Why Choose Breast Radiology?
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- Sharlene May
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1 Why Choose Breast Radiology? Hannah Gay ST6, St George s Hospital BSBR exec committee trainee representative.
2 Introduction Breast cancer is the most common cancer in the UK. Lifetime risk of 1 in 8 for UK women In 2011, nearly women diagnosed and 11,700 deaths. In the UK financial year 09/10, NHSBSP diagnosed 16,500 cases. Incidence rates have increased by 72% since the mid 70 s. Survival rate have improved for last 40 years. Now 2/ 3 women will survive beyond 20 years and 80% survive beyond 5 years. Breast radiology is a rapidly expanding & advancing specialty that is well worth consideration when choosing subspecialty training.
3 Why trainees don t choose breast radiology If your training scheme is not a breast centre, limited exposure to subspecialty. Common misconceptions: Endless mammo reading in the dark and ultrasounding fibroadenomas. This talk will endeavour to dispel these myths!
4 Patient interaction Some miss patient contact when entering radiology. Breast radiology has a good balance between mammo reading/cross section/procedures and seeing patients in clinic. Screening assessment: whole consultation from history and examination to imaging, intervention and referral. Breaking bad news & reassuring those without cancer.
5 Team working Many subspecialities mainly present imaging findings at MDT. As breast radiologists are involved in diagnostic intervention and treatment of patients, they have a crucial MDT role in decision making as regards further management. Collaborative working: One stop clinics Double reporting
6 Performance security & continual feedback PERFORMS: Personal Performance in Mammographic Screening (Self assessment tool) A key issue is how to improve and maintain image interpretation skills. Anonymous and detailed feedback. Performance review in comparison to UK peers. Initially daunting but actually in the most part reassuring and provides key information as to areas for improvement. Triple assessment and one stop clinics gives ongoing feedback and allows continuous improvement performance. Double reporting
7 Multiple technological advancements Recent advances: Digital Breast Tomosynthesis (DBT) US Elastography Volumetric ultrasound Functional MR (DWI) PET Current research tools: Contrast enhanced mammography Breast CT MR elastography CAD
8 Eliminates overlapping structures and improves lesion visibility Digital images reconstructed into high resolution slices. DBT
9
10 2D 3D Courtesy of Ingvar Andersson
11 Functional MRI (DWI)
12 Self extraction Volumetric Ultrasound Data Set G.Rizzatto
13 Contrast enhanced mammography 2 techniques: Standard subtraction Dual energy
14 Elastography Images courtesy of Dominic Amy
15 Multimodality diagnostics and Mammography Ultrasound MRI FNA Aspiration 14G Core biopsy Wire localisations Vacuum Biopsy intervention
16 Vacuum biopsy
17 Treating patients Aspiration of abcesses/seromas etc Vacuum excision of benign lesions eg fibroadenomas, obviating need for GA and surgery. Future: VACE of Small Grade 1 cancers.
18 Flexible working practice Very little if no out of hours work. Many part time trainees. Work/life balance Flexibility within subspecialty clinical and research. Combines well with many other subpecialties/general radiology Consultant jobs available nationally: Demands and work load increasing Impending retirements (national screening programme started in 1988).
19 Summary A more diverse specialty than meets the eye. Rapidly advancing technology Patient interaction Multimodality diagnostics & intervention Patient treatment Regular performance feedback Flexible working and jobs available. BSBR welcomes trainees members. We are a small and friendly community!
20 Questions
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