Mixed messages : an evaluation of NHS trust social media policies in the north west of England

Introduction: Despite National Health Service (NHS) information strategy promoting the use of Social Media (SoMe) to encourage greater engagement between service users and providers, a team investigating online SoMe interaction between breast screening practitioners and clients found that practitioners alleged discouragement from employers' policies. This study aimed to investigate whether this barrier was genuine, and illuminate whether local policy differed from national strategy. Method: The study used a qualitative grounded theory approach to generate a theory. Nine policies from the North West of England were analysed. A framework was derived from the data, and an analysis of policy tone followed by a detailed coding of policy content was undertaken. Comparative analysis continued by reviewing the literature, and a condensed framework revealed five broad categories that policies addressed. Results: The analysis revealed the policies varied in content, but not in tone, which was mostly discouraging. Coding the content revealed that the most frequently addressed point was that of protecting the employers’ reputation, and after further analysis, the resultant condensed framework showed that policies were imbalanced and heavily skewed towards Security, Conduct & Behaviour and Reputation. Conclusion: Practitioners within breast screening services are discouraged by overly prohibitive and prescriptive SoMe policies; with these varying tremendously in comprehensiveness, but with a narrow focus on security and employers reputation; in contrast with national strategy. Recommendations are that policy revision is undertaken with consultation by more than one stakeholder, and SoMe training is offered for all members of NHS staff

Calculating individual lifetime effective risk from initial mean glandular dose arising from the first screening mammogram

Objectives: To use the initial mean glandular dose (MGD) arising from the first screening mammogram to estimate the individual total screening lifetime effective risk. Methods: Organ doses from FFDM screening exposures (craniocaudal and mediolateral oblique for each breast) were measured using a simulated approach, with average breast thickness and adult ATOM phantoms, on 16 FFDM machines. Doses were measured using TLDs accommodated inside the ATOM phantom; examined breast MGD was calculated. Total effective risk during a client’s lifetime was calculated for 150 screening scenarios of different screening commencement ages and frequencies. For each scenario, a set of conversion factors were obtained to convert MGD values into total effective risk. Results: For the 16 FFDM machines, MGD contributes approximately 98% of total effective risk. This contribution is approximately constant for different screening regimes of different screening commencement ages. MGD contribution remains constant but the risk reduced because the radio-sensitivity of all body tissues, including breast tissue, reduces with age. Three sets of conversion factors were obtained for three screening frequencies (annual, biennial, triennial). Three relationship graphs between screening commencement age and total effective risk, as percentages of MGD, were created. Conclusions: Graphical representation of total risk could be an easy way to illustrate the total effective risk during a client’s lifetime. Screening frequency, commencement age, and MGD are good predictors for total effective risk generating more understandable data by clients than MGD

Practitioner variation of applied breast compression force in mammography

Rationale:Mammography practitioners control the amount of compression force applied to the breast. There are no quantifiable recommendations for optimal compression force levels for practitioners to follow. Clients report variations in pain and discomfort when compression force is applied. Until now practitioner compression force variability has not been investigated; even though this might lead to variations in client pain and discomfort. The primary purpose of this thesis was to investigate whether practitioner compression force variability exists.Method:Three research papers investigated practitioner compression force variability: one used a cross sectional design; two used longitudinal designs, one was single centre and the other was multicentre. Three further research papers investigated important issues which might confound practitioner variability results: the first investigated compression paddle bend and distortion; the second investigated how breast thickness and compression force vary; the third evaluated practitioner ability to grade breast density, visually. The final research paper was a ‘within client’ investigation to determine how image quality varied with breast thickness and compression force. Key findings:The research firmly demonstrates that practitioner compression force variability exists. Multicentre analysis (4500 client visits) confirmed two out of three screening sites with significant practitioner variability, with the third screening site having a minimum dictate of compression force at 100N. As displayed by MLO/CC projections clients underwent a 55%/57% (site one), 66%/60% (site two) and 27%/26% (site three) change in compression force through their three screening visits. The research confirmed that the compression force received by a client was highly dependent upon the practitioner, and not the client. Within an individual clients screening pathway the research has demonstrated that clients could receive significantly different compression force levels over time. Conclusion and further research:For the first time practitioner compression force variability has been identified. Novel methods for reducing breast thickness need investigating; an example of a novel method is the use of pressure rather than force

Does elevating image receptor increase breast receptor footprint and improve pressure balance?

There is no consensus in the literature regarding the image receptor (IR) position for the cradio-caudal projection in mammography. Some literature indicates the IR should be positioned to the infra mammary fold (IMF); other literature suggests the IR be raised 2 cm relative to the IMF. Using 16 female volunteers (32 breasts) and a pressure sensitive mat we investigated breast footprint and pressure balance with IR at IMF and IR 2 cm above the IMF. Breast area on IR and paddle and interface pressure between IR/breast and paddle/breast were recorded. A uniformity index (UI) gave a measure of pressure balance between IR/ breast and paddle/breast. IR breast footprint increases significantly by 13.81 cm2 (p < 0.02) when IR is raised by 2 cm. UI reduces from 0.4 to 0.00 (p ¼ 0.04) when positioned at IMF þ2 cm demonstrating an improved pressure balance. Practitioners should consider raising the IR by 2 cm relative to the IMF in clinical practice. Further work is suggested to investigate the effects of practitioner variability and breast asymmetry

The impact of simulated motion blur on lesion detection performance in full field digital mammography

Objective: Motion blur is a known phenomenon in full-field digital mammography, but the impact on lesion detection is unknown. This is the first study to investigate detection performance with varying magnitudes of simulated motion blur. Method: Seven observers (15±5 years’ reporting experience) evaluated 248 cases (62 containing malignant masses, 62 containing malignant microcalcifications and 124 normal cases) for three conditions: no blurring (0 mm) and two magnitudes of simulated blurring (0.7 mm and 1.5 mm). Abnormal cases were biopsy proven. Mathematical simulation was used to provide a pixel shift in order to simulate motion blur. A free-response observer study was conducted to compare lesion detection performance for the three conditions. The equally weighted jackknife alternative free-response receiver operating characteristic (wJAFROC) was used as the figure of merit. Test alpha was set at 0.05 to control probability of Type I error. Results: wJAFROC analysis found a statistically significant difference in lesion detection performance for both masses (F(2,22) = 6.01, P=0.0084) and microcalcifications (F(2,49) = 23.14, P&lt;0.0001). The figures of merit reduced as the magnitude of simulated blurring increased. Statistical differences were found between some of the pairs investigated for the detection of masses (0.0mm v 0.7mm, and 0.0mm v 1.5mm) and all pairs for microcalcifications (0.0 mm v 0.7 mm, 0.0 mm v 1.5 mm, and 0.7 mm v 1.5 mm). No difference was detected between 0.7 mm and 1.5 mm for masses. Conclusion: Mathematical simulation of motion blur caused a statistically significant reduction in lesion detection performance. These false negative decisions could have implications for clinical practice. Advances in knowledge: This research demonstrates for the first time that motion blur has a negative and statistically significant impact on lesion detection performance digital mammography

Mathematical modelling of radiation-induced cancer risk from breast screening by mammography

Objectives: Establish a method to determine and convey lifetime radiation risk from FFDM screening. Methods: Radiation risk from screening mammography was quantified using effective risk (number of radiation-induced cancer cases/million). For effective risk calculations, organ doses and examined breast MGD were used. Screening mammography was simulated by exposing a breast phantom for cranio-caudal and medio-lateral oblique for each breast using 16 FFDM machines. An ATOM phantom loaded with TLD dosimeters was positioned in contact with the breast phantom to simulate the client’s body. Effective risk data were analysed using SPSS software to establish a regression model to predict the effective risk of any screening programme. Graphs were generated to extrapolate the effective risk of all screening programmes for a range of commencement ages and time intervals between screens. Results: The most important parameters controlling clients’ total effective risk within breast screening are the screening commencement age and number of screens (correlation coefficients were -0.865 and 0.714, respectively). Since the tissue radio-sensitivity reduces with age, the end age of screening does not result in noteworthy effect on total effective risk. Conclusions: The regression model can be used to predict the total effective risk for clients within breast screening but it cannot be used for exact assessment of total effective risk. Graphical representation of risk could be an easy way to represent risk in a fashion which might be helpful to clients and clinicians

Optimax 2016 : peer observation of facilitation

In August 2016, a 3-week research Summer School was delivered at University of Salford. The Summer School, known as ‘OPTIMAX’ was in its fourth year of delivery. Previous iterations were held in the Netherlands (2015), Portugal (2014) and Salford (2013). The purpose of OPTIMAX is to facilitate collaborative international and interdisciplinary research between university academics and students. This offers an exceptional opportunity not only for students, but also for tutors who want to develop their facilitation skills. The project reported here used tutor observers (i.e. tutors who attend the summer school, in an observational capacity only, to develop their own skills as teachers) to observe, identify and reflect on a range of facilitation practices for managing the diverse OPTIMAX research groups. The project presents a description of the peer-observation method we used and highlights a number of findings related to facilitator strategies that appeared to influence group dynamics and learning. These observations are then used to make recommendations about how OPTIMAX tutors can be prepared for their facilitation experience

An exploration of mammographers’ attitudes towards the use of social media for providing breast screening information to clients

Background: Increasingly patients and clients of health services are using social media to locate information about medical procedures and outcomes. There is increasing pressure for health professionals to engage in on-line spaces to provide clear and accurate information to their patient community. Research suggests there are some anxieties on the part of practitioners to do this. This study aimed to explore the attitudes of the NHS breast screening programme workforce towards engaging in online discussions with clients about breast screening. Method: 78 practitioners, representing a range of professional roles within the NHS Breast Screening Programme, attended one of 4 workshops. We used a Nominal Group Technique to identify and rank responses to the question: “What are the challenges that practitioners face in using SoME as part of their role?” Responses were categorised into themes. Participants were also asked to identify solutions to these challenges. Results: Challenges: We identified two overarching themes: (1) Working within boundaries: which was further categorised into (a) Professional/legal accountability; (b) Information accuracy and (c)Time as a boundary, and (2) Support: further categorised into (a) Employer and (b) Manager . Solutions: These included: training in technical and interactional aspects of on-line communication and a responsibility to better understand employer and professional body SoMe policies

A 6 year study of mammographic compression force : practitioner variability within and between screening sites

Background The application of compression force in mammography is more heavily influenced by the practitioner rather than the client. This can affect client experience, radiation dose and image quality. This research investigates practitioner compression force variation over a 6 year screening cycle in three different screening units. Methods: Recorded data included: practitioner code, applied compression force(N), breast thickness(mm), BI-RADS® density category. Exclusion criteria included: previous breast surgery, previous/ongoing assessment, breast implants. 975 clients (2925) client visits, 11,700 mammogram images) met inclusion criteria across three sites. Data analysis assessed practitioner variation of compression force and breast thickness. Results: Practitioners across three breast screening sites behave differently in the application of compression force. Two of the three sites demonstrate variability within themselves, though they demonstrated no significant difference in mean, first and third quartile compression force and breast thickness values CC(p&gt;0.5), MLO(p&gt;0.1) between themselves. However, the third site (where mandate dictates a minimum compression force is applied) greater consistency was demonstrated; a significant difference in mean, first and third quartile compression force and breast thickness values(p&lt;0.001) was demonstrated between this site and the other two sites. Conclusion: Stabilisation of variations in compression force may have a positive impact on image quality, radiation dose reduction, re-attendance levels and potentially cancer detection. The large variation in compression forces could negatively impact on client experience between the units and within a unit. Further research is required to establish best practice guidelines for compression force within mammography. Keywords: Compression force, Breast compression, Compression variabilit