43: Mammogram Appointment

Breast Cancer awareness month has come and gone. However for me, as a Mammography Technologist it is everyday of the year. And now as a Breast Cancer survivor, bringing awareness is just that much more important.

I had intended to blog about how to prepare for your Mammogram Appointment prior to the month of October, but it just did not happen. Preparing for the Voyage to Lana’i , paddle for life took precedence over everything.

So here it goes:

Be on time

You are given a check in time and an appointment time. There is a reason for this. We are only given a certain time slot per patient. At my work we are given 15 minute time slots per patient for a routine screening, 30 minutes for a diagnostic appointment and/or a patient with an augmentation.  And please, IF you have an augmentation (implants) please mention it when making the appointment if you are not asked that question by the scheduler. Some patients register, then proceed to talk on the phone or just be on their smart phones instead of doing the questionnaire given to them. So, the purpose of you check in time is to complete all necessary paperwork prior to you appointment time.

No lotion, powder or deodorant. 

You are probably wondering about the picture above., I will explain that in a bit.

Deodorant, deodorant  mimics micro calcifications. Some micro calcs get worked up, meaning additional images and after the additional images IF they are deemed “indeterminate” by the radiologists they are either followed up in six months or he/she gives a recommendation to biopsy them! Lotion or powder can come out in the image, especially if it has some type of shimmer to it. Also with lotions and or body oil, it makes the breast slippery making it easy to move when in compression, causing motion. An image with motion will be rejected and repeated. I had a patient that had coconut oil all over her body, her breast were small, there was no friction between her skin and my paddle. I was using my small half paddle for her but her breast kept popping out from the compression paddle. She agreed to go into our bathroom to wash her breast off with soap/water and we proceeded. And of course by now we were well into her 15 minute time slot for her mammogram.

When I bring a patient in the room I will ask I they have product on. If they did come in with deodorant on we offer baby wipes to wipe it off. I document it in my paperwork when a patient comes in with deodorant on. I have had a patient get called back for possible “residual deodorant vs micro calcs” therefore, I do not recommend coming into your appointment with deodorant on.

Sand

Here on Maui I have come across sand artifact on a mammogram. I did one view on a patient, then when I did the oblique view (side view) I noticed that on my image there was artifact where there was no breast tissue. My image receptor had all these sparkly things on it. I remembered that when she came in she had on a beach cover-up with a swim suit top on. I asked her if by any chance she was swimming in the ocean this morning? The answer; “Yes, but I rinsed off at the park before coming here”.   Well there was enough sand in her suit that clung on. Solution, my schedule fortunately was pretty open that day, this was the patients baseline mammogram (first one) she lived literally in the neighborhood of our clinic so she went home and took a proper shower then came back and I worked her in!

The Picture

I begin to position my patients first view, and I can feel that there is some kind of product on my patients breast. I continue to compress the breast, my positioning light is on, and with the compression this white stuff seeps from my patients breast tissue!!! I lift my paddle off of my patients breast and ask her, again if she has product on?

Me: I thought you said you did not have lotion on?

Patient: I don’t

Me: oh, what’s this…..as I point to my paddle

Patient: It’s sunscreen

Me: (with a puzzled look on my face) were you not asked NOT to wear  any lotion, powder or deodorant?

Patient: YES, they didn’t say I couldn’t put SUNSCREEN on! ( in a very harsh tone)

SERIOUSLY!!!!! OMG I COULD NOT BELIEVE HER RESPONSE TO ME AND HER TONE.

Me: I walked over to the baby wipes, asked her to please wipe, said that I would take one image, if I saw artifact on my view I would delete it and cancel the appointment. I then grabbed my cell phone and told her that I was going to snap a photo of my paddle to show the scheduler how these products interfere with the imaging. I tilted the unit at an angle for the image.

Wiping this sunscreen off of the unit made a mess. I managed to get it all cleaned up and we were able to complete the exam……of coarse this exceeded her 15 minute time slot!

Prior Mammograms

If it is your first mammogram at a facility and you have had priors elsewhere, please arrange for you priors to be sent to the imaging facility. I we receive them ahead of time the images are imported and prior reports are scanned, we have everything for our radiologists to make a comparison when he looks at the current study. IF, you don’t make those arrangements, we get you to sign a release for priors, we look up the location of your priors, and it helps if you know where your last mammogram was at. Last week, I spent 22 minutes with a patient on the computer looking for a facility on the mainland. She knew the state and city and part of the name of the facility (her prior was a 2015 study, how can you not remember)  We managed to find it. Release signed, we got started at 825 am, by then my 815, 830 and 845 patients were registered…….THEN….she had implants and was not double booked!!! My morning snowballed after that. You can not rush through a mammogram to get caught up, it was not until a patient called to reschedule an appointment that I was able to get caught up from my morning fiasco.

Clothes

Make every attempt to wear two piece clothing and not a dress. We only require you to change from the waist up, when a dress is worn to the appointment the patient is standing in her underwear with a long paper gown on (my clinic uses paper disposable gowns). I have had patients not have under clothes on,  which made it pretty awkward. In this case I got creative and taped a gown creating a skirt like cover-up, then a half gown on top. I do not understand why someone would not wear under clothes to a medical appointment!

Time to sign off, Mahalo for taking the time to read my blog, was not my intention to make it this long.

Pina