1. The Procedures Manual shall contain:
    • clearly assigned responsibilities and procedures for quality assurance/quality control testing
    • procedures for proper use and maintenance of equipment, including the appropriate image receptors and kVp-target-filter combinations for mammography
    • mammographic techniques to be used, including pertinent information on positioning, compression, exposure techniques, image quality and average glandular doses with those techniques
    • precautions to protect the operator of the equipment, the patient, and individuals in surrounding areas from unnecessary radiation exposure
    • policies and employee responsibilities concerning personnel radiation monitoring
    • proper maintenance of records, including records of all quality control testing, equipment service and maintenance, and quality assurance meetings.
  2. There shall be a system in place for reviewing outcome data from mammography, including follow-up re the disposition of abnormal mammograms, and correlation of surgical biopsy results with mammogram reports5,16,17,19,26,27.
  3. Prior mammograms should be available for comparison when practical17.
  4. The following quality assurance mechanisms shall be in place:
    • double-readings of at least 5%15 of screening mammograms;
    • individual monitoring and feedback to radiologists consisting of: (a) referral rates, (b) outcomes of assessments, including rate of cancers detected per 1000 women screened at prevalence and incidence rounds, rate of small cancers (≤15mm) detected, and (c) rate of interval cancers15-17,29; and
    • inservice education programs and access to professional development workshops related to mammography15,16,19,21,30 (e.g., Level I, II and III Tabar courses in mammography) .

    Other possible strategies include:

    • monthly site reviews/rounds that include the radiologists and technologists to discuss new breast cancer cases detected, interval cancers, cases where opinions differed on double-reads, etc. 15,16;
    • annual multidisciplinary rounds where the radiologists, surgeons, pathologists and family physicians meet to review assessment findings15,16;
    • submission of a portion of mammograms for review by external radiologists16,30; and
    • Review of Breast Cancer Screening statistics.

Note: A list of references used in the development of this document is attached as Appendix A. Within the document, each reference is identified by a number which refers to the appropriate listed source.