Advanced Practice in Breast Imaging...2019/11/02 · Introduction Background in breast imaging and...
Transcript of Advanced Practice in Breast Imaging...2019/11/02 · Introduction Background in breast imaging and...
Advanced Practice in Breast
ImagingBy
Anne Lang
Consultant Radiographer in Breast Imaging
NHS Lanarkshire
Introduction
Background in breast imaging and drivers
to allow the role development
Education required to undertake the
advanced practice role
Impact on the service
Challenges
The future of Advanced Practice in breast
imaging
Background in speciality
16 years experience as a mammographer
14 years experience as a mammographic
film reader
Double reading programme (2006)
Success of programme and service
demand - 2nd radiographer undertaking
image interpretation
Drivers
Shortage of breast radiologists
Increased demands on the service (7000, breast patients per annum)
National drive to meet demands of the 4 tier structure
Ambition
Expert in clinical field
Education required for role
PgC - Mammography
PgM - Image interpretation
PgM - Interventional Breast Techniques
PgC – Defined Area of Ultrasound Practice -Breast
Optional - PgM – Advanced Research Methods
Optional - Masters dissertation
Impact of the role- Clinical
Increased capacity – 202 new ‘one-stop’ breast patients per week – 25% seen by Consultant Radiographer
Quality- MDT preparation time, QA programme
Expert in clinical field
Sharing examples of good practice – audits, reporting format
Leadership
Leading by example
Organisational change/strategic decision making
SRTP
Scottish Access Collaborative –Breast Surgery Speciality Group
WOS Managed Clinical Network for Breast
SCOR Consultant Radiographer group via ‘glass cubes’
Learning & Development
CPD – Masters, Study days
Mentoring: Advanced Practitioners
Teaching/Lecturing:
Students
Radiographers
Radiology registrars
Specialty doctors
BCN’s
Research
‘Within NHS Scotland what is the current
radiology service offered / variation in
practice in assessing the axilla with
ultrasound and how would any changes to
practice in light of new guidance from the
Royal College of Radiologists be accepted?’
(Pilot study).
Challenges faced
Study time
Service demand/capacity
Confidence
Communication
Relationships
Complexity of the role – decision making
Case Study 1
75 year old female presented to one-stop
breast clinic with a palpable breast lump
in the RLOQ Graded E5 plus palpable
lymph node.
Cranio-caudal views
Medio lateral oblique views
Ultrasound
Ultrasound axilla
Ultrasound guided biopsies and
marker insertion
Post clip mammogram
Magnification view
Stereotactic biopsy
Specimen Xray
Results of core biopsies and
outcome following MDT
Right breast - invasive ductal cancer B5b
Right axilla –malignant node
Left breast – DCIS B5a
MDT outcome - bilateral Mastectomy
Case 2
52 year old female presented to the one-
stop breast clinic with history of a lump in
the lower aspect of her left breast. Could
not be felt at time of clinic E1.
Mammography
Ultrasound of symptomatic area at
5 o,clock
Ultrasound of upper aspect
Marker Insertion
Post clip mammogram
Results and MDT outcome
Both lesions in upper aspect were
invasive ductal cancer B5b
MRI was performed confirming only two
lesions
MDT outcome either localisations WLE
or mastectomy depending on patient
preference
Case 3
35 year old female presented at the one–
stop breast clinic with an E3 lump medial
right breast
Ultrasound
Axilla ultrasound
Ultrasound guided biopsy
Results of core biopsies
Right breast biopsy – Grade 3 invasive
breast cancer B5b
Right axilla biopsy – malignant node
Mammography
Ultrasound guided marker insertion
Post clip mammogram
MDT outcome
Neo-adjuvant chemotherapy
Monitoring of tumour at intervals with
ultrasound
Followed by magnetic seed localisation
and WLE
Case 4
52 year old woman presented at the one-
stop breast clinic with an E4 lump in the
LLOQ. No previous mammogram
Mammogram
Ultrasound
Complications
On dual therapy anticoagulants – for a
pressing cardiac condition
Management of the patient
Ultrasound guided biopsy
Biopsy result and MDT outcome
Grade 3 invasive ductal cancer B5b
For neo adjuvant chemotherapy
Ultrasound guided marker insertion
Post clip mammogram
MDT outcome
Monitoring of neo adjuvant effect
Magnetic seed localisation
WLE
Complexity of cases
Ensure careful reporting and review of
images
Follow protocols - solid lesions in
patients 25 and over to be biopsied
Ultrasound is not a screening tool
Consider the whole medical history of
the patient
Future of Advanced Practice in NHS
Lanarkshire
Advanced Practitioner roles – accelerated training
Mentors available
Remit
Limitations
Skill mix
Summary
Advanced practice in breast imaging is
successful and has been shown to have a
beneficial impact on the breast service in
NHS Lanarkshire
Job Satisfaction
‘……we know who you are and we are
inspired by what you do’ (Band 5
Radiographer)
‘……thank you, I have been told by the
breast surgeon my cancer is very small and
could easily have been missed’ (Patient)