MAMMOMAT Inspiration Biopsy Daily Workflow from A to Z

Welcome to this training on the Daily Workflow steps using the MAMMOMAT Inspiration Biopsy System.  This training will help familiarize you with all of the workflow steps from startup of the system to completion of a stereotactic biopsy. Course Objectives   Perform all the steps necessary within a daily biopsy workflow including pre-patient setup, acquiring target information, biopsy procedure, and post-biopsy steps. Upon completing this web module, the user will be able to: Pre-patient Setup System Startup Attaching Biopsy Unit checklist Daily QC Attaching Needle Holder Registering a patient Acquiring Target Information Positioning the patient Acquiring a scout image Acquiring the stereo pair Checking the reference marks Selecting the needle and transmitting the target Biopsy Procedure Attaching the biopsy device Acquire prefire images Acquire postfire images Acquire post biopsy images Acquire post clip images Acquire specimen image Post-biopsy Steps Send images to archive Cleaning biopsy unit Removing biopsy unit System Shutdown In the Pre-patient setup section we will discuss all the steps that need to be completed before the patient is positioned, including: Startup of the Inspiration biopsy system Attaching the biopsy unit Daily QC Attaching the needle holder Registering the patient. To start-up the system, from standby mode turn off the system by pressing the power off button and wait two minutes.  Power the system back on by pressing the power on button. This will ensure that all the system components are started in the correct order.  Then login at the acquisition workstation (AWS) with your username and password. Click the links below to view step by step instructions and video on how to attach the biopsy unit. Attaching the biopsy unit - Checklist Attaching the biopsy unit - Checklist Checklist TitleChecklist TypeChecklist ContentStep 1HTMLSlide the stereo tower over the Inspiration detector until it clicks to lock in place. Step 2HTMLConnect the power cord to the port located beneath the detector.  Ensure that the cord is aligned correctly by matching the red dots on the cord and the port. Step 3HTMLEnsure that the handbox is connected to the back of the stereo tower. Step 4HTMLAttach the compression paddle holder with the appropriate compression plate installed. Step 5HTMLAttach the appropriate needle holder and open and close the safety switch to verify functionality. Step 6HTMLAttach the stereotactic face shield. Attaching the biopsy unit - Video Attaching the biopsy unit - Video   The daily biopsy check must be completed prior to performing the first biopsy of the day if biopsy procedures are scheduled.  This check confirms that needle accuracy is within 1mm of the target.  If results are outside of the 1mm range, a biopsy calibration must be performed.  Click the links below to view the step by step procedure and a video on how to perform the daily biopsy check.   Daily Biopsy Check - Checklist Daily Biopsy Check - Checklist Checklist TitleChecklist TypeChecklist ContentStep 1HTMLAttach Biopsy Unit, Biopsy Paddle Holder, remove the Plastic Paddle. Step 2HTMLAttach the Standard Needle Holder and bushings.  Step 3HTMLPlace pins into the Biopsy Phantom Pin Holder and tighten. Step 4HTMLAttach the Biopsy Phantom by bringing the Paddle Holder down until phantom touches detector.  Step 5HTMLRegister patient.  Select operator.  Step 6HTMLChoose “Daily Biopsy Check” located in the “Procedure” dropdown. Step 7HTMLVerify in the “Acquisition tab” in the Venetian Blinds, the “EXP” drop down should be “Manual Biopsy”. Verify technique displayed 28 kV, 56 MAS and W/RH. Step 8HTMLAcquire “Scout” image. Select “Ok” to continue, or “New” to repeat the exposure.  Check that stereo pair is enabled. Step 9HTMLAcquire the scan. Do not release the exposure button. The tube will acquire a -15 degree stereo image and then the tube will move to the +15 degree stereo for other exposure. Once the tube returns to the zero position, you can release the exposure button. Click reference point. Step 10HTMLRight click and select “Zoom from Point”. Click on reference point in both images to magnify.  Press ESC on the keyboard to disable “Zoom from Point”. Step 11HTMLCheck reference marks and “Confirm".  Adjust if needed. Step 12HTMLTarget the pin closest to the detector. If necessary, select “zoom from point”.Click “Confirm,” a dialog box should appear: “Target is out of Biopsy Range.” Click “Ok.” This verifies that the system is correctly calculating the safety distance. Step 13HTMLDrag the cursor to the center target position. Click “Confirm". Step 14HTMLHighlight the target numbers (x, y, z in stereo tab in the venetian blinds) and click “transmit” Verify that the correct holder (standard) and needle (calibration) are selected. Step 15HTMLClick “Move to Target,” click “Yes.” Arrows will appear in the Venetian blinds while the holder is moving. Step 16HTMLOnce the holder reaches the target a “Flag” is displayed next to the target on the AWS. Step 17HTMLInsert Calibration Needle. Touch the hand box to zero out. The tip of the needle should touch the tip of the pin targeted. If an adjustment is needed, push the safety switch to the back and adjust the needle by using the hand box.  Document values on the QC form. Step 18HTMLRemove the needle and turn the safety switch to the front. The system will return to the home position when the study is closed. Daily Biopsy Check - Video Daily Biopsy Check - Video    A different needle holder is needed for each different approach.  The vertical needle holder is used for  craniocaudal (CC), mediolateral (ML), lateromedial (LM) or mediolateral oblique (MLO) approaches.  The horizontal needle holder is used primarily for a thin breast or an inferior lesion.  The standard needle holder is used for QC testing, wire localizations, and with spring-loaded biopsy devices. Patients are registered from the patient browser on the acquisition workstation.  For every patient, you will have to select the BIOPSY RIGHT or BIOPSY LEFT procedure from the procedure dropdown and modify the views accordingly.  Click the link below to watch a video of this procedure. Registering a Patient - Video Registering a Patient - Video   In the acquiring target information section, we will discuss the procedures needed to acquire, mark, and trasmit target data from the AWS to the stereo unit.   After reviewing the mammography images with the physican, position the patient according to the pre-determined approach to achieve biopsy. In order to properly position the needle, a scout image must be taken to determine if the lesion is appropriately positioned within the biopsy window.  For appropriate visualization of the lesion on the stereo pair, the scout image must show the lesion in the middle third of the biposy window.  If the scout image is acceptable, click OK in the icon gallery.  If the scout image is not acceptable, click NEW in the icon gallery.  The patient will need to be repositioned and the scout repeated. Once the stereo pair has been acquired, the reference mark must be verified by clicking the reference point button and adjusting the mark as needed.  The reference mark on the AWS must line up vertically and horizontally to the reference point on the image.  This must be accurate because all measurements for targeting are taken from this point. Once the reference mark has been verified and confirmed, the lesion can be targeted by the physician with the mouse on the AWS.  Click the link below to view a video demonstrating this process. Checking Reference Marks - Video Checking Reference Marks - Video   After the needle holder has moved to the selected target position, the breast is prepped, anesthetic given, and incision made per facility guidelines.  In this section we will discuss the steps associated with a basic biopsy procedure.   Once the needle is loaded in its final position, a prefire stereo pair is taken.  The prefire image is used to determine whether the lesion has moved since the original stereo pair was taken. If the lesion is not in position, the physician can re-target. If the lesion is still in position, the physician is ready to advance the biopsy device. Click the link below to watch a video of this process. Acquire prefire images - Video Acquire prefire images - Video   After the physician has advanced the biopsy device, postfire images are acquired to verify that the lesion is within the sampling aperture.  Biopsy samples are taken. A post biopsy stereo pair is acquired to determine if the lesion has been adequately sampled.  This is achieved by partially retracting the needle for better visualization of the biopsy cavity. If the lesion has been adequately sampled, the biopsy device is returned to the original position and a tissue marker is placed per vendor recommendations. The biopsy device is then retracted from the patient and the post-clip stereo pair is acquired.  If the physician is satisfied with the tissue marker placement, the biopsy device can be removed from the vertical holder and the patient removed from compression.  Post-biopsy patient care is then applied per facility guidelines.   If the biopsy was taken for calcifications, the tissue samples can be radiographed for verification of calcifications. After the biopsy procedure is complete and the patient has been removed, images can be archived and the system cleaned, disassembled, and shutdown. If you are sending images to a PACS system, images will automatically be routed when the patient study is closed.  Please refer to the user manual for the steps to archive images to an alternate location. To clean the biopsy unit, use commercially available alcohol-free disinfectants for disinfecting the surface.  Disinfectants based on substituted phenols and chlorine-splitting compounds have a slightly corrosive effect and therefore are not recommended.  Disinfectant sprays must not be used since the spray mist may penetrate into the equipment and compromise system safety. To remove the biopsy unit, remove the compresion paddle holder, unplug the power cord, depress the locking buttons on the side of the stereo unit and slide off.  Be sure to keep the handbox together with the biopsy unit. To shutdown the system, select end session from the options menu.  Click shutdown system in the popup window, and confirm by clicking yes. In order to attach the biopsy device (needle), the tube head must first be moved to the side.  This is accomplished by depressing and holding the single touch button on the tube head.  Next, the plate on the back of the biopsy device is aligned with the slot on the needle holder and tightened in place. Note: The needle will enter the breast if the biopsy device is loaded in the final position.  If you are not ready for the needle to enter the breast, you can load it to partial position and lock in place until ready. Once the physician has targeted the lesion, the x, y, and z parameters are displayed in the subtask card.  The picture below illustrates what the x, y, and z values represent.   Select the parameters and click the transmit button.  A pop-up window will display prompting to select a holder and needle.  The only needles that will be displayed are those that are appropriate for use with this target.  Click "move to target" and then confirm selected needle and needle holder combination. The standard holder is most commonly used for quality control and wire localizations but can also be used for spring-loaded devices.  For quality control testing, the safety swtich can be overridden in order to move the holder with the needle in place. The vertical holder can be used not only for a CranioCaudal (CC) projection, but also for an MedioLateral Oblique (MLO), MedioLateral (ML), or LateroMedial (LM).  When using the vertical holder, the needle entry is the same direction as compresion. The horizontal holder is useful for thinly compressed breasts or inferior legions.  With the horizontal holder, the needle entry is opposite compresion.  Minimum z-value for use of this holder is 15mm. How to Attach Horizontal Needle Holder How to Attach Horizontal Needle Holder