Medicalauditofscreeningmammography–performingand.pptVIP

陳勁宇 醫師 Chin-Yu Chen, M.D., M.S. 奇美醫學中心 影像醫學部 Department of Radiology, Chi-Mei Medical Center Follow-up and outcome monitoring of a test, i.e., mammography. - 資料監測 ? Provide quantifiable evidence of the test (mammography) performance Definition and standard: ACR BI-RADS? 4th ed. (2003) section III. ACR: American College of Radiology BI-RADS: Breast Imaging Reporting and Data System A concrete feedback for radiologists in mammography interpretation – 判讀成效之具體回饋 ? Government regulation – 乳房攝影品管的要求 ? MQSA (Mammography Quality Standard Act) in U.S.A. (1992) Mammography quality assurance program by DOH (Department of Health) in Taiwan 明確區分乳房攝影之檢查屬性: screening or diagnostic 依照ACR BI-RADS? 之診斷分類 (assessment category) 完成報告 原始資料 (raw data) 之收集 衍生性資料 (derived data) 之計算 - 陳勁宇等, 使用Microsoft? Office 開發乳房攝之BI-RADS? 資料監測系統, 中華放射醫學雜誌, 2005; 30: 341-346 FP – false positive PPV – positive predictive value Cancer detection rate Percentage of minimal cancers Recall rate FP1 = initially screening category 0,4,5 - TP 數量最大, 包含原始篩檢結果異常之所有個案 FP2 = biopsied benign + non-biopsied cases = screening final category 4,5 – TP 數量較小, 包含所有篩檢之最終結果為 BR4 or 5者 FP3 = biopsied benign cases 數量最小, 只包含所有已知做 biopsy 的個案 PPV1 = TP / (TP + FP1) 數值最小, 分母包含原始篩檢結果異常之所有個案 PPV2 = TP / (TP + FP2) 數值較大, 分母包含所有篩檢之最終結果為 4or5者 PPV3 = TP / (TP + FP3) 數值更大, 分母只包含所有已知做 biopsy 的個案 若所有最終結果為 BR4 or 5 者皆完成 biopsy, 則 PPV2 = PPV3 白種人 非洲裔 亞洲裔 西班牙裔 Reference: Chen CY, et al. Adjusting mammography-audit recommendations in lower-incidence Taiwanese population. - JACR 5(9): 978-985, Sep. 2008. Data in ? ? ? Information out Garbage in ? ? ? Garbage out 陳勁宇 醫師 Chin-Yu Chen, M.D., M.S. 奇美醫學中心 影像醫學部 Department of Radiology, Chi-Mei Medical Center * * Sheet3 Sheet2 Sheet1 Chart1 Rank Number Breast Cancer Incidence in Taiwan from Department of Health, Taiwan Taiwan 15-19 20-24 25-29 30-34 35-59 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age-Specific Breast Cancer