It’s not something you’ve likely ever heard—that your patient, a woman awaiting her annual mammogram, is excited about the procedure. Mammograms are uncomfortable. The machine is usually sharp-edged and cold. Breast tissue is tightly compressed, frequently causing pain. And, the exam rooms are often uninviting and antiseptic.
But, that’s changing. As a whole, the industry’s focus in mammography is shifting away from mainly concentrating on image quality to considering the patient’s comfort during the exam, as well. Not only are the changes creating a more positive experience, but they could also increase patient compliance.
Currently, based on Centers for Disease Control & Prevention data, more than 35 percent of women over age 40 haven’t had a mammogram in more than two years. Prompting more women to show up for the test is paramount because early detection reduces mortality rates.
According to a May 2017 International Journal of Women’s Health (IJWH) study, led by researchers from medical device and software company Human Factor MD and radiology vendor Hologic, taking steps to make the annual mammogram more palatable can help radiology reach this goal.
“It is apparent that the patient experience of comfort and pain during mammography is an area warranting increased research and solutions,” the study authors write. “Approaches to reduce discomfort should be considered in order to provide screening compliance.”
The study surveyed 280 technologists who conduct at least 10 mammograms daily to determine the factors that weigh heaviest in determining a patient’s perception of a discomfort and reluctance to undergo a mammogram. Results point to breast compression and anxiety as the main issues preventing higher compliance.
To address those concerns, industry vendors are designing new mammography and breast ultrasound systems that cater to augmented physical and emotional comfort. The goal, says Dean J. Phillips, D.O., radiologist with New York-based Northern Radiology Imaging PLLC, is to create a more welcoming environment for women who could already be nervous about the exam.
“Women deserve more than a place to just get a mammogram,” says Phillips, whose practice provides mammography services with FujiFilm’s ASPIRE Cristalle system. “Women need a system that provides increased comfort and demands less time to obtain the exam.”
Based on academic research and industry surveys, vendors have chosen these areas of improve a woman’s experience with the annual mammogram.
Soothing environment: Existing research suggests women are more likely to comply with breast cancer screening recommendations if the radiologist’s office is more inviting. GE’s Senographe Pristina sensory suite offers this type of environment, including fresh scents, waterfall sounds and flowers, says Agnes Berzsenyi, GE president and chief executive officer of Healthcare Women’s Health.
“The sensory suite stimulates the senses, and at the same time we have them feeling more relaxed and comfortable,” she says. “They’re able to release more anxiety.”
In fact, says Kathy Schilling, MD, medical director of Boca Raton Regional Hospital’s Christine E. Lynn Women’s Health & Wellness Institute, her practice images 5 percent more breast tissue in women who experience the GE sensory suite.
Relaxed muscles: Muscle tension from grabbing paddles during the mammogram accounts for much of the pain associated with breast compression, Berzsenyi says. The tighter a woman hold her muscles, the more difficult it is for the machine to gather enough breast tissue for a quality image. To side-step this problem, GE’s Pristina replaced the paddles with arm rests.
“Holding onto conventional paddles made women’s arms too tense,” she says. “Arm rests allow them to lean into the mammogram unit, feeling more comfortable.”
Greater relaxation also enables the technologist to properly position the breast, reducing the time they usually spend adjusting the tissue to get the highest quality image.
Less pinching: For many patients, the hard, squared-off compression paddle edges can cause uncomfortable pinching. The severity of pain depends on a woman’s individual level of breast sensitivity.
Using patient and technologist feedback, FujiFilm outfitted the compression paddles on its ASPIRE with rubber trim. The impact is significant, says Rob Fabrizio, director of strategic marketing, digital radiology & women’s health.
“The trim around the edges eases the pinching of the skin at the chest wall,” he says. “It follows the curvature of the breast to allow for better compression and better image quality.”
Hologic’s SmartCurve Breast Stabilization System also offers a curved compression platform that is designed to make compression more comfortable for the patient.
Better images: Whether the mammogram is screening or diagnostic, all patients can benefit from having higher image quality. The more details the detector can capture about the breast tissues, the more accurate the radiologist read will be, Fabrizio says.
To reach that goal, the vendor switched to a hexagonal-shaped detector from a traditional square shaped one. By imaging more breast tissues, the different shape increased quality performance by approximately 20 percent, he says.
Patient compression control: A big part of a patient’s anxiety is not knowing how firmly the machine will compress the breast. The IJWH study revealed 53 percent of patients worried about compression force, and 27 percent were concerned about compression time.
GE also addressed these fears with Senographe Dueta, a wireless patient-assistance compression device that lets patients control the speed and intensity of breast compression. The technologist can prevent the patient from releasing too much compression. Having some control helps some patients manage their perception of pain — approximately 83 percent of patients reported being better able to control their perception of pain, Berzsenyi says.
Faster scan time: Similar to time spent in an MRI machine, some patients experience anxiety over how long their breasts will need to be compressed for a mammogram. Speeding up the scan process not only lessens that stress, but it also accelerates workflow for technologists and radiologists.
Patients undergoing mammograms in both Fujifilm’s ASPIRE and GE’s Senographe Pristina have experienced much faster exam times than in the past. According to Susan Crennan, Fujifilm’s women’s health product marketing manager, technologists can move the ASPIRE Cristalle system to the ideal position for each image at the touch of a button, limiting the amount of time needed to shift placements.The time saved has helped technologists engage with patients in other ways, Phillips says.
“By spending less time performing the image acquisitions, our techs have been able to personalize the needs of the patients, including genetic testing,” he says.
Schilling’s practice has also experienced time savings with Pristina. To date, she says, they’ve dropped screening mammography from 15 minutes to 6 to-7 minutes and diagnostic mammography from 30 minutes to 15 minutes.
Increased privacy: Advancements are also underway for secondary ultrasound screening. To protect patient privacy, Hitachi’s Sofia 3D breast ultrasound is designed to keep the patient covered throughout the study, says Matthew Ernst, ultrasound marketing manager for radiology and women’s health.
Instead of lying back with an open gown, women can open one side of the gown while lying face down on the scanning cone in a memory foam-padded table. The woman’s body weight provides the necessary pressure for compression, and the machine collects a full 360-degree image in roughly 30 seconds, he says.
Although there is still more the industry can do to perfect the patient’s experience with mammography, these developments put radiology on the right track for making a scary scenario far less frightening, Schilling says.
“Mammography has been around for 50 years, and for the first 45 years, the industry focused on image quality and decreasing radiation dose,” she says. “Now, it’s focusing on the patient and technologist experience. It has to be celebrated because that’s been ignored, and it’s very important.”