The reliability of PGMI can be further improved by peer review. Practitioners should be aware of their own proficiency but also how they compare to those of their peer group. Implementation of an organised peer review system with structured feedback and records should aim to maintain high standards and disseminate good practice within the department [7]. If underperformance is identified an action plan should be agreed. This may include additional training and a review of working practice to ensure practitioners maintain the necessary expertise to reach the standard required, thus providing a service acceptable to the general public.

Peer review also takes place during a formal visit to the unit by the regional QA Radiographer during a QA visit within the U.K. screening service. During this visit the standard of mammography will be assessed using a Mammographic Image Assessment form (Fig. 35.2). The aim of the QA visit is to confirm that the radiographic quality of the unit conforms to expected standards and to identify areas of underperformance. Recommendations will be made where improvement is required.

Each practitioner should review and reflect on their clinical practice as part of regular personal performance monitoring and continuous professional development (CPD). Regular review of professional performance is essential and each practitioner should receive feedback on their performance. Breast Screening Programmes are responsible for recording, collecting and monitoring repeat examination data. All practitioners have a responsibility to regularly audit their number of repeat examinations against local protocols and national standards.

The NHSBSP guidance on collecting, monitoring and reporting repeat examinations, Publication No. 4, version 2 [8], gives very clear guidance on the collecting of data and this guidance should be used when monitoring performance of the mammographic team and equipment.

Training needs can be identified from monitoring performance using the information from PGMI and TP, TC records. If underperformance is identified an action plan should be agreed. This may include additional training and a review of working practice to ensure practitioners maintain the necessary expertise to reach the standard required, thus providing a service acceptable to the general public.

To support the individuals audit their clinical practice, the radiography manager should regularly collect data from all repeat examinations (TR = TP + TC). The information collected should be:

This data should be monitored locally and the outcome of the audit should be available for feedback to the practitioners.

If a problem is identified a clear action plan, with time scales should be agreed.

All professional staff have a duty to continuously develop and improve themselves as a professional. CPD includes work based learning, professional activities and formal, educational learning. Evidence of CPD should be promoted and meet the learning requirements of the practitioner and should have at its focus the delivery of a high quality mammography service.

Figures 35.3, 35.4, 35.5, 35.6, 35.7, 35.8, 35.9, 35.10, 35.11, 35.12, 35.13, 35.14, 35.15 and 35.16, demonstrate examples of Perfect, Good, Moderate and Inadequate images, with and without artefacts.