MAMMOMAT Inspiration Biopsy Overview

Welcome to this overview training on the MAMMOMAT Inspiration Biopsy System.  This training will help familiarize you with the biopsy system components and functionality as well as the installation and configuration of the system. Course Objectives   Configure the unit to include Needle configuration, Needle holder configuration and system configuration   Demonstrate how to attach the biopsy unit   List the functions of the parts of the biopsy unit   List the parts of the Inspiration biopsy unit   Perform quality control tests Upon completing this web module, the user will be able to: System Components and Function Stereo Tower Compression Plates Needle Holders Vertical Horizontal Standard Handbox Acquisition Workstation Exposure Switches Control Pad Hand Switch Foot Pedal Attaching the biopsy unit Biopsy unit configuration Biopsy Calibration Daily Biopsy Check Weekly Phantom Hover your mouse over the hotspots in the image below to identify the system components. The stereo tower is the main component of the system which plugs into the Inspiration and holds the needle biopsy device. The Inspiration biopsy system comes with a metal compression plate holder into which two different compression plates can be inserted.  The fenestrated compression plate comes standard with the system and is used with the vertical and standard needle holders.  The non-fenestrated compression plate is a purchasable option and can be used with the horizontal needle holder. Needle holders attach to the stereo tower to secure the biopsy device.  The Inspiration accepts three different types of needle holders: vertical, horizontal, and standard.  Vertical and horizontal holders can be used for vacuum assisted biopsy devices.  These holders may vary depending on the needle vendor selected. The standard holder is used for spring loaded devices, wire localization, and quality control.  Each holder has a safety switch to prevent accidental movement when the needle is engaged.  The handbox is connected to the back of the stereo tower and functions to manually move the needle holders in the X, Y, and Z axes as needed.  The picture below illustrates what the x, y, and z values represent.  When a target is transmitted, the handbox will display the number of targets transmitted, the length of the needle selected, and the safety distance associated with that needle. All functions are initiated by the Acquisition Workstation (or AWS) and then transmitted to the biopsy system.  Needles and holders are configured on the AWS.  It also displays all images and allows the user to set targetting parameters. There are three different exposure switches, the control pad, the hand switch, and the foot pedal.  The control pad is standard and the hand switch and foot pedal are purchasable options. Click the link 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   > Cilck the links below to watch videos on how to configure the needle holders and the needles themselves. Needle Holder - Video Needle Holder - Video   Needles - Video Needles - Video   The Inspiration biopsy system needs to be calibrated yearly or if the daily biopsy check fails.  The biopsy calibration ensures the accuracy of the targeting device for patient procedures.   Click the links below to view the step by step procedure and a video on how to perform the biopsy calibration. Biopsy Calibration - Checklist Biopsy Calibration - Checklist Checklist TitleChecklist TypeChecklist ContentStep 1HTMLAttach Biopsy Unit. Step 2HTMLClick Patient>Biopsy Calibration. Step 3HTMLFollow on-screen instructions (no paddle or paddle holder used position, insert the two bushings and Standard Needle Holder, flip safety switch to the front).  Click “Move to position” Step 4HTMLTurn safety switch to the side and insert calibration needle.  Raise the bottom needle guide holder to the upmost position. This will allow you to see the tip of the needle on image. Step 5HTMLAcquire Scan. (Do not lift off of exposure button/foot pedal until both images are acquired and the tube returns to the zero position).  Follow on-screen instructions. Step 6HTMLClick “Ref. Point”. Step 7HTMLA blue line will appear through the reference point. Step 8HTMLRight click on the image and select zoom from point. Left click on the reference mark in the left image and then the same area on the right image to magnify the reference point. Click the ESC button on the keyboard to deactivate the zoom from point. Step 9HTMLLeft click on the reference mark on the left image to adjust if needed. Adjust the mark on the right image as well if needed.  Click “Confirm”. Step 10HTMLRight click on image and select “home zoom pan”. Step 11HTMLMove cursor to the tip of the pin in the left image and left click to place mark.  Repeat on the right image.  Click Confirm. Step 12HTMLRemove needle and flip safety switch to the front. Click “Move to position”, the holder will move to the next position. Flip safety switch back to the side and insert needle. Acquire the next scan.  Step 13HTMLRight click and select zoom from point. Click the tip of the pin in both images to zoom. Press Escape on the keyboard to end zoom from point. Step 14HTMLMark the tip of the pin in both images by moving the cursor and left clicking. Click Confirm. Remove needle and flip the safety switch to the front.  Press Move to position.  The holder will move to the third position. Flip safety switch to the side and insert needle. Acquire third scan. Step 15HTMLUse Zoom from point to magnify the tip of the pin. Step 16HTMLMove cursor and mark the tip of the pin in both images. Click Confirm. Step 17HTMLA message will display telling you that the calibration was successful. Click Ok.  You can now remove the needle and flip the safety switch to the front. The holder will go back to the home position. Biopsy Calibration - Video Biopsy Calibration - 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   The weekly phantom is recommended because the ACR will eventually be requiring this test for accreditation.  This test evaluates image quality.  It is performed utilizing a standard ACR mammography phantom or the digital mini phantom.  Click the links below to view the step by step procedure and a video on how to perform the weekly phantom.   Weekly Phantom - Checklist Weekly Phantom - Checklist Checklist TitleChecklist TypeChecklist ContentStep 1HTMLAttach biopsy unit.  Step 2HTMLRegister Patient. Step 3HTMLIn Procedure dropdown, choose “Biopsy Phantom”. Step 4HTMLChoose Opdose. Step 5HTMLCompress stereo phantom. Step 6HTMLAcquire scout image. (If not using the mini stereo phantom, you will have to acquire the image in quadrants.) Step 7HTMLScore phantom. Step 8HTMLEnd procedure and document on QC form. Weekly Phantom - Video Weekly Phantom - Video   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. 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 control pad can be used to turn the system on and off as well as make an exposure.  It is connected to the AWS. The hand switch connects to the control pad and enables exposure with flexibility. The foot pedal connects to the control pad and enables exposure while helping user ergonomics at high patient volumes.