Case Study | February 18, 2011

Prone Stereotactic Biopsy Upgrade Improves Patient Experience, Exam Efficiency and Access

Hologic MultiCare Maximum Comfort Package provides targeted pressure-point support while maintaining optimal positioning and maximum access

Dartmouth-Hitchcock Medical Center (DHMC) at Dartmouth College in Lebanon, New Hampshire, is one of the leading teaching hospitals in the country. With its focus on clinical excellence and high-quality patient care, DHMC recently installed the Hologic MultiCare Maximum Comfort Package to improve patient comfort during prone stereotactic biopsy procedures.

The Maximum Comfort Package is a collection of ergonomically engineered cushions and a new tabletop designed for use with the Hologic MultiCare Platinum prone stereotactic breast biopsy guidance system. The cushions provide targeted pressure-point support for all types of lesions and body types while maintaining optimal positioning and maximum access.

Dartmouth-Hitchcock radiologists and technologists have noticed significant improvements in patient comfort and workflow efficiency since they upgraded their prone biopsy table. Plus, they found the new package allows them to accommodate a greater number of patients for minimally invasive biopsies.

Maximum Comfort Package Transforms Patient Experience

According to radiologist Steven Poplack, M.D., co-director of Dartmouth-Hitchcock’s Breast Imaging Program, one of the biggest challenges of stereotactic biopsy procedures is patient discomfort as a result of the prone position.

“Based on my personal experience performing stereotactic biopsy at Dartmouth-Hitchcock over the last 18 years, I can say the importance of patient comfort cannot be overstated,” says Dr. Poplack. “Our primary clinical goal is to thoroughly sample the lesion. But the secondary goal is to do so with a minimum of discomfort so that the patient’s overall experience of the procedure is positive.”

When DHMC first began utilizing the MultiCare Platinum system in 2005 – which Dr. Poplack believed to be the most comfortable prone stereotactic table available at the time – radiologists and technologists often fielded complaints about the patient discomfort unrelated to the biopsy itself. When the Maximum Comfort Package came online, patients’ complaints related to the discomfort of the procedure largely stopped.

“We were used to hearing complaints about neck, rib and back discomfort. But since we added the Comfort Package, we seldom receive that feedback,” says Lead Interventional Technologist Janine Stammers. “The new technology gives us more choice regarding how we can address patient comfort – you can tell a lot of thought went into the materials and design that make the table more comfortable.”

The Maximum Comfort Package consists of a choice of four tabletop cushions. The cushion that is used depends on the patient’s body type, breast size and location of the lesion. The Standard Access cushion provides the same access as the existing tabletop, but is made of ergonomic memory foam that targets specific pressure points. The Maximum Access cushion is thinner and is useful for positioning patients with high chest wall lesions. The Maximum Comfort cushion consists of multiple layers of foam to ensure comfort, particularly when accessing more anterior lesions. The Arm-Through cushion features a slightly larger opening that allows patients to comfortably fit through the table when accessing high axillary regions.

For the majority of patients, technologists at DHMC use the Maximum Comfort cushion in order to make the procedure as comfortable as possible. For women with smaller breasts, the Standard Access cushion maintains comfort while maximizing the amount of tissue in the working area. Technologists say the Maximum Access cushion provides the best possible balance between comfort and access to challenging lesions, such as those located on the chest wall. In fact, the cushion improves access so much that it has spared many patients from the more difficult arm-through procedure.

Dr. Poplack says the new package has even simplified the arm-through procedure. While the technique is useful for accessing lesions located near the axilla, the one-size-fits-all opening on most tables can restrict access for some patients with physical limitations, and the lack of arm support can contribute to even greater discomfort. But the MultiCare Maximum Comfort Package provides a new arm-through pad and wider aperture that allow patients to comfortably fit their arms and shoulders through the table, along with an arm rest for greater support and stability.

Patient Comfort Improves Efficiency

According to Dr. Poplack, increasing comfort not only improves the patient experience – it also improves the speed and efficiency for a majority of DHMC’s stereotactic procedures. The design of the table and the comfort of the cushions enable patients to settle into the correct position much more quickly. As a result, for most patients technologists saw their procedure set-up time decrease by nearly half, going from five minutes to less than three minutes with the Maximum Comfort Package. In addition, greater patient comfort leads to less motion during the procedure, and radiologists are seeing a decline in the number of repeat exposures required.

Increased Access to Minimally Invasive Procedures

By increasing comfort and providing more options, the MultiCare Maximum Comfort Package has enabled DHMC to offer the benefits of minimally invasive breast biopsies to more women. In addition to the cushions, the package features three new interchangeable drop-in apertures, which allows for customized positioning. This increased flexibility enables radiologists to employ needle approaches that wouldn’t have been possible in the past.

“With the Maximum Comfort Package, we are now able to successfully biopsy nearly all of mammographically visible lesions with the MultiCare Platinum system,” says Dr. Poplack. “The small number of cases that were not amenable to stereotactic biopsy due to small breast size and posterior lesion location has been decreased even further.”

As a referral center that sees many of the challenging cases other facilities cannot accommodate, DHMC’s use of the Maximum Comfort Package means it is sparing even more women from unnecessary surgical biopsies. Dr. Poplack says the increased comfort improves stereotactic procedures not just for women, but also for the technologists and the radiologists. “It’s just a much more positive experience for everyone involved,” he says.

This case study was supplied by Hologic.
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