National Academies Press: OpenBook

Improving Breast Imaging Quality Standards (2005)

Chapter: Front Matter

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
×

IMPROVING BREAST IMAGING QUALITY STANDARDS

Sharyl Nass and John Ball, Editors

Committee on Improving Mammography Quality Standards

National Cancer Policy Board

INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C. www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
×

THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract No. 223–01–2460-T16 between the National Academy of Sciences and the Food and Drug Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for this project.

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Copyright 2005 by the National Academy of Sciences. All rights reserved.

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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J.Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A.Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V.Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J.Cicerone and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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COMMITTEE ON IMPROVING MAMMOGRAPHY QUALITY STANDARDS

JOHN R.BALL, M.D., J.D. (Chair), Executive Vice President,

American Society for Clinical Pathology, Chicago, IL

PATRICIA A.CARNEY, Ph.D., Cancer Control Program Director,

Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH

HOWARD FORMAN, M.D., M.B.A., Vice Chairman and Associate Professor of Diagnostic Radiology,

Yale University School of Medicine, New Haven, CT

JANE E.HENNEY, M.D., Senior Vice President and Provost for Health Affairs,

University of Cincinnati, OH

MARIA CAROLINA HINESTROSA, M.P.H., Executive Vice President,

Programs and Planning, National Breast Cancer Coalition, Washington, DC

BRADLEY HUTTON, M.P.H., Director,

Cancer Services Program, New York State Department of Health, Albany, NY

CATHERINE PARSONS, R.T., Administrative Director of Medical Imaging,

Cumberland Medical Center, Crossville, TN

ETTA D.PISANO, M.D., Professor of Radiology and Biomedical Engineering, Director,

Biomedical Research Imaging Center, University of North Carolina School of Medicine, Chapel Hill

EDWARD SALSBERG, M.P.A., Director,

Center for Workforce Studies, Association of American Medical Colleges, Washington, DC

ROBERT A.SMITH, Ph.D., Director of Cancer Screening,

American Cancer Society, Atlanta, GA

STEPHEN TAPLIN, M.D., M.P.H., Senior Scientist,

Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD

Liaison for the National Cancer Policy Board

TIMOTHY EBERLEIN, M.D., Bixby Professor and Chairman,

Department of Surgery, Washington University School of Medicine, St. Louis, MO

Consultants

Volunteers for the Duration of the Study:

PRISCILLA F.BUTLER, M.S., Senior Director,

Breast Imaging Accreditation Programs, Department of Quality and Safety, American College of Radiology, Reston, VA

BARBARA MONSEES, M.D.,

Mallinckrodt Institute of Radiology, St. Louis, MO

LAWRENCE N.ROTHENBERG, Ph.D.,

Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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EDWARD A.SICKLES, M.D.,

Department of Radiology, University of California, San Francisco Medical Center

Short-Term Volunteers:

MARTIN L.BROWN, Ph.D.,

Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD

DIONE FARRIA,

Mallinckrodt Institute of Radiology, St. Louis, MO

Paid Consultants:

JONATHAN SUNSHINE, Senior Director for Research,

American College of Radiology, Reston, VA

PAUL WING, Deputy Director,

Center for Health Workforce Studies, State University of New York (SUNY) School of Public Health, Rensselaer

Study Staff

SHARYL J.NASS, Ph.D., Study Director

ROGER HERDMAN, M.D., Director,

National Cancer Policy Board

KATHRYN BARLETTA, Research Assistant

MARY ANN PRYOR, Senior Project Assistant

ANIKE JOHNSON, Administrative Assistant

JULIE WILTSHIRE, Financial Associate

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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NATIONAL CANCER POLICY BOARD

JOSEPH V.SIMONE, M.D. (Chair), President,

Simone Consulting, Dunwoody, GA

BRUCE W.STILLMAN, Ph.D. (Vice-Chair), Director,

Cold Spring Harbor Laboratory, Cold Spring Harbor, NY

ELLEN STOVALL (Vice-Chair), Executive Director,

National Coalition for Cancer Survivorship, Silver Spring, MD

JILL BARGONETTI, Ph.D., Associate Professor,

Department of Biological Sciences, Hunter College, New York, NY

TIMOTHY EBERLEIN, M.D., Bixby Professor and Chairman,

Washington University School of Medicine, St. Louis, MO

KATHY GIUSTI,

The Multiple Myeloma Research Foundation, New Canaan, CT

KAREN HERSEY, J.D., Senior Intellectual Property Counsel,

Massachusetts Institute of Technology, Cambridge, MA

JIMMIE HOLLAND, M.D., Chair,

Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY

WILLIAM KAELIN, M.D., Professor of Medicine,

Harvard Medical School, Boston, MA

WILLIAM W.MCGUIRE, M.D., Chairman and CEO,

United Health Group, Minnetonka, MN

JOHN MENDELSOHN, M.D., President,

University of Texas, M.D. Anderson Cancer Center, Houston

KATHLEEN HARDIN MOONEY, Ph.D., Professor,

University of Utah College of Nursing, Salt Lake City

PATRICIA NOLAN, M.D., Director,

Rhode Island Department of Health, Providence

DAVID PARKINSON, M.D., Vice-President of Oncology,

Amgen, Inc., Thousand Oaks, CA

JOHN D.POTTER, M.D., Ph.D., Program Head,

Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA

LOUISE RUSSELL, Ph.D., Research Professor of Economics,

Rutgers University, New Brunswick, NJ

THOMAS J.SMITH, M.D., F.A.C.P., Professor,

Medical College of Virginia at Virginia Commonwealth University, Richmond

ED WAGNER, M.D., M.P.H., F.A.C.P., Director,

MacColl Institute for Healthcare Innovation at the Center for Health Studies, Seattle, WA

SUSAN WIENER, Ph.D., President,

The Children’s Cause, Silver Spring, MD

ROBERT C.YOUNG, M.D., President,

American Cancer Society and Fox Chase Cancer Center, Philadelphia, PA

National Cancer Policy Board Staff

ROGER HERDMAN, M.D., Director

JILL EDEN, M.P.H., M.B.A., Senior Program Officer

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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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HELEN GELBAND, M.H.S., Senior Program Officer

MARIA HEWITT, Dr.P.H., Senior Program Officer

SHARYL NASS, Ph.D., Senior Program Officer

JUDY WAGNER, Ph.D., Scholar-in-Residence

PENNY SMITH, M.P.H., Research Associate

KATHRYN BARLETTA, Research Assistant

ELIZABETH BROWN, Research Assistant

MARY ANN PRYOR, Senior Project Assistant

ANIKE JOHNSON, Administrative Assistant

JULIE WILTSHIRE, Financial Associate

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:


Robert H.Brook, M.D., Sc.D., Professor of Medicine and Health Services, UCLA Center for Health Sciences; Vice President of RAND and Director, RAND Health, RAND Corporation, Santa Monica, CA

Judy Destouet, M.D., Chief of Mammography, Comprehensive Breast Cancer Center, Greater Baltimore Medical Center, Baltimore, MD

Edward Hendrick, Ph.D., Director of Breast Imaging Research and Research Professor, Northwestern Memorial Hospital, Worthington, OH

Elizabeth D.Jacobson, Ph.D., JK Consultants, Hagerstown, MD

Carol H.Lee, M.D., Professor of Diagnostic Radiology, Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT

Allen S.Lichter, M.D., Newman Family Professor of Radiation Oncology and Dean, University of Michigan Medical School, Ann Arbor

Carol Mount, RT, Supervisor of Mammography, Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN

Deborah E.Powell, M.D., Dean, Assistant Vice President for Clinical Sciences, and McKnight Presidential Leadership Chair, University of Minnesota Medical School, Minneapolis

Rebecca Smith-Bindman, M.D., Associate Professor in Residence, Department of Radiology, University of California, San Francisco


Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Dr. Howard Rabinowitz, M.D., Professor of Family Medicine, Thomas Jefferson University, Department of Family Medicine, Jefferson Medical College, Philadelphia, PA; and Dr. Harold C.Sox, M.D., Editor, Annals of Internal Medicine, American College of Physicians of Internal Medicine, Philadelphia, PA. Appointed by the National Research Council and Institute of Medicine, they were responsible for

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
×

Acknowledgments

The Committee members all gave generously of their time to form a conscientious and hard-working collaborative team. Although the Committee was solely responsible for decisions regarding the content, conclusions, and recommendations of the report, four consultants and a liaison to the National Cancer Policy Board also attended the committee meetings and provided invaluable insight and information during the study process.

At the first Committee meeting, five working groups were established to take the lead in addressing specific charges put before the Committee in our statement of task. Etta Pisano chaired the “Mammography Quality Standards Act (MQSA) Regulations” working group and led her team (Priscilla Butler, Timothy Eberlein, Jane Henney, Carolina Hinestrosa, Lawrence Rothenberg) through a detailed examination of the current MQSA regulations and inspections. Patricia Carney chaired the “Interpretation” working group (Brad Hutton, Barbara Monsees, Edward Sickles, Robert Smith, Stephen Taplin), which took the lead on drafting Chapter 2 of the report. Edward Salsberg led the “Workforce” working group (Timothy Eberlein, Howard Forman, Barbara Monsees, Catherine Parsons, Etta Pisano), which took primary responsibility for Chapter 4. Robert Smith chaired a working group (Jane Henney, Carolina Hinestrosa, Catherine Parsons, Lawrence Rothenberg, Edward Salsberg) that was charged with examining issues that extended beyond MQSA, which led to Chapter 5 of the report. Howard Forman led the “Data” working group (Priscilla Butler, Patricia Carney, Brad Hutton, Edward Sickles, Stephen Taplin), which made important contributions to Chapters 2 and 4.

The Committee is grateful to many individuals who provided valuable input and information for the study, either through formal presentations or through informal communications with study staff, Committee members, and consultants, including William Barlow, Helen Barr, Craig Beam, Rebecca Belsaas, C.S.Bernstein, Mythreyi Bhargavan, Jonathon Bibb, Jennifer Bitticks, Jim Brice, Jerry Britt, Martin Brown, Cathy Coleman, Janet Corrigan, Harriet Crawford, Richard Ellis, Joann Elmore, Dione Farria, Charles Finder, Beatrice Gairard, Kaye Goss-Terry, Tim Haran, Richard Harris, John Hayes, Kelly Hecht, Pam Kassing, Kellee Kemp, Shukri Khuri, Dan Kopans, Joseph Levitt, Rebecca Lewis, Michael Linver, Sharon-Lise Normand, Bill Page, John Patti, Nicholas Perry, John Pila, Peggy O’Kane, Rhonda Richards, John Sandrik, Phillip Scott, Brigitte Seradour, Janet Shaefer, Lillie Shockney, Rebecca Smith-Bindman, Jeanette Spencer, Richard Suberman, Jonathan Sunshine, Helene Toiv, Anna Tosteson, Dan Trammell, Steve Tucker, Judy Wagner, Richard Wagner, Deb Wiggins, Paul Wing, Martin Yaffe, and Bonnie Yankaskas.

The Committee is also indebted to the IOM study staff. Special thanks go to the study director, Dr. Sharyl Nass, for epitomizing the best of that role. She was extremely knowledgeable, very efficient, and captured the essence of the Committee’s deliberations superbly. Kathryn Barletta provided dedicated and exceptional research support and was directly involved in the development, writing, and production of the report. Mary Ann

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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Pryor provided outstanding administrative support and took primary responsibility for organizing the logistics of Committee meetings and communications. In addition, Maria Hewitt, Judy Wagner, Jill Eden, and Janet Joy, current and former members of the staff of the National Cancer Policy Board, provided invaluable insight and input to the study. Alison Mack and Margie Patlack, consulting writers, were also instrumental in keeping the study report on schedule and on target. Both prepared written background material for the report, and Alison took the lead in drafting Chapter 4.

John Ball

Committee Chair

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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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Acronyms


AAFP

American Academy of Family Physicians

AAMC

American Association of Medical Colleges

ACCME

American Council for Continuing Medical Education

ACoS

American College of Surgery

ACR

American College of Radiology

ADEMAS

Association pour le Dépistage des Maladies du Sein

AHRQ

Agency for Healthcare Research and Quality

AIUM

American Institute of Ultrasound in Medicine

AOCR

American Osteopathic College of Radiology

ARDMS

American Registry of Diagnostic Medical Sonographers

ASRT

American Society of Radiologic Technologists

AUC

Area Under the Receiver Operating Curve


BCCMPA

Breast and Cervical Cancer Mortality Prevention Act

BCSC

Breast Cancer Surveillance Consortium

BIQSA

Breast Imaging Quality Standards Act

BI-RADS

Breast Imaging Reporting and Data System


CAD

Computer-Aided Detection

CEJA

American Medical Association’s Council on Ethical and Judicial Affairs

CLIA

Clinical Laboratory Improvement Amendments

CME

Continuing Medical Education

CMS

Centers for Medicare and Medicaid Services

CPT

Current Procedural Terminology

CSR

Center for Survey Research (University of Virginia)

CT

Computerized Tomography


DCIS

Ductal Carcinoma in Situ


EUSOMA

European Society of Mastology


FDA

Food and Drug Administration

FFDM

Full-Field Digital Mammography

FP

False Positive

FTE

Full-Time Equivalent


GAO

Government Accountability Office, formerly General Accounting Office

GPCI

Geographic Practice Cost Index

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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HCFA (now CMS)

Health Care Financing Administration

HELP

Senate Committee on Health, Education, Labor, and Pensions

HHS

Department of Health and Human Services

HIPAA

Health Insurance Portability and Accountability Act

HRSA

Health Resources and Services Administration


IOM

Institute of Medicine


LCIS

Lobular Carcinoma in Situ


MISA

Mammography Interpretive Skills Assessment

MQSA

Mammography Quality Standards Act

MQSRA

Mammography Quality Standards Reauthorization Act of 1997

MRI

Magnetic Resonance Imaging


NBCCEDP

National Breast and Cervical Cancer Early Detection Program

NCI

National Cancer Institute

NEXT

1985 Nationwide Evaluation of X-Ray Trends

NHSBSP

National Health Service Breast Screening Program

NHSC

National Health Service Corps

NMQAAC

National Mammography Quality Assurance Advisory Committee

NPV

Negative Predictive Value

NSQIP

National Surgical Quality Improvement Program


OPPS

Outpatient Prospective Payment System


PFQ

Pay for Quality

PIAA

Physician Insurers Association of America

PPV

Positive Predictive Value


RA

Radiologist Assistant

RADIUS

Routine Antenatal Diagnostic Imaging with Ultrasound

RBRVS

Resource-Based Relative Value Scale

ROC

Receiver Operating Curve

RT

Radiologic Technologist

RVU

Relative Value Unit


SBI

Society of Breast Imaging

SCARD

Society for the Chairmen of Academic Radiology Departments

SEER

Surveillance, Epidemiology, and End Results

SOSS

Scheduled On-Site Survey


US

Ultrasound

Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
×
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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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Boxes, Tables, and Figures

BOXES

ES-1

 

Summary of Recommendations to Improve Breast Imaging Quality,

 

2

1–1

 

Committee Statement of Task,

 

21

2–1

 

Mammography Self-Assessment Programs,

 

55

2–2

 

Models of Integrated Breast Care,

 

66

2–3

 

Paying for Quality,

 

68

3–1

 

MQSA Regulations Overview,

 

83

3–2

 

Examples of Preemptive National Standards,

 

111

4–1

 

The Mammography Workforce,

 

118

4–2

 

Key U.S. Mammography Workforce Statistics,

 

120

4–3

 

Reimbursement,

 

148

4–4

 

CLIA Regulation of Pap Testing,

 

154

5–1

 

Reminder System Models and Comparisons,

 

166

5–2

 

The Malpractice Claims Process,

 

168

5–3

 

Tort Reform Legislation,

 

172

TABLES

2–1

 

Terms Used to Define Test Positivity/Negativity in BI-RADS 1st and 4th Editions,

 

25

2–2

 

Possible Results for a Screening Test,

 

27

2–3

 

Recent Reports of Measures on Interpretive Performance of Screening and Diagnostic Mammography,

 

36

2–4

 

Summary of Recent Studies That Examine the Impact of Interpretive Volume and Experience on Accuracy,

 

39

3–1

 

Suggested Changes to MQSA Regulations,

 

86

3–2

 

Self-Reported Estimate of the Cost of MQSA Compliance,

 

112

4–1

 

Number of Interpreting Physicians by Year,

 

121

4–2

 

American College of Radiology (ACR) Mammography Accreditation Program: Reason for Facility Closures Since April 2001 (as of October 2004),

 

125

4–3

 

Fees for Screening Mammograms Vary by Insured Status,

 

127

4–4

 

Projected FTE Supply of Radiologists Performing Mammography,

 

130

4–5

 

Full-Time Equivalent (FTE) Supply of Radiologic Technologists Performing Mammography: Status Quo Projections for the United States, 2004 to 2025,

 

132

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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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4–6

 

Estimate of Workforce Burden Subsequent to Screening Mammography,

 

134

4–7

 

Medicare Reimbursement for Selected Radiology Procedures, 2005,

 

136

4–8

 

Percentages of Radiologists Interpreting Mammograms and Mammograms by Type of Location, 2003,

 

137

4–9

 

Estimated Numbers of New Radiologists Needed to Implement Double Reads on All Mammograms, Assuming Constant Average Volume for Interpreting Physicians,

 

138

C-1

 

Details of Calculations for Constant Rate Scenario for FTE RTs Performing Mammography,

 

205

C-2

 

Involvement of RTs in Mammography by Age Group, 2004,

 

207

C-3

 

Estimated RTs Working in Mammography by Age Group, 2004,

 

207

C-4

 

Estimates of Radiologists Performing Mammography by Age Group, 2003,

 

208

C-5

 

Mammography Certification Rates for a Sample of RTs Practicing Mammography in New York State, 2004,

 

209

FIGURES

1–1

 

A history of MQSA,

 

19

2–1

 

Ideal (A) and actual common (B) distribution of mammography interpretation,

 

33

2–2

 

ROC analysis,

 

34

2–3

 

Results of statistical modeling for unadjusted (Line A) and adjusted (Line B for patient characteristics, C for radiologist characteristics, and D for both patient and radiologist characteristics) false-positive rates for 24 radiologists in a community setting,

 

50

2–4

 

Radiologists’ perceived 5-year risk of breast cancer for a vignette of a 41-year-old woman whose mother had breast cancer, who had one prior breast biopsy with atypical hyperplasia, and who was age 40 at first live birth,

 

53

3–1

 

Full Field Digital Mammography (FFDM) growth,

 

106

3–2

 

Percentage of facilities by highest violation level,

 

108

4–1

 

Estimated radiologists interpreting mammograms and percentage of total mammograms, by volume, United States, 2003,

 

123

4–2

 

Simplified screening mammogram outcome pyramid,

 

135

4–3

 

Percentage of radiologists who interpret mammograms in different community settings, by degree of urbanness,

 

139

4–4

 

Number of radiologists who interpret mammograms per 10,000 women aged 40 and older in different communities, by degree of urbanness,

 

140

C-1

 

Schematic diagram of age-cohort flow projection method,

 

204

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Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine and National Research Council. 2005. Improving Breast Imaging Quality Standards. Washington, DC: The National Academies Press. doi: 10.17226/11308.
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Mammography is an important tool for detecting breast cancer at an early stage. When coupled with appropriate treatment, early detection can reduce breast cancer mortality. At the request of Congress, the Food and Drug Administration (FDA) commissioned a study to examine the current practice of mammography and breast cancer detection, with a focus on the FDA’s oversight via the Mammography Quality Standards Act (MQSA), to identify areas in need of improvement. Enacted in 1993, MQSA provides a general framework for ensuring national quality standards in facilities performing screening mammography, requires that each mammography facility be accredited and certified, and mandates that facilities will undergo annual inspections. This book recommends strategies for achieving continued progress in assuring mammography quality, including changes to MQSA regulation, as well as approaches that do not fall within the purview of MQSA. Specifically, this book provides recommendations aimed at improving mammography interpretation; revising MQSA regulations, inspections, and enforcement; ensuring an adequate workforce for breast cancer screening and diagnosis; and improving breast imaging quality beyond mammography.

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