Measurement of force applied during mammography

Article Abstract:

Mammography, the X-raying of the breasts, can be a painful process. A number of factors can contribute to experiencing pain during mammography. Application of force or compression of the breasts during the procedure is one major factor that affects how much discomfort or pain is felt. Some compression is needed in order to obtain high quality images. There are set standards on the maximal amount of force that may be applied during mammography, but there is little information on how much force is actually needed and how the amount of force applied relates to patient discomfort. To evaluate these issues, women undergoing mammography were asked to fill out a questionnaire asking about discomfort they felt during the procedure and personal data. The maximum amount of force applied during each procedure was recorded as was the breast thickness of each patient. The amount of force applied ranged from 49 to 186.2 N and breast thickness ranged from 10 to 88 mm. Of the 560 women who responded to the questionnaire, 47 (8 percent) reported the procedure was painful. There was a significant correlation between how much force was applied and breast thickness. The likelihood of pain was significantly correlated to the ratio of force to thickness with a greater likelihood of pain as the ratio increased. The average maximal force applied in this study was 127.4 N, well below the maximal limits usually suggested. Most images obtained were of a high-quality. The results indicated that excessive force used during mammography is both unnecessary in obtaining high-quality images and can cause great discomfort to patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Rate of compliance with recommendations for additional mammographic views and biopsies

Article Abstract:

Abnormal or unclear results of a mammogram require that the patient be quickly and clearly informed so she will return for further evaluation. Radiologists are usually responsible for informing the patient or her physician. This study examined the compliance rate of patients who were recommended to undergo further evaluations because of abnormal mammographic findings. Notification of the abnormal findings consisted of calling the patient directly, usually within 24 hours of finding the abnormality, and scheduling a follow-up exam along with sending a written report to the patient's physician. If a biopsy was recommended, it was discussed with the physician directly. Of 5,693 mammographic studies performed during this study, additional imaging examinations were recommended for 364 patients (6.4 percent) and biopsies were recommended for 180 patients (3.2 percent). All but one of the 364 women recommended for additional imaging examinations did so, with 98.4 percent having them performed within 30 days of notification. Of the 180 patients who were recommended to undergo biopsies, 165 (91.7 percent) did so within 30 days of being notified and by the end of the study period, 178 patients (98.9 percent) had undergone follow-up examinations. Cancer was diagnosed in 44 of the 173 patients (25.4 percent) who were biopsied. The results indicate that excellent compliance can be obtained by directly contacting the patient, by sending a written report to the patient's physician, and by scheduling a follow-up examination within 30 days of notification. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Calendar, Periodic health examinations

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Mammographic compression: science or art?

Article Abstract:

To obtain good images with mammography, some compression of the breasts is required. Unfortunately, too much compression can be quite painful. In the November 1991 issue of Radiology, Sullivan et al. report on the relationship between applied force and pain caused by mammography. They attempt to define a maximum allowable force that should not be exceeded during mammography. The problem with a study of this type is that it tries to quantify and put into scientific terms something that is more complex. Although the imaging technique itself is science, patient placement and use of compression during mammography is more of an art. The amount of compression to use cannot be derived from a formula, but must be determined for each patient based on a number of factors specific to that patient. The amount of compression that should be used is that which is appropriate for the patient at that time. Deciding what amount of compression is appropriate involves considering a number of factors. Whether or not the patient is aware that compression is required and knows why it is required is one important factor. Whether the patient has sensitive breasts is another important factor. Reactions to prior mammography and quality of the images obtained from earlier exposures are also important factors. The patient's psychological state during mammography is something that should be taken into consideration. These and other factors should be weighed when performing mammography. The goal should be to have both quality images and happy patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial

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