The majority of mammography units of Croatian hospitals and private clinics that participate in the country's nationwide breast cancer screening program do not conduct regular quality assurance programs.
Furthermore, serious deficiencies are occurring that could compromise breast cancer detection, according to Dr. Zoran Brnic, a radiologist at the University Hospital Merkur in Zagreb, and colleagues.
Results of a quality assessment of a sample of five sets of mammography exam films submitted by 84 of the country's mammography units revealed many deficiencies that reflected very different levels of competency both of radiographers and radiologists, noted an in-press report published online on 27 June in the European Journal of Radiology. The 84 participants represented almost half of Croatia's mammography facilities, and included eight university hospitals, 12 general county hospitals, 31 public healthcare centers, and 25 private clinics.
The mammography units were asked to select the best representative screening mammogram for five consecutive days to submit for assessment by an experienced mammographer and a technologist trained to perform quality assurance and quality control assessments. The image quality categories evaluated included proper identification of the patient and the examination, breast positioning and compression, exposure and contrast, and artifacts.
The scoring system was based on American College of Radiology (ACR) and European Commission proposals. The average score for the 84 mammography units was 13.5 out of a possible 25 point score. University hospitals had the highest scores (16.1 average) and private clinics the lowest scores (12.8 average).
University hospitals were significantly better than all other mammography units in overall quality, attributed by the authors to employing better breast positioning practices. Private clinics showed the worst results in identification, exposure, contrast and artifacts.
The authors stated that the evaluation was the first step in establishing a quality control program for Croatia's nationwide breast cancer screening program.
