Skip Navigation
Grant Details

Grant Number: 5R01CA107623-07 Interpret this number
Primary Investigator: Elmore, Joann
Organization: University Of Washington
Project Title: Understanding Variability in Community Mammography
Fiscal Year: 2007
Back to top


Abstract

DESCRIPTION (provided by applicant): BACKGROUND: Despite the proven value of mammography, its efficacy depends in large part on radiologists' interpretations and radiologists differ substantially in their interpretations. HYPOTHESES: Community mammography performance can be enhanced by better understanding sources of variability among radiologists and by working directly with radiologists in improving evaluation of their individual performance. SPECIFIC AIMS: 1.) To use statistical methods to estimate the accuracy of mammography at the level of individual radiologists and better understand reasons for variability. 2.) To better understand radiologist level characteristics associated with interpretive performance. 3.) To evaluate the feasibility and impact of an interactive web-based educational intervention and new audit reporting system. STUDY DESIGN: This cohort study will be organized within a conceptual framework previously proven to result in both physician behavior change and improved patient outcomes. Hierarchical statistical models will be developed using Breast Cancer Surveillance Consortium data from four population-based mammography registries in New Hampshire, Colorado, North Carolina, and Washington (Aim 1). Data from these Surveillance registries are available on more than two million mammography encounters. A survey, which will augment existing Surveillance data, will be sent to 400 radiologists to determine if radiologists understand concepts of numeracy (rates, risks and probability) in general and specifically related to breast cancer screening (Aim 2). Survey data will be linked with Surveillance data at an individual radiologist level. Information learned from Aims 1 and 2 will guide development and testing of an interactive web-based educational tool designed to improve radiologists' understanding of their own interpretive performance and to enhance use of audit reporting systems (Aim 3). RELEVANCE: Mandatory 'skills testing' is being considered in Congressional hearings as the Mammography Quality Standards Act is reviewed. Current methods of assessing the accuracy of individual radiologists are inadequate and there is no data to show that individual skills testing will improve accuracy of radiologists. This work builds on our previous model development and is a natural extension in a timely and important clinical area.

Back to top


Publications

Feasibility and acceptability of conducting a randomized clinical trial designed to improve interpretation of screening mammography.
Authors: Carney PA, Bogart A, Sickles EA, Smith R, Buist DS, Kerlikowske K, Onega T, Miglioretti DL, Rosenberg R, Yankaskas BC, Geller BM
Source: Acad Radiol, 2013 Nov;20(11), p. 1389-98.
PMID: 24119351
Related Citations

Back to top


Mammographic interpretation: radiologists' ability to accurately estimate their performance and compare it with that of their peers.
Authors: Cook AJ, Elmore JG, Zhu W, Jackson SL, Carney PA, Flowers C, Onega T, Geller B, Rosenberg RD, Miglioretti DL
Source: AJR Am J Roentgenol, 2012 Sep;199(3), p. 695-702.
PMID: 22915414
Related Citations

Back to top


Impact of an educational intervention designed to reduce unnecessary recall during screening mammography.
Authors: Carney PA, Abraham L, Cook A, Feig SA, Sickles EA, Miglioretti DL, Geller BM, Yankaskas BC, Elmore JG
Source: Acad Radiol, 2012 Sep;19(9), p. 1114-20.
EPub date: 2012 Jun 23.
PMID: 22727623
Related Citations

Back to top


Are radiologists' goals for mammography accuracy consistent with published recommendations?
Authors: Jackson SL, Cook AJ, Miglioretti DL, Carney PA, Geller BM, Onega T, Rosenberg RD, Brenner RJ, Elmore JG
Source: Acad Radiol, 2012 Mar;19(3), p. 289-95.
EPub date: 2011 Nov 30.
PMID: 22130089
Related Citations

Back to top


Mammographic interpretive volume and diagnostic mammogram interpretation performance in community practice.
Authors: Haneuse S, Buist DS, Miglioretti DL, Anderson ML, Carney PA, Onega T, Geller BM, Kerlikowske K, Rosenberg RD, Yankaskas BC, Elmore JG, Taplin SH, Smith RA, Sickles EA
Source: Radiology, 2012 Jan;262(1), p. 69-79.
EPub date: 2011 Nov 21.
PMID: 22106351
Related Citations

Back to top


Use of clinical history affects accuracy of interpretive performance of screening mammography.
Authors: Carney PA, Cook AJ, Miglioretti DL, Feig SA, Bowles EA, Geller BM, Kerlikowske K, Kettler M, Onega T, Elmore JG
Source: J Clin Epidemiol, 2012 Feb;65(2), p. 219-30.
EPub date: 2011 Oct 15.
PMID: 22000816
Related Citations

Back to top


Influence of annual interpretive volume on screening mammography performance in the United States.
Authors: Buist DS, Anderson ML, Haneuse SJ, Sickles EA, Smith RA, Carney PA, Taplin SH, Rosenberg RD, Geller BM, Onega TL, Monsees BS, Bassett LW, Yankaskas BC, Elmore JG, Kerlikowske K, Miglioretti DL
Source: Radiology, 2011 Apr;259(1), p. 72-84.
EPub date: 2011 Feb 22.
PMID: 21343539
Related Citations

Back to top


Using a tailored web-based intervention to set goals to reduce unnecessary recall.
Authors: Carney PA, Bowles EJ, Sickles EA, Geller BM, Feig SA, Jackson S, Brown D, Cook A, Yankaskas BC, Miglioretti DL, Elmore JG
Source: Acad Radiol, 2011 Apr;18(4), p. 495-503.
EPub date: 2011 Jan 20.
PMID: 21251856
Related Citations

Back to top


Feasibility and satisfaction with a tailored web-based audit intervention for recalibrating radiologists' thresholds for conducting additional work-up.
Authors: Carney PA, Geller BM, Sickles EA, Miglioretti DL, Aiello Bowles EJ, Abraham L, Feig SA, Brown D, Cook AJ, Yankaskas BC, Elmore JG
Source: Acad Radiol, 2011 Mar;18(3), p. 369-76.
EPub date: 2010 Dec 30.
PMID: 21193335
Related Citations

Back to top


Radiologists' perceptions of computer aided detection versus double reading for mammography interpretation.
Authors: Onega T, Aiello Bowles EJ, Miglioretti DL, Carney PA, Geller BM, Yankaskas BC, Kerlikowske K, Sickles EA, Elmore JG
Source: Acad Radiol, 2010 Oct;17(10), p. 1217-26.
PMID: 20832024
Related Citations

Back to top


Cost of breast-related care in the year following false positive screening mammograms.
Authors: Chubak J, Boudreau DM, Fishman PA, Elmore JG
Source: Med Care, 2010 Sep;48(9), p. 815-20.
PMID: 20706161
Related Citations

Back to top


Diagnosis of second breast cancer events after initial diagnosis of early stage breast cancer.
Authors: Buist DS, Abraham LA, Barlow WE, Krishnaraj A, Holdridge RC, Sickles EA, Carney PA, Kerlikowske K, Geller BM, Breast Cancer Surveillance Consortium
Source: Breast Cancer Res Treat, 2010 Dec;124(3), p. 863-73.
EPub date: 2010 Aug 11.
PMID: 20700648
Related Citations

Back to top


Radiologists' attitudes and use of mammography audit reports.
Authors: Elmore JG, Aiello Bowles EJ, Geller B, Oster NV, Carney PA, Miglioretti DL, Buist DS, Kerlikowske K, Sickles EA, Onega T, Rosenberg RD, Yankaskas BC
Source: Acad Radiol, 2010 Jun;17(6), p. 752-60.
PMID: 20457418
Related Citations

Back to top


Recommendation for short-interval follow-up examinations after a probably benign assessment: is clinical practice consistent with BI-RADS guidance?
Authors: Bowles EJ, Sickles EA, Miglioretti DL, Carney PA, Elmore JG
Source: AJR Am J Roentgenol, 2010 Apr;194(4), p. 1152-9.
PMID: 20308525
Related Citations

Back to top


Variability in interpretive performance at screening mammography and radiologists' characteristics associated with accuracy.
Authors: Elmore JG, Jackson SL, Abraham L, Miglioretti DL, Carney PA, Geller BM, Yankaskas BC, Kerlikowske K, Onega T, Rosenberg RD, Sickles EA, Buist DS
Source: Radiology, 2009 Dec;253(3), p. 641-51.
EPub date: 2009 Oct 28.
PMID: 19864507
Related Citations

Back to top


When radiologists perform best: the learning curve in screening mammogram interpretation.
Authors: Miglioretti DL, Gard CC, Carney PA, Onega TL, Buist DS, Sickles EA, Kerlikowske K, Rosenberg RD, Yankaskas BC, Geller BM, Elmore JG
Source: Radiology, 2009 Dec;253(3), p. 632-40.
EPub date: 2009 Sep 29.
PMID: 19789234
Related Citations

Back to top


Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors.
Authors: Cook AJ, Elmore JG, Miglioretti DL, Sickles EA, Aiello Bowles EJ, Cutter GR, Carney PA
Source: J Clin Epidemiol, 2010 Apr;63(4), p. 441-51.
EPub date: 2009 Sep 9.
PMID: 19744825
Related Citations

Back to top


Disclosing harmful mammography errors to patients.
Authors: Gallagher TH, Cook AJ, Brenner RJ, Carney PA, Miglioretti DL, Geller BM, Kerlikowske K, Onega TL, Rosenberg RD, Yankaskas BC, Lehman CD, Elmore JG
Source: Radiology, 2009 Nov;253(2), p. 443-52.
EPub date: 2009 Aug 25.
PMID: 19710002
Related Citations

Back to top


Variability of interpretive accuracy among diagnostic mammography facilities.
Authors: Jackson SL, Taplin SH, Sickles EA, Abraham L, Barlow WE, Carney PA, Geller B, Berns EA, Cutter GR, Elmore JG
Source: J Natl Cancer Inst, 2009 Jun 3;101(11), p. 814-27.
EPub date: 2009 May 26.
PMID: 19470953
Related Citations

Back to top


An assessment of the likelihood, frequency, and content of verbal communication between radiologists and women receiving screening and diagnostic mammography.
Authors: Carney PA, Kettler M, Cook AJ, Geller BM, Karliner L, Miglioretti DL, Bowles EA, Buist DS, Gallagher TH, Elmore JG
Source: Acad Radiol, 2009 Sep;16(9), p. 1056-63.
EPub date: 2009 May 12.
PMID: 19442539
Related Citations

Back to top


Radiologists' performance and their enjoyment of interpreting screening mammograms.
Authors: Geller BM, Bowles EJ, Sohng HY, Brenner RJ, Miglioretti DL, Carney PA, Elmore JG
Source: AJR Am J Roentgenol, 2009 Feb;192(2), p. 361-9.
PMID: 19155395
Related Citations

Back to top


Predictors of radiologists' perceived risk of malpractice lawsuits in breast imaging.
Authors: Dick JF 3rd, Gallagher TH, Brenner RJ, Yi JP, Reisch LM, Abraham L, Miglioretti DL, Carney PA, Cutter GR, Elmore JG
Source: AJR Am J Roentgenol, 2009 Feb;192(2), p. 327-33.
PMID: 19155390
Related Citations

Back to top


Statistical approaches for modeling radiologists' interpretive performance.
Authors: Miglioretti DL, Haneuse SJ, Anderson ML
Source: Acad Radiol, 2009 Feb;16(2), p. 227-38.
PMID: 19124109
Related Citations

Back to top


Mammography facility characteristics associated with interpretive accuracy of screening mammography.
Authors: Taplin S, Abraham L, Barlow WE, Fenton JJ, Berns EA, Carney PA, Cutter GR, Sickles EA, Carl D, Elmore JG
Source: J Natl Cancer Inst, 2008 Jun 18;100(12), p. 876-87.
EPub date: 2008 Jun 10.
PMID: 18544742
Related Citations

Back to top


Accuracy of short-interval follow-up mammograms by patient and radiologist characteristics.
Authors: Aiello Bowles EJ, Miglioretti DL, Sickles EA, Abraham L, Carney PA, Yankaskas BC, Elmore JG
Source: AJR Am J Roentgenol, 2008 May;190(5), p. 1200-8.
PMID: 18430832
Related Citations

Back to top


Joint modeling of sensitivity and specificity.
Authors: Puggioni G, Gelfand AE, Elmore JG
Source: Stat Med, 2008 May 10;27(10), p. 1745-61.
PMID: 18167634
Related Citations

Back to top


Radiologist characteristics associated with interpretive performance of diagnostic mammography.
Authors: Miglioretti DL, Smith-Bindman R, Abraham L, Brenner RJ, Carney PA, Bowles EJ, Buist DS, Elmore JG
Source: J Natl Cancer Inst, 2007 Dec 19;99(24), p. 1854-63.
EPub date: 2007 Dec 11.
PMID: 18073379
Related Citations

Back to top


Trends in study methods used in undergraduate medical education research, 1969-2007.
Authors: Baernstein A, Liss HK, Carney PA, Elmore JG
Source: JAMA, 2007 Sep 5;298(9), p. 1038-45.
PMID: 17785648
Related Citations