PAMM001 Mammography: Principles and Practice

2010-2011

Code: PAMM001
Level: M
Title: Mammography: Principles and Practice
Instructors: TBA
CATS Credit Value: 30
ECTS Credit Value: 15
Pre-requisites: N/A
Co-requisites: N/A
Duration: 12 months
Availability: Programme HSMY only
Background Assumed: -
Directed Study Time: 300 hours

Total Student Study Time

300 hours, to include: 36×1-hour lectures; 3×1-hour tutorials (essay and presentation preparation); 27×1-hour workshops; 10 hours directed reading; 6 hours of presentations; 35 hours of clinical training and practice; 100 hours assessment tasks; 83 hours private study.

Aims

To develop mammographers with advanced clinical-practice and communication skills who can produce high quality mammograms to enable accurate diagnosis. This module draws on the scientific disciplines of anatomy, physiology, radiation physics, etc., to describe the principles underpinning mammography imaging. Students will draw on evidence-based practice to critically evaluate processes and procedures of the breast care pathways within the screening and symptomatic services.

Intended Learning Outcomes

These have been designed to map onto the relevant workforce competencies M2, M8 and M11, including the NHS KSF dimensions applicable to a mammmographer.

Students will be able to:

Module Specific Skills
1. Describe in depth the normal anatomic and radiographic appearances of the breast, including lifetime changes.
2. Identify abnormalities and pathophysiololgical processes within the breast and use professional judgement to establish which further imaging and diagnostic tests may be required.
3. Use advanced patient-communication skills, and deal with emotionally charged situations and maintain the well-being and dignity of the patient.
4. Accurately report clinical history and findings.
5. Use equipment to produce diagnostic mammograms.
6. Critically evaluate mammograms from a technical and quality perspective and modify technique as appropriate.
7. Make purchasing recommendations based on an analytical comparison of clinical requirements and constraints with equipment specifications.
8. Use a working knowledge of radiation physics and relevant legislation (policies, etc.) to inform image production and safe use of equipment.
9. Perform quality assurance tests and performance audits — document, analyse and interpret results, implement remedial action if necessary.
10. Describe and critically evaluate the organisation of the NHS breast screening programme, including health promotion.
11. Explain and critically evaluate the symptomatic care pathway taken by patients presenting with breast symptoms, and the treatment pathways for those requiring enhanced screening/surveillance.
12. Describe and critically evaluate the multi-disciplinary team organisation and its decision making processes.
13. Describe how additional imaging modalities can be used to aid diagnosis.
14. Use a knowledge of ergonomics and body posture technique to reduce risk of repetitive strain injury.
15. Engage confidently and clearly in written and spoken professional communication.
Discipline Specific Skills
1. Maintain high standards of professional clinical practice; use safe and efficient working processes, taking account of issues such as radiation protection and ergonomics.
2. Use appropriate sources of evidence-based medical information to extend own knowledge base and apply this to: the clinical context, health promotion dissemination, and continuing professional development.
3. Identify ethical issues (including issues of informed consent and data protection), and suggest resolutions.
Personal and Key Skills
1. Exercise initiative and personal responsibility in professional practice, making decisions in complex and unpredictable situations.
2. Manage time and workloads, with minimal guidance
3. Learn independently, as required for continuing professional study.
4. Critically appraise evidence.
5. Apply reflective practice to own and others' functioning in order to improve practice.

Learning / Teaching Methods

Lectures; workshops; directed clinical practice; WWW resources and self-study documents.

Directed background reading: Anatomy of the breast will be self-taught anatomy revision and pre-course reading.

Assessment and Assignments

Note: To receive a non-zero mark for this module, students must pass all of the following components: clinical assessments (pass/fail), OSCE (50% pass mark), and the portfolio (50% pass mark).

Contribution	Assessment/Assignment	Size (duration/length)	When	ILOS Assessed (indicative)
15%	Presentation	25 minutes	Week M8	MS:15
22%	Portfolio	As specified in handbook.	Week T1	MS:2-6,8-11; DS:1-3; PK:1-5.
Formative	Essay	1000 words	Deadline Week M1	N/A
25%	Essay	3000 words	Deadline Week M10	MS:15; DS:2; PK:2-5.
30%	Examination	120 minutes	Week L0	MS:1,2,6,7,10-15; DS:3; PK:4.
8%	Objective structured clinical examination (OSCE)	1 hour	Week L11	MS:2-6,8; DS:1,3; PK:1
Pass/Fail	Clinical assessments	11 months	To be completed by Week T1	MS:2-6,8,14; DS:1,3; PK:1
Formative	Directed reading including anatomy revision	10 hours	Before theory lectures	N/A

Syllabus Plan and Content

Theory

Anatomy and pathophysiology of the breast and related structures
1. Identification of normal and abnormal breast appearances on mammogram with the inclusion of developmental changes to breast tissue due to age, HRT, radiotherapy and surgery. Common normal variants will be discussed and identified.
2. Signs and symptoms of breast disease, further treatment and breast cancer treatment pathways.
Radiographic technique and evaluation of mammograms
1. The production of consistently high quality images according to the standards of the NHSBSP and the College of Radiographers with understanding of how to adapt radiographic technique when required. Identification of factors indicating technically acceptable standards. Evaluation of mammographic quality. Causes of artefacts on images and importance of minimising/excluding them. Use of appropriate identification and legends. Correctly recorded clinical information disseminated to the film reader(s).
2. Assessment of radiological or clinical detected abnormalities through the screening or symptomatic pathways, utilising triple assessment and the multidisciplinary approach.
3. Use of supplementary and modified mammographic images, interventional techniques both x-ray and ultrasound guided, stereotactic, and vacuum assisted procedures, localisation techniques and specimen imaging.
4. Image handling devices, recording of images, image storage and retrieval
Imaging systems equipment, quality control and performance tests
1. Digital and analogue systems and features of exposure selection systems, means to minimise radiation dosage, image receptors and image handling devices including functions, specifications and performance, maintenance and cleaning. Requirement for regular QA checks.
2. Equipment tests and fault finding, user responsibility, and correct procedures for reporting performance problems.
3. Use of additional imaging modalities required to aid diagnosis e.g. Ultrasound, MRI and Radionuclide Imaging.
4. Emerging technologies e.g. Tomosynthesis.
Principles of the screening programme (NHSBSP)
1. Organisation and delivery, quality assurance.
2. Risks and benefits of screening, health promotion within the screening programme.
Communication skills and analysis
1. Development of effective communication skills requiring higher level understanding to engender confidence and strategies to deal with emotive issues, of anxiety and distress.
2. Adaptation of communication styles appropriate to person's culture, language or specific needs
3. Disclosure of results protocols and within appropriate time frames, informed consent, data protection issues to be compliant with local and national policies
4. Interpersonal communication skills development to enable integration within the multi-disciplinary team and foster confidence in mentor/mentee relationships and performing supervisory role for assistant practitioners.
Treatment care pathway (screening and diagnostic)
1. Structured on-site visits to provide a broad understanding of the patient journey, to include, assessment clinic, symptomatic outpatient clinic, breast care nurse, multidisciplinary team meeting, breast ward, pathology, breast surgery, radiotherapy dept, oncology, prosthesis fitting, MRI and Radionuclide Dept.

Practical clinical training

Clinical placement (5 days)
1. Practical instruction to develop a working knowledge of mammography equipment and procedures, to facilitate the production of consistently high quality images, using the standard breast projections of the cranio-caudad and medio-lateral oblique. Use of criteria to indicate technically acceptable standards. Evaluation of mammographic quality. Correct use of markers and identification of images.
2. Techniques to encourage compliance of the patient; adaptation of radiographic technique for factors that may inhibit compliance such as pain, anxiety, surgery changes, breast implants, and physical disability; management of correct personal and clinical details and informed consent; use of appropriate communication skills to deal with emotionally charged situations.
3. Assessment of radiological or clinically detected abnormalities through screening assessment or symptomatic clinics, utilising triple assessment and the multidisciplinary approach.
4. Use of supplementary and tailored views; specimen imaging.
5. Introduction to the use of breast ultrasound, breast interventional techniques under ultrasound guidance and x-ray guidance, use of stereotaxis, vacuum assisted procedures and localisation procedures.
6. Ergonomics and body posture of technique to reduce risk of repetitive strain injury.
Imaging in clinical practice
1. Practical instruction to facilitate the production of consistently high quality mammograms, with experience to be gained in assessment clinics and symptomatic clinic. Participation is expected in all aspects of mammography work to broaden experience. It is expected that the student will undertake at least 300 mammograms during the expected 12 month module duration.

Core Text

Lee L., Strickland V., Wilson R. and Evans A. (2002), Fundamentals of Mammography, Churchill Livingstone, ISBN 0-443-07114-4 (UL: WP 815 FUN)

Supplementary Text(s)

Dixon M. (Ed) (2006), ABC of Breast Diseases, BMJ Publishing group, ISBN 0-727-91828-1 (UL: WP840 ABC)
Kopans D.B. (2006), Breast Imaging (3^rd edition), Lippincott Williams and Wilkins, ISBN 0-781-74768-6 (UL: ???)
Tucker A. K. and Ng Y. Y. (2001), Textbook of Mammography (2^nd edition), Churchill Livingstone, ISBN 0-443-06340-0 (UL: ???)

Formative Mechanisms

Students will be given copies of assessment pro-formas and will have an opportunity to discuss these with a tutor.

Evaluation Mechanisms

The module will be evaluated using information gathered via the student representation mechanisms, the staff peer appraisal scheme, and measures of student attainment based on summative assessment.