Introduction and purpose: A significant variation in mammography technical repeat rates and image quality, by hospital and by mammographer, was observed during peer review visits undertaken to breast services within our network of hospitals.

A breast imaging leads quality forum was established, comprising of lead mammographers from each hospital. The remit of the group was to analyse the peer review findings, share good practice and implement a quality assurance programme to address variations in performance and improve overall results.

PURPOSE

Implementing a mammography quality assurance programme to improve technical image quality and reduce technical repeats

Steven C Dixon, London, UNITED KINGDOM; R Halls, BSC,MSc; S E Milner, BSC; N Buckley; M Shah, MBA,RT

METHODSAn action plan was developed to enable the implementation of the quality assurance programme and included the following;

• appointing a group lead QA mammographer

• ensuring all mammography staff have access to a superintendent radiographer highly experienced in mammography as a mentor, as well as

establishing a buddy system

• ensuring staff are suitably trained, including holding, or working towards, a postgraduate certificate of competence in mammography, in

addition to undertaking relevant breast specific CPD

• regularly feeding back results to staff on the quality of their work, including feedback from radiologists regarding technically inadequate

images

• developing and implementing standardised group wide policies, protocols and procedures, including those relating to customer care and

communication.

• developing standardised information leaflets and pre mammography questionnaires

• ensuring sufficient time in between appointments to enable mammographers undertake the procedure according to protocol

• reducing the number of staff performing mammography, where necessary, rotating staff throughout multiple hospitals and limiting the use

of agency staff. Thus enabling each staff member to perform a minimum numbers of mammograms per month

• undertake mammography specific patient experience surveys

• replacement of small plate technology with large plate

• a data collection programme, centrally coordinated, to monitor at group, hospital and mammographer level;

- monthly mammography technical repeat rates

- quarterly image quality reviews consisting of 30 annoymised images for each mammographer. These were graded, using agreed criteria, by

a review panel comprising of the group lead QA mammographer and two rotating mammographers from within the group.

Staff were tasked with completing these actions and progress was monitored at regular intervals.

RESULTSThe improvements put in place led to a decrease in the numbers of staff performing mammography across the group, resulting in increased

numbers of mammograms performed by each member of staff. Quantative measuring of the success of the quality assurance programme was

determined by the monitoring of the technical repeat and image quality rates. The peer review visits showed the technical repeat rate across

the group as a whole to be 13% in December 2011. By December 2013, this had decreased to less than 3.5%, with the rate for 2013 overall

being 3.6%. Using a Perfect, Good, Moderate and Inadequate system of image quality grading, the perfect and good rate was 60% in the final

Quarter of 2011. This result had increased to 88.1% by the final quarter in 2013.

60.00

58.22

73.98

53.94

73.08

67.40

78.51 81.57

88.16

85.69

79.71NHS /EuropeanStandard = > 75%

100

90

80

70

60

50

40

30

20

10

0

P&

G%

Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014

Technical Quality of Mammography Images Audit% of Perfect and Good Images

Technical Report RateDecember 2011 to June 2014

TR

ra

te%

Month

16

14

12

10

8

6

4

2

0

13.30

6.39 6.60

5.89

4.955.32

3.33

4.97

3.883.19

3.383.41

3.44

4.32

3.413.68

2.81

4.10

3.09

3.94

3.353.353.353.353.353.35 3.36

3.29

5.18

3.473.28

3.86

2.693.04 2.80

3.68 NHS /EuropeanStandard = < 3%

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GRAPHS

Quarter

CONCLUSIONThe implementation of the quality assurance programme which

addresses staffing, training, environment, equipment and working

relationships, not only between consultant and mammographer, but

mammographer and patient, has led to a reduction in the technical

repeat rates and improvement in image quality. Most importantly

however, this quality assurance programme has led to an improved

service to patients with a reduction in exposure to radiation and an

increase in efficiency throughout our hospitals.

Key aspects of the programme which have led to the improvements

include; the increased numbers of mammograms performed by each

mammographer, which is particularly important in hospitals with low

volumes; the quarterly image quality reviews, which have provided a

learning environment for mammographers to discuss image quality

and identify trends; the continuation of the breast imaging leads

meeting, enabling ongoing discussion of mammography issues across

our hospitals, with the group increasing its remit to provide training

sessions for staff.

The increased awareness of this initiative and the engagement of all

staff from mammographer to CEO levels, has been an important factor

with the success of the programme and it is now important that this

initiative continue so further improvements can be made.

HCAInt.RSNAposter.indd 1 02/11/2014 20:19