An NBC 5 investigation has revealed violations of state rules at nearly two dozen hospitals and clinics that perform mammograms in North Texas.
The violations were discovered during routine inspections conducted by the Texas Department of Health and Human Services between January 2010 and July 2011.
In Texas, state inspectors visit every mammogram center at least once year.
"It ensures that each facility is doing an acceptable standard of work across the board," said Dr. Zeeshan Shah, who teaches mammography to medical residents at Baylor University Medical Center.
Shah said the state inspections are a safeguard for women to make sure the staff has the latest training and the machines take the clearest pictures.
"For us, it's a big deal because even a slight amount of blurriness means that we're not going to see something in the millimeter size range, and that's our goal," Shah said.
NBC 5 obtained state records through a freedom of information request to see how local mammogram centers performed in state inspections.
In Dallas, Tarrant, Collin and Denton counties from January 2010 to July 2011, the records show 22 hospitals and clinics with violations the state ranks as "level 2." That's the second most serious type of violation inspectors can find -- violations that may "compromise the quality" of mammogram services.
The state took the extra step of fining several hospitals and clinics, including John Peter Smith Hospital, Tarrant County's public hospital. In late 2010, inspectors found records for quality control tests were not complete at women's clinics JPS runs in Arlington, Watauga and Fort Worth. They also discovered some staff did not have enough hours of training to keep up with state requirements.
Kathleen Whelan, vice president of operations at JPS, said the state's findings were the result of paperwork issues that the hospital quickly corrected.
"It's a lot of papers, and it's copies of all of the continuing education courses that staff take," Whelan said.
Since that inspection in late 2010, JPS said it's made major changes. They brought in new leadership and set up a system to better track education requirements. And when the state came back again in late 2011, it found no violations. Whelan said that tells her the changes are "working and working well."
The state also fined Texas Regional Medical Center (TRMC) in Sunnyvale after an inspection in late 2010 that discovered four doctors didn't read enough mammograms in a two-year period to keep up with state requirements.
TRMC said it quickly brought everyone up to speed within 30 days, and when state inspectors returned again last fall, they found no violations.
In a statement, the hospital's director of radiology services told NBC 5: "In 2011, TRMC's mammography department received a 100 percent compliance rating and a letter of commendation from the state for achieving excellence in women's health care. We proudly display our compliance certificate in the radiology suite."
Experts tell NBC 5 there's a reason you want a doctor who has read a lot of mammograms and looks at them often: Their eyes can become better trained to spot the smallest problems.
"The more you do, the better you become at something," Shah said.
Shah said he likes it when patients ask questions about his background and training when having a mammogram. And he encourages others to learn more about both the equipment and doctors involved in their mammogram test.
Cancer patient Dianne Hastings agrees.
Doctors recently used a mammogram to confirm the presence of a tumor after she discovered a lump in a self exam. She said she's learned to speak up throughout the process.
"You need to make sure you're asking questions and learning about all the alternatives for your care," she said.
When having a mammogram, patients can also ask to see the state compliance certificate, which should be posted at the mammogram center. The state also posts online a list of facilities that have been fined recently.