Optimising the diagnostic accuracy of First post-contrAst SubtracTed breast MRI (FAST MRI) through interpretation-training: a multicentre e-learning study, mapping the learning curve of NHS Breast Screening Programme (NHSBSP) mammogram readers using an enriched dataset
Authors: Jones Lyn I. , Marshall Andrea , Geach Rebecca , Elangovan Premkumar , O’Flynn Elizabeth , Timlin Tony , McKeown-Keegan Sadie , Rose Janice , Vinnicombe Sarah , Taylor-Phillips Sian , Halling-Brown Mark , Dunn Janet A. ,   the FAST MRI Study Group, Alison Clare , Atkinson Karen , Barta Miklos , Beckett Gemini , Betancourt Claudia , Bramwell Julie , Brown Holly , Burt Helen , Cann Louise , Carter Nick , Cartledge Claire , Ceney Jane , Clark Gillian , Cornford Eleanor , Cullimore Elizabeth , Curtis Siân , Dalgliesh Diana , Delve Jonathon , Doyle Sarah , Duncan Alison , Elbert Holly , Fearn Sarah , Foy Christopher , Friedrich Zsolt , Ghiasvand Hesam , Gifford John , Godden Dagmar , Goldthorpe Zoe , Gomes Sandra , Goud Narayan Aradhana , Gray Rosie , Harding Sam A. , Henning Kristin , Hobson Lucinda , Hulme Claire , Hynam Paula , Imane El Sanharawi , Jackson Emma , Jaffa Asif , Jhalla Ragini , Jenkin Margaret , Jones Thomas William , Kamangari Nahid , Kaur Vandana , Kingsnorth Beckie , Klimczak Katherine , Kutt Elisabeth , Litton Karen , Lloyd Simon , Lyburn Iain , Mahatma Anjum , Mankelow Anna , Massey Helen , Matthews Helen , McFeely Karis , McLachlan Clare , McWilliams Sarah , Mohammadi Shahrooz , Moody Alice , Muscat Elizabeth , Muthyala Sreenivas , Perrin Sarah , Peters Alison , Pocklington Alice , Preston Elizabeth , Rai Jasvinder , Robson Jo , Salter Corri , Scanlon Toni , Shrestha Anuma , Sidebottom Richard , Sinclair Mary , Singamaneni Sravya , Steel Jim , Stephenson Lesley , Stewart-Maggs Sam , Stubbs Cheryl , Taylor Michelle , Taylor Victoria , Taylor-Fry Olivia , Toth Erika , Trumble Matthew , Valencia Alexandra , Vincent Frances , Wang Anna , Warren Lucy , Watkin Sharon , Widdison Sue , Williams Jennifer , Wookey Jennifer 
Published: May 2024

Abstract
Background
Abbreviated breast MRI (FAST MRI) is being introduced into clinical practice to screen women with mammographically dense breasts or with a personal history of breast cancer. This study aimed to optimise diagnostic accuracy through the adaptation of interpretation-training.

Methods
A FAST MRI interpretation-training programme (short presentations and guided hands-on workstation teaching) was adapted to provide additional training during the assessment task (interpretation of an enriched dataset of 125 FAST MRI scans) by giving readers feedback about the true outcome of each scan immediately after each scan was interpreted (formative assessment). Reader interaction with the FAST MRI scans used developed software (RiViewer) that recorded reader opinions and reading times for each scan. The training programme was additionally adapted for remote e-learning delivery.

Study design
Prospective, blinded interpretation of an enriched dataset by multiple readers.

Results
43 mammogram readers completed the training, 22 who interpreted breast MRI in their clinical role (Group 1) and 21 who did not (Group 2).
Overall sensitivity was 83% (95%CI 81–84%; 1994/2408), specificity 94% (95%CI 93–94%; 7806/8338), readers’ agreement with the true outcome kappa = 0.75 (95%CI 0.74–0.77) and diagnostic odds ratio = 70.67 (95%CI 61.59–81.09). Group 1 readers showed similar sensitivity (84%) to Group 2 (82% p = 0.14), but slightly higher specificity (94% v. 93%, p = 0.001). Concordance with the ground truth increased significantly with the number of FAST MRI scans read through the formative assessment task (p = 0.002) but by differing amounts depending on whether or not a reader had previously attended FAST MRI training (interaction p = 0.02). Concordance with the ground truth was significantly associated with reading batch size (p = 0.02), tending to worsen when more than 50 scans were read per batch. Group 1 took a median of 56 seconds (range 8–47,466) to interpret each FAST MRI scan compared with 78 (14–22,830, p < 0.0001) for Group 2.

Conclusions
Provision of immediate feedback to mammogram readers during the assessment test set reading task increased specificity for FAST MRI interpretation and achieved high diagnostic accuracy. Optimal reading-batch size for FAST MRI was 50 reads per batch.
Trial registration (25/09/2019): ISRCTN16624917.