The Radiographers’ Perspective on the Perfect Good Moderate Inadequate (PGMI) Mammographic Image Evaluation Classification Approach: A Qualitative Study
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Abstract
Introduction: Malaysia has used the Perfect, Good, Moderate, Inadequate (PGMI) classification to assess mammographic image quality since 2018. Reliability of this classification is crucial for assessing image quality. Therefore, this study aims to investigate radiographers’ comprehension and perspectives regarding image criteria in the PGMI classification. Materials and Methods: Six female radiographers from six Malaysia’s public hospitals with work experience from six to seventeen years (mean = 13.5 years, SD = 4.11 years), were recruited to participate in a focus group discussion (FGD). All nine image quality domains in the PGMI classification were discussed during the FGD. The data was analyzed using content analysis with ATLAS.ti 22. Results: The study found that the professional group whom assess the mammographic image quality was varied among hospitals. The study also found ‘pectoral muscle visualized at chest wall’ and ‘nipple in midline of imaged breast’ quality criteria were not relevant and clinically not easily achievable. Participants had diverse interpretations of the acceptable tolerance for visualizing the pectoral muscle shadow up to nipple level and assessing image symmetry. Distinguishing between the Perfect (P) and Inadequate (I) categories was straightforward. However, differentiating the Good (G), Moderate (M), and Inadequate (I) categories based on entire breast tissue visualization, exposure, compression, and symmetry criteria posed challenges. Furthermore, participants had difficulty in deciding whether to accept or reject images. Conclusion: The definition and description of the quality criteria in the PGMI classification were not standardized and difficult to comprehend thus may lead to inaccurate classification of mammographic image quality.
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