Introduction

The overall performance of a breast screening program can be assessed by using various measures such as the standardized detection ratio (SDR). By this means the National Health Service Breast Screening Program (NHSBSP) is shown annually to be performing consistently well. Ultimately the performance of such a national program, a health region, or indeed each breast screening center depends on the skills of the individual radiologists or advanced practitioner radiographers in examining and reporting screening cases appropriately. Maintaining high levels of individual performance is difficult in any visual inspection task and this is particularly so in screening where the incidence of abnormality is very low. Consequently, breast screening is possibly the most difficult of radiological investigations to report accurately, and it is important to be able to both measure individual performance and understand the underlying factors that can affect this so as to enable someone to undertake further appropriate training to improve their performance if necessary.

In this chapter the background to understanding radiological performance is introduced, which leads on to the description of performance in breast screening. A self-assessment scheme is detailed, which gives insight into underlying aspects of performance. Finally what constitutes expert performance is considered and the roles of experience and volume of screening cases read per year are emphasized.

Radiological performance

It is impossible to perform perfectly in any visual inspection task and some mistakes will inevitably occur. The key issue is to reduce the potential for such errors to the minimum.