista@insp.mx.
14
Dirección de Economía de la Salud, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, CP. 62100, Cuernavaca, Morelos, Mexico. gilberto.sanchez@insp.mx.
15
Hospital de Oncología, Centro Médico Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Cuauhtemoc Doctores, Ciudad de México, D.F. 06720, Mexico. ogmartinez@salud.gob.mx.
16
Federación Mexicana de Colegios de Ginecología y Obstetricia, Nueva York 38, Col. Nápoles, Benito Juárez, Ciudad de México, D.F. 03810, Mexico. suscanga@prodigy.net.mx.
17
Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico. elazcano@insp.mx.
18
Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico. mhernan@insp.mx.

Abstract

BACKGROUND:

An alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries.

METHODS:

We evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed.

RESULTS:

Radiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms.

CONCLUSIONS:

Given the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography.

PMID:
25975383
PMCID:
PMC4436872
DOI:
10.1186/s12885-015-1399-2
[Indexed for MEDLINE]
Free PMC Article

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