Board 513 - Technology Innovations Abstract Innovative Approach with a Breast Biopsy Model that Impacts the World (Submission #281)
Adam Dodson, Julianne S. Perretta, Ryan W. Woods, Susan C. Harvey · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · 2013
Introduction/Background Large core needle breast biopsies (LCNBs) are performed with a variety of guidance Methods including mammography, ultrasound and Magnetic Resonance Imaging. Biopsies are performed to evaluate indeterminate imaging findings which carry a greater than 3% risk of malignancy. LCNBs are sometimes performed with palpation guidance to evaluate a mass, but image guidance is more typically the standard of care. Multiple studies have shown that image guided LCNB has accuracy similar to surgical biopsy and is a less costly procedure with better surgical outcomes. Ultrasound guided breast biopsy requires competency in breast ultrasound, patient positioning, sterile technique, effective use of local anesthesia, as well as more general skills such as dexterity, and interpersonal communication. The type of biopsy performed depends on the visibility on different imaging modalities as well as size and location of the lesion. The degree of radiology resident exposure to this procedure and training is inconsistent. Additionally, due to the efficiency required in breast imaging, the time allotted for the procedure makes it unlikely that residents will be adequately trained during the course of their residency. All image-guided procedures require high-level psychomotor skills that are difficult to teach on patients in the clinical setting. For ultrasound guided biopsies, breast ultrasound models are available on the market or can be made with gelatin or other meat products. However, we have found they are not ideal for simulating all the skills needed to learn image guided needle biopsy techniques. There are key learning objectives which are missing such as sterile technique, the use of local anesthesia, patient positioning and patient interactions. Additionally, the critical understanding of avoiding adjacent anatomic structures such as the pectoralis muscle, ribs, and thoracic structures are not well demonstrated with models that are simply placed on a table. During the development of an imaging directed specifically ultrasound guided, breast biopsy curriculum, our radiology residency program sought to use simulation to teach all aspects of the procedure. This necessitated the development of a full body model with anatomically accurately positioned breast models. The breast model needed to be amenable to the use of ultrasound, with multiple lesions that could be visualized. Additionally, the models had to accommodate multiple different ultrasound guided biopsy devices, be affordable and be durable enough to allow many training sessions. A full-body simulator was engineered that met the above criteria. Methods The Blue Phantom Breast Biopsy Ultrasound Training Model was the breast biopsy model selected, as it has more than a dozen visible lesions varying in size from 4mm to 11mm. The variety of the lesions and their locations requires trainees to determine patient positioning, lesion approach, and skilled use of the ultrasound transducer to allow selection of the appropriate biopsy device. The breast biopsy model also allowed trainees to practice adequate lesion anesthesia. The Laerdal Resusci Anne full body basic CPR manikin was the body selected for the construction. Incisions were made in the mannequin’s skin to facilitate placement of the breast biopsy model in an anatomically accurate location. Once assembled, the manikin was tested to reduce refraction and improve quality of hyperechoic or hypoechoic lesions. Results: Conclusion The creation and engineering of this manikin allows safe training and practice in a variety of clinical scenarios. While our program targeted the training of residents, other possible settings exist for the use of this model. The model, known as Mae, is portable and low-tech, which provides benefits such as facilitating self-directed learning, mastery assessment and outreach to under-resourced environments such as Uganda, Ghana, and Haiti. References 1. T. Uematsu: How to choose needles and probes for ultrasonographically guided percutaneous breast biopsy; a systemic approach. Breast Cancer Jul 2012. 2. Hassard MK, McCurdy Ll, Williams JC, Downey DB: Training module to teach ultrasound-guided breast biopsy skills to residents improves accuracy. Can Assoc Radiol J 2003 Jun. 3. Accuracy of ultrasound-guided, large core needle breast biopsy. Eur Radiol 2008 Sep. Disclosures None.