Improving Breast Imaging Quality Standards

by Nass, Sharyl

• ISBN13: 9780309096485
• ISBN10: 0309096480
• Edition: 1st
• Format: Paperback
• Copyright: 2005-10-01
• Publisher: NATL ACADEMY OF SCIENCE

Summary

Mammography is an important tool for detecting breast cancer at an early stage. When coupled with appropriate treatment, early detection can reduce breast cancer mortality. At the request of Congress, the Food and Drug Administration (FDA) commissioned a study to examine the current practice of mammography and breast cancer detection, with a focus on the FDA's oversight via the Mammography Quality Standards Act (MQSA), to identify areas in need of improvement. Enacted in 1993, MQSA provides a general framework for ensuring national quality standards in facilities performing screening mammography, requires that each mammography facility be accredited and certified, and mandates that facilities will undergo annual inspections. This book recommends strategies for achieving continued progress in assuring mammography quality, including changes to MQSA regulation, as well as approaches that do not fall within the purview of MQSA. Specifically, this book provides recommendations aimed at improving mammography interpretation, revising MQSA regulations, inspections, and enforcement; ensuring an adequate workforce for breast cancer screening and diagnosis; and improving breast imaging quality beyond mammography.

Table of Contents

Executive Summary	1	(15)
Introduction	16	(8)
A Brief History of MQSA	17	(3)
Committee Charge	20	(1)
Methods	20	(2)
Framework of the Report	22	(1)
References	22	(2)
Improving Interpretive Performance in Mammography	24	(58)
Current State of Knowledge Regarding Appropriate Standards or Measures	24	(11)
Factors Affecting Interpretive Performance of Both Screening and Diagnostic Mammography	35	(10)
Double-Reading Methods and Technical Tools Designed to Improve Performance	45	(2)
The Impact of Residency/Fellowship Training and CME on Interpretive Skills	47	(2)
The Influence of Skills Assessment and Feedback on Performance	49	(4)
Challenges to Using Medical Audit Data to Improve Interpretive Performance in the United States	53	(8)
Limitations of Current MQSA Audit Requirements	61	(2)
Strategies to Improve Medical Audit of Mammography	63	(1)
Breast Imaging Centers of Excellence	64	(3)
The Need for a Supportive Environment to Promote Quality Improvement	67	(3)
Summary and Conclusions	70	(1)
References	71	(11)
Mqsa Regulations, Inspections, and Enforcement	82	(35)
Regulations Overview	82	(3)
Suggested Changes to FDA Regulations	85	(24)
National Quality Standards	109	(3)
The Costs and Benefits of MQSA	112	(1)
Summary and Conclusions	113	(1)
References	114	(3)
Ensuring an Adequate Workforce for Breast Cancer Screening and Diagnosis	117	(47)
Current Status: Is Access to Mammography Endangered?	121	(7)
Future Projections: Workforce Demand Outstrips Supply	128	(9)
Addressing Underserved Communities	137	(6)
Factors Limiting the Supply of Interpreting Physicians	143	(7)
Strategies to Ensure an Adequate Mammography Workforce	150	(6)
Summary and Conclusions	156	(1)
References	157	(7)
Beyond MQSA	164	(47)
Reminder Systems	164	(1)
Medicolegal Liability and the Quality of Care	165	(9)
Oversight of Other Breast Imaging Modalities	174	(5)
Summary and Conclusions	179	(1)
References	180	(9)
APPENDIXES
A. ACR Survey Methods and Analysis	189	(11)
Analyses and Reports on Radiologists Performing Mammography	192	(8)
B. Society of Breast Imaging Survey	200	(2)
C. Workforce Projection Methods	202	(9)
Glossary	211