Disclosure. Objectives 2/6/ Allina Health System. What Every Technologist Would Like Their Radiologists To Know

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1 What Every Technologist Would Like Their Radiologists To Know Louise C. Miller, RTRM Director of Education Mammography 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

2 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 About our patients About our images About our job OUR PATIENTS

3 You can t always get what you want. Mick Jagger OUR PATIENTS PHYSICAL CHALLENGES PSYCHOLGICAL CHALLENGES

4 Physical Challenges 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 IT S NOT THAT EASY

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6 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.

7 Psychological Challenges Personality styles Friendly Neutral Crabby Rude Condescending Flat out mean Psychological Challenges State at the time of the exam Previous experience COMPASSION AND EMPATHY

8 DO YOUR BEST WHAT EVERY TECHNOLOGIST WOULD LIKE TO KNOW ABOUT OUR IMAGES Every image should look like an ACR image????????

9 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!!

10 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

11 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

12 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

13 THE HOW INITIAL TRAINING ACR ASRT TABAR A LITTLE BIT OF THIS A LITTLE BIT OF THAT Handbook of Mammography

14 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.

15 So the problem is: NO STANDARDIZATION OF TRAINING OR FOLLOW THROUGH WHICH MEANS LESS CONSISTENCY AND 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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17 Clinical Image Criteria * NO DATA PUBLISHED ON DIGITAL OR TOMO * DATA ON F/S PUBLISHED IN 1993

18 Clinical Criteria Mammographic Positioning: Evaluation from the View Box Bassett LW, Hibawi IA, DeBruhl N, Hayes MK Radiology; : 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

19 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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21 SKIN FOLDS - FAT FOLDS

22 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

23 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?

24 STANDARDIZED TRAINING Northwestern University 2012 After standardized training showed a 50% reduction in TCBs No published study cm cm cm cm

25 Previous Current Previous Current cm cm

26 cm cm Current Previous Previous Current

27 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 Bassett Training Training 1993 IMF visualized 84 % 64 % 49 % Skin/fat folds present Nipple in profile Pec muscle down to PNL *Data not published

28 CC Criteria* Standardized Misc Bassett Training Training 1993 Cleavage visualized 44 % 35 % n/a % Skin/fat folds present Pec muscle visualized Nipple in profile Missing lateral glandular tissue * Data not published 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

29 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

30 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

31 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

32 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

33 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.

34 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 Mammography Positioning Guidebook TO CONTACT ME: Louise C. Miller, RTRM Website: lcmrtrm@aol.com Phone: (619)