Test sets for assessing and improving radiologic image interpretation have been used for decades and typically evaluate performance relative to gold-standard interpretations by experts. To assess test sets for screening mammography, a gold-standard for whether a woman should be recalled for additional work-up is needed, given that interval cancers may be occult on mammography and some findings ultimately determined to be benign require additional imaging to determine if biopsy is warranted. Using experts to set a gold-standard assumes little variation occurs in their interpretations, but this has not been explicitly studied in mammography
