‘Thinking aloud’ about mammographic image quality: Radiographers’ cognitive processes for evaluating the craniocaudal view.

Abstract

Objective: To provide insight into radiographers cognitive processes1 during the task of evaluating craniocaudal CC views for positioning image quality. Provision of new knowledge is expected to contribute to more consistent application of image quality criteria2 with the possibility of a reduction in missed breast cancers.3 Methods: A ‘think aloud’ study was developed to provide verbal reports as data.4 Radiographers working in mammography from Australia and New Zealand attended individual face-to-face sessions (n = 17). The participants’ mammographic practice included diagnostic, private screening and/or population-based breast screening. During the first stage of the session, the participant reviewed a set of mammograms and verbalised their image quality decisions (‘concurrent verbalisation’). During the second stage, explanation of the evaluation and thought processes was explored (‘retrospective verbalisation’). Both stages were audio-recorded for encoding and protocol analysis.4 Result: Preliminary findings suggest that radiographers’ image evaluation is related to the woman’s body habitus and ability to undergo mammography. Decisions to repeat imaging are linked to radiation dose considerations. Discussion and Conclusion: With the advent of digital mammography, image quality decision making often occurs with the woman present within the mammographic room, creating changes from previous methods of assessment. ‘Think aloud’ is a useful methodology to evaluate clinical decisions through rich qualitative analysis. References 1. Ericsson KA, Credo R. The Cambridge handbook of expertise and expert performance. Cambridge; New York: Cambridge University Press 2006. 2. Sweeney R-JI, Lewis SJ, Hogg P, McEntee MF. A review of mam- mographic positioning image quality criteria for the craniocaudal projection. British Journal of Radiology 2018;91(1082):20170611. 3. Wadhwa A, Sullivan JR, Gonyo MB. Missed breast cancer: what can we learn? Current Problems in Diagnostic Radiology 2016;45 (6):402-19. 4. Ericsson KA, Simon HA. Protocol analysis: verbal reports as data. Rev. ed. Cambridge, Mass.: MIT Press 1993.