Increasing Access to Mammography Services for Women with Disabilities Perfecting your Mammography Positioning

Transcription

1 Increasing Access to Mammography Services for Women with Disabilities Perfecting your Mammography Positioning 1 2 1

2 Objectives: Setting the Tone/Exam Preparation Positioning Exam Completion Safety Factors for Success Discussion/Q&A 3 Setting the Tone Two ways of looking Disabled women Women with disabilities 4 2

3 Setting the Tone Comfort, inclusion, teamwork Use of previous knowledge and experience 5 Setting the Tone Using People First languagewatch for non-verbal Preparing supplies on hand, systems in place ( P&P) 6 3

4 Supports Foam sponges/wedges, pillows, linens Padded velcro straps, tape (with permission)( non latex) Helpers: Attendant, caregiver, another technologist Humor Good Attitude 7 8 4

5 9 Setting the Tone Our goals: Obtain the best image by maximizing tissue visualization Create an atmosphere of trust Provide a good experience Promote serial mammography 10 5

6 Exam Preparations Ask for direction Listen Provide assistance as needed (don t over assist) Discuss physical changes Discuss previous experience-what worked and what did not If age appropriate, ask if she s pregnant 11 Exam Preparations After assessing the situation do you need another technologist, care provider or aide to assist? need any supports? Encourage communication and input Most members do well in their chair 12 6

7 Exam Preparations Not all wheelchairs are the same Remove wheelchair arms and foot pedals (after asking & when possible) Get machine foot pedals out of the way Beware of position of hips, for diverse anatomy Use supports to move thorax forward Remember- lock wheels, buttons out of the way, and turn off chair 13 Reasons for Alternate Views Very limited upper body range of motion Wheelchair arms not removable Stiff neck Kyphosis Body habitus Woman s abilities 14 7

8 Positioning for Cranio Caudal View Consider using a mammography positioning chair Use cushions, pillows or anything soft To provide client support To position client To move thorax forward Remove face shield, if needed Assess body habitus to maximize tissue visualization 15 We know what to look for on the finished image how do we get there 16 8

9 17 Positioning Using Scientific Landmarks When positioning the patient for any view keep in mind you need to position the whole body not just the breast. To reduce the number of adjustments you make start with having the patient face the unit. Feet forward, hips forward, shoulders squared off, then walk them up to the unit only turning the head for CC views and raising the arm for LMO views. 18 9

10 Alternatives to CC View Cleavage (CV) Exaggerated CC (XCCL) Document- Document- Document 19 We know what to look for on the finished image how do we get there 20 10

11 21 Positioning Using Scientific Landmarks Visualize the chest without the skin or breast tissue. When the arm is lifted to the level of the shoulder the pectoral muscle at the insert will allow you to see what degree of angulations your MLO should be in. Not all patients are 45º. We have a naturally built in protractor (see image above). Our thumb and index finger make the prefect 90º angle. When you place that just below the pit of the patients arm you can see the angle of obliquity. Protractor 22 11

12 Use your own hand on the diagram above. You will clearly see this patient should not be positioned at 45º but more like 55º. Patients might gain or loss weight over time, they might sag or get plastic surgery or use a wheelchair however, the muscle attachment will not change. Each of us have our own very unique degree of angulations. 23 Positioning Mediolateral Oblique View - MLO If needed, use supports Determine degree of obliquity Position axilla into corner of imaging receptor, taking care to prevent arm or shoulder injury Explore the possibility of significant other or attendant holding client in position 24 12

13 Alternatives to MLO Reverse oblique, LMO shallow angle +/- 40 o 45 o SIO - Supero-lateral to inferomedial Oblique (SL-IM) or IM-SL If axilla position is not possible, do 90 o ML, LM, 25 Reverse oblique, LMO shallow angle +/- 40 o Best visualize: Replacement view for MLO Nonconforming clients 26 13

14 90 o ML, LM o SIO - Supero-lateral to inferomedial Oblique (SL-IM) Best visualize: Upper-inner UIQ Lower-outer quadrants of breast LOQ 28 14

15 Infero-Medial Supero-Lateral Oblique (IMSL) Imitates SIO, allowing access to inferior aspect Useful in stereotactic positioning & needle localization

16 Before You Give Up Consider decubitus position with gurney Client transfer Reschedule to longer appt. time Resources in place; add l staff, equip (lift), larger exam room 31 Exam Completion Does client need assistance to reposition or dress? Offer assistance as needed, don t assume Correct/ replace all changes made to wheel chair- e.g. arm rests and safety belts - Ask for directions When possible, allow client to change in exam room Need to leave room? Is she safe in the room alone? 32 16

17 Exam Completion Inform how results are communicated Discuss with client if follow-up care is needed Set times in presence of client 33 Safety for the Technologist Preparation, preparation, preparation a. Obtain as much info prior to appt. b. Have ready made supply kit in each room- towels, foam wedges, velcro strips etc.. c. Partner/communicate with client- let her help- do not over assist d. Spend several minutes for initial assessment (again-most clients do well in their chair) 34 17

18 Safety for the Technologist Team Up-consider Dep t policy Ergonomics/Body Mechanics (use and move feet) Watch your back, neck, & knees Conserve energy 35 Safety for the Technologist Practical Tips Consider using a stool- adjustable, e.g. saddle type Use light weight sturdy yoga block to get on your knees and to get back up! Have other technologists or appropriate care provider/ aide to assist 36 18

19 Critical Success Factors Promote realistic schedule Encourage preparation ahead of time- all staff Maximize tissue visualization- may need to team up 37 Critical Success Factors Watch verbal and nonverbal language When primary views cannot be done, do the next best option. Use your experience and knowledgebe creative 38 19

20 Critical Success Factors Client is the expert in her abilities- ask for feedback Active participation and partnership between technologist and client Atmosphere of comfort and inclusion = return visits Document techniques that work 39 Q & A & Discussion Past experience New ideas Think outside the box Be creative Use critical thinking skills 40 20

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