Teamwork: Technologists can help (or hinder) a radiologist’s screening performance

Mammographic technologists play a significant role in a radiologist’s performance when it comes to screenings, according to a new study.

Led by Louise M. Henderson, MSPH, PhD, of the University of North Carolina, the results were published Nov. 27 on Academic Radiology.

Henderson and colleagues noted the various studies in recent years that had looked into factors such as radiologist’s habits, gender and post residency training as well as studies that gauged technologists as prereaders or double readers for screening mammography. To the team’s knowledge, however, the current study was the first to examine variability among a radiologist’s screening performance by the technologists performing the examination.

"Hence, we used 15 years of community-based mammography data to determine whether the performance characteristics of screening mammography differ by technologist for screen-film mammography (SFM) and full-field digital mammography (FFDM) separately,” Henderson and colleagues wrote.

Using data collected between 1994 and 2009 from the Carolina Mammography Registry, the study included 1,003,276 bilateral screening mammograms of women older than 18 years with no breast implants and no personal history of breast cancer. Each mammogram interpretation was classified as positive or negative based on the radiologists’ Breast Imaging Reporting and Data System (BI-RADS) screening results.

The research team looked at recall rate, sensitivity, specificity, positive predictive value (PPV) and cancer detection rate (CDR) of the screening mammogram.

The study looked at mammograms performed by 356 mammographic technologists. Of these, 343 performed 889,347 SFM examinations, 51 performed 113,929 performed FFDM examinations and 38 performed both.

“In this cohort study, we found significant variability in recall rates, sensitivity, specificity, and CDR of screening mammography by the radiologic technologist who did the imaging while controlling for the radiologist interpreting the examination,” Henderson and colleagues wrote.

They noted this variability did not differ between the two imaging modalities. PPV variability by technologist was observed for SFM exams but not for FFDM exams.

The research team suspected the technologist’s work experiences, levels of education and training and communication with radiologists could affect the performance of screening mammography in clinical practice, one example being radiologic technologists assisting in the interpretation of screening mammograms.

The study also touched on a technologist’s roles with patients, stating the technologist has the potential to positively impact patient experience and thus a patient’s adherence with screening requirements, all leading to better screening interpretations.

“Given that the technologist is an integral part of the screening mammography process, being responsible for positioning the patient for the examination and generating the image for the radiologist to interpret, our findings seem reasonable,” Henderson and team concluded.  “Additional studies should aim to identify technologist characteristics that may explain this observed variation."