title: Patient and Radiologist Characteristics Associated With Accuracy of Two Types of Diagnostic Mammograms.
abstract: OBJECTIVE
  Earlier studies of diagnostic mammography found wide unexplained variability in accuracy among radiologists. We assessed patient and radiologist characteristics associated with the interpretive performance of two types of diagnostic mammography.
  
  
  METHODS
  Radiologists interpreting mammograms in seven regions of the United States were invited to participate in a survey that collected information on their demographics, practice setting, breast imaging experience, and self-reported interpretive volume. Survey data from 244 radiologists were linked to data on 274,401 diagnostic mammograms performed for additional evaluation of a recent abnormal screening mammogram or to evaluate a breast problem, between 1998 and 2008. These data were also linked to patients' risk factors and follow-up data on breast cancer. We measured interpretive performance by false-positive rate, sensitivity, and AUC. Using logistic regression, we evaluated patient and radiologist characteristics associated with false-positive rate and sensitivity for each diagnostic mammogram type.
  
  
  RESULTS
  Mammograms performed for additional evaluation of a recent mammogram had an overall false-positive rate of 11.9%, sensitivity of 90.2%, and AUC of 0.894; examinations done to evaluate a breast problem had an overall false-positive rate of 7.6%, sensitivity of 83.9%, and AUC of 0.871. Multiple patient characteristics were associated with measures of interpretive performance, and radiologist academic affiliation was associated with higher sensitivity for both indications for diagnostic mammograms.
  
  
  CONCLUSIONS
  These results indicate the potential for improved radiologist training, using evaluation of their own performance relative to best practices, and for improved clinical outcomes with health care system changes to maximize access to diagnostic mammography interpretation in academic settings.
authors.affiliation: 1 Division of General Internal Medicine, University of Washington, 325 Ninth Ave, Seattle, WA 98104.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Jackson
authors.affiliation: 2 Group Health Research Institute, Group Health Cooperative, Seattle, WA.
authors.forename: Linn
authors.initials: L
authors.lastname: Abraham
authors.affiliation: 2 Group Health Research Institute, Group Health Cooperative, Seattle, WA.|3 Division of Biostatistics, University of California Davis School of Medicine, Davis, CA.
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.affiliation: 2 Group Health Research Institute, Group Health Cooperative, Seattle, WA.
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.affiliation: 4 Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.affiliation: 5 Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: 6 Departments of Family Medicine and Public Health & Preventive Medicine, Oregon Health and Science University, Portland, OR.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.affiliation: 4 Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.affiliation: 1 Division of General Internal Medicine, University of Washington, 325 Ninth Ave, Seattle, WA 98104.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States
keywords: accuracy; characteristics; diagnostic mammography; patient; radiologist