Practitioner compression force variability in mammography : a preliminary study

Objective: This preliminary study determines whether the absolute amount of breast compression in mammography varies between and within practitioners. Methods: Ethics approval was granted. 488 clients met the inclusion criteria. Clients were imaged by 14 practitioners. Collated data included Breast Imaging Reporting and Data System (BI-RADS) density, breast volume, compression and practitioner code. Results: A highly significant difference in mean compression used by different practitioners (p,0.0001 for each BI-RADS density) was demonstrated. Practitioners applied compression in one of three ways using either low, intermediate or high compression force, with no significant difference in mean compression within each group (p50.99, p50.70, p50.54, respectively). Six practitioners showed a significant correlation (p,0.05) between compression and BI-RADS grade, with a tendency to apply less compression with increasing BI-RADS density. When compression was analysed by breast volume there was a wide variation in compression for a given volume. The general trend was the application of higher compression to larger breast volumes by all three practitioner groups. Conclusion: This study presents an insight into practitioner variation of compression application in mammography. Three groups of practitioners were identified: those who used low, intermediate and high compression across the BI-RADS density grades. There was wide variation in compression for any given breast volume, with trends of higher compression demonstrated for increasing breast volumes. Collation of further studies will facilitate a new perspective on the analysis of practitioner, client and equipment variables in mammography imaging. Advances in knowledge: For the first time, it has been practically demonstrated that practitioners vary in the amount of compression applied to breast tissue during routine mammography

Overview of the radiographers’ practice in 65 healthcare centers using digital mammography systems in Portugal

Purpose: To assess current practices in digital mammography (DM) in Portuguese healthcare providers using digital systems. To investigate compliance with European standards regarding mean glandular dose and quality control practice and to identify optimisation needs. Methods: Two questionnaires, targeted at breast radiographers and chief radiographers, were designed and applied in 65 imaging departments offering DM. Questions fielded were focused on the staff profile and technical/ clinical practice. Results: Prior to starting their activity in DM, 70% (82 out of 118) of the respondents received training in DM. The practice in 29 out of 59 providers was established by the manufacturers’ recommendations for image acquisition. Variations were observed between radiographers who belong to the same provider namely the selection of exposure parameters such as the target-filter combination and automatic mode. The use of the manual exposure mode was reported for imaging breast implants (44%) and surgical specimens (22%). The main causes of repeat examinations were skin folding (21%) and absence of pectoral muscle (PM) (20%). Conclusions: The study revealed opportunities to optimise radiographers’ practice in DM regarding the selection of exposure parameters. A robust and consistent training programme in DM and established local protocols can help to reduce the variations observed and improve clinical practice