Appendix B
SOCIETY OF BREAST IMAGING SURVEY

To gain insight into the practice patterns, use of emerging technologies, and concerns of breast imagers in current practice, a survey was undertaken with support from the Society of Breast Imaging (SBI) (Farria et al., submitted). SBI staff and representatives participated in the design and conduct of the study and in the collection, analysis, and interpretation of the data.

From October 2003 to April 2004, the SBI conducted a survey of breast imaging practices in the United States, using the SBI membership database. The SBI has 1,684 general members. Membership in the SBI indicates an interest in breast imaging and requires board certification in diagnostic radiology.

The survey tool was developed by Dione M.Farria, M.D., M.P.H.; Maria E. Schmidt, M.D.; Barbara S.Monsees, M.D.; Robert A.Smith, Ph.D.; Debra L.Monticciolo, M.D.; and Stephen A.Feig, M.D. Five of these authors actively practice breast imaging in academic or private practice settings. The sixth individual has expertise in survey design. One survey was requested per breast imaging practice. Duplicate surveys from the same practice were not included in the analysis. Each respondent was asked to give the names of other breast imagers in their practice, which enabled the tracking of duplicate surveys. In addition, the authors cross-referenced business addresses, business phone numbers, and practice names to identify duplicate surveys. If more than one survey from the same practice was received, the respondents were contacted by phone to determine which survey was most representative of their practice.

Retired individuals, nonpracticing physicians, foreign members, and nonphysicians were excluded from the database, resulting in 1,572 practicing breast imaging radiologists in the study sample. The survey was distributed via e-mail. Respondents could submit their responses online, by fax, or by postal mail. If an individual from a practice did not respond after three e-mail requests, one final request was sent via postal mail. Those individuals who did not supply an e-mail address received the survey by postal mail. If these radiologists did not respond, the survey was remailed, for a total of three attempts via postal mail.

The survey included 57 items covering general practice characteristics and trends, such as the type of practice, practice setting (rural versus urban versus suburban), practice location, patient population, case volume, and the spectrum of imaging and interventional services. Annual volumes of procedures refer to volume in 2002. Other questions focused on workload, staff shortages, appointment waiting times, and financial status. Questions on malpractice concerns and morale were also included.

Geographic regions were based on the classification used by the U.S. Census Bureau. Data for the questionnaire responses were either nominal or ordinal. Frequency and relative frequency distributions were calculated for the responses. Statistical tests were used to determine if associations existed between selected responses. If the responses were nominal, chi-square tests were used. If one of the responses was ordinal, Kruskal-Wallis tests for singly ordered R×C tables were used. If both responses were ordinal,



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Improving Breast Imaging Quality Standards Appendix B SOCIETY OF BREAST IMAGING SURVEY To gain insight into the practice patterns, use of emerging technologies, and concerns of breast imagers in current practice, a survey was undertaken with support from the Society of Breast Imaging (SBI) (Farria et al., submitted). SBI staff and representatives participated in the design and conduct of the study and in the collection, analysis, and interpretation of the data. From October 2003 to April 2004, the SBI conducted a survey of breast imaging practices in the United States, using the SBI membership database. The SBI has 1,684 general members. Membership in the SBI indicates an interest in breast imaging and requires board certification in diagnostic radiology. The survey tool was developed by Dione M.Farria, M.D., M.P.H.; Maria E. Schmidt, M.D.; Barbara S.Monsees, M.D.; Robert A.Smith, Ph.D.; Debra L.Monticciolo, M.D.; and Stephen A.Feig, M.D. Five of these authors actively practice breast imaging in academic or private practice settings. The sixth individual has expertise in survey design. One survey was requested per breast imaging practice. Duplicate surveys from the same practice were not included in the analysis. Each respondent was asked to give the names of other breast imagers in their practice, which enabled the tracking of duplicate surveys. In addition, the authors cross-referenced business addresses, business phone numbers, and practice names to identify duplicate surveys. If more than one survey from the same practice was received, the respondents were contacted by phone to determine which survey was most representative of their practice. Retired individuals, nonpracticing physicians, foreign members, and nonphysicians were excluded from the database, resulting in 1,572 practicing breast imaging radiologists in the study sample. The survey was distributed via e-mail. Respondents could submit their responses online, by fax, or by postal mail. If an individual from a practice did not respond after three e-mail requests, one final request was sent via postal mail. Those individuals who did not supply an e-mail address received the survey by postal mail. If these radiologists did not respond, the survey was remailed, for a total of three attempts via postal mail. The survey included 57 items covering general practice characteristics and trends, such as the type of practice, practice setting (rural versus urban versus suburban), practice location, patient population, case volume, and the spectrum of imaging and interventional services. Annual volumes of procedures refer to volume in 2002. Other questions focused on workload, staff shortages, appointment waiting times, and financial status. Questions on malpractice concerns and morale were also included. Geographic regions were based on the classification used by the U.S. Census Bureau. Data for the questionnaire responses were either nominal or ordinal. Frequency and relative frequency distributions were calculated for the responses. Statistical tests were used to determine if associations existed between selected responses. If the responses were nominal, chi-square tests were used. If one of the responses was ordinal, Kruskal-Wallis tests for singly ordered R×C tables were used. If both responses were ordinal,

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Improving Breast Imaging Quality Standards Jonckheere-Terpstra tests for doubly ordered R×C tables were used. If 20 percent of cells had expected counts of less than 5, exact p values were calculated by means of data permutation. If the calculation took longer than the StatXact software’s default limit of 30 seconds, Monte Carlo sampling (10,000 samples) was used to estimate the exact p values. For this study, alpha was set at 0.05. A Bonferroni corrected alpha value to adjust for the family-wise error rate of performing the 15 statistical tests of this study results in an alpha of 0.003. The use of the Bonferroni adjusted alpha value decreases the potential for Type I errors, but increases the potential for Type II errors. Unadjusted p values are reported in this article. Statistical analyses were performed with JMP Statistical Software (Release 5.0.1.2, SAS Institute, Inc., Cary, NC) and StatXact Statistical Software for Exact Nonparametric Inference (Version 6, Cytel Software Corp., Cambridge, MA). Ethics approval was obtained from the Washington University Medical School Human Studies Committee. The authors received surveys from 575 practices, which represent 1,006 radiologists or 64 percent of 1,572 actively practicing breast imagers in the SBI. This return rate provided a 99 percent level of confidence for report responses, with a confidence interval of ±3 percentage points (Rea and Parker, 1997). The sample included practices with a broad range of case volumes and serving a diverse population. The number of responses varied with each item. REFERENCES Farria D, Schmidt ME, Monsees BS, Smith RA, Hildebolt C, Yoffie R, Monticciolo DL, Feig SA, Bassett LW. In press. Professional and economic factors affecting access to mammography: A crisis today, or tomorrow? Results from a national survey. Cancer. Rea LM, Parker RA. 1997. Designing and Conducting Survey Research: A Comprehensive Guide. 2nd ed. San Francisco, CA: Jossey-Bass. Pp. 118–123.