Analysis of the results of a proficiency test in screening mammography at the CSPO of Florence: review of 705 tests.
OBJECTIVE
The aim of this study was to evaluate the performance of a sample of Italian radiologists undergoing a proficiency test of screening mammography.


METHODS
We retrospectively analysed the results of 705 tests (537 first tests, 168 repeat tests) taken during 1997-2005 by 537 Italian radiologists. The test, consisting of 17 screen-detected cancer cases and 133 negative controls, was validated by a panel of expert readers defining a minimum standard as to sensitivity for cancer and recall rate of negative controls. Success rates were assessed as a function of previous experience in mammography (years of experience, total mammograms read, mammograms read in the last year).


RESULTS
A total of 176 radiologists successfully passed the test at their first attempt (32.7%). Success correlated with experience, measured in terms of years of experience (5-year cutoff: chi(2) for trend=4.17, p=0.04), total mammograms read (chi(2) for trend =11.8, p=0.002) or mammograms read in the last year (chi(2) for trend=6.27, p=0.04). Training improves performance at repeat testing: after a first negative attempt, a second attempt was successful in 50.6% of cases (74/146) and a third in 68.1% (15/22).


CONCLUSIONS
A substantial proportion of Italian radiologists taking the test showed limited proficiency in screening mammography. This finding is consistent with several reports of poor performance of service screening compared with reference standards. As expected, test performance is associated with experience, suggesting that the current policy of employing non-dedicated, untrained, general radiologists in screening should be reconsidered. Test performance improves with training (courses, consultation of teaching atlases). Several screening programmes in Italy have been implemented without prior adequate radiologist training. Radiologist training needs to be considered a priority, at least in those screening programmes that are still to be implemented in one third of the country.
Ciatto
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Centro per lo Studio e la Prevenzione Oncologica, Viale A. Volta 171, I-50131, Firenze, Italy. s.ciatto@cspo.it
Ambrogetti
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Morrone
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Del Turco
M Rosselli
MR
D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007558:Italy; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D012189:Retrospective Studies