title: Does Breast Imaging Experience During Residency Translate Into Improved Initial Performance in Digital Breast Tomosynthesis?
abstract: OBJECTIVE
  To determine the initial digital breast tomosynthesis (DBT) performance of radiology trainees with varying degrees of breast imaging experience.
  
  
  METHODS
  To test trainee performance with DBT, we performed a reader study, after obtaining IRB approval. Two medical students, 20 radiology residents, 4 nonbreast imaging fellows, 3 breast imaging fellows, and 3 fellowship-trained breast imagers reviewed 60 unilateral DBT studies (craniocaudal and medio-lateral oblique views). Trainees had no DBT experience. Each reader recorded a final BI-RADS assessment for each case. The consensus interpretations from fellowship-trained breast imagers were used to establish the ground truth. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated. For analysis, first- through third-year residents were classified as junior trainees, and fourth-year residents plus nonbreast imaging fellows were classified as senior trainees.
  
  
  RESULTS
  The AUCs were .569 for medical students, .721 for junior trainees, .701 for senior trainees, and .792 for breast imaging fellows. The junior and senior trainee AUCs were equivalent (P < .01) using a two one-sided test for equivalence, with a significance threshold of 0.1. The sensitivities and specificities were highest for breast imaging fellows (.778 and .815 respectively), but similar for junior (.631 and .714, respectively) and senior trainees (.678 and .661, respectively).
  
  
  CONCLUSIONS
  Initial performance with DBT among radiology residents and nonbreast imaging fellows is independent of years of training. Radiology educators should consider these findings when developing educational materials.
authors.affiliation: Carl E. Ravin Advanced Imaging Laboratories, Duke University, Durham, North Carolina; Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina. Electronic address: lars.grimm@duke.edu.
authors.forename: Lars J
authors.initials: LJ
authors.lastname: Grimm
authors.affiliation: Carl E. Ravin Advanced Imaging Laboratories, Duke University, Durham, North Carolina; Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Joseph Y
authors.initials: JY
authors.lastname: Lo
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Johnson
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sujata V
authors.initials: SV
authors.lastname: Ghate
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Ruth
authors.initials: R
authors.lastname: Walsh
authors.affiliation: Carl E. Ravin Advanced Imaging Laboratories, Duke University, Durham, North Carolina; Department of Radiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Maciej A
authors.initials: MA
authors.lastname: Mazurowski
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008327:Mammography; D011856:Radiographic Image Enhancement / Q000379:methods*; D011871:Radiology / Q000193:education*; D012680:Sensitivity and Specificity
keywords: digital breast tomosynthesis; radiology residency; reader performance