Improving ACRs: Peer review and mentorship

icon peer review and mentorshipPeer review and mentorship bring radiologists together to review screens and give each other feedback on their performance. They help radiologists identify strengths, challenges and areas for improvement that can then be addressed through formal and informal education.

What peer review and mentorship look like in practice

Peer review and mentorship are used around the world to reduce abnormal call rates (ACRs). In one Australian program, radiologists are audited by peers every four years and given a ranking from 1 to 4. At Level 1, radiologists are considered clinical “champions” and act as mentors to help others improve their performance.

Most parts of Canada have some form of peer review, though there is no single standard model across the country. In one jurisdiction, radiologists and mammogram technologists jointly review all cancer cases every three months. In another, practitioners hold monthly quality assurance meetings. Some organizations use multiple strategies, such as reviewing 15 positive cases every quarter and providing recall lists and feedback to all radiologists.

How to put this approach into action

Following these steps will help breast cancer screening programs implement peer review and mentorship:

  1. Bring screening and diagnostic staff together on a monthly, quarterly or annual basis to review all recall cases.
  2. Focus the reviews specifically on false positive cases.
  3. Adjust the frequency of reviews based on performance: if performance is good, meet annually. If ACRs get too high, meet quarterly or monthly.

What is needed to succeed

  • A pan-Canadian group to champion the initiative
  • Collaborative and non-threatening environments
  • Group discussions
  • Anonymity in case reviews as much as possible
  • A medical advisory committee and chief screener at each site
  • Involvement of all technologists, screening and diagnostic staff

Challenges to overcome

  • Groupthink
  • Time and resources to plan, organize and attend meetings

More approaches on improving abnormal call rates in breast cancer screening with mammography

Learn more about education, standardized report cards, minimum reading volumes, batch reading and double reading.