When radiologists perform best: The learning curve in screening mammogram interpretation

Diana L Miglioretti, Charlotte C. Gard, Patricia A. Carney, Tracy L. Onega, Diana S M Buist, Edward A. Sickles, Karla Kerlikowske, Robert D. Rosenberg, Bonnie C. Yankaskas, Berta M. Geller, Joann G. Elmore

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Purpose: To examine changes in screening mammogram interpretation as radiologists with and radiologists without fellowship training in breast imaging gain clinical experience. Materials and Methods: In an institutional review board - approved HIPAA-compliant study, the performance of 231 radiologists who interpreted screen-film screening mammograms from 1996 to 2005 at 280 facilities that contribute data to the Breast Cancer Surveillance Consortium was examined. Radiologists' demographic data and clinical experience levels were collected by means of a mailed survey. Mammograms were grouped on the basis of how many years the interpreting radiologist had been practicing mammography, and the influence of increasing experience on performance was examined separately for radiologists with and those without fellowship training in breast imaging, taking into account case-mix and radiologist-level differences. Results: A total of 1 599 610 mammograms were interpreted during the study period. Performance for radiologists without fellowship training improved most during their 1st 3 years of clinical practice, when the odds of a false-positive reading dropped 11%-15% per year (P < .015) with no associated decrease in sensitivity (P > .89). The number of women recalled per breast cancer detected decreased from 33 for radiologists in their 1st year of practice to 24 for radiologists with 3 years of experience to 19 for radiologists with 20 years of experience. Radiologists with fellowship training in breast imaging experienced no learning curve and reached desirable goals during their 1st year of practice. Conclusion: Radiologists' interpretations of screening mammograms improve during their first few years of practice and continue to improve throughout much of their careers. Additional residency training and targeted continuing medical education may help reduce the number of work-ups of benign lesions while maintaining high cancer detection rates.

Original languageEnglish (US)
Pages (from-to)632-640
Number of pages9
JournalRadiology
Volume253
Issue number3
DOIs
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Learning Curve
Breast
Radiologists
Breast Neoplasms
Health Insurance Portability and Accountability Act
Continuing Medical Education
Diagnosis-Related Groups
Research Ethics Committees
Mammography
Internship and Residency
Reading

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Miglioretti, D. L., Gard, C. C., Carney, P. A., Onega, T. L., Buist, D. S. M., Sickles, E. A., ... Elmore, J. G. (2009). When radiologists perform best: The learning curve in screening mammogram interpretation. Radiology, 253(3), 632-640. https://doi.org/10.1148/radiol.2533090070

When radiologists perform best : The learning curve in screening mammogram interpretation. / Miglioretti, Diana L; Gard, Charlotte C.; Carney, Patricia A.; Onega, Tracy L.; Buist, Diana S M; Sickles, Edward A.; Kerlikowske, Karla; Rosenberg, Robert D.; Yankaskas, Bonnie C.; Geller, Berta M.; Elmore, Joann G.

In: Radiology, Vol. 253, No. 3, 12.2009, p. 632-640.

Research output: Contribution to journalArticle

Miglioretti, DL, Gard, CC, Carney, PA, Onega, TL, Buist, DSM, Sickles, EA, Kerlikowske, K, Rosenberg, RD, Yankaskas, BC, Geller, BM & Elmore, JG 2009, 'When radiologists perform best: The learning curve in screening mammogram interpretation', Radiology, vol. 253, no. 3, pp. 632-640. https://doi.org/10.1148/radiol.2533090070
Miglioretti, Diana L ; Gard, Charlotte C. ; Carney, Patricia A. ; Onega, Tracy L. ; Buist, Diana S M ; Sickles, Edward A. ; Kerlikowske, Karla ; Rosenberg, Robert D. ; Yankaskas, Bonnie C. ; Geller, Berta M. ; Elmore, Joann G. / When radiologists perform best : The learning curve in screening mammogram interpretation. In: Radiology. 2009 ; Vol. 253, No. 3. pp. 632-640.
@article{f50a6125c0eb40f186a5ecf275106579,
title = "When radiologists perform best: The learning curve in screening mammogram interpretation",
abstract = "Purpose: To examine changes in screening mammogram interpretation as radiologists with and radiologists without fellowship training in breast imaging gain clinical experience. Materials and Methods: In an institutional review board - approved HIPAA-compliant study, the performance of 231 radiologists who interpreted screen-film screening mammograms from 1996 to 2005 at 280 facilities that contribute data to the Breast Cancer Surveillance Consortium was examined. Radiologists' demographic data and clinical experience levels were collected by means of a mailed survey. Mammograms were grouped on the basis of how many years the interpreting radiologist had been practicing mammography, and the influence of increasing experience on performance was examined separately for radiologists with and those without fellowship training in breast imaging, taking into account case-mix and radiologist-level differences. Results: A total of 1 599 610 mammograms were interpreted during the study period. Performance for radiologists without fellowship training improved most during their 1st 3 years of clinical practice, when the odds of a false-positive reading dropped 11{\%}-15{\%} per year (P < .015) with no associated decrease in sensitivity (P > .89). The number of women recalled per breast cancer detected decreased from 33 for radiologists in their 1st year of practice to 24 for radiologists with 3 years of experience to 19 for radiologists with 20 years of experience. Radiologists with fellowship training in breast imaging experienced no learning curve and reached desirable goals during their 1st year of practice. Conclusion: Radiologists' interpretations of screening mammograms improve during their first few years of practice and continue to improve throughout much of their careers. Additional residency training and targeted continuing medical education may help reduce the number of work-ups of benign lesions while maintaining high cancer detection rates.",
author = "Miglioretti, {Diana L} and Gard, {Charlotte C.} and Carney, {Patricia A.} and Onega, {Tracy L.} and Buist, {Diana S M} and Sickles, {Edward A.} and Karla Kerlikowske and Rosenberg, {Robert D.} and Yankaskas, {Bonnie C.} and Geller, {Berta M.} and Elmore, {Joann G.}",
year = "2009",
month = "12",
doi = "10.1148/radiol.2533090070",
language = "English (US)",
volume = "253",
pages = "632--640",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "3",

}

TY - JOUR

T1 - When radiologists perform best

T2 - The learning curve in screening mammogram interpretation

AU - Miglioretti, Diana L

AU - Gard, Charlotte C.

AU - Carney, Patricia A.

AU - Onega, Tracy L.

AU - Buist, Diana S M

AU - Sickles, Edward A.

AU - Kerlikowske, Karla

AU - Rosenberg, Robert D.

AU - Yankaskas, Bonnie C.

AU - Geller, Berta M.

AU - Elmore, Joann G.

PY - 2009/12

Y1 - 2009/12

N2 - Purpose: To examine changes in screening mammogram interpretation as radiologists with and radiologists without fellowship training in breast imaging gain clinical experience. Materials and Methods: In an institutional review board - approved HIPAA-compliant study, the performance of 231 radiologists who interpreted screen-film screening mammograms from 1996 to 2005 at 280 facilities that contribute data to the Breast Cancer Surveillance Consortium was examined. Radiologists' demographic data and clinical experience levels were collected by means of a mailed survey. Mammograms were grouped on the basis of how many years the interpreting radiologist had been practicing mammography, and the influence of increasing experience on performance was examined separately for radiologists with and those without fellowship training in breast imaging, taking into account case-mix and radiologist-level differences. Results: A total of 1 599 610 mammograms were interpreted during the study period. Performance for radiologists without fellowship training improved most during their 1st 3 years of clinical practice, when the odds of a false-positive reading dropped 11%-15% per year (P < .015) with no associated decrease in sensitivity (P > .89). The number of women recalled per breast cancer detected decreased from 33 for radiologists in their 1st year of practice to 24 for radiologists with 3 years of experience to 19 for radiologists with 20 years of experience. Radiologists with fellowship training in breast imaging experienced no learning curve and reached desirable goals during their 1st year of practice. Conclusion: Radiologists' interpretations of screening mammograms improve during their first few years of practice and continue to improve throughout much of their careers. Additional residency training and targeted continuing medical education may help reduce the number of work-ups of benign lesions while maintaining high cancer detection rates.

AB - Purpose: To examine changes in screening mammogram interpretation as radiologists with and radiologists without fellowship training in breast imaging gain clinical experience. Materials and Methods: In an institutional review board - approved HIPAA-compliant study, the performance of 231 radiologists who interpreted screen-film screening mammograms from 1996 to 2005 at 280 facilities that contribute data to the Breast Cancer Surveillance Consortium was examined. Radiologists' demographic data and clinical experience levels were collected by means of a mailed survey. Mammograms were grouped on the basis of how many years the interpreting radiologist had been practicing mammography, and the influence of increasing experience on performance was examined separately for radiologists with and those without fellowship training in breast imaging, taking into account case-mix and radiologist-level differences. Results: A total of 1 599 610 mammograms were interpreted during the study period. Performance for radiologists without fellowship training improved most during their 1st 3 years of clinical practice, when the odds of a false-positive reading dropped 11%-15% per year (P < .015) with no associated decrease in sensitivity (P > .89). The number of women recalled per breast cancer detected decreased from 33 for radiologists in their 1st year of practice to 24 for radiologists with 3 years of experience to 19 for radiologists with 20 years of experience. Radiologists with fellowship training in breast imaging experienced no learning curve and reached desirable goals during their 1st year of practice. Conclusion: Radiologists' interpretations of screening mammograms improve during their first few years of practice and continue to improve throughout much of their careers. Additional residency training and targeted continuing medical education may help reduce the number of work-ups of benign lesions while maintaining high cancer detection rates.

UR - http://www.scopus.com/inward/record.url?scp=73949139887&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73949139887&partnerID=8YFLogxK

U2 - 10.1148/radiol.2533090070

DO - 10.1148/radiol.2533090070

M3 - Article

C2 - 19789234

AN - SCOPUS:73949139887

VL - 253

SP - 632

EP - 640

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 3

ER -