Factors Affecting Radiologist Inconsistency in Screening Mammography
Section snippets
Radiologists
In our study, approved by an institutional review board, 110 radiologists interpreted mammograms from the same 148 screening cases and reported the presence or absence of four findings (calcifications, mass, architectural distortion, and asymmetric density) in each of 296 breasts. This large sample of observers enabled us to obtain case-specific measures of interpretation inconsistency that are reliable to an extent not achieved before in the literature, to our knowledge.
The interpreting
Results
Figure 3 plots left breast versus right breast disagreement probabilities for each of the four mammographic findings. In each plot we observed the following: (a) some breasts had the lowest degree of disagreement possible (unanimity among the 110 radiologists), while others had the highest (55 radiologists reported the finding, 55 did not); (b) inconsistency was present across the entire range of possible values; (c) there were cases in which one breast had high and the other had low
Discussion
The degree of inconsistency in interpretation among radiologists varies substantially across cases typically found in mammography screening populations. The extent of disagreement in radiologists' reporting of findings is influenced by mammographic features specific to the breast, features specific to the case, and naturally occurring differences among observers. At present in the United States, however, our study shows that differences among radiologists are the smallest component of the
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Supported by a grant from the National Institutes of Health (CA 74011).