Peter Hogg Judith Kelly Claire Mercer Editors Digital Mammography A Holistic Approach 123 Digital Mammography [email protected] [email protected] Peter Hogg • Judith Kelly Claire Mercer Editors Digital Mammography A Holistic Approach [email protected] Editors Peter Hogg Claire Mercer University of Salford The Nightingale Centre and Salford Genesis Prevention Centre UK Wythenshawe Hospital University Hospital of South Manchester Judith Kelly Manchester Breast Care Unit UK Countess of Chester Hospital NHS Foundation Trust Chester UK ISBN 978-3-319-04830-7 ISBN 978-3-319-04831-4 (eBook) DOI 10.1007/978-3-319-04831-4 Library of Congress Control Number: 2015931089 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 This work is subject to copyright. 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Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) [email protected] Foreword This book is aimed at all those involved in breast imaging. It provides an in- depth analysis of current imaging techniques which will provide the basis of learning for those new to breast imaging; particularly those taking up this speciality for the fi rst time. For those already experienced in the fi eld, the breadth of subject areas covered will make this an excellent reference text. Technology has changed signifi cantly over recent years in all aspects of breast imaging but particularly as digital mammography has replaced tradi- tional analogue fi lm. The techniques involved for the processes of both image acquisition and image reporting are, whilst fundamentally similar, also pro- foundly different, and this book is timely in addressing these issues. The inclusion of a patient’s story is both innovative and extremely moving. Understanding the patient’s perspective will assist all breast professionals in their work, and Sue and her husband provide great insight into many areas of practice often neglected. Of particular note is the requirement for everything that happens to patients to be explained in full, together with the benefi t of human contact and conversation at times of stress. Social media impacts on almost all aspects of the modern world, and it is refreshing to see the impact of this on breast imaging services analysed here. There has been signifi cant recent controversy concerning the benefi ts and harms of screening programmes for breast cancer. The chapter which explores this provides a balanced overview of the current debate with a further section devoted to describing these services in Europe. At a time of increasing inter- est in personalised healthcare, a separate chapter on breast density, its evolu- tion and signifi cance makes important reading. This topic will undoubtedly become more important following the American adoption of processes to inform all women of their mammographic breast density assessment. Explaining these fi ndings to women may become part of routine UK and European practice in years to come. This book is likely to become a standard text for breast imaging profes- sionals and, if read by many, will improve the service we provide. Norwich, UK Erika Denton v [email protected] [email protected] Pref ace Extensive implementation of full fi eld digital mammography in recent years, coupled with an increasing desirability within healthcare to continue deliver- ing patient-centred care, provided the impetus for writing this text. It is hoped it will supplement the imperative within professional practice to adopt a con- tinuing refl ective approach in providing such care. Historically, much of the evidence underpinning mammographic practice was intended for analogue systems, hence the need for a comprehensive and new evidence base to underpin the principles of digital mammography and optimise the potential of this technology. In addition, signifi cant gaps in the guidance informing aspects of mam- mographic practice have been identifi ed, and recent research attempts to address some of these defi cits. A notable example is the variation in compres- sion force applied by practitioners on serial mammograms and the important question of how much compression force is necessary to produce a diagnostic mammogram [1]. Conventional wisdom suggested that applying as much compression force as tolerable contributed to the best possible image quality. However, a recent study demonstrated that continuing to apply compression force does not reduce breast thickness in a linear fashion. In fact, too high a compression force may not achieve the desired impact on image quality and might be counterproductive to the patient/client experience [2]. Signifi cantly, evidence also suggests that some women are deterred from attending for a mammogram due to the discomfort or pain that may be experienced and therefore, ipso facto , a minimum amount of compression force is desirable, provided image quality and radiation dose reduction are not compromised [3]. This issue is extremely important particularly within breast screening since the success of any screening programme depends on uptake [4]. Rapid technological advances enabling easy access to web-based informa- tion have resulted in the public becoming increasingly well-informed and empowered regarding their healthcare. Expectations of healthcare are high. These expectations include listening to the patient and taking account of their perspectives. Attention to such detail – moving towards the holistic approach, illustrated and evidence-based in this text – should assist in gaining the trust and confi dence of the patient/client and result in an optimal experience for both practitioner and patient/client. For this reason a chapter has been included in this book from a patient who has experienced breast cancer. Her detailed description, recalling the diagnostic and treatment pathways, is greatly appreciated. vii [email protected] viii Preface It is now widely recognised that healthcare should be holistic, an approach which takes account of the physical, mental, emotional and social factors of patients/clients. In a mammographic context this implies delivering tailored care to the ‘whole person’ (who is not simply an accessory to the breast being imaged), whilst being acutely aware that such a procedure can be a signifi cant ordeal for many people. Again, this is the rationale for including comprehen- sive information relating to the care component of this book, which is highly patient-centred. The challenge for practitioners today is how to choreograph their delivered care – balancing art and science in their approaches to patients. The current healthcare culture of quantifi cation-at-all-costs and scientifi c management can, on occasion, overestimate the science and impoverish the art [5]. Perhaps most novel of all in this book is the chapter covering tissue viability which can sometimes be a signifi cant issue when mammography results in skin tearing or damage particularly around the infra-mammary angle regions. Though there is a heavy use of UK practice and policy, this book has a multinational authorship and it is intended to appeal to an international readership. Whilst it is recognised that aspects of mammographic practice vary considerably across different regions and countries, many issues and principles within healthcare remain generic and are transferable across populations. An important issue to address for a wide readership is the terminology used in clinical practice. For example, the individual performing the mam- mogram is described variously as radiographer, mammographer, mammogra- phy practitioner, and radiologic technologist – all performing similar roles. In this book we describe the person performing the imaging as the practitioner. Similar differences exist in naming the subject of the mammography proce- dure as woman, client, patient and