Specially trained radiographers are increasingly double-reading screening cases with radiologists. Each year the majority of these film-readers interpret a 'PERFORMS' set of difficult cases as a means of self-assessing their skills. We examined the radiographers' confidence in their interpretation of these difficult cases and investigated whether they performed as well as radiologists. We also studied radiographers' performance and confidence ratings over a number of years, comparing those with different levels of experience. Additionally, by closely matching individual radiographers and radiologists, we investigated real-life experience, performance and confidence levels on PERFORMS, fractionating by both volume of cases read, and years of experience. Data were examined for approximately 250 breast-screening radiologists and 90 specially trained radiographers over 3 years. Overall, radiographers did not perform as well as radiologists on this particular task, nor were they as confident of their diagnosis. However, when closely matched on real-life factors these differences in performance levels disappeared and radiographers performed as well as radiologists. Although the more experienced radiographers performed at a level similar to the radiologists, differences in confidence levels remained. This supports the current UK practice of radiographers double-reading with radiologists and implies that experienced radiographers, like radiologists, may be able to be single-readers.