Summary of Recommendations to Improve Breast Imaging Quality

Improve mammography interpretation

  1. Revise and standardize the required medical audit component of MQSA.

  2. Facilitate a voluntary advanced medical audit with feedback.

  3. Designate specialized Breast Imaging Centers of Excellence and undertake demonstration projects and evaluations within them.

  4. Further study the effects of CME, reader volume, double reading, and CAD.

Revise MQSA regulations, inspections, and enforcement

  1. Modify regulations to clarify their intent and address current technology.

  2. Streamline inspections and strengthen enforcement for patient protection.

Ensure an adequate workforce for breast cancer screening and diagnosis

  1. Collect and analyze data on the mammography workforce and service capacity.

  2. Devise strategies to recruit and retain highly skilled breast imaging professionals.

  3. Make more effective use of breast imaging specialists.

Improve breast imaging quality beyond mammography

  1. Mandate accreditation for nonmammography breast imaging methods that are routinely used for breast cancer detection and diagnosis, such as ultrasound and magnetic resonance imaging (MRI).


The effectiveness of mammography greatly depends on the quality of image interpretation, but reading mammograms and assessing interpretive performance are both challenging. MQSA regulations include requirements for interpreting physicians regarding initial training, Continuing Medical Education (CME), continuing experience, and medical audits. The Committee addresses three primary questions relevant to interpretive performance: (1) whether the current audit procedures are likely to ensure or improve the quality of interpretive performance, (2) whether additional audit procedures could allow for more meaningful estimates of performance, and (3) whether the current CME and continuing experience requirements enhance performance.

MQSA requires that mammography facilities track their performance by obtaining outcome data on women recommended for breast biopsy based on an abnormal mammogram. However, the Committee concludes that current MQSA medical audit requirements are inadequate for measuring or improving the quality of image interpretation. Ideally, medical audits should be designed to link practice patterns to patient outcomes in a way that can influence interpretive performance. Interpreting physicians need to know and understand their current level of performance before they can determine whether and how it could be improved. The first two recommendations aim to improve the quality of mammography interpretation through enhanced and standardized medical audits, one mandatory and one voluntary. The third recommendation, for demonstration projects

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