植入医疗设备女性的乳腺钼靶检查：对图像质量、疼痛和焦虑的影响。
Mammography in females with an implanted medical device: impact on image quality, pain and anxiety.
作者信息
Paap Ellen, Witjes Marloes, van Landsveld-Verhoeven Cary, Pijnappel Ruud M, Maas Angela H E M, Broeders Mireille J M
机构信息
1 Dutch Reference Centre for Screening, Nijmegen, Netherlands.
2 Department of Radiology, University Medical Centre Utrecht, Utrecht, Netherlands.
出版信息
Br J Radiol. 2016 Oct;89(1066):20160142. doi: 10.1259/bjr.20160142. Epub 2016 Jul 25.
OBJECTIVE
To assess the image quality of mammograms in females with an implanted medical device (IMD), to evaluate pain and anxiety during mammography in these females and to investigate the experience of radiographers.
METHODS
Image quality was evaluated by two radiographers and one radiologist in the images of females with an IMD participating in the Dutch screening programme (clients). Pain and anxiety were scored using a Numeric Rating Scale in both clients visiting a screening organization and patients from the Isala Hospital, Zwolle. Experience of screening radiographers was collected with a questionnaire.
RESULTS
Images of the breast with IMD showed reduced contrast in craniocaudal (CC) and mediolateral-oblique (MLO) views [by both the radiographers and radiologist (range: 11-29%)], less projected breast tissue [only radiographers; CC lateral side: 25.5%, 95% confidence interval (CI): 18.7-32.2] and reduced projection of the pectoral muscle (only radiographers; MLO width pectoral muscle: 31.5%, 95% CI: 24.4-38.7). Clients experienced more pain and anxiety during mammography in the breast with IMD compared to the breast without IMD in the breast (pain difference CC: 0.48 ± 0.16, p = 0.003; pain difference MLO: 0.46 ± 0.16, p = 0.004; anxiety difference 1.30 ± 0.22; p < 0.001). Patients experienced more pain (1.05 ± 0.12; p < 0.001) and anxiety (1.22 ± 0.15; p < 0.001) after placement of IMD. Radiographers are more cautious, more anxious and use less compression during mammography of breasts with IMD.
CONCLUSION
Image quality in a breast with an IMD could be improved by projecting more breast tissue on the mammogram, thereby including (part of) the IMD between the paddles, if required. In addition, radiographers should pay sufficient attention to reducing discomfort both before and during the screening examination.
ADVANCES IN KNOWLEDGE
Little is known about the quality of mammography in females with an IMD or how these females and radiographers experience the screening examination. The results of our study showed that having an IMD could result in a suboptimal mammogram and increased discomfort.
目的
评估植入医疗设备（IMD）的女性乳房X线照片的图像质量，评估这些女性在乳房X线摄影过程中的疼痛和焦虑情况，并调查放射技师的经验。
方法
由两名放射技师和一名放射科医生对参与荷兰筛查项目的植入IMD的女性（客户）的图像进行图像质量评估。使用数字评分量表对前往筛查机构的客户以及兹沃勒伊萨拉医院的患者的疼痛和焦虑进行评分。通过问卷调查收集筛查放射技师的经验。
结果
植入IMD的乳房的图像在头尾位（CC）和内外斜位（MLO）视图中对比度降低[放射技师和放射科医生评估结果均如此（范围：11 - 29%）]，投射的乳房组织较少[仅放射技师评估；CC位外侧：25.5%，95%置信区间（CI）：18.7 - 32.2]，胸肌投射减少（仅放射技师评估；MLO位胸肌宽度：31.5%，95%CI：24.4 - 38.7）。与未植入IMD的乳房相比，植入IMD的乳房在乳房X线摄影过程中，客户经历了更多疼痛和焦虑（CC位疼痛差异：0.48±0.16，p = 0.003；MLO位疼痛差异：0.46±0.16，p = 0.004；焦虑差异1.30±0.22；p < 0.001）。植入IMD后，患者经历了更多疼痛（1.05±0.12；p < 0.001）和焦虑（1.
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