OPTIMAL REFERENCE EXAM FOR MAMMOGRAPHIC INTERPRETATIONS

由于许多女性每年都要进行乳房x光检查，作为乳腺癌筛查的一部分，她们中的许多人都有多个较早的乳房x光检查，可以与当前的乳房x光检查进行比较。在一个大容量、快速的筛查项目中，放射科医生将所有之前的乳房x光片与当前的检查结果进行比较是不现实的。我们不知道有任何综合研究将诊断表现作为参考检查的功能进行调查，也没有一个与年龄相关的最佳参考（例如，55岁及以上女性的2年前或55岁以下女性的1年前）。除了可能存在年龄依赖的最佳参考外，在接受激素替代治疗的妇女和未接受激素替代治疗的妇女中，年龄依赖的最佳参考可能存在差异。在这项研究中，我们将邀请7位放射科医生在四种类似于筛查环境的不同阅读模式下诊断180例病例。除了第一种模式不包括与先前检查的比较外，所有其他三种模式都将包括先前的乳房x光片以与当前检查进行比较。两次考试之间的时间间隔为一年、两年或三年。因此，使用r0c型方法，我们将研究这些环境如何影响（或不影响）读者的表现，我们希望为大多数患者找到一种有效和高效的阅读模式。或者，我们可能会发现不同的模式对不同的患者（例如，不同的年龄组）是最优的。

As many women have annual mammograms as part of screening for breast cancer, many of them have multiple older mammograms available to compare with the current mammogram. In a high volume, rapid screening program, it is not practical for a radiologist to compare all of the prior mammograms to the current examination. We are not aware of any comprehensive study that investigates the diagnostic performance as a function of the reference examination nor is a there an age dependent optimal reference (e.g. 2 year prior for women age 55 and over or l year prior for women under 55 years of age). In addition to the possibility of an age dependent optimal reference, there may be a difference in an age dependent optimal reference in women who take hormone replacement therapy and those who do not. In this study, we will ask seven radiologists to diagnose 180 cases under four different reading modes similar to a screening environment. Except the first mode that does not include a comparison to the prior examinations, all other three modes will include a prior mammogram for comparison with the current examination. The time interval between two examinations will be either one, two, or three years. Hence, using an R0C-type methodology, we will investigate how these environments affect (or not) reader-performance, and we hope to find an effective and efficient reading mode for the majority of patients. Alternatively, we may find that different modes are optimal for different patients (e.g., for different age groups).