How should screening breast US be audited? The patient perspective

The practice guideline for breast US (33) includes orthogonal views, and, although not specific to screening, these are required in the clinical images of cysts and solid masses submitted for breast US accreditation by the American College of Radiology (34). Mammography's technical recalls reflect bad positioning or ill-chosen exposures, and the recall of patients for repeat views is not counted as audit positive. In MR imaging, if the patient moves or if the bolus of contrast material extravasates, the patient's examination is listed among technical errors; similarly, if orthogonal US views of a mass (other than a simple cyst) are not supplied or imaging parameters are not appropriate (1), the technical standard has not been met and the examination should be classified among the substandard studies, rather than as positive in an audit. We wholeheartedly support an approach to auditing screening US that is consistent, is validated, and allows comparison to established benchmarks and to other breast imaging modalities. We object to the single-view approach, as screening US documentation would be on par with neither other examinations nor with the literature to date. Importantly, we believe that the only validated approach for documenting handheld screening US includes orthogonal views that include the longest axis of the lesion and its perpendicular, with and without calipers, for findings other than simple cysts. Such orthogonal views improve both the detection and interpretation of breast US findings. A screening US examination performed by a technologist should only be considered audit positive when, after review of appropriate initial orthogonal static images, the patient is required to undergo further testing before the next screening examination.