title: [Diagnostic image quality of mammograms in german outpatient medical care].
abstract: OBJECTIVE
  A total of 79115 mammograms from statutory health insurance (SHI) physicians within German outpatient care were evaluated with respect to the diagnostic image quality.
  
  
  METHODS
  Mammograms were randomly selected between 2006 and 2008 by the regional Associations of Statutory Health Insurance Physicians and submitted to regional boards of experts for external evaluation. The mammogram quality was evaluated using a 3-point scale (adequate, borderline, failure) and documented using a nationally standardized protocol.
  
  
  RESULTS
  87.6% of the mammograms were classified as adequate, 11.0% as borderline and 1.4% as failure. Mediolateral oblique mammograms (mlo) had worse ratings than craniocaudal mammograms (cc). Main reasons for classifying the mammograms as borderline or failure were "inframammary fold not adequately visualized" (mlo), "pectoral muscle not in the correct angle or not to the level with the nipple" (mlo), "the nipple not in profile" (mlo, cc) and "breast not completely or not adequately visualized" (cc).
  
  
  CONCLUSIONS
  The results show a good overall quality of mammograms in German outpatient medical care. Failures can be associated predominantly with incorrect positioning of the breast. More precisely defined quality criteria using objective measures are recommended, especially for craniocaudal mammograms (cc).
authors.affiliation: Kassenärztliche Bundesvereinigung, Berlin.
authors.forename: R
authors.initials: R
authors.lastname: Pfandzelter
authors.forename: U
authors.initials: U
authors.lastname: Wülfing
authors.forename: B
authors.initials: B
authors.lastname: Boedeker
authors.forename: S
authors.initials: S
authors.lastname: Heywang-Köbrunner
mesh_terms: D000553:Ambulatory Care; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D005858:Germany; D006291:Health Policy; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000592:standards*; D008327:Mammography / Q000592:standards*; D009313:National Health Programs; D011786:Quality Control; D011856:Radiographic Image Enhancement / Q000592:standards*; D012680:Sensitivity and Specificity