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2/6/2016

©2016Allina Health System

What Every Technologist Would Like Their Radiologists To Know__________________________

Louise C. Miller, RTRMDirector of EducationMammography Educators – San Diego, CA

February 6, 2016

Disclosure

There are no conflicts of interest or relevant financial interests in making this presentation and have indicated that my presentation does not include discussion of an unlabeled use of a commercial product, or an investigational use not yet approved for any purpose.

Objectives

Define common issues technologists encounter in their role as mammographers

Describe how lack of communication and knowledge may influence expectations and performance

State methods for overcoming barriers and improving quality of care

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The Member Newsletter of the Society of Breast Imaging

Fall 2011 – Winter & Spring 2012

“What Every Technologist Would Like Their Radiologist to Know About:

Our Patients

Image Quality

The Role of the Technologist

www.SBI-online.org

About our patients

About our images

About our job

OUR PATIENTS

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You can’t always get what you want….

Mick Jagger

OUR PATIENTS

PHYSICAL CHALLENGES

PSYCHOLGICAL CHALLENGES

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Patient height Patient weight Breast size Breast shape Congenital abnormalities Mobility issues Limited ROM Instability “Extras” (pacemakers, portacath, recent surgery) Implants Overly medicated Developmentally disabled Partial or full paralysis Location of nipple

Physical Challenges

IT’S NOT THAT EASY

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Patient Stability

Document, document, document

Use appropriate terminology

Keep it brief and concise

Mammo Combo

Patient confined to wheelchair with O2, could not stand. Limited ROM due to bilateral frozen shoulders and contracture. Kyphotic with prominent abdomen. Patient was disoriented and unable to cooperate or tolerate proper positioning and compression. Limited exam done.

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Psychological Challenges

Personality styles

FriendlyNeutralCrabbyRudeCondescendingFlat out mean

Psychological Challenges

State at the time of the exam

Previous experience

COMPASSION AND EMPATHY

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DO YOUR BEST

ABOUT OUR IMAGES

WHAT EVERY TECHNOLOGIST WOULD LIKE TO KNOW

“Every image should look like an ACR image”

????????

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The problem is:

Variability of patient body habitus

Patient anxiety

Everyone positions differently

Lack of consistency and reproducibility

The problem is:

Variability of patient body habitus

Patient anxiety

Everyone positions differently

Lack of consistency and reproducibility

THIS IS CONTRARY TO THE PRINCIPLES OF GENERAL

RADIOLODY!!

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SCIENCE FIRST!!

General X-ray Positioning Based on knowledge of anatomy and physiology

Based on identifying and using visible and palpable anatomical landmarks

Clinical competency testing

* Sequence

* Positioning technique

- X-ray machine

Tube, IR, cassette

- Patient

- Anatomical part

* Clinical image analysis – Correlational anatomy

Mammography Positioning

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Mammography Positioning Based on knowledge of anatomy and physiology

Based on identifying and using visible and palpable anatomical landmarks

Clinical competency testing

* Sequence

* Positioning technique

- X-ray machine

Tube, IR, cassette

- Patient

- Anatomical part

* Clinical image analysis – Correlational anatomy

No Standards for Mammography Positioning

There are standards for WHAT are images should look like….but not HOW you get to that point!

Quality Standards for Mammography

MQSA

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MQSA

Equipment standards

Personnel qualifications

On going monitoring of equipment and clinical images

Initial Training and CEUs for technologists

40 hours

8 hours in specialized modalities

15 credits every three years

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THE HOW INITIAL TRAINING

ACR

ASRT

TABAR

A LITTLE BIT OF THIS

A LITTLE BIT OF THAT

Handbook of Mammography

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So here we are…….30 years later doing what??

What’s changed?

Equipment changes

Scheduling changes

Average age of mammographers

More repeats/rejects and TCB

Increased and often unnecessary increased radiation.

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So the problem is:

NO STANDARDIZATION OF TRAINING OR FOLLOW THROUGH

WHICH MEANS LESS CONSISTENCYAND MORE RETAKES

MORE ACR FAILURES

MISSED BREAST CANCERS???

INCREASED EXPOSURE

POSITIONING TECHNIQUES

BASED ON ERGONOMIC PRINICPLES

MORE EFFICIENT

MORE PROFICIENT

CONSISTENT

REPRODUCABLE

Consistency Reproducibility

Ergonomics

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Clinical Image Criteria

* NO DATA PUBLISHED ON DIGITAL OR TOMO

* DATA ON F/S PUBLISHED IN 1993

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Clinical Criteria

Mammographic Positioning:

Evaluation from the View Box

Bassett LW, Hibawi IA,

DeBruhl N, Hayes MK

Radiology; 1993 188:803-806

After standardized positioning training there was an overall improvement seen on 68%

of their images

Yet all criteria was only met 64% of the time

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“Issues”

Skin folds

Fat folds

Motion

FS vs Digital

Increase in repeats for motion

Increase in visualization of skin folds

Motion Artifact

* Utilizing breathing technique

* Most prevalent on LMLO and LCC views

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SKIN FOLDS - FAT FOLDS

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And there are more “issues” that are almost impossible to overcome and result in only about 80% of our images meeting “acceptable” criteria.

“Issues”

Patient physical condition

Patient personality

Patient’s breast

Issue at time of the exam

Others

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Even more so….why we need consistency and reproducibility

• Create and maintain quality

• Reduce repeats/rejects/call backs (TCB)

• Facilitate comparison to previous studies

• Provides standardization for future trainings

• Decreases probability of accreditation failure

• Economics

How about difficult patients??

I’m too short??

The patient is too big??

I don’t want to get that close to the patient

Does standardized training really work?

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STANDARDIZED TRAINING

Northwestern University 2012

After standardized training showed a 50% reduction in TCBs

No published study

2011 – 13.1 cm 2013- 16.6 cm

2011- 14.8 cm 2013- 16.8 cm

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Previous Current

Previous Current

2011- 17.1 cm 2013- 18.1 cm

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2012 - 13.1 cm 2013 -13.2 cm

Current Previous

Previous Current

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Preliminary data regarding the use of standardized

positioning techniques are impressive!

Does TTT program help improve the quality of images taken by participating mammography technologists?

MLO Criteria*

Standardized Misc BassettTraining Training 1993

IMF visualized 84 % 64 % 49 %

Skin/fat folds present 58 58 15

Nipple in profile 94 92 88

Pec muscle down to PNL 87 79 81

*Data not published

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Standardized Misc BassettTraining Training 1993

Cleavage visualized 44 % 35 % n/a %

Skin/fat folds present 34 26 10

Pec muscle visualized 17 6 32

Nipple in profile 96 96 89

Missing lateral glandular tissue 50 57 63

* Data not published

CC Criteria*

Digital compared to FS*

Visualization of pec muscle on CC -15 %

Skin/fat folds on CC +14

Skin/fat folds on MLO +43

Visualization of IMF +35

Pec muscle down to PNL + 6

*Data not published

Other Considerations

No current date on motion or related call backs

Method for recording repeat/rejects

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Suggestions for improvement

Establish a QIP Program which evaluates techniques and images (quarterly)

Self or peer assessment (monthly)

Ongoing feedback as needed

Establish criteria for repeat/rejects

Data collection and regular feedback….positive and otherwise

For ongoing success

Support and feedback

Supervisor/ Lead Technologist

Radiologist

Peers

Room for improvement

Working together in a collaborate, cooperative and supportive environment that focuses on positive changes and mutual ongoing efforts and commitment to quality improvement

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Quality of Care is one of THE most important

factor in saving lives

DO YOUR BEST!!

What Every Technologist Would Like Their Radiologist to Know About

Our Role as Technologists

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Our Role As Technologists

Medical professional

Breast “expert”

Confidant

BFF

Therapist

Acrobat

Super girl

Computer expert

Our Role as Technologists

Lack of support

Lack of feedback

Radiologists

Managers

Coworkers

Lack of Support

No educational dollars

No onsite training

Little feedback for improving images

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Radiologists

Communication skills

Attitude

Work habits

Feedback

Inappropriate behavior

Lack of positive feedback

What ever happens to your patients????

Bosses/Managers

Communication skills

Attitude

Work habits

Feedback

Inappropriate behavior

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Coworkers

Differences in

Personalities

Work habits

Work ethics

Attitude

Empathy and compassion

Motivation

Solutions for Success

Improve communications

Develop consistent policy and procedures with clear

direction and expectations

Be open to new ideas and ways of doing things

Give more POSITIVE feedback

Respect each other

Be kind.

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References

* Miller, Louise C. What Every Technologist Would Like Their Radiologist to Know; The Member Newsletter of the Society of Breast Imaging: Fall 2011, Winter - Spring 2012

* The Member Newsletter of the Society of Breast Imaging:

• The Member Newsletter of the Society of Breast Imaging:

* Miller, Louise C. 2015 Mammography Positioning Guidebook

TO CONTACT ME:

Louise C. Miller, RTRM

Website: www.mammmographyeducators.com

email: [email protected]

Phone: (619) 787-2293

10-whateverytech-miller · partial or full paralysis ... email: [email protected] phone: (619)...

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