title: Criteria for identifying radiologists with acceptable screening mammography interpretive performance on basis of multiple performance measures.
abstract: OBJECTIVE
  Using a combination of performance measures, we updated previously proposed criteria for identifying physicians whose performance interpreting screening mammography may indicate suboptimal interpretation skills.
  
  
  METHODS
  In this study, six expert breast imagers used a method based on the Angoff approach to update criteria for acceptable mammography performance on the basis of two sets of combined performance measures: set 1, sensitivity and specificity for facilities with complete capture of false-negative cancers; and set 2, cancer detection rate (CDR), recall rate, and positive predictive value of a recall (PPV1) for facilities that cannot capture false-negative cancers but have reliable cancer follow-up information for positive mammography results. Decisions were informed by normative data from the Breast Cancer Surveillance Consortium (BCSC).
  
  
  RESULTS
  Updated combined ranges for acceptable sensitivity and specificity of screening mammography are sensitivity≥80% and specificity≥85% or sensitivity 75-79% and specificity 88-97%. Updated ranges for CDR, recall rate, and PPV1 are: CDR≥6 per 1000, recall rate 3-20%, and any PPV1; CDR 4-6 per 1000, recall rate 3-15%, and PPV1≥3%; or CDR 2.5-4.0 per 1000, recall rate 5-12%, and PPV1 3-8%. Using the original criteria, 51% of BCSC radiologists had acceptable sensitivity and specificity; 40% had acceptable CDR, recall rate, and PPV1. Using the combined criteria, 69% had acceptable sensitivity and specificity and 62% had acceptable CDR, recall rate, and PPV1.
  
  
  CONCLUSIONS
  The combined criteria improve previous criteria by considering the interrelationships of multiple performance measures and broaden the acceptable performance ranges compared with previous criteria based on individual measures.
authors: 1 Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, One Shields Ave, Med Sci 1C, Rm 144, Davis, CA 95616.
authors: Diana L
authors: DL
authors: Miglioretti
authors: Laura
authors: L
authors: Ichikawa
authors: Robert A
authors: RA
authors: Smith
authors: Lawrence W
authors: LW
authors: Bassett
authors: Stephen A
authors: SA
authors: Feig
authors: Barbara
authors: B
authors: Monsees
authors: Jay R
authors: JR
authors: Parikh
authors: Robert D
authors: RD
authors: Rosenberg
authors: Edward A
authors: EA
authors: Sickles
authors: Patricia A
authors: PA
authors: Carney
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence / Q000592:standards*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
keywords: Breast Cancer Surveillance Consortium (BCSC); audit; mammography; performance; screening