An audit to investigate the impact of false positive breast screening results and diagnostic work-up on re-engagement with subsequent routine screening

Introduction Women attending breast screening may have suspicious mammographic findings that are subsequently found at assessment clinic to be normal (false positive, FP). A false positive diagnosis is not harmless, with short and long term negative psychosocial consequences reported. Women are at increased relative risk of breast cancer therefore their attendance at subsequent screening is essential. Aims To assess the impact of FP breast screening diagnosis and diagnostic work-up on re-attendance rates across four consecutive screening rounds at a typical breast screening centre. Method Diagnostic interventions and screening re-attendance rates at one prior and two consecutive rounds were analysed for women receiving an FP diagnosis between 2004 and 2006. Results 397 women (5.57%) were referred for further assessment, including 228 (57.43%) false positives. 34 eligible women failed to re-attend routine screening (+3 years), with 17 failing to re-attend subsequently (+6 years). 70.6% (24/34) of non-attenders had attended at least two screening rounds prior to FP assessment. 75% of FP women had an imaging-only assessment with 17.5% (30/171) failing to re-attend, and 25% received a biopsy, with 7% (4/57) failing to re-attend subsequently. Conclusion This study is unique as it follows FP women through four consecutive screening rounds. FP non-attendance rates were considerably lower compared to the general screening population, with diagnostic work-up having limited influence. FP non-attendance may appear insignificant in comparison to total screened population, but these women are at greater risk of subsequent cancer so should be actively encouraged to re-engage with the screening programme

Understanding experiences of the radiography workforce delivering medical imaging as part of patients’ end of life care: An exploratory qualitative interview study

AbstractIntroductionPeople nearing the end of life often require medical imaging in hospitals to manage symptoms and care, despite this little is known about the experiences of those delivering it. The aim of this study is therefore to explore the experiences of the radiography workforce delivering medical imaging as part of patients’ end-of-life care.MethodQualitative design using semi-structured interviews and thematic analysis. A total of 8 participants participated in the study including registered diagnostic radiographers (n = 5), imaging assistants (n = 2) and assistant practitioners (n = 1). All have been involved in the medical imaging of patients receiving end of life care in UK hospitals.ResultsFindings identified an absence of end of life care policy guidance and education accessible to radiography staff, limiting their ability to provide evidenced based care for those nearing the end of life during medical imaging examinations. Findings also suggest difficulty in identifying patients receiving end of life care further hindered staffs’ ability to adapt their care to provide a more person-centred approach. Lastly, the workforce felt an accumulative emotional burden following their interactions with patients nearing the end of life.ConclusionThere is a clear need to develop policy and education to support the radiography workforce to ensure care is appropriately identified and adapted to those nearing the end of life. Furthermore, staff support and wellbeing needs to be considered.Implications for practiceFuture research is required exploring the patient perspective to understand their experiences so that the education and practice provision is driven by patient need. International exploration of end of life care in medical imaging is recommended to explore whether similar challenges related to clinical practice exist in other countries

Closed-loop control of compression paddle motion to reduce blurring in mammograms

Background: Since the introduction of full field digital mammography (FFDM) a large number of UK breast cancer screening centers have reported blurred images, which can be caused by movement at the compression paddle during image acquisition. Purpose: To propose and investigate the use of position feedback from the breast side of the compression paddle to reduce the settling time of breast side motion. Method: Movement at the breast side of the paddle was measured using two calibrated linear potentiometers. A mathematical model for the compression paddle, machine drive and breast was developed using the paddle movement data. Simulation software was used to optimize the position feedback controller parameters for different machine drive time constants and simulate the potential performance of the proposed system. Results: The results obtained are based on simulation alone and indicate that closed-loop control of breast side paddle position dramatically reduced the settling time from over 90 seconds to less than 4 seconds. The effect of different machine drive time constants on the open-loop response is insignificant. With closed-loop control, the larger the time constant the longer the time required for the breast side motion to settle. Conclusions: Paddle motion induced blur could be significantly reduced by implementing the proposed closed-loop control

An exploration of factors involved in the roll out of a digital application in breast services: A case study approach.

Acceptance of new technologies in health care, by those who use them as part of their role, is challenging with confounding contextual factors surrounding the acceptance of technology. As healthcare is rapidly digitising, stakeholder groups should be included in each stage of evaluation and implementation to allow opportunities to influence and contribute to digital health policies. This research employed a case study methodology to initiate an exploration into the factors associated with implementing a digital application into a mammography service. It examined the initial implementation and subsequent impact of the rollout of a digital application (VA) within a breast service in South Australia. Stakeholders' opinions on team performance and feedback mechanisms of the digital application were evaluated through a staff questionnaire distributed through an online survey JISC. The incorporation of digitised technology into a service is evidently met with challenges. Although there is potential value in utelising automated feedback for workflow improvement and patient services, it appears imperative to provide targeted and developmental resources for educational development and staff well-being during the implementation phase. This case study approach delves into key discussion areas and serves as the initial insight into the implementation of a digital application. It could be regarded as a foundational reference for future evaluations of digital applications. Research around digital fluency within the radiography profession requires further consideration. Under-utilisation or resistance may result in missed opportunities to enhance patient experiences and care outcomes and support staff wellbeing. Therefore, continued engagement and the encouragement of user feedback during the implementation phase are crucial to demonstrate future acceptance of digital applications in clinical settings. [Abstract copyright: Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

Practitioner compression force variation in mammography : a 6 year study

The application of breast compression in mammography may be more heavily influenced by the practitioner rather than the client. This could affect image quality and will affect client experience. This study builds on previous research to establish if mammography practitioners vary in the compression force they apply over a six year period. This longitudinal study assessed 3 consecutive analogue screens of 500 clients within one screening centre in the UK. Recorded data included: practitioner code, applied pressure (daN), breast thickness (mm), BI-RADS® density category and breast dose. Exclusion criteria included: previous breast surgery, previous/ongoing assessment, breast implants. 344 met inclusion criteria. Data analysis: assessed variation of compression force (daN) and breast thickness (mm) over 3 sequential screens to determine whether compression force and breast thickness were affected by practitioner variations. Compression force over the 3 screens varied significantly; variation was highly dependent upon the practitioner who performed the mammogram. Significant thickness and compression force differences over the 3 screens were noted for the same client (<0.0001). The amount of compression force applied was highly dependent upon the practitioner. Practitioners fell into one of three practitioner compression groups by their compression force mean values; high (mean 12.6daN), intermediate (mean 8.9daN) and low (mean 6.7daN). For the same client, when the same practitioner performed the 3 screens, maximum compression force variations were low and not significantly different (p>0.31). When practitioners from different compression force groups performed 3 screens, maximum compression force variations were higher and significantly different (p<0.0001). The amount of compression force used is highly dependent upon practitioner rather than client. This has implications for radiation dose, patient experience and image quality consistency

A free-response evaluation determining value in the computed tomography attenuation correction image for revealing pulmonary incidental findings : a phantom study

RATIONALE AND OBJECTIVES: The purpose of this study was to compare lesion-detection performance when interpreting computed tomography (CT) images that are acquired for attenuation correction when performing single photon emission computed tomography/computed tomography (SPECT/CT) myocardial perfusion studies. In the United Kingdom, there is a requirement that these images be interpreted; thus, it is necessary to understand observer performance on these images. MATERIALS AND METHODS: An anthropomorphic chest phantom with inserted spherical lesions of different sizes and contrasts was scanned on five different SPECT/CT systems using site-specific CT protocols for SPECT/CT myocardial perfusion imaging. Twenty-one observers (0-4years of CT experience) searched 26 image slices (17 abnormal, containing 1-3 lesions, and 9 normal, containing no lesions) for each CT acquisition. The observers marked and rated perceived lesions under the free-response paradigm. Four analyses were conducted using jackknife alternative free-response receiver operating characteristic (JAFROC) analysis: (1) 20-pixel acceptance radius (AR) with all 21 readers, abbreviated to 20/ALL analysis, (2) 40-pixel AR with 21 readers (40/ALL), (3) 20-pixel AR with 14 readers experienced in CT (20/EXP), and (4) 20-pixel AR with 7 readers with no CT experience (20/NOT). The significance level of the test was set so as to conservatively control the overall probability of a type I error to &lt;0.05. RESULTS: The mean JAFROC figure of merit (FOM) for the five CT acquisitions for the 20/ALL study were 0.602, 0.639, 0.372, 0.475,and 0.719 with a significant difference in lesion-detection performance evident between all individual treatment pairs (P&lt;.0001) with the exception of the 1-2 pairing, which was not significant (these differed only in milliamp seconds). System 5, which had the highest performance, had the smallest slice thickness and the largest matrix size. For the other analyses, the system orderings remained unchanged, and the significance of FOM difference findings remained identical to those for 20/ALL, with oneexception: for 20/EXP analysis the 1-2 difference became significant with the higher milliamp seconds superior. Improved detection performance was associated with a smaller slice thickness, increased matrix size, and, to a lesser extent, increased tube charge. CONCLUSIONS: Protocol variations for CT-based attenuation correction (AC) in SPECT/CT imaging have a measurable impact on lesion-detection performance. The results imply that z-axis resolution and matrix size had the greatest impact on lesion detection, with a weaker but detectable dependence on the product of milliamp and seconds

An investigation of pressure ulcer risk, comfort and pain in medical imaging

In this study, we investigated the interface pressure of healthy volunteers on medical imaging (MI) table surfaces to determine the risks of developing pressure ulcers (PU). We also investigated volunteers’ perception of pain and comfort while lying on the MI table surfaces. Evidence from this study will enhance the understanding of factors contributing to PU formation and help improve service delivery to patients undergoing MI procedures

Image quality, system optimisation and quality control

Mammography equipment must be assessed regularly to ensure that images will be of acceptable diagnostic quality with keeping radiation dose as low as reasonably practicable. Quality Assurance (QA) aims to provide systematic and constant improvement through a feedback mechanism to address the technical, clinical and training aspects (Reis et al., Insights Imaging, 4(5), 539–553, 2013; Andolina and Lillé, Mammographic imaging: a practical guide, 2011). Quality Control (QC), in relation to mammography equipment, comprises a series of tests to determine equipment performance characteristics. The introduction of digital technologies promoted changes in QC tests and protocols and there are some tests that are specific for each manufacturer (Andolina and Lillé, Mammographic imaging: a practical guide, 2011). Within each country specific QC tests should be compliant with regulatory requirements and guidance (Reis et al., Insights Imaging, 4(5), 539–553, 2013). Ideally, one mammography practitioner should take overarching responsibility for QC within a service, with all practitioners having responsibility for actual QC testing. All QC results must be documented to facilitate troubleshooting, internal audit and external assessment (IAEA, Quality assurance programme for digital mammography, 2011; Perry et al., Ann Oncol, 19(4), 614–622, 2008). Although tests can vary from country to country, and manufacturer to manufacturer, the main principles of system quality that are assessed during mammography QC are: contrast resolution, spatial resolution, noise, and radiation dose. All parameters are assessed to ensure that measurements are not deviating from when the machine was commissioned. This chapter aims to provide a clear summary of image quality, system optimisation and quality control for the practitioner

Pressure based mammographic compression: a feasibility study to determine operational level

Background: Research has established large variations in breast compression force within and between practitioners. A requirement, therefore, exists for to standardize compression to improve client experience whilst minimising radiation dose and image quality differences. Rationale: A new approach to breast compression, using pressure rather than force, has been suggested to reduce patient discomfort and improve consistency. Using this approach, the optimal pressure, based on breast detector footprint and thickness, has not been investigated.info:eu-repo/semantics/publishedVersio

Skin tears in mammography: A narrative review

Skin tears are classed as traumatic wounds mainly caused by shearing and frictional forces. Incidences of skin tears are noted to be significant mostly in the elderly population and those with fragile and vulnerable skin. Individuals undergoing mammography are susceptible to skin tears due to factors associated with skin breakdown such as thinning of the epidermis, use of steroids, presence of moisture, but this, when compounded with the procedure of mammography can increase the risk further.Mammography, an x-ray imaging method, which exerts adequate compression force on the breast tissue for the mammographer to obtain a high-quality image for diagnostic purposes. However, when compression force is applied during mammography resulting incidences of cutaneous skin tears can occur.Lack of and under reporting of skin tears during mammography makes it difficult to ascertain the extent of this problem and scale of its incidence. Therefore, the purpose of this narrative review is to focus on providing an overview of skin tears associated with mammography and a discussion of the current literature with regards to its incidence and diagnosis. In addition, the review will also discuss the theoretical and contextual perspective of the prevention and management strategies associated with skin tears