Elmore JG, Aiello Bowles EJ, Geller B, Oster NV, Carney PA, Miglioretti DL, Buist DSM, Kerlikowske K, Sickles EA, Onega T, Rosenberg RD, Yankaskas BC. 2010 June; 17(6): 752–760. doi: 10.1016/j.acra.2010.02.010.


The US Mammography Quality Standards Act mandates medical audits to track breast cancer outcomes data associated with interpretive performance. The objectives of our study were to assess the content and style of audits and examine use of, attitudes toward, and perceptions of the value that radiologists’ have regarding mandated medical audits.

Radiologists (n = 364) at mammography registries in seven US states contributing data to the Breast Cancer Surveillance Consortium (BCSC) were invited to participate. We examined radiologists’ demographic characteristics, clinical experience, use, attitudes, and perceived value of audit reports from results of a self-administered survey. Information on the content and style of BCSC audits provided to radiologists and facilities was obtained from site investigators. Radiologists’ characteristics were analyzed according to whether or not they self-reported receiving regular mammography audit reports. Latent class analysis was used to classify radiologists’ individual perceptions of audit reports into overall probabilities of having “favorable,” “less favorable,” “neutral,” or “unfavorable” attitudes toward audit reports.

Seventy-one percent (257 of 364) of radiologists completed the survey; two radiologists did not complete the audit survey question, leaving 255 for the final study cohort. Most survey respondents received regular audits (91%), paid close attention to their audit numbers (83%), found the reports valuable (87%), and felt that audit reports prompted them to improve interpretative performance (75%). Variability was noted in the style, target audience, and frequency of reports provided by the BCSC registries. One in four radiologists reported that if Congress mandates more intensive auditing requirements, but does not provide funding to support this regulation they may stop interpreting mammograms.

Radiologists working in breast imaging generally had favorable opinions of audit reports, which were mandated by Congress; however, almost 1 in 10 radiologists reported that they did not receive audits.