| Summary: | Breast screening requires film readers to exercise considerable expertise when examining breast X-rays (or 'mammograms') for signs of malignancy. Understandably; errors are sometimes made, and the screening programme is continually investigating ways to improve detection performance. In recent years, interest has grown in using computer based prompting systems to assist with reading. Prompting systems use image analysis techniques to identify possible cancers within a digitised mammogram and cue film readers to their location with the aim of preventing cancers from being overlooked. A qualitative analysis of clinic work practices show reading to be a situated activity with important collaborative dimensions. Tensions were found to exist between making decision-making visible (hence rendering it accountable and providing a reference by which performance can be monitored) and the possibility of being biased by exposure to the decision processes of others. It is argued that use of PROMAM offers a similar mix of advantages and pitfalls, and that lessons can be learned for prompting from how these tensions are managed for conventional forms of evidence. In subsequent investigations of prompting it was found that readers' interpretation and use of PROMAM were often problematic. Readers often had difficulties understanding prompts, and used them in ways contingent on the particular problem at hand rather than purely to aid detection. It is argued that effective prompting is not only a problem of achieving sufficient system performance, but also one of ensuring prompts are comprehensible, accountable, and appropriately used. Achieving the latter requires an understanding of how readers make sense of prompts in the context of their conventional reading practice.
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