Reality check: Perceived versus actual performance of community mammographers
Reality check: Perceived versus actual performance of community mammographers
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DOI：
10.2214/ajr.05.0455
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发表时间：
2006-07-01
影响因子：
5
通讯作者：
Elmore, JG
中科院分区：
文献类型：
--
作者：
Fenton, JJ;Egger, J;Elmore, JG
OBJECTIVE.联邦法规要求放射科医生定期收到关于其乳腺X线摄影解释准确性的有限反馈。我们试图确定定期接受更广泛反馈的放射科医生是否能够准确报告他们在筛查乳腺X线摄影中的实际表现。2001年，在三个州（华盛顿、科罗拉多和新罕布什尔州）对筛查性乳房X线照片进行常规解读的放射科医师（n = 105）完成了一项邮寄调查。放射科医生被要求估计他们在筛查乳腺X线摄影后推荐额外诊断检测的频率以及他们推荐活检的阳性预测值（PPV 2）。然后我们使用了1998年至2001年由放射科医生解释的336，128例筛查性乳腺X线摄影检查的结果，以确定他们推荐诊断性检查和PPV 2的真实比率。放射科医生自我报告的建议立即进行额外成像的比率（11.1%）超过了他们的实际比率（9.1%）（平均差异，1.9%; 95%置信区间[CI]，0.9-3.0%）。自我报告的推荐短间隔随访的平均比率为6.2%;真实比率为1.8%（平均差异为4.3%; 95% CI为3.6-5.1%）。同样，建议立即活检或手术评估的平均自我报告率和真实率分别为3.2%和0.6%（平均差异，2.6%; 95% CI，1.8-3.4%）。相反，放射科医生自我报告的平均PPV 2（18.3%）显著低于他们的平均真实PPV 2（27.6%）（平均差异，-9.3%; 95% CI，-12.4%至-6.2%）。尽管有定期的表现反馈，社区放射科医生可能高估了他们在筛查乳腺X线摄影后建议进一步评估的真实比率，并低估了他们真正的阳性预测值。
OBJECTIVE. Federal regulations mandate that radiologists receive regular albeit limited feedback regarding their interpretive accuracy in mammography. We sought to determine whether radiologists who regularly receive more extensive feedback can report their actual performance in screening mammography accurately.SUBJECTS AND METHODS. Radiologists (n = 105) who routinely interpret screening mammograms in three states (Washington, Colorado, and New Hampshire) completed a mailed survey in 2001. Radiologists were asked to estimate how frequently they recommended additional diagnostic testing after screening mammography and the positive predictive value of their recommendations for biopsy (PPV2). We then used outcomes from 336,128 screening mammography examinations interpreted by the radiologists from 1998 to 2001 to ascertain their true rates of recommendations for diagnostic testing and PPV2.RESULTS. Radiologists' self-reported rate of recommending immediate additional imaging (11.1%) exceeded their actual rate (9.1%) (mean difference, 1.9%; 95% confidence interval [CI], 0.9-3.0%). The mean self-reported rate of recommending short-interval follow-up was 6.2%; the true rate was 1.8% (mean difference, 4.3%; 95% CI, 3.6-5.1%). Similarly, the mean self-reported and true rates of recommending immediate biopsy or surgical evaluation were 3.2% and 0.6%, respectively (mean difference, 2.6%; 95% Cl, 1.8-3.4%). Conversely, radiologists' mean self-reported PPV2 (18.3%) was significantly less than their mean true PPV2 (27.6%) (mean difference, -9.3%; 95% CI, -12.4% to -6.2%).CONCLUSION. Despite regular performance feedback, community radiologists may overestimate their true rates of recommending further evaluation after screening mammography and underestimate their true positive predictive value.