Image quality assessment in mammography of women with cardiac implantable electronic devices: An insight into radiographers' experiences in Australia

INTRODUCTION: To report radiographers' experiences of the impact of cardiac implantable electronic devices (CIEDs) on mammographic image quality and assessment; to identify differences between the screening and diagnostic settings. METHOD: A survey was conducted to investigate Australian radiographers' experiences of assessing image quality during mammograms of women with a CIED. Closed Likert scale responses of 'never', 'sometimes', 'often' or 'always' were analysed descriptively using percentages. A Pearson's chi-squared test, with a significance level of p < 0.05, was used to determine differences between screening and diagnostic mammography settings. Associated open-ended comments were analysed thematically. RESULTS: Most respondents reported that they 'sometimes' or 'often' experienced increased difficulty in meeting mammographic image quality criteria (82.7%); performed suboptimal mammograms according to image criteria (84.3%) and changed their approach to image quality assessment (71.1%). Repeat exposure of suboptimal images was undertaken only some of the time (53.6%). A statistically significant difference was reported between settings for changing approach to image quality assessment in women with a CIED (p= 0.048). Screening radiographers were significantly more reliant on automatic exposure control (AEC) compared to the diagnostic setting (p< 0.001). CONCLUSION: The results highlight the challenges radiographers face in imaging women with CIEDs, both in attaining high-quality mammograms and assessing the resultant image quality. Of concern, the difficulty in meeting image evaluation systems (IES) criteria can change the way radiographers approach image quality assessment, which may lead to repeat or additional views and increased patient radiation exposure. IMPLICATIONS FOR PRACTICE: Radiographers need to be aware that the presence of a CIED will impact image quality and that variability in approaches to image quality assessment is a known outcome of assessment not being successfully applied.