How To Not Be Awkward in Mammography Departments

Fact: No-one enjoys having a mammogram. No-one!

Stardate: 93085.08

I've gone pink for this post, (I know it's not October, but for this post I wanted to give a quick nod to the Breast Cancer Awareness organisation, Pink Ribbon) so if you have trouble reading it, I do apologise! I have also dedicated this post to my amazing and brave Auntie Mich, who kept me motivated to keep this blog going way back when I was just starting out!

It was the one placement I was openly dreading. After already having done radiography for nearly two years, you'd think I was already okay with seeing humans undressed in most ways, shapes and forms. No matter how many times you tell patients they can keep their underwear on, there's always one who didn't hear you... Apparently, I was not fully prepared.

I have to admit, despite having heard and been taught about Mammography, I'd never taken an active interest in the modality, nor fully looked into it. But once I'd looked into (aka Googled) the basic physics of mammography equipment  to refresh my memory post-exams (e.g. ultrasound, mammography units), I started to warm more to the subject than I had previously. The other plus side post-graduation wise: men currently can't do the job, so there is less competition for job applications (although I don't agree with this, from a work gender-equality angle).

Mammography is basically low energy x-rays that image the breasts. It's most well-known for its being an early detector of breast cancer, by finding masses or microcalcifications. I spent time in both screening clinics, where women who fit the criteria are checked every few years for any changes; and assessment clinics, where women have attended their GP after having found a lump, for example. 

So last Monday after having arrived at the department and been shown around, I witnessed my first mammogram, and couldn't help but look everywhere in the room, except at the body parts being examined. Eventually, I had to buck up and pay attention, or last week's block was going to go pretty slowly for me.

Every patient I saw examined was happy for me to stand in the room and have everything explained to me, and some even explained instead of the mammographer, which was a new experience! But this did put me more at ease, as being a student I'm used to doing the 'Student Shuffle' (basically constantly moving out of everyone's way) and being quiet when not in the general radiography or CT departments.

Once I'd followed a few women through from their mammograms to their ultrasound, I started to gain more interest and look in more detail at the images. I particularly enjoyed helping one of the consultant radiographers (yes, you read that correctly, we can become consultants!) with an ultrasound guided biopsy, where I was shown different types of tissue structures within the breast that would be going for testing.

I also got to spend one morning sitting with a doctor while he ran a clinic. It was interesting to see the other side, watching the pre-assessment, and then seeing how the imaging side was requested and for what reasons.

However, with Mammography, you will eventually come across sad news at some time or another. A number of the patients I saw examined at the department had already had a mastectomy (breast tissue removal surgery), and some images I was shown for comparison and to help me understand breast anatomy, displayed what were cancerous masses. For me, this was quite a tough experience (hence why I've never considered Radiotherapy), and it hammered home how beneficial Mammography is as a department. Even for a small number of men.

From what I've witnessed, being a mammographer, is a very intimate job. During the examination, you will be in the patient's personal space, and the procedure can be difficult and uncomfortable for patients. It's a difficult job to do, putting apprehensive and worried women at ease, and if they're upset, you have to be the type of person who knows how to handle that situation kindly and professionally. Not only that, nothing can be missed off the image, because something small could be hiding in that one area not included, so you have to be skilled enough to make sure you've gotten everything on the receptor. There is also a chance to be a breast sonographer, giving you a little more autonomy in your work.

Personally, I'm not completely sold on Mammography myself. If I had to say what I enjoyed the most, it would be the ultrasound examinations and biopsies, as I could 'see' more on those images, than on the plain film ones (a slightly odd situation for an undergrad radiographer). I wouldn't mind going back for another week, but right now, it's not something I could see myself going towards once I graduate. I can see why it's an appealing job to some, and don't get me wrong, I found the diagnostic side of it and the variation interesting, but all day and every day would be breasts. And I don't think I'm ready for that just yet!

This week I'm in the Paediatric department witnessing all sorts of examinations. But, more on that in my next post!

LLAP Guys!

Ps. I hope you've all gone to see Jurassic World... 

Managing Placement Assessments, and CT in (Dino)Nutshell!

How I feel handling all my different placements and assessments...

Stardate: 93066.03

I apologise, as this post is a few (ahem... five) days late. This is once again because of part-time work, and placement in a different hospital due to the department I'm in this week (more on that in my next post!)

As I'm now in my "Summer stretch" of placement blocks, second year clinical assessments are now creeping up on me, rather ominously too, as they're not easy to pick appropriate patients for! And as you have so little time in each department, due to rotations, every moment there is precious. No-one ever said second year was easy... Including me!

So far, I've passed my CT head and Extradepartmental Chest X-ray (Mobile/Portabe) assessments; so only three more to go! To celebrate passing my CT assessment, I decided to dedicate this post (briefly) on CT, and also went to see 'Jurassic World'... my inner child was incredibly happy (so was the grown-up, because Chris Pratt; 'nuff said.) It's amazing, I highly advise everyone to see it.

So, about CT, or Computed Tomography! Most people have heard of, or at least have had, a CT (or CAT) scan. For Leeds university students, CT is a department we visit, to further our understanding of extradepartmental modalities, that involve medical imaging. CT scans, use a 360-degree x-ray beam to create a 3D image, using a number of imaged slices taken from a large series of two-dimensional images, to visualise the internal structures of the body, without having to cut open the patient! CT has plenty of applications, including the detection of abnormalities, as well as diseases, such as cancer, inflammation and trauma etc.

There are a multitude of advantages to CT over the usual 2D medical radiography. It doesn't have the issue of superimposition (organs/tissues lying over each other), allowing structures to be assessed, and allowing the area of interest to be studied in detail. CT also has a high-contrast resolution, meaning that tissues with even the slighest difference in density can be distinguished from one another. Finally, CT images can be viewed in various ways, or "planes", allowing any exisiting pathology's position to be pin-pointed.

Non-medical uses of CT include discovering flaws in industrial parts before they are used, and to identify the existence of any oil, water or gas etc. in structures.

I find CT an interesting department to look into once I've qualified, as they're used quite often in forensic radiography for virtual autopsies, which I'm thinking of writing about for my final-year dissertation. Being able to see all the internal anatomy without it being superimposed onto itself is great, as it makes spotting abnormalities that little bit easier... but not by much for the inexperienced!

And that is basically CT in its barest form! This week I've been in the Mammography department, so I'll have a more in-depth post coming up regarding the Breast Screening process, and a little on the modified equipment.

Final Note: GO AND SEE 'JURASSIC WORLD'. Think I made that clear enough...

LLAP Guys!

My First Conference - IAFR Annual Conference 2014

A look into the pack we were given today at the conference.

Stardate: 92305.32

Prepare for a long post...

I have to admit it, I am knackered. Due to a 5.20AM start to get a train at 6.34AM to Middlesbrough, and getting home at 7.40PM, I have had one heck of a long day, but I think it has definitely been worth my time. I don't know many undergrad students who attend conferences, but I certainly think that we should. I met so many new people, gained a lot of information from qualified radiographers, their views and advice, and I also learnt a good deal about the new and upcoming future developments in radiography (mainly forensic imaging). It's definitely motivated me to attend more conferences in the future! 

The morning started with a talk from Her Majesty's Senior Coroner in Sunderland, Derek Winter, who spoke about the role of a coroner and the role of post-mortem CT. For those of you who are unsure, a coroner is an independent judicial office holder appointed by a local authority, that investigates deaths that have been reported to them, if they have reason to suspect the death was violent or unnatural, has an unknown cause, or the deceased died in prison, police custody or another type of state detention (Ministry of Justice, 2013). His presentation explained that CT imaging is considered to be one possible way to reduce the number of autopsies in Britain, which is 2-3 times the rate of comparable countries. Post-mortem CT (PMCT) is also more cost-effective than an autopsy, but is a developing field, and has certain limitations. Certain faith groups are keen to avoid autopsy, as are bereaving families, in these cases CT virtual autopsies would be favourable.

Our next talk was then on Multi-Phase Post-mortem CT Angiography, which has been a major research project at the University Centre of Legal Medicine in Lausanne-Geneva. This presentation informed us of courses available to radiographers, as well as the current developments and benefits of MPMCT Angiography. In Lausanne, the forensic radiographers carry out examinations and cases themselves, including incisions and cannulations, which usually requires training, but gives these radiographers more autonomy in their practice.

After a well-needed coffee break (I was beginning to nod off from being tired!), the subject turned to Non-Accidental Injury and Physical Abuse cases in children. I had the chance to actually meet one of the speakers (Dr. Amaka C Offiah) prior to her talk, as I took the same train as her from Darlington to Middlesbrough, and we also shared a taxi. A national expert in radiological research into child abuse, and the first woman to be appointed as the Royal College of Radiology Roentgen Professor, she is well-known within her field and her talk was excellent and incredibly informative about the pitfalls in radiological diagnosis of physical abuse in children. Her presentation highlighted many key areas within this subject, and how to avoid future issues from arising within departments.

Our final talk was on ballistics, which highlighted and identified different bullet types, gun 'anatomy', trajectory and basic witness statements on forensic radiography ballistics. It was quite an interactive and entertaining way to end the day!

The members of the IAFR (International Association of Forensic Radiographers) were all very welcoming, and happy to answer questions, and I also got to speak to a few recent graduates of the Masters course at Teeside.

Overall, I thoroughly enjoyed my day, gained a CPD (Continuing Professional Development) certificate, and got to speak to the Forensic Radiography Masters course co-ordinator, who re-assured me about the content, and applications process.

For anyone interested, I've posted a link to the IAFR website for you to have a look at :3

An added bonus: I even managed to watch Doctor Who without nodding off. So now, I'm off to read my Stephen King book until I fall asleep! I'm too tired to pay attention to 'Once Upon a Time' tonight...

LLAP guys! Told you it would be long....

The IAFR website: http://afr.org.uk/