Recent Submissions

  • Interventions for healthcare professionals, organisations and patients to enhance quality of life for people diagnosed with palliative esophagogastric cancer: A systematic review

    Cowley, Alison; Cooper, Joanne (2017)
    EXECUTIVE SUMMARY Background Esophagogastric (EG) cancer is the fifth most common malignancy, and its incidence is increasing. The disease is fast paced, and five-year survival rates are poor. Treatment with palliative intent is provided for the majority of patients but there remains a lack of empirical evidence into the most effective service models to support EG cancer patients. Objectives The overall objective of this quantitative systematic review was to establish best practice in relation to interventions targeted at healthcare professionals or the structures in which healthcare professionals deliver care (i.e. models of care and practice) and patients (diagnosed with palliative EG cancer) to enhance the quality of life for people diagnosed with palliative EG cancer. Inclusion criteria Search strategy A three-step search strategy was utilized. Sixteen databases were searched for papers from the year 2000 onward and followed by hand searching of reference lists. Methodological quality Methodological quality was not assessed as no articles were found that met the inclusion criteria. Data extraction Data extraction was not possible as no articles were found that met the inclusion criteria. Data synthesis It was not possible to complete data synthesis as no articles were found that met the inclusion criteria. Results Comprehensive searching and study selection process failed to identify any studies that were eligible for inclusion in the review. Conclusion There is currently a lack of published evidence to establish which interventions and strategies are most effective in delivering services to patients diagnosed with palliative EG cancer in terms of service structure, process and delivery.
  • Patient, nursing and medical staff experiences and perceptions of the care of people with palliative esophagogastric cancer: A systematic review of the qualitative evidence

    Cowley, Alison; Cooper, Joanne (2016)
    EXECUTIVE SUMMARY Background Esophagogastric cancer is the fifth most common malignancy and its incidence is increasing. The disease progresses quickly and five-year survival rates are poor. Treatment with palliative intent is provided for the majority of patients but there remains a lack of empirical evidence on the most effective service models to support esophagogastric cancer patients. Objectives The overall objective of this systematic review was to synthesize the best available evidence on the experiences and perceptions of patients and health professionals with regard to the care of people diagnosed with palliative esophagogastric cancer. Inclusion criteria Search strategy A three-step search strategy was utilized. A total 11 databases were searched for studies from 2000 onward, followed by hand searching of reference lists. Methodological quality Methodological quality was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool (JBI-QARI). Data extraction Qualitative findings were extracted using the JBI-QARI data extraction Instrument. Data synthesis Qualitative research findings were pooled using a pragmatic meta-aggregative approach. Results The review included two publications. There were 46 findings which were aggregated into four categories and one overall synthesized finding: "In addition to support for physical needs, patients need support that takes into account changing life situations to achieve the best quality of life." Conclusions The review shows that patients value services and support that addresses their complex, fluctuating and highly individual needs. No evidence was uncovered regarding how these services should be designed and delivered.
  • Clinical academic radiographers - A challenging but rewarding career

    Costigan, Carolyn (2021)
    OBJECTIVES: To explain what a clinical academic career can be, what it can lead to for the individual, profession and most importantly the patient, and why these roles are so important to radiography. KEY FINDINGS: Multiple challenges to the adoption of clinical academic careers exist, including achievable measurable outcomes, visibility & senior support, and balancing different time demands. Equally the rewards are wide ranging and can advance both the individual and profession through role extension opportunities, increased career progression, patient benefits, and academic and research skills. CONCLUSION: Clinical academic careers can provide advantages for the individual, department, profession and most importantly the patient with advanced clinical practice through evidenced based research. IMPLICATIONS FOR PRACTICE: Improving clinical academic careers within Radiography will promote research participation and increase radiographic roles in patient-centred research delivery and development. Combining evidenced based research with academic skills will lead to improved patient care and better clinical outcomes. Copyright © 2021 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
  • Interventions for supporting parents of infants requiring neonatal inter-hospital transport: A systematic review

    Mason, Libuse; Marufu, Takawira C.; Manning, Joseph C. (2023)
    Background Neonatal inter-hospital transport is associated with heightened stress for parents whose needs may remain unmet around this time. Aim To identify interventions which are used to support parents whose infants require neonatal inter-hospital transport. Study Design A systematic literature review approach was used. Six online databases (CINAHL, EMBASE, EMCARE, Medline, PsycINFO, Web of Science) were searched up to February 2022. The eligibility criteria included interventional studies published in the English language. Methodological quality was assessed by the Critical Appraisal Skills Programme checklists. Data were extracted using a predefined framework and synthesized narratively because of heterogeneity of reported outcomes. Results A total of 671 articles were screened, with five meeting the eligibility criteria. Three interventions were reported within the five studies: a communication-based intervention before transport represented by 223 parents in one study, Kangaroo Care during transport, which was carried out with 136 infants in three studies, and video calls after transport evaluated by one study in seven parents versus a control group. The effectiveness of the interventions could not be reliably determined. Neonatal nurses were the main providers of all the interventions pre-, peri-, and post-transport. Conclusion Limited evidence of mixed quality and inconsistent outcome measurements is available. Future research should focus on developing a contemporary intervention, determining the optimum timing for its implementation, and evaluating it using a robust study design. Relevance to Clinical Practice Neonatal nurses need to be aware of the importance of their role in supporting parents through the distressing time of neonatal transport.
  • Effectiveness of preventative care strategies for reducing pressure injuries (PIs) in children aged 0-18 admitted to intensive care: A systematic review and meta-analysis

    Setchell, Bradley; Marufu, Takawira C.; Manning, Joseph C.
    Introduction: The development and prevention of pressure injuries is a complex phenomenon, dependent on a wide variety of extrinsic and intrinsic risk factors. Children with critical illness form an extremely vulnerable patient group with an exceptionally high risk of immobility-related and medical device-related pressure injuries. Recent reviews on this subject matter largely been focused on adult patients. The aim of this review is to systematically synthesise the evidence on the most effective interventions to prevent pressure injury development in children admitted to intensive care. Methods: Four electronic databases; CINAHL, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched. Studies were screened at three stages, title, abstract, and full text against the inclusion and exclusion. Quality appraisal was conducted using the Joanna Briggs Institute Critical Appraisal Tools and two authors independently extracted study data from included studies using a predesigned data collection form. A meta-analysis was performed using RevMan 5. Results: After removal of duplicates, twenty studies met the inclusion criteria. Observed interventions included; use of risk assessment tool, preventative skin regimes, nutrition, repositioning, support surfaces, medical devices care, and staff education and training. A bundle intervention approach was used to implement pressure ulcer preventative strategies. Meta-analysis demonstrated an associated 51% potential reduction in pressure injury post intervention (pooled OR 0.49 (95% confidence Interval (CI) 0.39 – 0.62) P < 0.0001). Conclusion: Pressure injury preventative strategies are more likely to reduce the number and severity of pressure injuries. Paediatric nurses are pivotal members of the direct care multidisciplinary team with unique expertise and influence over the risk assessment, implementation and maintenance of pressure injury preventative strategies for children admitted to intensive care.
  • Chapter 4: Normal child development

    James, Nadya (Elsevier, 2017)
    Learning objectives. By the end of this chapter the reader should: • Have an understanding of normal child development • Understand the scientific basis of normal development • Be aware of the theory and tools available for assessment • Understand the concept of ‘red flags’ and limit ages for developmental milestones • Understand the importance of repeated developmental assessment over time • Understand the basis of the Healthy Child Programme
  • Chapter 27: Neurodevelopmental medicine

    James, Nadya; Martin, Katherine (Elsevier, 2022)
    After reading this chapter you should be able to assess, diagnose and manage: • developmental disorders and learning difficulties • speech and language disorders including autism spectrum disorder • neurodevelopmental disorders • a child with neurodisability
  • Chapter 5: Developmental problems and the child with special needs

    James, Nadya; Martin, Katherine (Elsevier, 2017)
    Learning objectives. By the end of this chapter the reader should: • Be aware of the epidemiology of neurodisability • Know about the aetiology, different clinical patterns and management of cerebral palsy • Know about the causes of impaired development and regression • Know about attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and developmental coordination disorder (DCD).
  • Chapter 28: Neurology

    James, Nadya (Elsevier, 2017)
    Learning objectives. By the end of this chapter the reader should: • Know the anatomy and embryology of the central and peripheral nervous systems • Understand the role of cerebrospinal fluid (CSF) and how CSF analysis can be used for diagnosis of neurological conditions including infections • Understand how the physiology of the central and peripheral nervous systems applies to neurophysiology (e.g. EEG, EMG) • Understand the role of imaging in neurological disorders • Know the genetic and environmental factors in the aetiology of important neurological disorders and brain development • Understand the physiological and pathophysiological changes that occur in neurological disorders, including headache, migraine, raised intracranial pressure and epilepsy • Know the pharmacology of agents commonly used in neurological disease • Understand the basis of non-pharmacological treatments for the management of neurological disorders.
  • Looked after children: An overview for the dental team

    James, Nadya (Springer, 2023)
    Looked after children (LAC) are children and young people (CYP) who have been under the continuous care of the local authority for more than 24 hours. Reasons for becoming looked after include concerns about abuse or neglect, breakdown in family functioning, or absence of a suitable caregiver (for example bereavement, parental illness, or separation, such as for unaccompanied asylum-seeking children). Many LAC live with foster families, extended family, or in residential care homes, but a CYP can be legally 'looked after' and still be living with their original or birth family, or living independently with support. Regardless of the circumstances, the local authority has responsibility for meeting the needs of the CYP, including dental care, usually via a named social worker. The evidence available suggests that LAC are at higher risk of dental caries and pain. In 2021, Public Health England reported on inequalities in oral health in England and although evidence was limited, found LAC to have poorer oral health and access to care. It is important that LAC are considered for enhanced prevention and reviewed regularly to enable appropriate provision of dental care. Understanding who can consent for dental treatment is essential. Copyright © 2023. The Author(s), under exclusive licence to the British Dental Association.
  • Measuring reader fatigue in the interpretation of screening digital breast tomosynthesis (DBT)

    James, Jonathan (BIR Publications, 2023)
    OBJECTIVES: The interpretation of digital breast tomosynthesis (DBT) screening examinations is a complex task for an already overstretched workforce which has the potential to increase pressure on readers leading to fatigue and patient safety issues. Studies in non-medical and medical settings have suggested that changes in blink characteristics can reflect fatigue. The purpose of this study is to investigate the use of blink characteristics as an objective marker of fatigue in readers interpreting DBT breast screening examinations., METHODS: Twenty-six DBT readers involved in the UK PROSPECTS trial interpreted a test set of 40 DBT cases while being observed by an eye tracking device from November 2019 to February 2021. Raw data from the eye tracker were collected and automated processing software was used to produce eye blinking characteristics data which were analysed using multiple linear regression statistical models., RESULTS: Of the 26 DBT readers recruited, eye tracking data from 23 participants were analysed due to missing data rendering 3 participants' data uninterpretable. The mean reading time per DBT case was 2.81 min. There was a statistically significant increase in blinking duration of 0.38 ms/case as the reading session progressed (p < 0.0001). This was the result of a significant decrease in the number of ultra-short blinks lasting <=50 ms (p = 0.0005) and a significant increase in longer blinks lasting 51-100 ms (p = 0.008)., CONCLUSION: Changes in blinking characteristics could serve as objective measures of reader fatigue and may prove useful in the development of DBT reading protocols., ADVANCES IN KNOWLEDGE: Blink characteristics can be used as an objective measure of fatigue; however there is limited evidence of their use in radiological settings. Our study suggests that changes in blink duration and frequency could be used to monitor fatigue in DBT reading sessions.
  • Performance of radiologists and radiographers in double reading mammograms: The UK national health service breast screening program

    James, Jonathan (RSNA, 2023)
    Background Double reading can be used in screening mammography, but it is labor intensive. There is limited evidence on whether trained radiographers (ie, technologists) may be used to provide double reading. Purpose To compare the performance of radiologists and radiographers double reading screening mammograms, considering reader experience level. Materials and Methods In this retrospective study, performance and experience data were obtained for radiologists and radiographer readers of all screening mammograms in England from April 2015 to March 2016. Cancer detection rate (CDR), recall rate (RR), and positive predictive value (PPV) of recall based on biopsy-proven findings were calculated for first readers. Performance metrics were analyzed according to reader professional group and years of reading experience using the analysis of variance test. P values less than .05 were considered to indicate statistically significant difference. Results During the study period, 401 readers (224 radiologists and 177 radiographers) double read 1 404 395 screening digital mammograms. There was no difference in CDR between radiologist and radiographer readers (mean, 7.84 vs 7.53 per 1000 examinations, respectively; P = .08) and no difference for readers with more than 10 years of experience compared with 5 years or fewer years of experience, regardless of professional group (mean, 7.75 vs 7.71 per 1000 examinations respectively, P = .87). No difference in the mean RR was observed between radiologists and radiographer readers (5.0% vs 5.2%, respectively, P = .63). A lower RR was seen for readers with more than 10 years of experience compared with 5 years or fewer, regardless of professional group (mean, 4.8% vs 5.8%, respectively; P = .001). No variation in PPV was observed between them (P = .42), with PPV values of 17.1% for radiologists versus 16.1% for radiographers. A higher PPV was seen for readers with more than 10 years of experience compared with 5 years or less, regardless of professional group (mean, 17.5% and 14.9%, respectively; P = .02). Conclusion No difference in performance was observed between radiographers and radiologists reading screening mammograms in a program that used double reading. Published under a CC BY 4.0 license Online supplemental material is available for this article. See also the editorial by Hooley and Durand in this issue.
  • Promoting simulation-based training in radiology: A homemade phantom for the practice of ultrasound-guided procedures

    Gianotti, Elisabetta; Closs, Samantha; Sun, Rachel; Bhatti, Hamnah; James, Jonathan; Clarke, Chris (BIR Publications, 2022)
    OBJECTIVE: Ultrasound-guided intervention is an essential skill for many radiologists and critical for accurate diagnosis and treatment in many radiology subspecialties. Simulation using phantoms have demonstrated statistically significant benefits for trainees within the literature. We propose a novel phantom model which the authors feel is ideal for training clinical radiology trainees in the performance of ultrasound-guided procedures., METHODS: The recipe to prepare a homemade phantom is described. Results of a local survey from trainees preparing and using the phantom are also presented., RESULTS: This realistic training simulation model can be adapted to suit a variety of biopsy devices and procedures including soft tissue biopsy and cyst aspiration. The phantom mimics the sonographic appearances of soft tissue and biopsy targets can be concealed within. The phantom was easily prepared by 22 trainees (Likert score 4.5) and it functioned well (Likert score of 4.7)., CONCLUSION: In summary, our phantom model is ideal for training clinical radiology trainees in the performance of ultrasound-guided core biopsy. The availability and low cost of the model, combined with the ease of preparation and reproducibility, make this an efficient and effective addition to the training process., ADVANCES IN KNOWLEDGE: A low cost easily handmade phantom recipe is described that could be easily implemented in training schemes.
  • Contrast-enhanced spectral mammography (CESM)-guided breast biopsy as an alternative to MRI-guided biopsy

    James, Jonathan (BIR Publications, 2022)
    OBJECTIVE: Contrast-enhanced spectral mammography (CESM) breast biopsy has been recently introduced into clinical practice. This short communication describes the technique and potential as an alternative to MRI-guided biopsy., METHODS AND MATERIALS: An additional abnormality was detected on a breast MRI examination in a patient with lobular carcinoma. The lesion was occult on conventional mammography, tomosynthesis and ultrasound and required histological diagnosis. Traditionally, this would have necessitated an MRI-guided breast biopsy, but was performed under CESM guidance., RESULTS: A diagnostic CESM study was performed to ensure the lesion visibility with CESM and then targeted under CESM guidance. A limited diagnostic study, CESM scout and paired images for stereotactic targeting were obtained within a 10 min window following a single injection of iodinated contrast agent. The time from positioning in the biopsy device to releasing compression after biopsy and marker clip placement was 15 min. The biopsy confirmed the presence of multifocal breast cancer., CONCLUSION: CESM-guided breast biopsy is a new technique that can be successfully used as an alternative to MRI-guided breast biopsy., ADVANCES IN KNOWLEDGE: CESM-guided biopsy can be used to sample breast lesions which remain occult on standard mammography and ultrasound.
  • Which lesions with a radiological or core biopsy diagnosis of fibroadenoma should be excised?

    Lee, Andrew H.S.; James, Jonathan; Whisker, Lisa; Rakha, Emad A.; Ellis, Ian O. (Royal College of Surgeons of England, 2022)
    INTRODUCTION: A recent Association of Breast Surgery summary statement on fibroadenoma management recommends excision only for cellular fibroepithelial lesions and rapidly growing lesions with a core biopsy diagnosis of fibroadenoma; persistent pain is a relative indication for excision., METHODS: This retrospective study looked at the impact this approach would have on the diagnosis of phyllodes tumours., RESULTS: From 2014 to 2018, there were 1,058 core biopsy diagnoses of fibroadenoma; 112 lesions were excised, of which 98 were fibroadenomas, 4 were hamartomas and 10 were phyllodes tumours. In this group, an excision diagnosis of phyllodes tumour was associated with size more than 40 mm, age more than 40 years and radiological suspicion of phyllodes tumour or carcinoma. One hundred and sixty-six excised fibroepithelial lesions with no previous core biopsy included eight phyllodes tumours; in this group, rapid growth was associated with phyllodes tumour diagnosis. Twelve of the 26 fibroepithelial lesions classified as B3 (cellular fibroepithelial lesion or phyllodes tumour) were diagnosed as phyllodes tumours on excision. Using a combination of radiological, clinical and pathological features it was possible to create an excision policy that would recommend excision of 22 of the 31 phyllodes tumours in this period. Eight of the nine 'missed' phyllodes tumours were benign., CONCLUSION: The Association of Breast Surgery summary statement will reduce the number of fibroadenomas excised, but may also result in delayed diagnosis of some phyllodes tumours. Appropriate safety netting advice should be provided to identify rapidly growing lesions.
  • The relationship between missed breast cancers on mammography in a test-set based assessment scheme and real-life performance in a national breast screening programme

    James, Jonathan (Elsevier Ltd., 2021)
    PURPOSE: This retrospective study determined whether a test-set based assessment scheme (PERFORMS) used in a national breast screening programme could be used to predict real-life performance by investigating if the number of cancers missed by mammography readers in real-life related to the number of cancers missed in the PERFORMS test-set and whether real-life reading volumes affected performance., METHOD: Data was obtained from consenting readers in the screening programme in England (NHSBSP) where double reading is standard. The rate of cancers missed by individual first readers but correctly identified by second readers was compared with the number of cancers missed in the PERFORMS test-set over a 3-year period. NHSBSP readers are required to interpret at least 1500 cases per year as a first reader, so results were compared between readers who exceeded this target and those that did not. Parametric and non-parametric correlations were calculated., RESULTS: Amongst the 536 readers, there was a highly significant positive correlation between the real-life and PERFORMS test-set missed cancer metrics (Pearson Correlation = 0.228, n = 536, p < .0001, Spearman's rho = 0.265, n = 536, p < .0001). There was no significant difference in rates of missed cancers between the 452 readers who exceeded the 1500 first read per year target and those who did not (t(94.2) = -1.87, p = .0643, r = 0.19)., CONCLUSIONS: The use of a test-set based assessment scheme accurately reflects real-life mammography reading performance, indicating that it can be a useful tool in identifying poor reader performance. Crown Copyright © 2021. Published by Elsevier B.V. All rights reserved.
  • Effectiveness of percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions) as an alternative to open surgical biopsy

    Gianotti, Elisabetta; James, Jonathan; Sun, Rachel; Karuppiah, Amanjot; Lee, Andrew H.S. (Springer, 2021)
    OBJECTIVES: Traditionally B3 breast lesions are treated surgically, but overtreatment is a concern, as the majority have a final benign diagnosis. A national screening program introduced vacuum-assisted excision (VAE) for managing B3 lesions in late 2016. This retrospective study aimed to assess the outcomes associated with this approach., METHODS: All B3 lesions diagnosed between 01/2017 and 12/2019 were identified at two centres. Information was obtained on the initial biopsy and final histology, and method of VAE image guidance, needle size and number of cores. Lesions were excluded if there was cancer elsewhere in the breast at the time of diagnosis; the lesion was not suitable for VAE due to position in the breast or had B3 pathology for which open biopsy was still required. The final decision to offer VAE was always made at a multidisciplinary meeting (MDM). Risk difference was used to test the significance at p <= .05., RESULTS: In total, 258 B3 lesions were diagnosed, 105 (40.7%) met the inclusion criteria and underwent VAE. VAE was performed under X-ray (89/105) or ultrasound guidance (16/105), taking an average of 18.5 cores with the 10-G needle or 10.8 cores with the 7-G needle. Nine cases (8.6%) were upgraded to a malignant diagnosis following VAE. Malignancy was found in 15.5% (9/58) of B3 lesions with epithelial atypia, but in none without atypia (0/47) (p = .004). No new lesions or malignancy has occurred at the site of the VAE with an average mammographic follow-up of 2.2 years., CONCLUSION: Upgrade to malignancy following VAE was uncommon (8.6%) and associated with atypia in the initial biopsy. VAE is an alternative approach to the management of B3 lesions, reducing open surgical procedures., KEY POINTS: * Upgrade to malignancy after a vacuum-assisted excision of a B3 breast lesion is uncommon with an 8.6% upgrade rate. * The risk of a malignant diagnosis after a vacuum-assisted excision was significantly higher for B3 lesions with atypia compared to those without (+15.5% difference, p = .004). Copyright © 2021. European Society of Radiology.
  • Opportunities in cancer imaging: Risk-adapted breast imaging in screening

    James, Jonathan (Elsevier Ltd., 2021)
    In the UK, women between 50-70 years are invited for 3-yearly mammography screening irrespective of their likelihood of developing breast cancer. The only risk adaption is for women with >30% lifetime risk who are offered annual magnetic resonance imaging (MRI) and mammography, and annual mammography for some moderate-risk women. Using questionnaires, breast density, and polygenic risk scores, it is possible to stratify the population into the lowest 20% risk, who will develop <4% of cancers and the top 4%, who will develop 18% of cancers. Mammography is a good screening test but has low sensitivity of 60% in the 9% of women with the highest category of breast density (BIRADS D) who have a 2.5- to fourfold breast cancer risk. There is evidence that adding ultrasound to the screening mammogram can increase the cancer detection rate and reduce advanced stage interval and next round cancers. Similarly, alternative tests such as contrast-enhanced mammography (CESM) or abbreviated MRI (ABB-MRI) are much more effective in detecting cancer in women with dense breasts. Scintimammography has been shown to be a viable alternative for dense breasts or for follow-up in those with a personal history of breast cancer and scarring as result of treatment. For supplemental screening to be worthwhile in these women, new technologies need to reduce the number of stage II cancers and be cost effective when tested in large scale trials. This article reviews the evidence for supplemental imaging and examines whether a risk-stratified approach is feasible. Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
  • Women's attitudes to the use of AI image readers: A case study from a national breast screening programme

    James, Jonathan (BMJ Publishing, 2021)
    BACKGROUND: Researchers and developers are evaluating the use of mammogram readers that use artificial intelligence (AI) in clinical settings., OBJECTIVES: This study examines the attitudes of women, both current and future users of breast screening, towards the use of AI in mammogram reading., METHODS: We used a cross-sectional, mixed methods study design with data from the survey responses and focus groups. We researched in four National Health Service hospitals in England. There we approached female workers over the age of 18 years and their immediate friends and family. We collected 4096 responses., RESULTS: Through descriptive statistical analysis, we learnt that women of screening age (>=50 years) were less likely than women under screening age to use technology apps for healthcare advice (likelihood ratio=0.85, 95% CI 0.82 to 0.89, p<0.001). They were also less likely than women under screening age to agree that AI can have a positive effect on society (likelihood ratio=0.89, 95% CI 0.84 to 0.95, p<0.001). However, they were more likely to feel positive about AI used to read mammograms (likelihood ratio=1.09, 95% CI 1.02 to 1.17, p=0.009)., DISCUSSION AND CONCLUSIONS: Women of screening age are ready to accept the use of AI in breast screening but are less likely to use other AI-based health applications. A large number of women are undecided, or had mixed views, about the use of AI generally and they remain to be convinced that it can be trusted. Copyright © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
  • The relationship between mammography readers' real-life performance and performance in a test set-based assessment scheme in a national breast screening program

    James, Jonathan; Cornford, Eleanor J. (RSNA, 2020)
    Purpose: To compare an individual's Personal Performance in Mammographic Screening (PERFORMS) score with their Breast Screening Information System (BSIS) real-life performance data and determine which parameters in the PERFORMS scheme offer the best reflection of BSIS real-life performance metrics., Materials and Methods: In this retrospective study, the BSIS real-life performance metrics of individual readers (n = 452) in the National Health Service Breast Screening Program (NHSBSP) in England were compared with performance in the test set-based assessment scheme over a 3-year period from 2013 to 2016. Cancer detection rate (CDR), recall rate, and positive predictive value (PPV) were calculated for each reader, for both real-life screening and the PERFORMS test. For each metric, real-life and test set versions were compared using a Pearson correlation. The real-life CDR, recall rate, and PPV of outliers were compared against other readers (nonoutliers) using analysis of variance., Results: BSIS real-life CDRs, recall rates, and PPVs showed positive correlations with the equivalent PERFORMS measures (P < .001, P = .002, and P < .001, respectively). The mean real-life CDR of PERFORMS outliers was 7.2 per 1000 women screened and was significantly lower than other readers (nonoutliers) where the real-life CDR was 7.9 (P = .002). The mean real-life screening PPV of PERFORMS outliers was 0.14% and was significantly lower than the nonoutlier group who had a mean PPV of 0.17% (P = .006)., Conclusion: The use of test set-based assessment schemes in a breast screening program has the potential to predict and identify poor performance in real life.© RSNA, 2020Keywords: Breast, ScreeningSee also the commentary by Thigpen and Rapelyea in this issue. Copyright 2020 by the Radiological Society of North America, Inc.

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