Pain-preventing strategies in mammography: an observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle

Contains fulltext : 153582.pdf (publisher's version ) (Open Access)BACKGROUND: Many women consider mammography painful. Existing studies on pain-preventing strategies only mention pain scores reported before and after breast compression. Studying the pain dynamics during the entire compression cycle may provide new insights for effective pain-preventing strategies. METHODS: This observational study included 117 women who consented to use a custom turning knob to indicate their pain experience during standard mammographic breast compressions in the Academic Medical Center in Amsterdam, The Netherlands. The breast thickness, compression force, contact area, contact pressure and pain experience were recorded continuously. Breast volume was calculated retrospectively from the mammograms. We visualized the progression of pain in relation to breast mechanics for five groups of breast volumes and we performed multivariable regressions to identify factors that significantly predict pain experience. RESULTS: Breast compressions consisted of a deformation phase for flattening, and a clamping phase for immobilization. The clamping phase lasted 12.8 +/- 3.6 seconds (average +/- standard deviation), 1.7 times longer than the 7.5 +/- 2.6 seconds deformation phase. During the clamping phase, the average pain score increased from 4.75 to 5.88 (+24 %) on a 0 - 10 Numerical Rating Scale (NRS), and the proportion of women who reached severe pain (NRS >/= 7) increased from 23 % to 50 % (more than doubled). Moderate pain (NRS >/= 4) was reported up to four days after the mammogram. Multivariable analysis showed that pain recollection of the previous mammogram and breast pain before the compression, are significant predictors for pain. Women with smallest breasts experienced most pain: They received highest contact pressures (force divided by contact area) and the pressure increased at the highest rate. CONCLUSION: We suggest further research on two pain-preventing strategies: 1) using a personalized compression protocol by applying to all breasts the same target pressure at the same, slow rate, and 2) shortening the phase during which the breast is clamped

How to objectively classify residents based on their psychomotor laparoscopic skills?

In minimally invasive surgery (MIS), a surgeon needs to acquire a certain level of basic psychomotor MIS skills to perform surgery safely. Evaluation of those skills is a major impediment. Although various assessment methods have been introduced, none of them came as a superior. Three aspects of assessing psychomotor MIS skills are discussed here: (i) advantages and disadvantages of currently available assessment methods, (ii) methods to objectively classify residents according to their level of psychomotor skills, and (iii) factors that influence psychomotor MIS skills. Motion analysis has a potential to be the means to deal with assessment of psychomotor skills. Together with classification methods (e.g. linear discriminant analysis), motion analysis provides an aid in deciding whether a resident is ready to move to the next level of training. Presence of factors that influence psychomotor MIS skills results in a high need for standardisation of valid tasks and setups used for the assessment of MIS skills.Technology assessment of reproductive medicin

New Technologies Supporting Surgical Interventions and Training of Surgical Skills: A Look at Projects in Europe Supporting Minimally Invasive Techniques

Biomechanical EngineeringMechanical, Maritime and Materials Engineerin

Towards personalized compression in mammography: a comparison study between pressure- and force-standardization

Contains fulltext : 154324.pdf (Publisher’s version ) (Open Access)OBJECTIVE: To compare a conventional 14 decanewton (daN) force-standardized compression protocol with a personalized 10kilopascal (kPa) pressure-standardized protocol. METHODS: A new add-on contact area detector, which enables pressure-standardized compression, is validated in a double-blinded intra-individual comparison study. Breast screening participants (433) received one craniocaudal (CC) and one mediolateral oblique (MLO) compression for both breasts. Three of these compressions were force-standardized, and one, blinded and randomly assigned, was pressure-standardized. Participants scored their pain experience on an 11-point numerical rating scale (NRS). Three experienced breast-screening radiologists, blinded for compression protocol, indicated which images required retakes. RESULTS: An unanticipated under-compression issue that occurred at forces below 5daN was effectively solved with minimal extra radiographer training during the study. For pressure-standardized compressions obtained at 5daN or more, the compressed breasts thickness increased on average 4.2% (MLO)-6.3% (CC), average pain scores were reduced by 10% (MLO)-17% (CC) and the proportion of women experiencing severe pain (NRS>/=7) was reduced by 27% (MLO)-32% (CC), compared with force-standardized compressions (all p-values <0.05). Average glandular dose (AGD) and proportions of retakes were similar for both protocols. CONCLUSION: Pressure-standardized compressions resulted in AGD values and a retake proportion similar to force-standardized compressions, while pain was significantly reduced