title: Effect of Training on Qualitative Mammographic Density Assessment.
abstract: OBJECTIVE
  The aim of this study was to evaluate the accuracy of visual mammographic breast density assessment and determine if training can improve this assessment, to compare the accuracy of qualitative density assessment before and after training with a quantitative assessment tool, and to evaluate agreement between qualitative and quantitative density assessment methods.
  
  
  METHODS
  Consecutive screening mammograms performed over a 4-month period were visually assessed by two study breast radiologists (the leads), who selected 200 cases equally distributed among the four BI-RADS density categories. These 200 cases were shown to 20 other breast radiologists (the readers) before and after viewing a training module on visual density assessment. Agreement between reader assessment and lead radiologist assessment was calculated for both reading sessions. Quantitative volumetric density of the 200 mammograms, determined using a commercially available tool, was compared with both sets of reader assessment and with lead radiologist assessment.
  
  
  RESULTS
  Compared with lead radiologist assessment, reader accuracy of breast density assessment increased from 65% before training to 72% after training (odds ratio, 1.41; P < .0001). Training specifically improved assignment to BI-RADS categories 1 (P < .0001) and 4 (P < .10). Compared with quantitative assessment, reader accuracy showed statistically nonsignificant improvement with training (odds ratio, 1.1; P = .26). Substantial agreement between qualitative and quantitative breast density assessment was demonstrated (κ = 0.78).
  
  
  CONCLUSIONS
  Training may improve the accuracy of mammographic breast density assessment. Substantial agreement between qualitative and quantitative breast density assessment exists.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Sughra
authors.initials: S
authors.lastname: Raza
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: mmackesy@partners.org.
authors.forename: Meaghan M
authors.initials: MM
authors.lastname: Mackesy
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Winkler
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Shelley
authors.initials: S
authors.lastname: Hurwitz
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Robyn L
authors.initials: RL
authors.lastname: Birdwell
mesh_terms: D000328:Adult; D001900:Boston; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003194:Computer-Assisted Instruction / Q000706:statistics & numerical data*; D003720:Densitometry / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D011361:Professional Competence / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000706:statistics & numerical data; D011871:Radiology / Q000193:education*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: BI-RADS density; Breast density; breast density legislation; mammographic density; volumetric breast density