Institut National de Santé Publique du Quebec, Québec, Québec, Canada.
Institut National de Santé Publique du Quebec, Québec, Québec, Canada.
Can Assoc Radiol J. 2014 Aug;65(3):199-206. doi: 10.1016/j.carj.2014.02.001. Epub 2014 Jun 16.
To assess the quality of screening mammograms performed in daily practice in the Quebec Breast Cancer Screening Program.
Clinical image quality of a random subsample of 197 screening mammograms performed in 2004-2005 was independently evaluated by 2 radiologists based on the criteria by Canadian Association of Radiologists (CAR). When disagreement occurred for overall judgement or positioning score, the mammograms were reviewed by a third radiologist. Cohen's kappas for interrater agreement were computed. Multivariable robust Poisson regression models were used to study associations of overall quality and positioning with body mass index (BMI) and breast density.
The CAR criteria were not satisfied for 49.7% of the mammograms. Positioning was the quality attribute most often deficient, with 37.2% of mammograms failing positioning. Interrater agreement ranged from slight (kappa = 0.02 for compression and sharpness) to fair (kappa = 0.30 for exposure). For overall quality, women with a BMI ≥ 30 kg/m(2) had a failure proportion of 67.5% compared with 34.9% for women with a BMI<25 kg/m(2) (risk ratio 2.1 [95% confidence interval, 1.5-3.0]). For positioning, women with a BMI ≥ 30 kg/m(2) had a failure proportion of 53.8% compared with 27.9% for women with a BMI < 25 kg/m(2) (risk ratio 1.9 [95% confidence interval, 1.2-3.1]). Effects of breast density on image quality differed among radiologists.
Despite measures to ensure high-quality imaging, including CAR accreditation, approximately half of this random sample of screening mammograms failed the CAR quality standards. It would be important to define quality targets for screening mammograms carried out in daily practice to interpret such observations.
评估魁北克乳腺癌筛查计划中日常实践中进行的筛查乳房 X 光片的质量。
对 2004-2005 年进行的随机选择的 197 例筛查乳房 X 光片的临床图像质量，由 2 名放射科医生根据加拿大放射协会 (CAR) 的标准进行独立评估。当整体判断或定位评分出现分歧时，由第三位放射科医生对乳房 X 光片进行复查。计算了两位观察者之间的κ一致性系数。采用多变量稳健泊松回归模型研究整体质量和定位与体重指数 (BMI) 和乳房密度之间的关系。
有 49.7%的乳房 X 光片不符合 CAR 标准。定位是最常出现缺陷的质量属性，有 37.2%的乳房 X 光片定位失败。观察者之间的一致性从轻微 (压缩和清晰度的 κ 值为 0.02)到良好 (曝光的 κ 值为 0.30)不等。对于整体质量，BMI≥30 kg/m2的女性有 67.5%的失败比例，而 BMI<25 kg/m2的女性有 34.9%的失败比例 (风险比 2.1 [95%置信区间，1.5-3.0])。对于定位，BMI≥30 kg/m2的女性有 53.8%的失败比例，而 BMI<25 kg/m2的女性有 27.9%的失败比例 (风险比 1.9 [95%置信区间，1.2-3.1])。乳房密度对图像质量的影响在不同的放射科医生之间有所不同。
尽管采取了措施来确保高质量成像，包括 CAR 认证，但在这个随机选择的筛查乳房 X 光片样本中，仍有近一半未达到 CAR 质量标准。为了解释这些观察结果，重要的是要为日常实践中进行的筛查乳房 X 光片定义质量目标。
