Perceptual issues influence reading digital mammograms
CHICAGO, Nov. 29—Digital mammography has a strong growth, yet workflow and reading remains a challenge for many healthcare facilities. “We really are at the beginning of our learning curve in digital mammo,” said Margarita L. Zuley, MD, director of breast imaging at the University of Pittsburgh Medical Center. Zuley presented “Perceptual Issues in Reading Digital Mammograms” at the 93rd annual meeting of the Radiological Society of North America (RSNA).

Zuley comes from a background of having worked in a less-than-desirable environment with four different workstations in her office. Today she embraces having an easy-to-use system with worklists to limit interaction with the workstation and improve efficiency.

Soft-copy interpretation of digital mammography isn’t as simple as a film read and it has its own set of challenges. Of her talk, Zuley said, “I wanted to explain how mammography is different.”

Typical mammograms are read in less than a minute and 95 percent are normal. “It is actually our job and our perception to interpret the change in the patient and deal with all the perceptual issues that digital has put on us—including the different interfaces, the different monitors and the difference in the appearance of the breasts,” she said.

There are factors that radiologists are challenged by when reading digital mammograms: high volume; short viewing time; complex image interpretation; extremely low cancer incidence at screening (95 percent are normal); and human factors such as interruptions and fatigue. Additionally, reading room environment, interaction with the system and the digital technology also play a role in perception for the radiologist.

“Perception in digital mammography is influenced by factors, the most important of which is the patient changing over time,” said Zuley. “The second most important influence is us [the radiologist] and our goal to perceive those changes given all the different variables we are dealing with in digital mammography.”

Among the aids to better perception are user-friendly worklists to minimize distraction from reading; ergonomic furniture and well-designed reading rooms; proper displays; and established protocols.

 “The perceptual effects that all these types of parameters have on our final image interpretations isn’t really clinically understood yet,” though the UPMC is now gathering data to measure perceptual influences.