Mammography workstation design: effect on mammographer behaviour and the risk of musculoskeletal disorders

In the UK Breast Screening Programme there is a growing transition from film to digital mammography, and consequently a change in mammography workstation ergonomics. This paper investigates the effect of the change for radiologists including their comfort, likelihood of developing musculoskeletal disorders (MSD’s), and work practices. Three workstations types were investigated: one with all film mammograms; one with digital mammograms alongside film mammograms from the previous screening round, and one with digital mammograms alongside digitised film mammograms from the previous screening round. Mammographers were video-taped whilst conducting work sessions at each of the workstations. Event based Rapid Upper Limb Assessment (RULA) postural analysis showed no overall increase in MSD risk level in the switch from the film to digital workstation. Average number of visual glances at the prior mammograms per case measured by analysis of recorded video footage showed an increase if the prior mammograms were digitised, rather than displayed on a multi-viewer (p<.05). This finding has potential implications for mammographer performance in the transition to digital mammography in the UK

Influencing clinicians and healthcare managers: can ROC be more persuasive?

Receiver Operating Characteristic analysis provides a reliable and cost effective performance measurement tool, without using full clinical trials. However, when ROC analysis shows that performance is statistically superior in one condition than another it is difficult to relate this result to effects in practice, or even to determine whether it is clinically significant. In this paper we present two concurrent analyses: using ROC methods alongside single threshold recall rate data, and suggest that reporting both provides complimentary data. Four mammographers read 160 difficult cases (41% malignant) twice, with and without prior mammograms. Lesion location and probability of malignancy was reported for each case and analyzed using JAFROC. Concurrently each participant chose recall or return to screen for each case. JAFROC analysis showed that the presence of prior mammograms improved performance (p<.05). Single threshold data showed a trend towards a 26% increase in the number of false positive recalls without prior mammograms (p=.056). If this trend were present throughout the NHS Breast Screening Programme then discarding prior mammograms would correspond to an increase in recall rate from 4.6% to 5.3%, and 12,414 extra women recalled annually for assessment. Whilst ROC methods account for all possible thresholds of recall and have higher power, providing a single threshold example of false positive, false negative, and recall rates when reporting results could be more influential for clinicians. This paper discusses whether this is a useful additional method of presenting data, or whether it is misleading and inaccurat

The time course of cancer detection performance

The purpose of this study was to measure how mammography readers' performance varies with time of day and time spent reading. This was investigated in screening practice and when reading an enriched case set. In screening practice records of time and date that each case was read, along with outcome (whether the woman was recalled for further tests, and biopsy results where performed) was extracted from records from one breast screening centre in UK (4 readers). Patterns of performance with time spent reading was also measured using an enriched test set (160 cases, 41% malignant, read three times by eight radiologists). Recall rates varied with time of day, with different patterns for each reader. Recall rates decreased as the reading session progressed both when reading the enriched test set and in screening practice. Further work is needed to expand this work to a greater number of breast screening centres, and to determine whether these patterns of performance over time can be used to optimize overall performance

Positive and negative agreement: Standard microbiology methods vs. xTAG (Benchmark).

<p>Positive and negative agreement: Standard microbiology methods vs. xTAG (Benchmark).</p

Positive and negative agreement: xTAG vs. standard microbiology methods (benchmark).

<p>Positive and negative agreement: xTAG vs. standard microbiology methods (benchmark).</p

Positive agreement: xTAG vs. conventional testing (benchmark).

<p>Positive agreement: xTAG vs. conventional testing (benchmark).</p

PRISMA flow diagram of study selection.

<p>PRISMA flow diagram of study selection.</p

Positive agreement: Conventional testing vs. xTAG (Benchmark).

<p>Positive agreement: Conventional testing vs. xTAG (Benchmark).</p

Contingency table of test agreement.

<p>Contingency table of test agreement.</p

Additional file 1: Table S1. of Evaluation of pre-symptomatic nitisinone treatment on long-term outcomes in Tyrosinemia type 1 patients: a systematic review

Search strategy for Ovid Medline. This table shows the electronic search strategy developed for Medline (Ovid) and the number of hits retrieved per line. Figure S1. EPHPP quality assessment tool for quantitative studies. This file shows the EPHPP “Quality assessment tool for quantitative studies” that was used to appraise the quality of all included studies. Table S2. Excluded studies with reason. This table lists all studies that were excluded at full text stage and reasons for their exclusion. (DOCX 126 kb