A robust breast imaging program is the backbone of early cancer detection and quality patient care. With the right structure in place, including standardized training, clear protocols, and a strong emphasis on fundamentals, facilities can ensure high-quality imaging, minimize liability, and improve outcomes. Below, I’m sharing key strategies to build a cohesive and effective breast imaging program, particularly for mammography technologists. These strategies are equally valuable when adapted for ultrasound and MRI teams
The Radiologist: More Than a “Reader of Films”
In any thriving breast imaging program, radiologists should be the leaders, the captains of the ship. They set the tone, establish standards, and unify the team. Rather than working in silos, radiologists should collaborate to design and align protocols before introducing them to staff. This proactive approach ensures consistency across the entire care team, from front desk to technologists, and reinforces a shared commitment to patient-centered care.
Start Strong: How Standardized Onboarding Shapes Long-Term Quality
Technologist onboarding is where quality starts. A structured, standardized approach brings clarity and consistency across roles, including clerical and administrative staff.
A comprehensive onboarding program should include a core curriculum that covers the history and purpose of breast imaging, the differences between screening and diagnostic workflows, proper positioning techniques using trusted resources, and the criteria for standard screening and diagnostic views.
Additional topics might include patient education tools for common symptoms, ACR screening recommendations, and facility-specific protocols for transitioning between screening and diagnostic during patient visits.
Establishing a clear training timeline with signed acknowledgments ensures accountability, while unified communication protocols help reduce confusion and improve patient experience. The “teaching set” used in onboarding can be tailored to each facility and serves as a long-term reference for staff.
Quality Doesn’t Stop at Onboarding
To maintain a high-performing breast imaging program, quality improvement must be ongoing and collaborative. This means hosting regular monthly meetings with technologists, radiologists, and admin staff to discuss updates, challenges, and training needs. Creating an open environment where team members feel comfortable asking questions and sharing feedback is key to fostering growth.
Facilities should also conduct regular reviews of positioning techniques, reinforcing the importance of proper imaging even when utilizing advanced tools like tomosynthesis and AI. During the early stages of implementation, feedback should focus on encouragement and improvement, not punishment. This helps build trust and supports continued excellence.
Technologists: The Eyes and Ears of the Program
Since radiologists often don’t interact directly with patients during screening exams, technologists play a critical role. They are responsible for taking patient histories, noting symptoms, and ensuring that high-quality images are captured. Their attention to detail can be the deciding factor in whether subtle abnormalities are identified early.
Don’t Let Technology Do All the Talking
While advanced technologies like AI and tomosynthesis can enhance breast imaging, they are only effective when supported by strong foundational practices. Poor positioning or incomplete imaging can undermine even the best technology. By focusing first on essentials such as standardized training and protocols, facilities can maximize their technology investments.
Why This Matters
Mammographic screening remains one of the most effective tools in the fight against breast cancer. By enabling radiologists to detect cancers at earlier, more treatable stages, it has significantly improved survival rates—women diagnosed with early-stage breast cancer that is confined to the breast have a five-year survival rate exceeding 98% (see The Breast Test Book, page 12).
However, this life-saving benefit depends on the consistent delivery of high-quality imaging. When image quality is compromised—whether due to poor positioning, inconsistent protocols, or lack of training—critical findings can be missed or misinterpreted. This can delay diagnosis and treatment, ultimately putting patients at greater risk.
To enhance the onboarding process, facilities should also consider incorporating a receptor plate cover such as Bella Blankets® Protective Coverlets, which help hold the breast in place to help technologists with positioning, and mammographic skin markers, such as TomoSPOT® for Digital Breast Tomosynthesis, which enhance communication by clearly marking areas of concern for the radiologist.
Investing in standardized training and adherence to best practices is essential. It ensures reliable, high-quality mammograms, supports early detection, improves outcomes, and maintains patient trust in the screening process.
If you want to build a successful breast imaging program, start with the basics.
Focus on standardized onboarding, clear protocols, ongoing education, and empowered technologists who work in tandem with radiologists who lead with consistency and clarity. These elements create a strong foundation for better detection, reduced liability, and more confident, collaborative care teams.
Recommended Resources
The Breast Test Book – Offers insights into screening controversies and guidelines (especially Chapter 2)
Mammography Educators – Provides positioning videos, articles, and training materials
ACR Appropriateness Criteria – Outlines age- and risk-based screening recommendations
ACR Learning Network – Supports ongoing education and professional development
