National
Mammography Database
Margarita Zuley, MD
Associate Professor of Radiology
University of Pittsburgh
Medical Director Breast Imaging
Magee Womens Hosp of UPMC
Credit and thanks to Mythreyi Bhargavan
Chatfield, PhD Director, Data Registries for
sample report slides
NMD
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American College of Radiology (ACR) Initiative
Part of the NRDR ( National Radiology Data
Registry)
Collects MQSA required data
Provides comparative information back to
participating sites every 6 months
Allows sites to do national and regional
benchmarking
nrdr.acr.org
What is NRDR?
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Information system
Provides objective measures of practice processes and
outcomes
Designed by radiologists
Includes
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National Oncologic PET Registry (NOPR)
CT Colonography Registry
General Radiology Improvement Database (GRID)
IV Contrast Extravasation Registry (ICE)
National Mammography Database Registry
Quality Improvement Registry for CT scans in Children
(QuIRCC)
Dose Index Registry
Benchmark Data
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National benchmark data provided by Breast
Cancer Surveillance Consortium (BCSC) are
used for comparisons with facility data in the
semi-annual reports provided to NMD
participants
Also uses NMD results of all participating
facilities as benchmarks
Facilities receive facility level and provider level
data
Benefits
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ABR has qualified the NMD for practice quality
improvement (PQI) for ABR Maintenance of
Certification (MOC) Program
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3 PQI projects are required every 10 years for all
radiologists who have not been given a lifetime
certificate by the ABR
Joining
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Any radiology facility can participate
A participation agreement and a business
associate’s agreement between ACR and the
facility must be signed first
Upload from facility to NMD
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Obtained through input of data elements into
facility RIS/ HIS
The RIS/HIS vendor must support the NMD
platform (HL-7) fields
Vendor software must be approved by NMD
Facility requests upgrade to NMD version
Assign one person to upload data
Upload is one click
NMD-Certified Software Partners
10
Data Security
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PHI, NPI is uploaded
Encryption of all incoming traffic to NRDR
Firewalls to secure data
Has third party safety monitoring
Data on individual patients stay property of facility
Aggregate, anonomyzed data from registry are property
of ACR
Data Elements
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Patient Identifiers
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Patient name, SSN, facility MRN, zip code
Race, ethnicity
Gender
LMP, height, weight
Family and personal h/o breast cancer
Biopsy and surgical history
Data Elements
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Mmg date
Radiologist NPI number
Reason for exam
Clinical symptoms
Prior mmg date, was it compared at read
Breast density
Data Elements
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BI-RADS category (7 point)
Mmg only
 Combined assessment
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Recommendations
Classification of most significant finding
S/F or digital
Use of CAD or double read
Data Elements
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Biopsy results
Modality used
 Biopsy result ( benign, HR, malignant)
 If cancer
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Type ( invasive or DCIS)
 Size
 Nodal status
 Stage at diagnosis
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Goals
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PPV1
PPV2
Tumors found- stage 0 or 1
Tumors found- minimal
5-10%
25-40%
>50%
>30%
(1cm or less invasive or DCIS)
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Node positive rate
<25%
From Linver et al AJR;1995;165:19-25
Goals
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CDR (Ca/1000)
Prevalent
 Incident
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Recall rate
Sensitivity
Specificity
2-10
6-10
2-4
10% or less
>85%
>90%
From Linver et al AJR;1995;165:19-25
SAMPLE FACILITY REPORT
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Data Presented
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Initial upload can be last 6 months or year
Can elect to upload prior data if you like
Initial older data can be incomplete
First report back will only give data results that
you upload
Will get 2 reports going forward, data with at
least 1 year follow up and preliminary data that
does not yet have 1 year follow up
SAMPLE PHYSICIAN REPORT
32
Summary
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NMD will help with MQSA audit
NMD will help with required PQI
NMD provides a feedback mechanism for
radiologists and facilities to see if their practice
can be improved