Korean J Radiol.  2013 Oct;14(5):701-710. 10.3348/kjr.2013.14.5.701.

Clinical Image Evaluation of Film Mammograms in Korea: Comparison with the ACR Standard

• Gwak YJ
• Kim HJ
• Kwak JY
• Son EJ
• Ko KH
• Lee JH
• Lim HS
• Lee YJ
• Park JW
• Shin KM
• Jang YJ

• KMID: 1711422
• DOI: http://doi.org/10.3348/kjr.2013.14.5.701

Abstract

OBJECTIVE
The goal of this study is to compare the overall quality of film mammograms taken according to the Korean standards with the American College of Radiology (ACR) standard for clinical image evaluation and to identify means of improving mammography quality in Korea.
MATERIALS AND METHODS
Four hundred and sixty eight sets of film mammograms were evaluated with respect to the Korean and ACR standards for clinical image evaluation. The pass and failure rates of mammograms were compared by medical facility types. Average scores in each category of the two standards were evaluated. Receiver operating characteristic curve analysis was used to identify an optimal Korean standard pass mark by taking the ACR standard as the reference standard.
RESULTS
93.6% (438/468) of mammograms passed the Korean standard, whereas only 80.1% (375/468) passed the ACR standard (p < 0.001). Non-radiologic private clinics had the lowest pass rate (88.1%: Korean standard, 71.8%: ACR standard) and the lowest total score (76.0) by the Korean standard. Average scores of positioning were lowest (19.3/29 by the Korean standard and 3.7/5 by the ACR standard). A cutoff score of 77.0 for the Korean standard was found to correspond to a pass level when the ACR standard was applied.
CONCLUSION
We suggest that tighter regulations, such as, raising the Korean pass mark, subtracting more for severe deficiencies, or considering a very low scores in even a single category as failure, are needed to improve the quality of mammography in Korea.

Keyword

Mammography; Quality assurance; Accreditation; Breast

MeSH Terms

Accreditation/*standards
Female
Humans
Mammography/*standards
*Quality Improvement
ROC Curve
Republic of Korea
Retrospective Studies

Figure

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  Fig. 1 Korean Clinical Image Evaluation Form.

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  Fig. 2 Details of Korean Clinical Image Evaluation Criteria.

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  Fig. 3 Mammograms passed Korean standard but failed ACR standard. Average total scores according to Korean standards was 71, but these mammograms failed ACR standard due to score of 2 in exposure category. ACR = American College of Radiology

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  Fig. 4 Receiver operating characteristic curve analysis shows optimal Korean standard pass mark of 77.0, when ACR standard was regarded as reference standard. ACR = American College of Radiology

Reference

1. Korean National Cancer Center. Report on the statistics for national cancer incidence 2006-2007. Korean National Cancer Center;2009.

2. Ko SS. Korean Breast Cancer Society. Chronological changing patterns of clinical characteristics of Korean breast cancer patients during 10 years (1996-2006) using nationwide breast cancer registration on-line program: biannual update. J Surg Oncol. 2008; 98:318–323.

3. Lee CH. Screening mammography: proven benefit, continued controversy. Radiol Clin North Am. 2002; 40:395–407.

4. Kim SH, Kim MH, Oh KK. Analysis and comparison of breast density according to age on mammogram between Korean and Western women. J Korean Radiol Soc. 2000; 42:1009–1014.

5. Bassett LW. The regulation of mammography. Semin Ultrasound CT MR. 1996; 17:415–423.

6. Suleiman OH, Spelic DC, McCrohan JL, Symonds GR, Houn F. Mammography in the 1990s: the United States and Canada. Radiology. 1999; 210:345–351.

7. Destouet JM, Bassett LW, Yaffe MJ, Butler PF, Wilcox PA. The ACR's Mammography Accreditation Program: ten years of experience since MQSA. J Am Coll Radiol. 2005; 2:585–594.

8. McLelland R, Hendrick RE, Zinninger MD, Wilcox PA. The American College of Radiology Mammography Accreditation Program. AJR Am J Roentgenol. 1991; 157:473–479.

9. Korean Society of Breast Imaging. A manual of the mammography quality control. Seoul: Sung Mun Gak;2001.

10. Korean Society of Radiology. Guidance on installation and management of special medical equipments. Accessed April 30, 2012. Available from: http://www.radiology.or.kr.

11. Bassett LW, Farria DM, Bansal S, Farquhar MA, Wilcox PA, Feig SA. Reasons for failure of a mammography unit at clinical image review in the American College of Radiology Mammography Accreditation Program. Radiology. 2000; 215:698–702.

12. Korean Institute for Accreditation of Medical Image. Accessed April 30, 2012. Available from: http://www.ikiami.or.kr/info/KMI418QD.aspx.

13. Korea Ministry of Health and Welfare. National health insurance system. Accessed April 30, 2012. Available from: http://english.mw.go.kr.

14. Li Y, Poulos A, McLean D, Rickard M. A review of methods of clinical image quality evaluation in mammography. Eur J Radiol. 2010; 74:e122–e131.

15. Lee SH, Choe YH, Chung SY, Kim MH, Kim EK, Oh KK, et al. Establishment of quality assessment standard for mammographic equipments: evaluation of phantom and clinical images. J Korean Radiol Soc. 2005; 53:117–127.

16. Moon WK, Kim TJ, Cha JH, Cho KS, Choi EW, Lee YJ, et al. Clinical image evaluation of mammograms: a national survey. J Korean Radiol Soc. 2003; 49:507–511.

17. National Institute of Food and Drug Safety Evaluation. Statistics of the diagnostic radiation generator devices installation in the last 5 years. 2010. Accessed April 30, 2012. Available from: http://www.nifds.go.kr.