H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
Clin Imaging. 2021 May;73:13-17. doi: 10.1016/j.clinimag.2020.11.036. Epub 2020 Nov 16.
The Enhancing Quality Using the Inspection Program (EQUIP) initiative was launched to improve clinical image quality. The purpose of this study was to determine if the implementation of the EQUIP reporting system resulted in an increased number of extra views performed at the technologists' discretion during screening mammography.
Following IRB approval at a single comprehensive cancer center, patients who underwent screening mammography with combination full-field digital mammography plus digital breast tomosynthesis during a 6-month period before (January 2017 to June 2017) and after (January 2018 to June 2018) EQUIP implementation were identified. For each patient, both screening mammograms were retrospectively reviewed by 1 of 3 subspecialized breast radiologists (3-10 years of experience). The following data were recorded: demographics, breast density, surgical history, technologist, number and type of extra views, final BI-RADS assessment, radiologist-assigned indication for the view, and radiologist-assigned necessity of the view. McNemar's test for paired data was computed with p value of <0.05 considered statistically significant.
Of 820 patients, 370 (45%) had additional views in 2018 compared to 317 (39%) in 2017. After EQUIP, patients were 38% more likely to have additional views (OR = 1.38, 95% CI = 1.11-1.73). The total number of additional views in 2018 was 636 compared to 530 in 2017 (20% increase). Among patients with extra views in both years, the number of additional views per patient did not significantly increase post EQUIP implementation (OR = 1.18, 95% CI = 0.73-1.92). The most common extra view was exaggerated craniocaudal lateral, and the most common reason cited by the reviewing radiologist was lateral fibroglandular tissue at the edge of the images. Most of the extra views performed in 2018 were not performed in 2017 and over half were deemed unnecessary. Eight of eleven technologists demonstrated an increased frequency of screening mammograms with extra views performed post EQUIP.
Following EQUIP implementation, screening mammography patients were significantly more likely to have extra views performed at the technologists' discretion. Our findings emphasize the importance of ongoing technologist education and radiologist feedback.
启动质量提升检查计划（EQUIP）倡议是为了提高临床图像质量。本研究的目的是确定在实施 EQUIP 报告系统后，在筛查性乳房 X 光检查中，技术员是否会根据需要增加额外的视图数量。
在一家综合性癌症中心获得机构审查委员会批准后，对 2017 年 1 月至 6 月（实施 EQUIP 之前）和 2018 年 1 月至 6 月（实施 EQUIP 之后）期间接受全野数字化乳腺摄影加数字乳腺断层合成筛查性乳房 X 光检查的患者进行了识别。每位患者的两次筛查性乳房 X 光检查均由 3 名具有乳腺放射学专业知识的放射科医生（3-10 年经验）之一进行回顾性审查。记录的数据包括：人口统计学信息、乳房密度、手术史、技术员、额外视图的数量和类型、最终 BI-RADS 评估、放射科医生分配的视图指征以及放射科医生分配的视图必要性。采用 McNemar 检验进行配对数据比较，p 值<0.05 被认为具有统计学意义。
在 820 名患者中，与 2017 年的 317 名患者相比，2018 年有 370 名患者（45%）有额外的视图。在实施 EQUIP 后，患者有 38%的可能性会增加额外的视图（OR=1.38，95%CI=1.11-1.73）。2018 年的额外视图总数为 636 个，而 2017 年为 530 个（增加了 20%）。在两年都有额外视图的患者中，在实施 EQUIP 后，每位患者的额外视图数量并没有显著增加（OR=1.18，95%CI=0.73-1.92）。最常见的额外视图是夸大的头尾侧斜位，审查放射科医生最常见的理由是图像边缘的外侧纤维腺体组织。2018 年进行的大多数额外视图都没有在 2017 年进行，其中一半以上被认为是不必要的。11 名技术员中有 8 名在实施 EQUIP 后，其筛查性乳房 X 光检查中增加了额外视图的频率。
在实施 EQUIP 后，筛查性乳房 X 光检查的患者更有可能在技术员的酌情下进行额外的视图检查。我们的研究结果强调了持续的技术员教育和放射科医生反馈的重要性。
