Sarah Naylor

A study to find the optimal orientation of the breast for the cranio caudal view, for screening purposes

AIM It is generally accepted that the cranio-caudal (CC) view cannot image the whole breast. The aim of this study was to investigate whether emphasis should be put on imaging the medial or lateral aspect of the breast when performing the CC view. METHOD The mammograms of all cancers arising within a screened population were reviewed. These included 120 screen detected cancers and 41 interval cancers. Two mammographers individually assessed the CC view to ascertain if the cancer would have been excluded from the film if the patient had been rotated to emphasis the medial or lateral aspect of the breast. A radiologist acted as arbitrator in cases of discordance. RESULTS No cancers were excluded from the reviewed images, however five would be excluded by 5 degrees lateral rotation and eight by 10 degrees lateral rotation. Four would be excluded by 5 degrees medial rotation and two by 10 degrees medial rotation. CONCLUSION The optimal position of the breast for the CC view is with the breast straight, i.e. with the nipple pointing towards the edge of the film. More cancers would have been missed off the film if over emphasis had been given to imaging either the medial or lateral aspect of the breast.

Breast compression techniques in screening mammography – A Maltese evaluation project

INTRODUCTION In screening mammography, the radiographer should be responsible for providing mammograms of high diagnostic value, possibly without subjecting clients to a painful experience. This skill is demonstrated via the technique of breast compression and is explored in this study by analysing insights about methods and underlying principles in regards to this procedure. METHODS One-to-one semi-structured interviews were conducted with radiographers who perform screening mammography in Malta. For data analysis, a descriptive phenomenological approach following a simplified version of Hycners (1985) method was adopted. RESULTS Five general themes were extracted from the data; meeting the client, preparing the client, the mammography procedure, pain from compression and client turnout. It was determined that the participants alter their breast compression technique according to the client rather than following a rigid step-by-step process and that explanation and requesting client feedback are essential to obtain cooperation. Additionally, mammography positioning and compression application are tailored in a way that encourage compliance, however not at the expense of degrading image quality. Ultimately, it is also believed that a proper breast compression technique positively influences client turnout. CONCLUSION The results of this study demonstrate that radiographers should be flexible in their approach in order to carry out a successful breast compression technique. However, it has also been shown that such effectiveness in practice is gained from experience rather than initial training. If exposed to this studys findings, new mammographers would be able to form a robust core of knowledge before embarking on the challenging specialisation of mammography.

Diagnostic Radiographers working in the operating theatre: an action research project

INTRODUCTION Failures in interprofessional communication are well-documented and are an established cause of medical error and negative health outcomes. Socio-historical issues like imbalances in power and status are particularly prevalent in the operating theatre environment, adding complications to interprofessional working. Simulation, used in healthcare education, may impact positively on interprofessional working. METHODS The aim of this action research study was to develop, pilot and run a simulation experience for Diagnostic Radiography (DRAD) students. Action research was used to structure this study. The first phase of the action research was to look at the problem; this was undertaken using critical incident technique. Findings from the critical incident technique influenced the simulation event. A focus group was held immediately after the event for reflection. A second simulation using a cohort of 48 students and a reflection after a period of three months formed the second round of the project. The simulation took place in a hi-fidelity simulated operating theatre. Thematic content analysis was undertaken of the focus group, data from the critical incident technique, and the reflections. RESULTS The findings are discussed under the themes; identification, clarity, preparation, and the expert. Identification and lack of clarity in communication were seen as an important issue in the operating theatre. Lack of preparation of the working environment was also highlighted. Lack of confidence in the operating theatre inhibits interprofessional working. CONCLUSION Simulation can help prepare students for working in the operating theatre. Realism is important as is scheduling the event to ensure maximum benefit.