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