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Objective critique of mammographic image quality (IQ) is vital to assess efficacy of services provided by mammography units. The European Guidelines for Screening Mammography require an inadequate image rate of 3%. The subjectivity within current IQ criteria allows symptomatic mammograms with surgically altered breasts to appear to achieve these requirements; however, as evidenced in the analysis of symptomatic breast images within a national optimisation study, current methods of classification for symptomatic mammograms are largely subjective, resulting in poor inter/intra-departmental agreement on IQ.

Objective critical appraisal of mammography images in clinical audit: can we achieve this?