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for mammography facility personnel, inspectors, and consumers about the implementation of the Mammography Quality Standards Act of 1992 (MQSA) |
PERFORMANCE EVALUATION OF ACCREDITATION
BODIES UNDER THE MAMMOGRAPHY QUALITY STANDARDS ACT OF 1992 as amended by the MAMMOGRAPHY QUALITY STANDARDS REAUTHORIZATION ACT OF 1998 |
January 1, 2002 through December 31, 2002
Executive Summary
The goal of the Mammography Quality Standards Act (MQSA) of 1992, as amended by the Mammography Quality Standards Reauthorization Act (MQSRA) of 1998, is to assure that facilities meet standards for performing high quality mammography. The Food and Drug Administration (FDA) administers MQSA. Among other things, MQSA provides for FDA-approved accreditation bodies (ABs) to evaluate and accredit mammography facilities against quality standards. Based on successful completion of this process, FDA then issues certificates to the facilities so that they can legally operate. MQSA requires annual reports to Congress on AB performance. This seventh annual report covers the period from January 1, 2002, through December 31, 2002.
To implement the MQSA (Public Health Service Act section 354, 42 USC section 263b), FDA issued final regulations that became effective on April 28, 1999 (21 CFR Part 900). The final regulations state that FDA’s evaluation of ABs shall include a(n):
(a) Assessment of the reports of FDA or State inspections of facilities accredited by the body as well as any additional information deemed relevant by FDA that has been provided by the accreditation body or other sources or has been required by FDA as part of its oversight initiatives; (b) Determination of whether there are major deficiencies in the AB’s performance that, if not corrected, would warrant withdrawal of the approval of the AB under the provisions of Section 900.6.
Status of Accreditation Bodies
FDA approved the American College of Radiology, a private, nonprofit organization, as well as the States of Arkansas, Iowa, and Texas under the MQSRA of 1998 and the final regulations. The State of California (SCA) was approved under the interim regulations, and has applied for accreditation approval under the final regulations. However, its application is pending approval until the State’s final mammography standards are signed and in effect. FDA approved SCA’s draft standards which are currently moving through the State’s emergency legislative process.
Core Functions of the Accreditation Bodies
The ABs review documentation and clinical1 and phantom2 images that are submitted by mammography facilities for accreditation purposes. On determining that facilities meet specific requirements, the ABs make a positive accreditation decision. The FDA then certifies the facilities based on that accreditation.
FDA evaluates the ABs on a number of elements, but concentrates on these core AB functions:
Performance Indicators
FDA evaluates the performance of its ABs through:
To assess overall performance of the ABs, the agency evaluates information in various areas: administrative processes, reporting and record keeping processes, accreditation review and decision-making processes, AB on-site visits to facilities, random clinical image reviews, additional mammography reviews, and accreditation revocations and suspensions. FDA’s evaluation includes on-site visits to the ABs and ongoing written and oral communications with the ABs.
Findings from CY 2002 AB Performance Evaluations
The following items are the highlights of FDA’s CY 2002 report to congress. Where FDA found that an AB did not meet established requirements, it notes action items for these areas in the individual 2002 AB Performance Evaluations:
FDA is working cooperatively and collaboratively with each AB to address all issues noted in this report and as described in the ABs’ CY 2002 Performance Evaluations.
FDA and the ABs, working in partnership with the certified mammography facilities in the United States, as well as the states participating in inspections and other MQSA activities, are ensuring quality mammography across the Nation.
1Clinical image review: the facility must submit
to the AB two cases (one fatty breast and one dense breast) to be reviewed and
scored by an AB panel of trained interpreting physicians. Each case consists
of four views, two craniocaudal and two mediolateral oblique views.
2Phantom images are x-ray films of plastic objects
that contain various simulated abnormalities of breast tissues. Phantom images
are used to test the ability of the equipment to discriminate abnormalities
Updated February 25, 2004
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