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;19(2)::-121918.
EvaluationofRadiographers’ExperienceinMammography:An
ExplanatoryStudy
SalmanAlbeshan1,*,YazeedAlashban1,NasserShubayr2,ArwaAlkhudairy3andFatmaEliraqi4
1RadiologicalSciencesDepartment,CollegeofAppliedMedicalSciences,KingSaudUniversity,Riyadh,SaudiArabia
2DiagnosticRadiologyDepartment,CollegeofAppliedMedicalSciences,JazanUniversity,Jazan,SaudiArabia
3MedicalImagingDepartment,KingAbdullahBinAbdulazizUniversityHospital,Riyadh,SaudiArabia
4TheGeneralOrganizationforTeachingHospitalsandInstitutes,NationalInstituteofNeurologyandUrology,Cairo,Egypt
*Correspondingauthor:RadiologicalSciencesDepartment,CollegeofAppliedMedicalSciences,KingSaudUniversity,Riyadh,:******@
Received2021December27;Revised2022June15;Accepted2022June19.
Abstract
Background:Similartomostimagingprocedures,thehighqualityofimagesisakeyfactorinensuringthatmammographydeliv-
-qualityimages,astheyareresponsiblefor
notonlybreastpositioningandcompression,butalsoqualitycontrolandpatientcare.
Objectives:Toidentifythechallengesanddifficultiesofradiographersindailypracticeandtodeterminethemaincomponentsof
mammographythatrequirefurthertrainingandeducation.
PatientsandMethods:Anonlinesurveywasconductedtocollectdataregardingtheradiographers’demographicdata,institution
profile,imageassessmenttools,mammographychallenges,qualitycontrol,andcontinuingprofessionaldevelopment.
Results:Atotalof73radiographersparticipatedinthisstudy,themajorityofwhomwerefull-timeradiographerswithabachelor’s
ofRadiology(ACR)criteriawerethemostfamiliarimagequalityassessmenttool(52%).Themostfrequentlyusedscaletoevaluate
imagequalitywasposteriorbreasttissuevisualizationonbothcraniocaudal(CC)andmediolateraloblique(MLO)views,followedby
,positioning,artifacts,andcompressionwerethemainreasonsfor
,wheelchair-boundpatients,overweightpatients,andbreastcompressionwerethegreatestchallenges
ofpatientpositioning.
Conclusion:Thispilotstudyhighlightedtheimportanceofdevelopingin-housetrainingcoursesforradiographers,whichfocuson
patientpositioning,imagequalityassessment,andpatient-,furtherstudies
onalargersamplesizeareneededtovalidatethepresentresults.
Keywords:ImageQuality,Mammography,Positioning,Radiographer,BreastCancer
(4).
Therefore,theclinicalefficacyofmammographyislargely
Breastcancerremainsoneofthemajorpublichealthdependentontheimagesacquiredbyradiographers.
problemsaroundtheworld,withmorethantwomillionInclinicalpractice,radiographersencounterdifferent
femalecasesreportedin2018(1).Nonetheless,earlydetec-challengesanddifficultiesduetotechnologicaladvances,
tionofsmalltissuechangescanimprovebothmorbiditypatientinteractions,individualneeds,andrequirements
andmortalityratesofthisdisease(2).Notably,studieshaveforcontinuousprofessionaldevelopment(5).Arecentin-
reportedfive-yearsurvivalratesofapproximately85%andtegrativereviewreportedthatthechallengesofEuropean
27%inwomendiagnosedwithregionalanddistantbreastradiographerswererelatedtopatientpositioning,breast
cancer,respectively,withthesurvivalrateincreasingcon-compression,contrast,noise,sharpness,andlabeling;
siderablyto99%inwomenwithlocallydiagnosedbreastsuchdifficultieshavebeenalsoidentifiedinpreviousstud-
cancer(3).iesoutsideEurope(5).Besides,theprimaryimagequality
Mammography,
breasts,remainsthemostuniversallyacceptedscreeningregard,theresultsofapreviousstudyshowedthat3%to
%ofmammography-basedimagequalitymonitoring
suggestthatapoormammographicimagequalityis
Copyright©2022,Author(s).Thisisanopen-accessarticledistributedunderthetermsoftheCreativeCommonsAttribution-
(-nc//)whichpermitscopyandredistributethematerialjustinnoncommercialusages,providedtheoriginalworkisproperly
cited.
AlbeshanSetal.
didnotadequatelysatisfythequalitycriteria(6).
areaofdevelopment(7items),andtheotheronewasre-
questionsweregenerallyclose-ended,multiple-choice,di-
Thisstudyaimedtodescribethechallengesanddif-chotomous,orbasedonathree-orsix-pointLikertscale.
ficultiesofradiographersindailypracticeandtoinves-Duetomissingresponses,thetotalnumberoftherespon-
tigatetheradiographers’knowledgeofimagequalityas-dentsmightvaryforeachquestion.
-
pertinmammographyandthensenttoanexperienced
,thetoolwas
-
Thisonlinequestionnairestudy,whichwasapprovedplicability,identifydifficulties,estimatethesurveycom-
bytheEthicsCommitteeofKingFahadMedicalCity(IRBpletiontime,anddeterminewhethertheparticipantsin-
2033-8E)inRiyadh,SaudiArabia,wasperformedonSauditerpretedandunderstoodeachitemasintendedbythere-
-searchers.
Saudiparticipantswerealsoincludedinthissurveyfor
-probabilitysamplingmethod
Consideringthestudysubject,descriptiveandanalyt-
(snowballsampling)wasusedtorecruittheparticipants.
icalapproachescouldbeappliedinthetheoreticalsec-
Aparticipationconsentformwasalsoattachedtotheweb
tiontoacquireaccurateknowledgeoftheelementsofthe
problembydeterminingdifferenttheoreticalaspectsof
ElectronicDataCapture(REDCap),whichisaHealthInsur-
,foranaccurateanddetaileddescrip-
ancePortabilityandAccountabilityAct(HIPAA)-compliant
tionofthephenomenon,analyseswereperformedtoob-
andvalidatedsurveytool(7),wasusedtoensuredatapro-
-
tectionandsecurity.
tivestatistics(frequencyandpercentage)weremeasured
tosummarizetheparticipants’
studyfocusedonSaudimammographers,comparisonbe-
Tomeetthestudyobjectives,a15-itemquestionnaire
tweenSaudiandnon-Saudimammographerswascarried
wasdevelopedbasedonpreviouslypublishedstudies(5-
outforeachitem;theresultsarepresentedintablesand
9).-
,theinternalvalidity,internalconsis-
tion1wasrelatedtothedemographicandprofessional
tency,andconstructvalidityoftheLikert-scaleitemswere
information(8questions),includingnationality,typeof
-
work,age,levelofeducation,experienceinmammogra-
sides,thecorrelationofselectedvariableswiththeimage
phy,numberofmammogramsperweek,andtypeofwork-
evaluationtoolsandACRimagequalityassessmentscales
place(.,private,public,orbreastscreeningcenter).Sec-
’salphacoefficientwasalso
tion2,whichwasrelatedtotheradiographers’practice,
measuredtodeterminethereliabilityofthescales,aswell
asthequestionnaire.
ACRcriteriausedforevaluatingthepositioningqualityof
mammograms,whiletheotherquestionwasrelatedtothe
individual’
systemsortools,includingthePerfect,Good,Moderate,In-
adequate(PGMI),Excellent,Acceptable,Repeat(EAR),Euro-
peanGuidelinesonQualityCriteriaforDiagnosticRadio-
Anumberoftestswereperformedtoensuretheva-
graphicImages(EUROPEAN),andACRtools.
Section3consistedoftwomultiple-choicequestions.
examinedbasedontwomeasures,thatis,internalconsis-
Oneofthequestionswasrelatedtoreasonsforrepeat
tencyandconstructvalidity.
mammographyindailypractice(8items),andtheother
onewasrelatedtothechallengesofmammographersdur-
ingdailypractice(13items).Section4wasrelatedtocon-
-Internalvaliditywastheprimarystatisticalmeasure
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AlbeshanSetal.
determinedbymeasuringthecorrelationcoefficientbe-’KnowledgeofImageQualityAssessment
presentstheinternalconsistencyofthequestionnairesec-
Theparticipants’knowledgeofimagequalityassess-
tionswithaspecificscaleforratingresponses.
Forquestion9,
tools,theACRmanualwasthemostfamiliartoolforboth
item,exceptitem7,whichstatedthat“theposteriornipple
Saudiandnon-Saudiparticipants(52%).
line(PNL)onthecraniocaudal(CC)viewmeasureswithin1
TheSaudiparticipantswerenotfamiliarwiththeEAR,
cmofthesamemeasurementonthemediolateraloblique
PGMI,andEUROPEANtoolsascomparedtonon-Saudipar-
(MLO)view”.Therefore,thecorrelationcoefficientsofthe
-itemrelia-
majorityofitemsweresignificantatP≤
bility(Cronbach’salpha,).Intermsofconstructva-
statedthatthissectionwasvalidformeasuringwhatitwas
lidity,thecorrelationcoefficientforquestion10wasr=
intendedtomeasureforachievingthemaingoalofthis
(P<).Theresultsshowedapositivecorrelation
study(exceptitem7).Forquestion10,thePvaluewasless
betweentheknowledgeofimageevaluationassessment
;therefore,thecorrelationcoeffi-
tools(EAR,PGMI,EUROPEAN,andACR)andagegroup,ex-
cientsweresignificant(P≤).Itcanbeconcludedthat
perienceinmammography,andnumberofpatientsper
thissectionwasvalidformeasuringwhatitwassupposed
week(Table3).
tomeasureforachievingthemaingoalofthisstudy.
Theparticipantswerethenaskedtoratetheitemsused
toassesspositioningbasedontheACR(Figure2).Based
ontheresults,themostfrequentlyuseditemwasposte-
Thesecondstatisticalmeasureusedtoexaminetheva-riorbreasttissuevisualizationonbothCCandMLOviews
-(Saudi,n=-Saudi,n=25),followedbythepec-
sureevaluateswhetheratoolreflectstheintendedcon-toralmusclevolumeontheMLOview(Saudi,n=-
structandiscentraltoestablishingtheoverallvalidityofaSaudi,n=24)andnippleinprofile(Saudi,n=-
,thecorrelationcoefficientswereSaudi,n=21).Ontheotherhand,otherbodypartspro-
significantatr=(P≤)andr=(P≤),jectedoverthebreast(Saudi,n=-Saudi,n=13),
,forQ10,thecorrelationcoefficientmotionartifacts(Saudi,n=-Saudi,n=9),andpor-
wasnotsignificant(r=,P=).tionofbreasttissuecutoffontheimage(Saudi,n=14vs.
non-Saudi,n=6)wereneverusedbytheparticipantstoas-
.
Generally,thereliabilityofaninstrumentisthede-TheACRitemsshowedgoodinter-itemreliability
greeofconsistencywithwhichitmeasuresanattributeit(Cronbach’salpha,).Intermsofconstructvalidity,
(r=,P
producesinrepeatedmeasurementsofanattribute,the=).Regardingthecorrelationswiththeselectedvari-
,reliabilityreferstothesta-ablesinTable3,nosignificantcorrelationwasfoundwith
bility,consistency,.
TheCronbach’
thetotalquestionnaire,