Mammography Quality Management
Mammography Quality Management
As a high school student, Wendy’s guidance counselor encouraged her to explore the field of radiology, a division of healthcare that was beckoning women interested in challenging opportunities. As an x-ray student, she observed the special interaction and skills required by technologists working in the developing discipline of mammography. After graduating in 1976 from Western Wisconsin Technical Institute in LaCrosse, WI, she was given the unique benefit of observing the delivery of this specialized service while working at the world renowned Mayo Clinic in Rochester, MN.
Family brought her closer to home, where she began her 38 years of service at Dean/SSM in Madison, WI. It was at Dean that Wendy was able to fulfill her high school guidance counselor’s prediction of career opportunities in radiology. Wendy began working in mammography in 1979 and successfully passed the first ARRT advanced certification exam offered in mammography in 1991. She held a variety of positions at Dean, including Lead Mammography Technologist, assisting administration in the implementation of a computerized mammography tracking system, and the development of a Core Biopsy program. Eventually, Wendy settled into the role of Quality Compliance Technologist at all Madison locations, standardizing system wide quality control procedures, estimating successful completion of over 50 FDA inspections.
In 1995, her mentor, Tamnit Ansusinha, MD, asked her to provide mammography training in Bangkok, Thailand at the Thanyrak Breast Center, the government’s state of the art breast center developed under his leadership. Wendy returned to Thailand again in 2001 and 2007, when she and Shelly visited as a team. Providing training to new technologists in the field was especially rewarding to Wendy, and in 1996 she was asked to join a team of instructors for a Mammography Initial Qualifications Training course that satisfied the requirements of MQSA. This course would eventually pair Wendy and Shelly together as instructors dedicated to producing quality mammography professionals for the future. Part of this course included the introduction of mammography quality control, Wendy’s area of expertise. Understanding the need for proficiency in radiology quality assurance motivated Wendy to take and pass the ARRT advanced certification test in Quality Management (QM).
Wendy’s QM background lead her to develop the first metric measurement method detailing improvements in the performance of mammography technologists. After a year of combined efforts to enhance and improve Wendy’s original concept, Wendy and Shelly have developed MammoCheck™, a detailed quality improvement methodology for technologists in the performance of mammography.
Shelly is a mammography technologist, an educator, lecturer, and author. Her husband affectionately nicknamed her “Janey Appleseed” because she has visited thousands of mammography facilities and worked with thousands of mammography technologists.
Shelly graduated from the State University of New York at Cortland with a degree in education. Little did she know she would eventually use her teaching degree to instruct mammography technologists! Together Wendy and Shelly have trained more mammography technologists than anyone in the world; a statistic they are very proud of.
After graduating from x-ray school, Shelly worked as chief technologist at the world-renowned breast center founded by Wende Logan-Young, M.D., in Rochester, NY. Although recently retired, Dr. Logan-Young continues to be Shelly’s role model. During the 1980s, Dr. Young was influential in disseminating the rapidly developing technique of screen-film mammography. We conducted conferences in Rochester: radiologists were trained in diagnostic interpretation, and technologists practiced positioning and learned the intricacies of film processing. As an extension of these conferences, Shelly began her career-long “Janey Appleseed” travels to facilities to work one-on-one with technologists. In 1991 she was one of three technologists who established the ACR/CDC “Train the Trainers” conference agenda, standardizing the performance of mammography in the U.S.
In the early 1990s, Shelly began lecturing at 40-hour Initial Training courses attended by radiologic technologists entering the field of mammography. It was through these courses that Wendy and Shelly were paired as lecturers because of their complementary teaching styles; eventually this pairing resulted in formation of their company to continue their commitment in mammography education. In addition, since 1991, Shelly has lectured one Saturday each month on various mammography topics. Shelly is co-author of the most widely used textbook for mammography technologists, currently in its third edition. Wendy and Shelly are in the process of writing the 4th edition, to be published in 2018.
Mammography Quality Management™ evolved from discussions between educators, who became friends and eventually business colleagues due to their shared interest in all things related to mammography. The favorite topic of these late-night discussions centered on the delivery of quality mammography services - encompassing more than just positioning of the patient that led to the following.
A realization that the mammography technologist is the missing piece of the puzzle. Mammography equipment is highly regulated and continuously monitored by medical physicists and QC technologists. Radiologists are monitored via the annual medical audit, with published sensitivity and specificity performance standards. The technologist is evaluated only once every three years during the Accreditation process.
A recognition that the pendulum has passed out of equilibrium. In the industry’s zeal to perform a digital mammogram quickly, checks and balances utilized in analog imaging that monitored image quality were lost sight of.
A lost legacy, where the technologist and radiologist worked as a team, depending on the skills of one another to build a successful mammography program. The radiologists who pioneered the development of mammography acknowledged the important contributions of the technologist: “I am only as good as my technologist lets me be” was an oft-heard refrain. The technologist and radiologist worked as a team, depending on the skills of one another to build a successful mammography program.
A commitment to educating new technologists who will replace those of us who, in the 1980s, helped figure out how to perfect the art of performing a mammogram. We need to prepare to pass the baton to a new generation of mammographers.