Readability and Quality of Online Patient Education Material on Websites of Breast Imaging Centers

Sadia Choudhery, Yin Xi, Heng Chen, Nader Aboul-Fettouh, YPaul P. Goldenmerry, Charles Ho, Hannah Viroslav, Chelsea Zhang, Sally Goudreau

Research output: Contribution to journalArticlepeer-review


Objectives: The purpose of this study was to assess the readability and quality of patient information regarding mammography, tomosynthesis, and breast density on the websites of ACR-designated mammography Breast Imaging Centers of Excellence (BICOEs) in the United States. Materials and Methods: In this institutional review board–exempt study, websites of mammography BICOEs were identified by state. Websites were assessed for presence of patient education material on screening mammography, tomosynthesis, and breast density. This material was then assessed for readability using five well-established readability metrics (Flesch-Kincaid Reading Ease Index, Flesch-Kincaid Grade Level, Gunning-Fog Score, Coleman-Liau Index, and Simple Measure of Gobbledygook Index) and for quality using the DISCERN instrument. Results: We identified 1,482 BICOE centers, of which 1,451 (98%) had websites; 79% (1,156 of 1,451) of websites had information on screening mammography, 45% (657 of 1,451) on tomosynthesis, and 16% (228 of 1,451) on breast density. Readability analysis showed that the overall average grade level of patient information was 12.4. Average readability grade levels by tested indexes were Flesch-Kincaid Grade Level of 11.5, Gunning-Fog Score of 14.1, Coleman-Liau Index of 14.1, and Simple Measure of Gobbledygook Index of 10.9. The average Flesch-Kincaid Reading Ease score was 45, with 0 being the most difficult and 100 being the easiest text to read. The overall DISCERN score nationally was 2.61 of 5 (with 5 representing the highest quality). Conclusions: Although most BICOEs have patient education material on their websites regarding mammography and some have information regarding tomosynthesis and breast density, the average readability grade level of this material is more than double the nationally recommended readability grade level of 6 for health care information. Additionally, the overall quality of this material is relatively low per established quality metrics.

Original languageEnglish (US)
Pages (from-to)1245-1251
Number of pages7
JournalJournal of the American College of Radiology
Issue number10
StatePublished - Oct 2020


  • Mammography
  • online
  • patient education quality
  • readability

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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