title: Evaluation of radiographers' mammography screen-reading accuracy in Australia.
abstract: BACKGROUND
  This study aimed to evaluate the accuracy of radiographers' screen-reading mammograms. Currently, radiologist workforce shortages may be compromising the BreastScreen Australia screening program goal to detect early breast cancer. The solution to a similar problem in the United Kingdom has successfully encouraged radiographers to take on the role as one of two screen-readers. Prior to consideration of this strategy in Australia, educational and experiential differences between radiographers in the United Kingdom and Australia emphasise the need for an investigation of Australian radiographers' screen-reading accuracy.
  
  
  METHODS
  Ten radiographers employed by the Westmead Breast Cancer Institute with a range of radiographic (median = 28 years), mammographic (median = 13 years) and BreastScreen (median = 8 years) experience were recruited to blindly and independently screen-read an image test set of 500 mammograms, without formal training. The radiographers indicated the presence of an abnormality using BI-RADS®. Accuracy was determined by comparison with the gold standard of known outcomes of pathology results, interval matching and client 6-year follow-up.
  
  
  RESULTS
  Individual sensitivity and specificity levels ranged between 76.0% and 92.0%, and 74.8% and 96.2% respectively. Pooled screen-reader accuracy across the radiographers estimated sensitivity as 82.2% and specificity as 89.5%. Areas under the reading operating characteristic curve ranged between 0.842 and 0.923.
  
  
  CONCLUSIONS
  This sample of radiographers in an Australian setting have adequate accuracy levels when screen-reading mammograms. It is expected that with formal screen-reading training, accuracy levels will improve, and with support, radiographers have the potential to be one of the two screen-readers in the BreastScreen Australia program, contributing to timeliness and improved program outcomes.
authors.affiliation: Westmead Breast Cancer Institute Westmead, New South Wales, Australia.
authors.forename: Josephine C
authors.initials: JC
authors.lastname: Debono
authors.affiliation: Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney Lidcombe, New South Wales, Australia.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Poulos
authors.affiliation: Screening and Test Evaluation Program, School of Public Health (A27), Sydney Medical School, University of Sydney Sydney, New South Wales, Australia.
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales Sydney, New South Wales, Australia.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Turner
authors.affiliation: Macquarie University Cancer Institute, Macquarie University Hospital, Australian School of Advanced Medicine, Macquarie University Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Boyages
keywords: Accuracy; image interpretation; mammogram; radiographer; screen-reading