Evaluation of the pectoral muslce in mammography images the Australian experience /

Introduction: Critical to the success of early breast cancer detection is the consistent production of high quality mammographic images. Image evaluation systems are used to evaluate mammographic image quality and must be reliable and valid. This study set out to investigate radiographers’ perceptions of the current image evaluation systems such as the PGMI as well as their interpretation of criteria relating to the presentation of the pectoral muscle in the mediolateral oblique view. Method: A survey method was employed for this exploratory study as a way of collecting data from the largest possible sample. Surveys were distributed to radiographers employed in all different types of work in mammography. Following collation of responses descriptive statistics were developed. Thematic analysis was applied to the responses to the open-ended questions. Results: One hundred and sixty eight surveys were returned. The questionnaire responses were grouped into two categories: image evaluation systems and the presentation of the pectoral muscle. Overall the study results demonstrate variations in Australian radiographers’ practice when evaluating mammogram images. Conclusion: The study demonstrated worrying variations in the interpretation of criteria in current image evaluation systems. Inconsistent interpretation of criteria relating to the presentation of the pectoral muscle increases the risk of breast tissue not being included in the image. This study has provided evidence for the need for clearly defined criteria using objective measures so that the subjectivity of interpretation is minimised

Mammography : current practice in Australia for the selection of bucky angle in the mediolateral oblique view of the breast

Introduction: Due to the configuration of the breast and its variability between individuals, correct selection of the angle of the bucky (bucky may be interchanged with film holder; image receptor; cassette holder; detector; film holder and compression paddle; image receptor; gantry; column; C-arm) in the mediolateral oblique view of the breast is critical to maximise the amount of breast tissue demonstrated. However, there is no standardisation within the literature to instruct radiographers on how best to determine the correct angle. Most radiographers are taught to ‘‘angle to the pectoral muscle’’. The result is that there is significant variation in the techniques used to select the angle of the bucky. This study set out to investigate the current practice of bucky angle selection in Australia. Method: Surveys were distributed to both BreastScreen Australia and private practice radiographers as a way of collecting a large data sample. Responses were grouped into three categories: sample profile, clinical practice and understanding. Following collation, thematic analysis was undertaken and descriptive statistics developed. Results: One hundred and sixty eight surveys were returned. Overall the study results demonstrate that Australian radiographers were aware of the importance of correct selection of the bucky angle to maximise image quality and breast cancer detection. However significant variations in current practice exist for the method of determination of the angle of the bucky for the mediolateral oblique view of the breast. Conclusion: Current practice for the selection of the angle of the bucky in Australia is varied and non-standardised. Variation in positioning techniques may lead to inconsistency in image quality and reproducibility and could ultimately compromise the diagnostic value of the images produced. Further research into the most appropriate method for the selection of the bucky angle needs to be undertaken to inform a standardised approach to bucky angle selection, to maximise the visualisation of breast tissue and the early detection of breast cancer

Communication during breast ultrasound, the reporting of differential diagnosis to patients by sonographers the Australian experience /

Introduction: With technological advancement sonographers work with increasing independence and expertise, forming intimate relationships and engaging in extended communication during breast ultrasound. However the nature and extent of any current communication is unknown. This study set out to examine sonographer’s attitudes, beliefs, fears and the constraints that determined the communication of differential diagnosis. Method: A survey was sent to a purposive sample of sonographers. Questions relating to demographics, experience and employment were included. Comments on communication, nonverbal cues, restraints, communication skills and fears of disclosure were asked. Following collation descriptive statistics were developed.Results: 82% of the surveys were returned. 89% of sonographers agreed patients were aware of non-verbal cues. 83% communicated normal and abnormal findings to the patient. 32% reported using cryptic language to answer patient’s questions. 65% worked in practices that placed no constraints on what or how much information was communicated. Fear of medico-legal issues and loss of credibility with medical practitioners rated highly as an influence in the decision to impart a differential diagnosis. Conclusion: The study demonstrated varied approaches to the provision of differential diagnosis during breast ultrasound. This study has provided evidence for the development of specific guidelines for sonographers wanting to impart differential diagnosis. The provisionof communication skills workshops to guide and provide strategies to deal with the emotional needs of the patient and sonographer when ‘‘bad news’’ is to be given is also recommended

Radiographers' decision‐making processes in the movement of pain‐afflicted adult trauma patients in planar diagnostic imaging

Abstract Introduction: The need to balance pain management and radiographic image quality is at the forefront of patient care in diagnostic radiography. This study aimed to identify the decision‐making that radiographers employ when undertaking planar diagnostic imaging for pain‐afflicted adult trauma patients and the factors that influence these decisions. Methods: A virtual focus group interview was undertaken with six experienced Australian radiographers using a realistic scenario and questions based on it. Thematic analysis was employed to explore how radiographers approached planar diagnostic imaging of trauma patients and what influenced decisions regarding patient movement. Results: Five key factors in radiographers' decision‐making were identified: assistance from the multidisciplinary team, understanding the patient, pain reduction methods, the patient being informed and radiographer competence. Radiographers were found to further utilise professional knowledge of image interpretation and anatomy and physiology, in conjunction with interpersonal capabilities, to undertake radiographic examinations. Conclusion: The decision‐making process that informs the movement of pain‐afflicted adult trauma patients is multifactorial, aligning with the broad healthcare principles of multidisciplinary teamwork, holistic management of the patient and professional knowledge and practice. Further research is needed to explore correlations with different patient groups to validate this research

Mammography : current practice in Australia for the selection of bucky angle in the mediolateral oblique view of the breast

Introduction: Due to the configuration of the breast and its variability between individuals, correct selection of the angle of the bucky (bucky may be interchanged with film holder; image receptor; cassette holder; detector; film holder and compression paddle; image receptor; gantry; column; C-arm) in the mediolateral oblique view of the breast is critical to maximise the amount of breast tissue demonstrated. However, there is no standardisation within the literature to instruct radiographers on how best to determine the correct angle. Most radiographers are taught to ‘‘angle to the pectoral muscle’’. The result is that there is significant variation in the techniques used to select the angle of the bucky. This study set out to investigate the current practice of bucky angle selection in Australia. Method: Surveys were distributed to both BreastScreen Australia and private practice radiographers as a way of collecting a large data sample. Responses were grouped into three categories: sample profile, clinical practice and understanding. Following collation, thematic analysis was undertaken and descriptive statistics developed. Results: One hundred and sixty eight surveys were returned. Overall the study results demonstrate that Australian radiographers were aware of the importance of correct selection of the bucky angle to maximise image quality and breast cancer detection. However significant variations in current practice exist for the method of determination of the angle of the bucky for the mediolateral oblique view of the breast. Conclusion: Current practice for the selection of the angle of the bucky in Australia is varied and non-standardised. Variation in positioning techniques may lead to inconsistency in image quality and reproducibility and could ultimately compromise the diagnostic value of the images produced. Further research into the most appropriate method for the selection of the bucky angle needs to be undertaken to inform a standardised approach to bucky angle selection, to maximise the visualisation of breast tissue and the early detection of breast cancer

Communication during breast ultrasound, the reporting of differential diagnosis to patients by sonographers : the Australian experience

Introduction: With technological advancement sonographers work with increasing independence and expertise, forming intimate relationships and engaging in extended communication during breast ultrasound. However the nature and extent of any current communication is unknown. This study set out to examine sonographer’s attitudes, beliefs, fears and the constraints that determined the communication of differential diagnosis. Method: A survey was sent to a purposive sample of sonographers. Questions relating to demographics, experience and employment were included. Comments on communication, nonverbal cues, restraints, communication skills and fears of disclosure were asked. Following collation descriptive statistics were developed.Results: 82% of the surveys were returned. 89% of sonographers agreed patients were aware of non-verbal cues. 83% communicated normal and abnormal findings to the patient. 32% reported using cryptic language to answer patient’s questions. 65% worked in practices that placed no constraints on what or how much information was communicated. Fear of medico-legal issues and loss of credibility with medical practitioners rated highly as an influence in the decision to impart a differential diagnosis. Conclusion: The study demonstrated varied approaches to the provision of differential diagnosis during breast ultrasound. This study has provided evidence for the development of specific guidelines for sonographers wanting to impart differential diagnosis. The provisionof communication skills workshops to guide and provide strategies to deal with the emotional needs of the patient and sonographer when ‘‘bad news’’ is to be given is also recommended

Evaluation of the pectoral muslce in mammography images : the Australian experience

Introduction: Critical to the success of early breast cancer detection is the consistent production of high quality mammographic images. Image evaluation systems are used to evaluate mammographic image quality and must be reliable and valid. This study set out to investigate radiographers’ perceptions of the current image evaluation systems such as the PGMI as well as their interpretation of criteria relating to the presentation of the pectoral muscle in the mediolateral oblique view. Method: A survey method was employed for this exploratory study as a way of collecting data from the largest possible sample. Surveys were distributed to radiographers employed in all different types of work in mammography. Following collation of responses descriptive statistics were developed. Thematic analysis was applied to the responses to the open-ended questions. Results: One hundred and sixty eight surveys were returned. The questionnaire responses were grouped into two categories: image evaluation systems and the presentation of the pectoral muscle. Overall the study results demonstrate variations in Australian radiographers’ practice when evaluating mammogram images. Conclusion: The study demonstrated worrying variations in the interpretation of criteria in current image evaluation systems. Inconsistent interpretation of criteria relating to the presentation of the pectoral muscle increases the risk of breast tissue not being included in the image. This study has provided evidence for the need for clearly defined criteria using objective measures so that the subjectivity of interpretation is minimised

Mammography image quality analysis of evaluation criteria using pectoral muscle presentation /

Purpose: To investigate the mammographic presentation of the pectoral muscle on the mediolateral oblique view of the breast and its relationship to current image evaluation criteria. Methods: A retrospective review of 100 paired mediolateral oblique mammograms performed on women undergoing routine mammographic screening with BreastScreen NSW South West, Australia was undertaken. Measurements of length, width, contour type and inferior angle of the pectoral muscle and of the relationship of its inferior aspect to the posterior nipple line and the nipple level were recorded. Results: A wide range of parameter values representing acceptable imaging were found to exist for each of the key imaging criteria. In 75.5% of images reviewed the inferior aspect of the pectoral muscle did not reach the level of the nipple, failing the quality criterion of the image evaluation systems used by the UK National Health Service Breast Screening Programme and the Australian BreastScreen Program. Conclusion: It is recommended that aspects of current image evaluation criteria relating to the presentation of the pectoral muscle should be modified to include quantified ranges to reduce inherent subjectivity and variability in interpretation. The criterion for the inferior aspect of the pectoral muscle to reach the level of the nipple should be reviewed by the national accreditation bodies

Mammography image quality : analysis of evaluation criteria using pectoral muscle presentation

Purpose: To investigate the mammographic presentation of the pectoral muscle on the mediolateral oblique view of the breast and its relationship to current image evaluation criteria. Methods: A retrospective review of 100 paired mediolateral oblique mammograms performed on women undergoing routine mammographic screening with BreastScreen NSW South West, Australia was undertaken. Measurements of length, width, contour type and inferior angle of the pectoral muscle and of the relationship of its inferior aspect to the posterior nipple line and the nipple level were recorded. Results: A wide range of parameter values representing acceptable imaging were found to exist for each of the key imaging criteria. In 75.5% of images reviewed the inferior aspect of the pectoral muscle did not reach the level of the nipple, failing the quality criterion of the image evaluation systems used by the UK National Health Service Breast Screening Programme and the Australian BreastScreen Program. Conclusion: It is recommended that aspects of current image evaluation criteria relating to the presentation of the pectoral muscle should be modified to include quantified ranges to reduce inherent subjectivity and variability in interpretation. The criterion for the inferior aspect of the pectoral muscle to reach the level of the nipple should be reviewed by the national accreditation bodies

Mammography : correlation of pectoral muscle width and the length in the mediolateral oblique view of the breast

Purpose: To investigate the relationship between the width and length of the pectoral muscle in the mediolateral oblique mammogram of the breast.Method: Mammograms reviewed for this study were performed on women undergoing routine mammographic screening with BreastScreen NSW South West, Australia. The study included a total of 2800 randomly selected mediolateral oblique mammograms from examinations taken between July 2004 and September 2006. Measurements of the width and length of the pectoral muscle were recorded.Results: No statistically significant difference was demonstrated between the mean values for right and left width (p = 0.5293) or length (p = 0.2079). Matched pair analysis demonstrated a statistically significant difference width, (p = 0.0069) and length, (p = 0.0369). No relationship could be demonstrated between the width and length of the pectoral muscle, (p = 0.0701).Conclusion: The inability to determine a relationship between the width and length of the ectoral muscle suggests that these criteria should be assessed independently of each other. This new understanding of the presentation of the pectoral muscle will enable clinically relevant redevelopment of current image evaluation systems to include statistically supported mean performance values. Further research is needed to explore the relationship of width and length to other key image evaluation criteria used in mammography image quality evaluatio