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Mammography self-evaluation online test for screening readers: an Italian Society of Medical Radiology (SIRM) initiative



To report and analyse the characteristics and performance of the first cohort of Italian radiologists completing the national mammography self-evaluation online test established by the Italian Society of Medical Radiology (SIRM).


A specifically-built dataset of 132 mammograms (24 with screen-detected cancers and 108 negative cases) was preliminarily tested on 48 radiologists to define pass thresholds (62% sensitivity and 86% specificity) and subsequently made available online to SIRM members during a 13-month timeframe between 2018 and 2019. Associations between participants’ characteristics, pass rates, and diagnostic accuracy were then investigated with descriptive statistics and univariate and multivariable regression analyses.


A total of 342 radiologists completed the test, 151/342 (44.2%) with success. All individual variables, except gender, showed a significant correlation with pass rates and diagnostic sensitivity, confirmed by univariate logistic regression, while only involvement in organised screening programs and number of mammograms read per year showed a positive association with specificity at univariate logistic regression. In the multivariable regression analysis, fewer variables remained significant: > 3000 mammograms read per year for success rate; female gender, public practice setting, and higher experience self-judgement for sensitivity; no variables were significantly associated with specificity.


This national self-evaluation test effectively differentiated multiple aspects of mammographic reading experience, but specific breast imaging experience was shown not to strictly guarantee good diagnostic accuracy. Due to its easy use and the validity of obtained results, this test could be extended to all Italian breast radiologists, regardless of their experience, also as a Breast Unit accreditation criterion.

Key Points

This self-evaluation test was found to be able to differentiate various degrees of mammographic interpretation experience.

Breast cancer screening readers should undergo a self-assessment test, since experience parameters alone do not guarantee diagnostic ability.

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Breast Imaging Reporting and Data System


Gruppo Italiano Screening Mammografico – Italian Group for Mammographic Screening


Interquartile range


Osservatorio Nazionale Screening


Region of interest


Società Italiana di Radiologia Medica e Interventistica – Italian Society of Medical Radiology


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We thank SIRM for the scientific and logistical support and all SIRM members participating in the survey.


No funding was received for this study.

Author information



Corresponding author

Correspondence to Beniamino Brancato.

Ethics declarations


The scientific guarantor of this publication is Dr. Beniamino Brancato.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject of the article.

Statistics and biometry

One of the authors, Dr. Calogero Saieva, has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (radiologists sitting the test) in this study.

Ethical approval

Specific Ethics Committee approval was not required for this study, being it an anonymous survey on fully-deidentified images.


• Retrospective

• Diagnostic study

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Brancato, B., Peruzzi, F., Saieva, C. et al. Mammography self-evaluation online test for screening readers: an Italian Society of Medical Radiology (SIRM) initiative. Eur Radiol (2021).

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  • Breast neoplasms
  • Mammography
  • Mass screening
  • Diagnostic self-evaluation