The future of mammography: radiology residents' experiences, attitudes, and opinions

Factors Influencing Trainees' Interest in Breast Imaging

Purpose: To gauge the level of interest in breast imaging (BI) and determine factors impacting trainees' decision to pursue this subspecialty. Methods: Canadian radiology residents and medical students were surveyed from November 2020 to February 2021. Training level, actual vs preferred timing of breast rotations, fellowship choices, perceptions of BI, and how artificial intelligence (AI) will impact BI were collected. Chi-square, Fisher's exact tests and univariate logistic regression were performed to determine the impact of trainees' perceptions on interest in pursuing BI/women's imaging (WI) fellowships. Results: 157 responses from 80 radiology residents and 77 medical students were collected. The top 3 fellowship subspecialties desired by residents were BI/WI (36%), abdominal imaging (35%), and interventional radiology (25%). Twenty-five percent of the medical students were unsure due to lack of exposure. The most common reason that trainees found BI unappealing was repetitiveness (20%), which was associated with lack of interest in BI/WI fellowships (OR = 3.9, 95% CI: 1.6-9.5, P = .002). The most common reason residents found BI appealing was procedures (59%), which was associated with interest in BI/WI fellowships (OR, 3.2, 95% CI, 1.2-8.6, P = .02). Forty percent of residents reported an earlier start of their first breast rotation (PGY1-2) would affect their fellowship choice. Conclusion: This study assessed the current level of Canadian trainees' interest in BI and identified factors that influenced their decisions to pursue BI. Solutions for increased interest include earlier exposure to breast radiology and addressing inadequacies in residency training.

Perceptions of Adequacy of Breast Imaging Training in the United States among Breast Radiologists

OBJECTIVE

To evaluate the perceptions of breast imaging training in the United States among practicing breast radiologists.

METHODS

An anonymous electronic survey was sent to physician members of the Society of Breast Imaging. Study participants were queried about why they practice breast imaging, what percentage of their clinical practice consists of breast imaging, details about their breast imaging training, and how well their training prepared them for their breast imaging practice. Results were stratified by whether respondents completed a breast imaging fellowship and length of time practicing breast imaging. Results were compared using the Chi-squared test or Fisher's exact test.

RESULTS

We received 271 completed survey responses. Of the survey respondents, 52.4% (141/269) were employed in private practice, 24.2% (65/269) in academic practice, and 23.4% (63/269) in a mixed/hybrid practice. Overall, 46.6% (125/268) of respondents reported practicing a greater proportion of breast imaging than anticipated during training and 18.7% (50/268) had not anticipated that their future practice would include breast imaging at all. The 62.3% (167/268) of survey respondents who had completed a breast or women's imaging fellowship were significantly more likely to report sufficient training in screening mammography, diagnostic mammography, breast procedures, and MRI interpretation.

CONCLUSION

Our study highlights perceived areas of insufficiency in breast imaging training. These were most notable among those who did not complete a breast imaging fellowship. These insufficiencies may be considered when updating the next version of the residency training curriculum.

Assessing Resident Performance in Screening Mammography: Development of a Quantitative Algorithm

RATIONALE AND OBJECTIVES

This study aims to provide objective performance data and feedback, including examination volumes, recall rates, and concordance with faculty interpretations, for residents performing independent interpretation of screening mammography examinations.

METHOD AND MATERIALS

Residents (r) and faculty (f) interpret screening mammograms separately and identify non-callbacks (NCBs) and callbacks (CBs). Residents review all discordant results. The number of concordant interpretations (fCB-rCB and fNCB-rNCB) and discordant interpretations (fCB-rNCB and fNCB-rCB) are entered into a macro-driven spreadsheet. These macros weigh the data dependent on the perceived clinical impact of the resident's decision. Weighted outcomes are combined with volumes to generate a weighted mammography performance score. Rotation-specific goals are assigned for the weighted score, screening volumes, recall rate relative to faculty, and concordance rates. Residents receive one point for achieving each goal.

RESULTS

Between July 2013 and May 2017, 18,747 mammography examinations were reviewed by 31 residents, in 71 resident rotations, over 246 resident weeks. Mean resident recall rate was 9.9% and significantly decreased with resident level (R), R2 = 11.3% vs R3 = 9.4%, R4 = 9.2%. Mean resident-faculty discordance rate was 10% and significantly decreased from R2 = 12% to R4 = 9.6%. Weighted performance scores ranged from 1.1 to 2.0 (mean 1.6, standard deviation 0.17), but did not change with rotation experience. Residents had a mean goal achievement score of 2.6 (standard deviation 0.47).

CONCLUSIONS

This method provides residents with easily accessible case-by-case individualized screening outcome data over the longitudinal period of their residency, and provides an objective method of assessing resident screening mammography performance.

Radiology resident mammography training: interpretation difficulty and error-making patterns

RATIONALE AND OBJECTIVES

The purpose of this study was to better understand the concept of mammography difficulty and how it affects radiology resident performance.

MATERIALS AND METHODS

Seven radiology residents and three expert breast imagers reviewed 100 mammograms, consisting of bilateral medial lateral oblique and craniocaudal views, using a research workstation. The cases consisted of normal, benign, and malignant findings. Participants identified abnormalities and scored the difficulty and malignant potential for each case. Resident performance (sensitivity, specificity, and area under the receiver operating characteristic curve [AUC]) was calculated for self- and expert-assessed high and low difficulties.

RESULTS

For cases classified by self-assessed difficulty, the resident AUCs were 0.667 for high difficulty and 0.771 for low difficulty cases (P = .010). Resident sensitivities were 0.707 for high and 0.614 for low difficulty cases (P = .113). Resident specificities were 0.583 for high and 0.905 for low difficulty cases (P < .001). For cases classified by expert-assessed difficulty, the resident AUCs were 0.583 for high and 0.783 for low difficulty cases (P = .001). Resident sensitivities were 0.558 for high and 0.796 for low difficulty cases (P < .001). Resident specificities were 0.714 for high and 0.740 for low difficulty cases (P = .807).

CONCLUSIONS

Increased self- and expert-assessed difficulty is associated with a decrease in resident performance in mammography. However, while this lower performance is due to a decrease in specificity for self-assessed difficulty, it is due to a decrease in sensitivity for expert-assessed difficulty. These trends suggest that educators should provide a mix of self- and expert-assessed difficult cases in educational materials to maximize the effect of training on resident performance and confidence.

Changes in the availability of screening mammography, 2000-2010

BACKGROUND

Rates of screening mammography have plateaued, and the number of mammography facilities has declined in the past decade. The objective of this study was to assess changes over time and geographic disparities in the availability of mammography services.

METHODS

Using information from the US Food and Drug Administration and the US Census, county-level mammography capacity was defined as the number of mammography machines per 10,000 women aged ≥ 40 years. Cross-sectional variation and longitudinal changes in capacity were examined in relation to county characteristics.

RESULTS

Between 2000 and 2010, the number of mammography facilities declined 10% from 9434 to 8469, the number of mammography machines declined 10% from 13,100 to 11,762, and the median county mammography capacity decreased nearly 20% from 1.77 to 1.42 machines per 10,000 women aged ≥ 40 years. In cross-sectional analysis, counties with greater percentages of uninsured residents, less educated residents, greater population density, and higher managed care penetration had lower mammography capacity. Conversely, counties with more hospital beds per 100,000 population had higher capacity. High initial mammography capacity, growth in both the percentage of the population aged ≥ 65 years and the percentage living in poverty, and increased managed care penetration were all associated with a decrease in mammography capacity between 2000 and 2010. Only the percentage of rural residents was associated with an increase in capacity.

CONCLUSIONS

Geographic variation in mammography capacity and declines in capacity over time are associated with demographic, socioeconomic, and health care market characteristics. Maldistribution of mammography resources may explain geographic disparities in breast cancer screening rates.