How experience and training influence mammography expertise

Rationale and Objectives. The authors evaluated the influence of perceptual and cognitive skills in mammography detection and interpretation by testin g three groups representing different levels of mammography expertise in te rms of experience, training, and talent with a mammography screening-diagno stic task. Materials and Methods. One hundred fifty mammograms, composed of unilateral cranial-caudal and mediolateral oblique views, were displayed in pairs on a digital workstation to 19 radiology residents, three experienced mammogra phers, and nine mammography technologists. One-third of the mammograms show ed malignant lesions; two-thirds were malignancy-free. Observers interacted with the display to indicate whether each image contained no malignant les ions or suspicious lesions indicating malignancy. Decision time was measure d as the lesions were localized, classified, and rated for decision confide nce. Results. Compared with performance of experts, alternative free response op erating characteristic performance for residents was significantly lower an d equivalent to that of technologists. Analysis of overall performance show ed that, as level of expertise decreased, false-positive results exerted a greater effect on overall decision accuracy over the time course of image p erception. This defines the decision speed-accuracy relationship that chara cterizes mammography expertise. Conclusion. Differences in resident performance resulted primarily from lac k of perceptual-learning experience during mammography training, which limi ted object recognition skills and made it difficult to determine difference s between malignant lesions, benign lesions, and normal image perturbations . A proposed solution is systematic mentor-guided training that links image perception to feedback about the reasons underlying decision making.