National Mammography Database Margarita Zuley, MD Associate Professor of Radiology University of Pittsburgh Medical Director Breast Imaging Magee Womens Hosp of UPMC

Credit and thanks to Mythreyi Bhargavan Chatfield, PhD Director, Data Registries for sample report slides

NMD American College of Radiology (ACR) Initiative Part of the NRDR ( National Radiology Data Registry) Collects MQSA required data Provides comparative information back to participating sites every 6 months Allows sites to do national and regional benchmarking

nrdr.acr.org

What is NRDR? Information system Provides objective measures of practice processes and outcomes Designed by radiologists Includes National Oncologic PET Registry (NOPR) CT Colonography Registry General Radiology Improvement Database (GRID) IV Contrast Extravasation Registry (ICE) National Mammography Database Registry Quality Improvement Registry for CT scans in Children (QuIRCC) Dose Index Registry

Benchmark Data National benchmark data provided by Breast Cancer Surveillance Consortium (BCSC) are used for comparisons with facility data in the semi-annual reports provided to NMD participants Also uses NMD results of all participating facilities as benchmarks Facilities receive facility level and provider level data

Benefits ABR has qualified the NMD for practice quality improvement (PQI) for ABR Maintenance of Certification (MOC) Program 3 PQI projects are required every 10 years for all radiologists who have not been given a lifetime certificate by the ABR

Joining Any radiology facility can participate A participation agreement and a business associate’s agreement between ACR and the facility must be signed first

Upload from facility to NMD Obtained through input of data elements into facility RIS/ HIS The RIS/HIS vendor must support the NMD platform (HL-7) fields Vendor software must be approved by NMD Facility requests upgrade to NMD version Assign one person to upload data Upload is one click

NMD-Certified Software Partners                                                                                                                                                                                             10 10

Data Security PHI, NPI is uploaded Encryption of all incoming traffic to NRDR Firewalls to secure data Has third party safety monitoring Data on individual patients stay property of facility Aggregate, anonomyzed data from registry are property of ACR

Data Elements Patient Identifiers Race, ethnicity Gender Patient name, SSN, facility MRN, zip code Race, ethnicity Gender LMP, height, weight Family and personal h/o breast cancer Biopsy and surgical history

Data Elements Mmg date Radiologist NPI number Reason for exam Clinical symptoms Prior mmg date, was it compared at read Breast density

Data Elements BI-RADS category (7 point) Recommendations Mmg only Combined assessment Recommendations Classification of most significant finding S/F or digital Use of CAD or double read

Data Elements Biopsy results Modality used Biopsy result ( benign, HR, malignant) If cancer Type ( invasive or DCIS) Size Nodal status Stage at diagnosis

Goals PPV1 5-10% PPV2 25-40% Tumors found- stage 0 or 1 >50% Tumors found- minimal >30% (1cm or less invasive or DCIS) Node positive rate <25% From Linver et al AJR;1995;165:19-25

Goals CDR (Ca/1000) 2-10 Recall rate 10% or less Sensitivity >85% Prevalent 6-10 Incident 2-4 Recall rate 10% or less Sensitivity >85% Specificity >90% From Linver et al AJR;1995;165:19-25

SAMPLE FACILITY REPORT 18 18

Data Presented Initial upload can be last 6 months or year Can elect to upload prior data if you like Initial older data can be incomplete First report back will only give data results that you upload Will get 2 reports going forward, data with at least 1 year follow up and preliminary data that does not yet have 1 year follow up

SAMPLE PHYSICIAN REPORT 32 32

Summary NMD will help with MQSA audit NMD will help with required PQI NMD provides a feedback mechanism for radiologists and facilities to see if their practice can be improved