Award Number : W 81 XWH - 11 - 1 - 0755 TITLE : Adaptive Computer - Assisted Mammography Training for Improved Breast Cancer Screening PRINCIPAL

250 words) Rationale and Objectives The purpose of this study is to better understand the concept of mammography difficulty and how it affects radiology resident performance. Materials and Methods Seven radiology residents and three expert breast imagers reviewed 100 mammograms, consisting of bilateral medial lateral oblique and craniocaudal views, using a research workstation. The cases consisted of normal, benign, and malignant findings. Participants identified abnormalities and scored the difficulty and malignant potential for each case. Resident performance (sensitivity, specificity, and area under the receiver operating characteristic curve [AUC]) was calculated for selfand expert-assessed high and low difficulty. Results For cases classified by self-assessed difficulty, the resident AUC was 0.667 for high difficulty and 0.771 for low difficulty cases (p=0.010). Resident sensitivity was 0.707 for high and 0.614 for low difficulty cases (p=0.113). Resident specificity was 0.583 for high and 0.905 for low difficulty cases (p<0.001). For cases classified by expert-assessed difficulty, the resident AUC was 0.583 for high and 0.783 for low difficulty cases (p=0.001). Resident sensitivity was 0.558 for high and 0.796 for low difficulty cases (p<0.001). Resident specificity was 0.714 for high and 0.740 for low difficulty cases (p=0.807). Conclusion Increased selfand expert-assessed difficulty is associated with a decrease in resident performance in mammography. However, the etiology is due to a decrease in specificity for selfassessed difficulty but a decrease in sensitivity for expert-assessed difficulty. These trends suggest that educators should provide a mix of selfand expert-assessed difficult cases in educational materials to maximize the effect of training on resident performance and confidence.