Mammography of high quality depends a great deal on the cooperation of our clients. When our 'clients' become 'patients' who are ill, frail, incapacitated, helpless, unbalanced, delayed or otherwise handicapped, the assignment of obtaining excellence becomes gargantuan.
Without writing a thesis on the subject, I have assembled a concise list of helpful hints under some short universal topics related to imaging disabled patients.
THE FACILITY
- Accessible parking close to entrances
- Accessible front entrance
- Doors that are wide and easy to open
- Accessible route through facility
- Sign language information
- Braille information
- Large print documentation
- Space in waiting area for wheelchairs
- Space in change area for wheelchairs
- Adjustable height examination tables
- Mammography units that will adjust to wheelchairs or gurneys
- Mammography rooms large enough to allow stretcher access
COMMUNICATION
- General Communication
- Treat every person with respect
- Do not use patient's first name useless prompted by the patient to do so
- Offer assistance but WAIT until the patient accepts your help
- Allow the patient to give you instructions on the best way to help
- Always speak to the patient rather than to the companion
- Let the patient set the pace for the procedure
- Relax, do not feel discomfort on the patient's behalf
- Assistive devices are part of the patient's personal space. Do not move them without permission
- When conversing with a chair or bed bound person, always put yourself at eye level
- Always ask before moving a patient who is immobilized in any way
Communication with the Visually Impaired
- Allow the person to take your arm when assisting
- You are acting as a guide NOT a leader
- Speak in a normal tone of voice
- Identify yourself and all others with you
- Always indicate when you are moving from one place to another during the test
Communication with the Hearing Impaired
- Tap the person softly on the shoulder or gently wave your hand to get their attention
- Look directly at the person and speak clearly, directly and expressively
- Written notes or illustrations may be of great assistance
- Do not eat, chew gum or place you hands near your face
Communication with Persons with Speech Impairment
- Give whole and unhurried attention to people who have difficulty speaking
- Be encouraging, patient and allow the person to complete their thoughts
- Ask short questions that require only very short answers
- Never pretend to understand, take your time and understand in a different way
Communication with the Cognitively Deficient
- Take the time to achieve clear understanding
- Use body language
- Use simpler words
- Use pictures, cartoons or diagrams
- Provide the patient with the same information in different ways (be creative)
POSITIONING
Positioning of the disabled patient is the most important and most difficult aspect of dealing with the handicapped. There are innumerable problems involved in safely and efficiently controlling the examination of the disabled. I hope these concise tips dealing with actual manipulation and acquisition of the required views will facilitate the technologist in obtaining quality images.
Common Concerns with Positioning the Handicapped Patient
- Inadequate amount of retroglandular tissue imaged
- Inability to position C-arm parallel to chest wall
- Inability of patient to cooperate with exam
- Exam room of inadequate size to accommodate stretcher, wheelchairs or immobilization devices
- Extra views may be necessary to view tissue adequately
- Two mammographers may be necessary to safely handle the patient and obtain satisfactory views
- Enough time assigned to the procedure to allow it to be carried out with care, safety and precision
The Basic Positions Required for Handicapped Patients
- From Below(stretcher)/CC(Chairbound)
- Mediolateral Oblique
- 90 degree Lateromedial
OBTAINING THE REQUIRED PROJECTIONS
From Below (Stretcher)
- Stretcher patients must lie on their unaffected side
- Tube is placed in the 90 degree position and moved under the affected breast
- The compression is applied from beneath
- Mammographer should stand behind the image receptor for better control
- CC (Chairbound)
- Wheelchair patients must be able to lean into receptor
- Wheelchair patients may have to be moved to a wheeled armless positioning chair or moveable bench
- Remove face plate if needed and turn the patient’s head away from the tube
- Have the patient grip the underside of the bucky
- Tilt the tube 5˚ if needed
Mediolateral Oblique
- A proper MLO view cannot be acquired on a stretcher bound patient without the patient being able to tolerate the head of the gurney being elevated at least 60 degrees
- Raise the head of the stretcher as far as will be permitted
- The image receptor should be placed against the stretcher, parallel to the patient's pectoralis
- Move the patient over to side of gurney and raise her arm up out of the field of vision
- Have her lean into the receptor and compress the tissue adequately
- Patients confined to wheelchairs must be able to lean into the image receptor or they must be transferred to an armless wheeled positioning chair or moveable bench
Lateromedial
- This may be the most valuable and easiest view to accomplish dealing with the stretcher bound patient
- The patient should lie flat on their side with the affected side up
- Rotate the tube so that it is parallel to the gurney
- Place the bucky along the patient's sternum
- Roll the patient slightly forward and raise her top arm out of the way
- Move the breast superior and laterally
- Bring the compression down as far laterally as possible without including the latissimus dorsa
SUMMARY
Most people will experience some form of disability as they age. Physicians often have difficulty prescribing preventative services for their disabled patients because of lack of adequate facilities.
For women with disabilities access to mammography greatly diminishes with age and increase of functional limitation. By age 65, 57% of healthy women have had a mammogram, as compared with 43% of women who are functionally challenged.
Encourage you facility to part of the solution NOT part of the problem.
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