The Mammography Quality Standards Act (MQSA)
Breast Imaging Experience Requirements

The Accreditation Council for Graduate Medical Education (ADGME) Residence Review Committee (RRC) for diagnostic radiology requires three months of breast imaging. The latest RRC regulations state: "There must be a minimum of 12 weeks of clinical rotations in breast imaging. Each resident should have documentation of the interpretation/multireading of at least 240 mammograms within a six-month period within the last two years of the residency program."

The RRC regulations are posted on the ACGME website as "Effective July 1, 2008." Because the MQSA governs x-ray mammography experience, all breast imaging rotations are expected to include mammography.

MQSA regulations are more complicated and depend on whether the resident passes his/her board examinations on the first attempt.

If a resident conditions any section of the oral board examination, the FDA considers this as not having passed the board examination on the first attempt. Therefore, the resident falls into category 3.b, below. This is difficult to predict for any resident, so it is prudent to give residents the experience necessary should they condition any section or fail their oral examination. However, it may be difficult to incorporate a breast imaging rotation into the last six months of every resident's schedule.

Residents completing radiology residency must fulfill the following requirements as initial qualifications for interpreting mammograms:

1. Be licensed to practice medicine in a state.
    
2. Have a minimum of 60 hours of documented medical education in mammography, which shall include
   • instruction in the interpretation of mammograms and education in basic breast anatomy, pathology, and physiology;
   • technical aspects of mammography; and
   • quality assurance and quality control in mammography. Hours spent in residency specifically devoted to mammography will be accepted if documented in writing by the appropriate representative of the training institution.
      
3. Be board certified in diagnostic radiology.
   
   1. If the radiologist has become appropriately board certified at the first allowable time , he/she must have interpreted or multi-read at least 240 mammographic examinations under the direct supervision of an interpreting physician in any six-month period during the last two years of a diagnostic radiology residency.
   2. If the radiologist is not board certified at the first allowable time, he/she must have interpreted or multi-read at least 240 mammographic examinations within the six-month period immediately prior to the date that the physician qualifies as an interpreting physician . This interpretation or multi-reading shall be under the direct supervision of an interpreting physician.

Alternate pathways are available for those who are unable to become board certified (refer to www.FDA.gov for these MQSA regulations) .