Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

BackgroundAn alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries.MethodsWe evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed.ResultsRadiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms.ConclusionsGiven the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography

Focal Spot, Summer/Fall 2005

https://digitalcommons.wustl.edu/focal_spot_archives/1100/thumbnail.jp

Object-aware Process Support in Healthcare Information Systems: Requirements, Conceptual Framework and Examples

The business processes to be supported by healthcare information systems are highly complex, producing and consuming a large amount of data. Besides, the execution of these processes requires a high degree of flexibility. Despite their widespread adoption in industry, however, traditional process management systems (PrMS) have not been broadly used in healthcare environments so far. One major reason for this drawback is the missing integration of business processes and business data in existing PrMS; i.e., business objects (e.g., medical orders, medical reports) are usually maintained in specific application systems, and are hence outside the control of the PrMS. As a consequence, most existing PrMS are unable to provide integrated access to business processes and business objects in case of unexpected events, which is crucial in the healthcare domain. In this context, the PHILharmonicFlows framework offers an innovative object-aware process management approach, which tightly integrates business objects, functions, and processes. In this paper, we apply this framework to model and control the processes in the context of a breast cancer diagnosis scenario. First, we present the modeling components of PHILharmonicFlows framework applied to this scenario. Second, we give insights into the operational semantics that governs the process execution in PHILharmonicFlows. Third, we discuss the lessons learned in this case study as well as requirements from the healthcare domain that can be effectively handled when using an object-aware process management system like PHILharmonicFlows. Overall, object-aware process support will allow for a new generation of healthcare information systems treating both data and processes as first class citizens

Overdiagnosis due to screening mammography for women aged 40 years and over

This is a protocol for a Cochrane Review. The objective was to assess the effect of screening mammography for breast cancer on overdiagnosis in women aged 40 years and older at average risk of breast cancer

Feasibility of Using Technology to Disseminate Evidence to Rural Nurses and Improve Patient Outcomes

Background: Rural African American women receive less frequent mammography screening and die of breast cancer at a higher rate than is seen in the general population. To overcome this disparity, it is necessary to assist rural providers in their efforts to influence women to obtain screening. Method: This study examined the feasibility of using distance education to disseminate knowledge about timely and appropriate mammography screening to rural nurses, using patient outcome data to evaluate the effectiveness of this intervention. Results: Overall, there was a decline in referrals and mammography screening, but the intervention group centers showed a smaller decline after the educational intervention than did the control group. Conclusion: The findings show the effect of dissemination of information and the feasibility of using patient outcome data for educational evaluation. Neighboring academic health centers and nursing schools should include in their mission the provision of educational programs for relatively isolated rural nurses.health technology, rural health