Focus on early detection


Early detection is key in the treatment of breast cancer. Therefore, in The Netherlands, the national screening organization performs the breast cancer screening programme. The target group consists of 2,2 million women aged 50 to 70. Each year, half of them are invited (1,1 million women). From this target group, about 80% participates in the programme.

How does this work? A radiographer takes a mammogram of each participant. This is done in a screening unit (SU). Next, two screening radiologists (first and second reader) assess each mammogram independently from each other in a reading unit (RU). Each mammogram consists of four photos, two of each breast, one from above and one from the side. A reading unit (RU) assesses the mammograms of multiple screening units.

Triennial audits
To ensure we can continuously improve the quality of early diagnosis, prevention, and treatment, the LRCB audits each organizational unit once every three years. Using documents and mammographic images, an external independent audit team gets a picture of the quality of the professionals and the equipment of an organizational unit, and provides feedback and recommendations for improvement. The learning effect of the audit is paramount in this respect. The audit protocol (Dutch only) describes the entire process, the parties involved, the scope of the audit, and how it should be established that an item is OK or not. An audit consists of several parts. The screening organization and the coordinating radiologist fill out a questionnaire, which provides the audit team, among other things, with information on quality indicators such as the recall and detection rates. In addition, the radiological reviews are also very important.

Prior to the audit day, the positioning technique of the radiographers of the organizational unit is assessed. Four half a day’s productions per SU are assessed according to the appendix Quality criteria positioning technique mammography (Dutch only), of the Quality document screening radiographers. For a full mammogram this results in four scores. During the audit day the expert radiographer discusses the results with the manager(s) of the radiographers. The equipment audit looks back upon the biannual quality tests and the weekly quality control of the past three years. This results in an overview of the most important findings: a summary of the test results. In addition, the audit assesses how the screening organization has handled recommendations. Have they been implemented or not? The equipment audit also assesses the image quality of the mammograms.

Each screening radiologist must be listed in the Quality Register. The audit team gets a picture of the quality of the screening radiologists at group level, not at an individual level. Each screening radiographer must be listed in the Quality Register. Also in this case, audit is at group level.

Equipment check
The screening units of the breast cancer screening programme are only allowed to purchase equipment with an LRCB type approval. The physics group of the LRCB performs an acceptance test prior to first use. This is done according to a measurement protocol (Dutch only), describing all quality measurements. After that, a test is performed every six months, based on the same measurement protocol, to check if the equipment still delivers sufficient quality. The LRCB describes the result of each test in a report. If there are problems or abnormalities, the LRCB recommends possible improvements to the organizational unit. In addition a weekly stability check is done, which also checks system calibration for systems involving user performed calibration. To this end, radiographers of a screening unit take quality images of a standard phantom before and after calibration. They send these every week to the physics group of the LRCB for assessment. If there are instabilities or changes, the LRCB will advise on improvements. This advice can by light (just a recommendation), but also more serious, up to the advice that screening has to be stopped. Furthermore, at any time radiographers can send anonymous mammograms to the LRCB, for advice on visual artefacts.

Audits on request
The audit team of the LRCB can also perform a medical audit on request, for screening programmes abroad. You can also call in the physics group for equipment check support at your screening units or hospital. The LRCB can also provide support on consultancy questions regarding radiation hygienics. For example, to perform a risc analysis for a new system or for building a new room. For there an other questions we are happy to help.

Questions or more info?

For questions or more information on audits, equipment checks or audits on request, please feel free to contact us by using our general contact form.