Reading High Breast Density Mammograms: Differences in Diagnostic Performance between Radiologists from Hong Kong SAR/Guangdong Province in China and Australia

Document Type : Research Articles


1 Breastscreen REader Assessment Strategy (BREAST), Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

2 Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

3 Department of Diagnostic Radiology, Faculty of Medicine, The University of Hong Kong, Hong Kong, China.

4 Department of Medical Imaging, The University of Hong Kong-Shenzhen Hospital, Hong Kong, China.


Background: Variations in the performance of radiologists reading mammographic images are well reported, but key parameters explaining such variations in different countries are not fully explored. The main aim of this study is to investigate performances of Chinese (Hong Kong SAR and Guangdong Province) and Australian radiologists in interpreting dense breast mammographic images. Methods: A test set, contained 60 mammographic examinations with high breast density, was used to assess radiologists’ performance. Twelve Chinese and thirteen Australian radiologists read all the cases independently and were asked to identify all lesions and provide a grade from 1 to 5 to each lesion. Case sensitivity, specificity, lesion sensitivity, AUC and JAFROC were used to assess radiologists’ performances. Demographic information and reading experience were also collected from the readers. Performance scores were compared between the two populations and the relationships between performance scores and their reading experience were discovered. Results: For radiologists who were less than 40-year-old, lesion sensitivity, AUC and JAFROC were significantly lower in Chinese radiologists than those in Australian (52.10% vs 71.45%, p=0.043; 0.76 vs 0.84, p=0.031; 0.59 vs 0.72, p=0.045; respectively). Australian radiologists with less than 10 years of reading experience had higher AUC and JAFROC scores compared with their Chinese counterparts (0.83 vs 0.76, p=0.039; 0.70 vs 0.56, p=0.020, respectively). Conclusions: We found that younger Australian radiologists performed better at reading dense breast cases which is likely to be linked to intensive fellowship training, immersion in a screening program and exposure to the benefits of a performance-measuring education tool.


Main Subjects

Volume 21, Issue 9
September 2020
Pages 2623-2629
  • Receive Date: 10 February 2020
  • Revise Date: 21 July 2020
  • Accept Date: 07 September 2020
  • First Publish Date: 07 September 2020