Observer Form

Reader initials

Mammograms were of ( Left Right Both ) breast(s).

- - - - - - -

Subjective rating for diagnostic quality:

(bad) 1 - 5 (good):

Left CC	Left MLO	Right CC	Right MLO

If any rating is < 4 the problem is:

1) sharpness	2) contrast	3) position	4) breast compression
5) noise	6) artifact	7) penetration

Recommend repeat? Yes No

Breast Density: Left 1 2 3 4 Right 1 2 3 4

1) almost entirely fat	2) scattered fibroglandular densities
3) heterogeneously dense	4) extremely dense

Findings: Yes No

Note: If there are NO findings, the assesment is: (1) (N) negative - return to screening

Findings (detection): Dominant Incidental,focal Incidental,diffuse

Individual finding side: Left Right Both/Bilateral Finding # of

Finding type: (possible, definite)

1) mass	7) architectural distortion
2) clustered calcifications	8) solitary dilated duct
3) mass containing calcifications	9) asymmetric breast tissue
4) mass with surrounding calcs	10) focal asymmetric density
5) spiculated mass	11) breast edema
6) ill defined mass
12) multiple scattered and occasionally	20) fibroadenoma
clustered benign appearing calcs	21) calcified fibroadenoma
13) occasional scattered benign appearing calcs	22) vascular calcs
14) multiple benign appearing masses	23) dermal/skin calcs
15) skin lesion	24) post biopsy scar
16) milk of calcium	25) reduction mammoplasty
17) plasma cell mastitis/secretory calcs	26) implants
18) oil cysts	27) benign mass
19) lymph node
28) other

Location:

1) UOQ	5) 12:00	9) outer/lateral	13) whole breast	17) both breasts/
2) UIQ	6) 3:00	10) inner/medial	14) central	bilateral
3) LOQ	7) 6:00	11) upper/cranial	15) axillary tail
4) LIQ	8) 9:00	12) lower/inferior	16) retroareolar

View(s) in which finding is seen: CC MLO CC and MLO

Associated findings include: (p= possible, d= definite)

1) breast edema	( p , d )	8) architectual distortion	( p , d )
2) skin retraction	( p , d )	9) calcs associated	( p , d )
3) nipple retraction	( p , d )	with mass
4) skin thickening	( p , d )	10) multiple similar masses	( p , d )
5) lymphadenopathy	( p , d )	11) dilated veins	( p , d )
6) trabecular thickening	( p , d )	12) asymmetric density	( p , d )
7) scar	( p , d )	13) none	( p , d )

Assessment: The finding is

(A)

indeterminate/incomplete, additional assessment needed
What? 1) spot mag 2) extra views 3) U/S 4) old films 5) mag
What is your best guess as to the finding's 1-5 assessment? or are you uncertain if the finding exists? Y

(1)

(N) negative - return to screening

(2)

(B) benign (also negative but with benign findings) - return to screening

(3)

(P) probably benign finding requiring 6-month followup

(4L)

(S) suspicion of malignancy (low), biopsy

(4M)

(S) suspicion of malignancy (moderate), biopsy

(4H)

(S) suspicion of malignancy (high), biopsy

(5)

radiographic malignancy, biopsy

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