Breasts are one of the trickiest scans I have ever done and I used to find them very intimidating.
However, after my mother was diagnosed with breast cancer and went through a bilateral mastectomy I firmly resolved to find a way to understand breast scanning techniques better and become more confident so that I could help other women the way that my mother was helped.
The following series of articles is due to the wealth of knowledge that I acquired from skilled instructors and coworkers. These are the first of the tricks that helped me become a confident breast sonographer.
1. Positioning the patient for the best image
If you are scanning the left breast you want to tilt her a little onto her right side, so she is facing you a bit, and put her left arm up over her head to that the left breast is laying as flat and even as possible.
Keep the rest of her covered for warmth and modesty. Putting a roll of towels or support cushion behind her lower back helps her to relax in this position.
Use a generous amount of gel and warn her before you apply it, or even better, ask permission to make her feel more comfortable with the intimate contact. A simple smile and asking “All ready to begin?” can go a long way to relax your patient and begin building a positive rapport.
2. Understand what normal breast tissue looks like
This is the single most helpful tip that I have ever gotten: imagine that breast tissue is like an ocean. There is a gentle flowing motion to the ultrasound appearance of normal fat and fibrous tissue in a breast. It is smooth and continuous.
So when there is something abnormal in the breast tissue, whether a cyst or a mass, benign or malignant, it will disrupt that smooth flow of tissue, the same way that a boat on the ocean disrupts the smooth pattern of the waves.
Anything that catches your attention and stands out in this way is something that you need to pause at and investigate closer.
3. Your eyes are only as good as your properly adjusted settings
I always make my adjustments in a certain order: depth, TGC, frequency, contrast and focal zones (I use from 2 to 4 focal zones depending on what my machine can handle without lag, more is usually better) to ensure that I am seeing all the way down to the chest wall in as much detail as possible.
Remember also that when harmonics are ON, it can affect penetration. So ensure that it is off when you are trying to optimize deep tissue. And when trying to determine if something small has posterior shadowing or enhancement, narrow your sector width and try removing crossbeam.
Of course these tips depend on the type of machine that you use, I most commonly did breast scanning on a Loqic machine. So for specific details on how to do this on your machine utilize the resources you have at hand: ask your local rep and your coworkers and take the time to play with settings to learn for yourself.
Small adjustments like these can make a big difference in image quality and how much information you can gleam for your doctor. The more you know, the more confident you will feel.
Remember: As you practice these tips while scanning, always begin with confidence in your abilities. Trust in yourself. You can do this and you can do it well.