scholarly journals Self-reported Pain Associated With Screening With Digital Breast Tomosynthesis

2020 ◽  
Author(s):  
Nataliia Moshina ◽  
Anders Skyrud Danielsen ◽  
Åsne Sørlien Hølen ◽  
Berit Hanestad ◽  
Elisabeth Stephansen ◽  
...  
Keyword(s):  
Pain Score ◽  
Rating Scale ◽  
Digital Breast Tomosynthesis ◽  
Ordinary Least Squares ◽  
Least Squares Regression ◽  
Compression Force ◽  
Compression Pressure ◽  
Breast Tomosynthesis ◽  
The Mean ◽  
Breast Thickness

Abstract Objective We aimed to investigate self-reported pain during screening with digital breast tomosynthesis (DBT). Methods The study was approved by the Regional Committee for Medical and Health Research Ethics in the South East of Norway (2015/424). Women completed a questionnaire about experienced pain directly after the examination, August–November 2019. A numeric rating scale (NRS, 0–10) was used. Data on compression force (N), pressure (kPa), and compressed breast thickness (mm) were obtained from the Digital Imaging and Communication in Medicine header and density assessment software. Stepwise ordinary least-squares regression was used to estimate mean self-reported pain score with 95% confidence interval (CI) for values of compression force, pressure, and compressed breast thickness. Results The mean pain score was 1.9, whereof 19.3% (822/4266) of the women reported moderate or severe pain. The mean pain score of 2.6 (95% CI: 2.4–2.7) was observed at a compression force of 60 N, decreasing to 1.3 (95% CI: 1.2–1.4) at 130 N. The mean pain score of 1.3 (95% CI: 1.1–1.4) was at a compression pressure of 6 kPa, increasing to 2.9 (95% CI: 2.7–3.1) at 16 kPa. The mean pain score was 0.6 (95% CI: 0.4–0.6) at a compressed breast thickness of 20 mm, increasing to 2.9 (95% CI: 2.7–3.1) at 90 mm. Conclusion The mean pain score was low, 1.9 on NRS, for women screened with DBT. A compression force of 60–130 N and a pressure 6–16 kPa were associated with no or mild pain.

Visualization of the Nipple in Profile: Does It Really Affect Selected Outcomes in Organized Mammographic Screening?

2021 ◽  
Author(s):  
Åsne S Holen ◽  
Marthe Larsen ◽  
Nataliia Moshina ◽  
Gunvor G Wåade ◽  
Ioannis Sechopoulos ◽  
...  
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Mammographic Screening ◽  
Descriptive Statistics ◽  
Breast Volume ◽  
Compression Force ◽  
Compression Pressure ◽  
Breast Tomosynthesis ◽  
Screening Technique ◽  
Study Results ◽  
Screening Mammograms

Abstract Objective To investigate whether having the nipple imaged in profile was associated with breast characteristics or compression parameters, and whether it affected selected outcomes in screening with standard digital mammography or digital breast tomosynthesis. Methods In this IRB-approved retrospective study, results from 87 450 examinations (174 900 breasts) performed as part of BreastScreen Norway, 2016–2019, were compared by nipple in profile status and screening technique using descriptive statistics and generalized estimating equations. Unadjusted and adjusted odds ratios with 95% confidence intervals (95% CIs) were estimated for outcomes of interest, including age, breast volume, volumetric breast density, and compression force as covariates. Results Achieving the nipple in profile versus not in profile was associated with lower breast volume (845.1 cm3 versus 1059.9 cm3, P < 0.01) and higher mammographic density (5.6% versus 4.4%, P < 0.01). Lower compression force and higher compression pressure were applied to breasts with the nipple in profile (106.6 N and 11.5 kPa) compared to the nipple not in profile (110.8 N and 10.5 kPa, P < 0.01 for both). The adjusted odds ratio was 0.95 (95% CI: 0.88–1.02; P = 0.15) for recall and 0.92 (95% CI: 0.77–1.10; P = 0.36) for screen-detected cancer for nipple in profile versus not in profile. Conclusion Breast characteristics and compression parameters might hamper imaging of the nipple in profile. However, whether the nipple was in profile or not on the screening mammograms did not influence the odds of recall or screen-detected cancer, regardless of screening technique.

scholarly journals Pressure-based Compression Guidance of the Breast in Digital Breast Tomosynthesis Using Flexible Paddles Compared to Conventional Compression

2020 ◽  
Vol 2 (6) ◽  
pp. 541-551
Author(s):  
Monique G J T B van Lier ◽  
Jerry E de Groot ◽  
Serge Muller ◽  
Gerard J den Heeten ◽  
Kathy J Schilling
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Control Device ◽  
Institutional Review Board ◽  
Target Range ◽  
Compression Pressure ◽  
Breast Tomosynthesis ◽  
Breast Compression ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Breast Thickness

Abstract Objective We investigated the effect of introducing a pressure-based flexible paddle on compression parameters and user and patient experience of digital breast tomosynthesis (DBT) combined with patient-assisted compression or technologist compression. Methods After institutional review board approval, women with a DBT appointment who gave informed consent received pressure-based flexible paddle breast compression. Eight lights on the paddle were illuminated (1.9 kPa per light) as pressure was applied, aiming for an 8–13.9 kPa target range. The compression level was applied by the technologist or the participant utilizing a remote control device. The participant’s and technologist’s experiences were assessed by a questionnaire. Compression parameters were compared to previous examinations. Comparative statistics were performed using t-tests. Results Pressure-based compression (PBC) was judged to be similar or more comfortable compared with previous traditional exams (80%, 83/103), and 87% (90/103) of participants would recommend PBC to friends. Pressure variability decreased for craniocaudal (CC) views (-55%, P < 0.001) and mediolateral oblique (MLO) views (-34%, P < 0.0001). Subgroup analysis showed a similar glandular dose for CC views, while breast thickness was reduced (-3.74 mm, P < 0.0001). For MLO views, both glandular dose (-0.13 mGy, P < 0.0001) and breast thickness were reduced (-6.70 mm, P < 0.0001). Mean compression parameters were similar for technologist compression and patient-assisted examinations. Conclusion Use of the pressure-based flexible paddle in DBT, with or without patient-assisted compression, improved participant and technologist experience and reduced compression pressure variability, mean breast thickness, and glandular dose.

Breast compression parameters among women screened with standard digital mammography and digital breast tomosynthesis in a randomized controlled trial

2019 ◽  
Vol 61 (3) ◽  
pp. 321-330 ◽  
Author(s):  
Gunvor Gipling Waade ◽  
Åsne Holen ◽  
Sofie Sebuødegård ◽  
Hildegunn Aase ◽  
Kristin Pedersen ◽  
...  
Keyword(s):  
Digital Mammography ◽  
Controlled Trial ◽  
Digital Breast Tomosynthesis ◽  
Compression Pressure ◽  
Breast Tomosynthesis ◽  
Breast Compression ◽  
Randomized Controlled ◽  
Mean Glandular Dose ◽  
Evidence Based Guidelines ◽  
Breast Thickness

Background No evidence-based guidelines regarding optimal breast compression in mammography exist, neither for standard digital mammography nor for digital breast tomosynthesis. Purpose To compare breast compression parameters and mean glandular dose in a randomized controlled trial with digital mammography versus digital breast tomosynthesis. Material and Methods We used information from 21,729 women aged 50–69 years, who participated in the To-Be trial, as part of BreastScreen Norway, 2016–2017. Information was obtained from the DICOM header and by assessing the images in an automated software for density estimation (VolparaDensity). Using linear regression, we investigated the effect of screening technique on breast compression parameters; compression force (N), compression pressure (kPa), and compressed breast thickness (mm), and mean glandular dose (mGy), by view (craniocaudal [CC] and mediolateral oblique [MLO]). We adjusted for age, breast volume and fibroglandular volume. Results A total of 11,056 (50.9%) women were screened with digital mammography and 10,673 (49.1%) with digital breast tomosynthesis. Adjusted regression analysis showed that women undergoing digital mammography received higher compression forces than women undergoing digital breast tomosynthesis (CC: –4.7 N; MLO: –1.1 N, P < 0.001 for both), higher compression pressure (CC: –1.0 k Pa; MLO: –0.1 kPa, P < 0.001 for both), and higher values of compressed breast thickness in the MLO view (–0.3 mm, P = 0.02). The women undergoing digital mammography received a lower mean glandular dose than women undergoing digital breast tomosynthesis ([+]0.06 mGy, P < 0.001). Conclusion Women undergoing digital breast tomosynthesis received lower compression force, compression pressure, and compressed breast thickness in MLO view, compared to women undergoing digital mammography. Further studies should investigate the impact of breast compression on image quality, screening outcome, and radiation dose for digital mammography and digital breast tomosynthesis in order to establish evidence-based guidelines for breast compression.

scholarly journals Intravenous versus oral paracetamol in a UK ambulance service: a case control study

2020 ◽  
Vol 5 (1) ◽  
pp. 1-6
Author(s):  
Karl Charlton ◽  
Matthew Limmer ◽  
Hayley Moore
Keyword(s):  
Pain Score ◽  
Acute Pain ◽  
Rating Scale ◽  
Hospital Setting ◽  
Numeric Rating Scale ◽  
Time Period ◽  
Intravenous Paracetamol ◽  
Common Causes ◽  
The Mean ◽  
Clinically Significant

Objectives: To determine the effectiveness of intravenous versus oral paracetamol (acetaminophen) in the management of acute pain in the out-of-hospital setting.Methods: We extracted ambulance electronic patient care records for all patients who received 1 g intravenous paracetamol throughout January 2019, and case matched these by sex and age with consecutive patients who received 1 g oral paracetamol over the same time period. Eligible for inclusion were all patients aged ≥ 18 who received 1 g paracetamol for acute pain and who were transported to the emergency department (ED). The primary outcome was the mean reduction in pain score using the numeric rating scale (NRS), with a reduction of 2 or more accepted as clinically significant.Results: 80 care records were eligible for analysis; 40 patients received intravenous and 40 patients received oral paracetamol. The mean age of both groups was 54 years (± 3 years) and 67.5% (n = 54) were female. Patients receiving intravenous paracetamol had a clinically significant mean (SD) improved pain score compared to those receiving oral paracetamol, 2.02 (1.64) versus 0.75 (1.76), respectively [p = 0.0013]. 13/40 (32.5%) patients who received intravenous paracetamol saw an improved pain score of ≥ 2 compared to 8/40 (20%) who received oral paracetamol. No patients received additional analgesia or reported any adverse symptoms. Abdominal pain, infection and trauma were the most common causes of pain in both groups.Conclusion: Our study suggests that intravenous paracetamol is more effective than oral paracetamol when managing acute pain in the out-of-hospital setting. Our findings support further investigation of the role of paracetamol in paramedic practice using more robust methods.

scholarly journals Average Absorbed Breast Dose (2ABD) to Mean Glandular Dose (MGD) Conversion Function for Digital Breast Tomosynthesis: A New Approach

2021 ◽  
pp. 183-191
Author(s):  
‪Raffaele M Tucciariello ◽  
Rocco Lamastra ◽  
Patrizio Barca ◽  
Marine Evelina Fantacci ◽  
Antonio C Traino
Keyword(s):  
Monte Carlo ◽  
Digital Breast Tomosynthesis ◽  
Dose Assessment ◽  
Conversion Function ◽  
Breast Tomosynthesis ◽  
New Approach ◽  
Mean Glandular Dose ◽  
The Mean ◽  
Good Agreement ◽  
Dosimetric Index

Background: In this work a new method for the Mean Glandular Dose evaluation in digital breast tomosynthesis (DBT) is presented. Methods: Starting from the experimental-based dosimetric index, 2ABD, which represents the average absorbed breast dose, the mean glandular dose MGD2ABD was calculated using a conversion function of glandularity f(G), obtained through the use of Monte Carlo simulations.Results: f(G) was computed for a 4.5 cm thick breast: from its value MGD2ABD for different compressed breast thicknesses and glandularities was obtained. The comparison between MGD2ABD estimates and the dosimetric index provided in the current dosimetry protocols, following the Dance's approach, MGDDance, showed a good agreement (<10%) for all the analyzed breast thicknesses and glandularities. Conclusion: The strength of the proposed method can be considered an accurate mean glandular dose assessment starting from few and accessible parameters, reported in the header DICOM of each DBT exam.

Effect of Compression Force and Target or Target/Filter Combination on Mean Glandular Dose for Japanese Women in Full-Field Digital Mammography System

2021 ◽  
Vol 11 (10) ◽  
pp. 2695-2700
Author(s):  
Mie Ishii ◽  
Mai Nakamura ◽  
Rie Ishii ◽  
Keiichi Shida ◽  
Toshikazu Hatada ◽  
...  
Keyword(s):  
Digital Mammography ◽  
Japanese Women ◽  
Compression Pressure ◽  
Full Field ◽  
Breast Compression ◽  
Mean Glandular Dose ◽  
Full Field Digital Mammography ◽  
The Mean ◽  
The Difference ◽  
Breast Thickness

We constructed a mammography database of 807 Japanese women and 2,772 images obtained using five commercial full-field digital mammography (FFDM) devices at four different facilities. Five types of mammography devices fabricated by four manufacturers were used: one with a Mo target (AMULET F), one with Mo and Rh targets (Senographe DS), one with Mo and W targets (AMULET), and two with a W target (MAMMOMAT Fusion and Selenia Dimensions). The purpose of this study was to focus on the mean glandular dose (MGD) in the database and analyze the difference in the MGD of Japanese women radiographed by mammographic devices with different targets or target/filter combinations. Furthermore, we clarify the difference between the displayed and measured MGDs for the three types of mammography devices. The average compression pressure and compression breast thickness of the Japanese women in the mammography in this study were 90.9±21.7 N and 43.3±12.9 mm, respectively. The breast compression pressure slightly varied depending on the facility or FFDM device, while the compression breast thickness decreased with the increase in the compression pressure for all FFDM devices. Differences in breast compression thickness existed depending on the mammography devices. The MGDs of the two types of mammography devices using the W target were smallest (1.335±0.358, 1.218±0.464 mGy). The displayed and measured MGDs of the three types of FFDM devices had a good correlation. However, the difference between the displayed and measured MGDs of the two devices increased with the MGD.

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