title: Clinical image quality in daily practice of breast cancer mammography screening.
abstract: OBJECTIVE
  To assess the quality of screening mammograms performed in daily practice in the Quebec Breast Cancer Screening Program.
  
  
  METHODS
  Clinical image quality of a random subsample of 197 screening mammograms performed in 2004-2005 was independently evaluated by 2 radiologists based on the criteria by Canadian Association of Radiologists (CAR). When disagreement occurred for overall judgement or positioning score, the mammograms were reviewed by a third radiologist. Cohen's kappas for interrater agreement were computed. Multivariable robust Poisson regression models were used to study associations of overall quality and positioning with body mass index (BMI) and breast density.
  
  
  RESULTS
  The CAR criteria were not satisfied for 49.7% of the mammograms. Positioning was the quality attribute most often deficient, with 37.2% of mammograms failing positioning. Interrater agreement ranged from slight (kappa = 0.02 for compression and sharpness) to fair (kappa = 0.30 for exposure). For overall quality, women with a BMI ≥ 30 kg/m(2) had a failure proportion of 67.5% compared with 34.9% for women with a BMI<25 kg/m(2) (risk ratio 2.1 [95% confidence interval, 1.5-3.0]). For positioning, women with a BMI ≥ 30 kg/m(2) had a failure proportion of 53.8% compared with 27.9% for women with a BMI < 25 kg/m(2) (risk ratio 1.9 [95% confidence interval, 1.2-3.1]). Effects of breast density on image quality differed among radiologists.
  
  
  CONCLUSIONS
  Despite measures to ensure high-quality imaging, including CAR accreditation, approximately half of this random sample of screening mammograms failed the CAR quality standards. It would be important to define quality targets for screening mammograms carried out in daily practice to interpret such observations.
authors.affiliation: Institut National de Santé Publique du Quebec, Québec, Québec, Canada. Electronic address: marie-helene.guertin@inspq.qc.ca.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Guertin
authors.affiliation: Institut National de Santé Publique du Quebec, Québec, Québec, Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Théberge
authors.affiliation: Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada.
authors.forename: Michel-Pierre
authors.initials: MP
authors.lastname: Dufresne
authors.affiliation: Centre de Recherche du CHU de Québec, Axe Santé des populations et pratiques optimales en santé, Québec, Québec, Canada.
authors.forename: Hervé Tchala Vignon
authors.initials: HT
authors.lastname: Zomahoun
authors.affiliation: Institut National de Santé Publique du Quebec, Québec, Québec, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Major
authors.affiliation: Ministère de la Santé et des Services sociaux, Québec, Québec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Tremblay
authors.affiliation: Clinique Radiologique Audet Inc, Québec, Québec, Canada.
authors.forename: Carmen
authors.initials: C
authors.lastname: Ricard
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Rene
authors.initials: R
authors.lastname: Shumak
authors.affiliation: Memorial University, Faculty of Medicine, St John's, Newfoundland, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Wadden
authors.affiliation: Institut National de Santé Publique du Quebec, Québec, Québec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Pelletier
authors.affiliation: Centre de Recherche du CHU de Québec, Axe Oncologie, Québec, Québec, Canada; Département de Médecine Sociale et Préventive, Faculté de médicine and Centre de Recherche sur le cancer, Université Laval, Québec, Québec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Brisson
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008403:Mass Screening; D008875:Middle Aged; D056888:Patient Positioning; D011787:Quality of Health Care; D011792:Quebec / Q000453:epidemiology; D012680:Sensitivity and Specificity
keywords: Breast cancer; Mammography; Quality; Screening