Practitioner variation of applied breast compression force in mammography

Mercer, CE

Abstract

Rationale:
Mammography practitioners control the amount of compression force applied to the breast. There are no quantifiable recommendations for optimal compression force levels for practitioners to follow. Clients report variations in pain and discomfort when compression force is applied. Until now practitioner compression force variability has not been investigated; even though this might lead to variations in client pain and discomfort. The primary purpose of this thesis was to investigate whether practitioner compression force variability exists.

Method:
Three research papers investigated practitioner compression force variability: one used a cross sectional design; two used longitudinal designs, one was single centre and the other was multicentre. Three further research papers investigated important issues which might confound practitioner variability results: the first investigated compression paddle bend and distortion; the second investigated how breast thickness and compression force vary; the third evaluated practitioner ability to grade breast density, visually. The final research paper was a ‘within client’ investigation to determine how image quality varied with breast thickness and compression force.

Key findings:
The research firmly demonstrates that practitioner compression force variability exists. Multicentre analysis (4500 client visits) confirmed two out of three screening sites with significant practitioner variability, with the third screening site having a minimum dictate of compression force at 100N. As displayed by MLO/CC projections clients underwent a 55%/57% (site one), 66%/60% (site two) and 27%/26% (site three) change in compression force through their three screening visits.

The research confirmed that the compression force received by a client was highly dependent upon the practitioner, and not the client. Within an individual clients screening pathway the research has demonstrated that clients could receive significantly different compression force levels over time.

Conclusion and further research:
For the first time practitioner compression force variability has been identified. Novel methods for reducing breast thickness need investigating; an example of a novel method is the use of pressure rather than force.

Citation

Mercer, C. Practitioner variation of applied breast compression force in mammography. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Sep 18, 2015
• Publicly Available Date: Sep 18, 2015