title: Diagnostic performance of breast technologists in reading mammograms in a clinical patient population.
abstract: OBJECTIVE
  In the setting of an increasing workload for radiologists, this study focuses on the feasibility of skill mixing in breast imaging in a hospital radiology department.
  
  
  METHODS
  Two radiological technologists with more than 10 years of experience in performing mammograms were trained in prereading mammograms to select the cases that require further evaluation by a radiologist. Mammograms of consecutive patients were independently evaluated by the technologists, next to the standard clinical interpretation by the radiologist on duty. Mammographic findings were recorded and a BI-RADS classification was assigned for each breast. Different prereading scenarios were analysed using clinical decision rules. Two different cut-off points of BI-RADS classifications were applied to the data. Analysis was performed for the overall clinical patient population as well as for a subgroup of patients with no immediate indication for further work-up.
  
  
  RESULTS
  Mammograms of 1994 patients were evaluated. In total, 93 breast cancers were found in 91 patients (prevalence 4.6%). Sensitivity and specificity in selecting mammographic findings (cut-off point between BI-RADS 1 and BI-RADS 0, 2-5 and the radiologist's diagnosis as reference standard) was 98% and 74% for technologist 1 and 98% and 78% for technologist 2. In distinguishing normal and benign mammograms from those with abnormalities that are probably benign, suspicious or highly suggestive for malignancy (cut-off point BI-RADS 1-2 and BI-RADS 0, 3-5 and pathology results as reference standard), sensitivity decreased to 89% and 91% respectively. Specificity increased to 82% for both technologists. In a subgroup of 1389 patients with no immediate indication for additional imaging with the involvement of a radiologist, technologists obtained a mean sensitivity and specificity of 98% and 77% in detecting mammographic findings, and a mean sensitivity and specificity of 78% and 88% in detecting suspicious abnormalities.
  
  
  CONCLUSIONS
  The employment of technologists in prereading mammograms seems to be an effective working strategy in daily clinical practice. However, its position in clinical practice remains indistinct as a continuous availability of radiologists still needs to be guaranteed. Nevertheless, as a substantial proportion of mammograms could be evaluated without the attention of a radiologist, the employment of technologists in prereading mammograms seems a promising new working strategy.
authors.affiliation: Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: F J H M
authors.initials: FJ
authors.lastname: van den Biggelaar
authors.forename: A G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: J M A
authors.initials: JM
authors.lastname: van Engelshoven
authors.forename: K
authors.initials: K
authors.lastname: Flobbe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence / Q000592:standards*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D011871:Radiology / Q000592:standards*; D055815:Young Adult