Suggestions on Imaging

To all,

Here is a collection of practical suggestions that we have compiled concerning acquiring good SureTouch scans.

Thanks to Ian, David and Jae for their help with this list.

Best regards,
Denis ______________________________________________________
Some Practical Suggestions for Ensuring Good Image Acquisition with the Sure Touch System

• The SureTouch system is a complementary clinical tool to the Clinical Breast Examination (CBE). It is designed to be used in conjunction with the CBE in order to highlight, enhance and document what the CBE examiner has felt. It should not be viewed as a replacement for CBE. The combination of SureTouch and CBE will provide optimal CBE clinical results.
  

• The amount of pressure used on the breast should depend on the breast size and firmness. Ensuring that all four corners of the sensor probe are in contact with the breast tissue should be sufficient pressure for a good examination.

• Rotate the patient slightly to the side to help flatten the breast region where the exam is being performed. Use your other hand to stabilize the breast tissue being scanned.

• Use the mesh view to provide better examination feedback.

• Rocking the probe in a circular motion will provide pressures at the corners to allow more reliable hardness measurement.

• Be sure to collect sufficient data of the lesion. Continue to apply pressure and scan until the message turns green. This will give optimal results rather than performing just a quick press with the sensor.

• The hardness calculation is a simple ratio of the peak pressure (subtracting the baseline) divided by the baseline (pressures at the corners) which is then scaled to fit from a 1-5 scale. If there is poor contact at the corners of the sensors, the system will return a hardness value of 5.

• For patients with small breasts (or who have regions where it is not possible to load the entire probe), the hardness value may not be accurate due to insufficient tissue in contact with the probe. Typically in such cases, very little pressure is needed to load the probe enough for a good image. Since the calculated hardness may not be accurate, it is recommended that the operator examine all areas of the breast to see normal tissue, as well as the corresponding area in the opposite breast, using the same force level as used for the lesion. This can give us a comparison to assess how much the area of interest differs from the patient's baseline tissue hardness.

• The algorithm size calculation is based on % peak so it can be adjusted to provide desired results. Lower percentage provides larger lesion size estimations, higher percentages provide smaller lesions estimations.
  

• In a fatty breast where the background is consistently smooth, any small bump warrants further investigation.

• A young women with fibrocystic breast tissue can be made to look very worrisome by pressing too hard or setting the color map pressure level very low (such as 10-20 kPa). Keep in mind the age and the monthly cycle and check the other breast if there is a concern. For these patients, set the color map to 40 kPa to visually flatten out the background. A cancerous lump will still show up much harder and prominent. (see earlier post on this topic)

• For optimal calibration results, we suggest that the SureTouch system be turned on and stabilized for 30 minutes before tuning and calibrating the unit. Once calibration has been performed and remains on, then you shouldn’t have to recalibrate for the remainder of the day.

• Just prior initiating to the examination, we suggest that the operator test the probe response by pressing down on the calibration pad to ensure that it is functional.
  

• Finally, the five keys to collecting optimal SureTouch studies are: (1) use plenty of lubricant, (2) keep the sensor level against the breast when scanning, (3) keep the area of interest centered in the view area, (4) gently move the probe over the breast and (5) apply just sufficent pressure to the probe to load the edges of the sensor.

If you have any suggestions for the above list or suggestions for topics, please contact me at denis@medicaltactile.com•.

Best regards,
Denis

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First Post on the New Blog Site

To our entire Medical Tactile Community,

Since I first joined MTI a few months ago, I have heard several stories of successes concerning the SureTouch system. I have also been asked many questions on it usage, support and findings.

This is the first in a series of ongoing articles on the SureTouch system. I hope to publish regular updates to the site to help keep everyone informed of issues and events occurring with the SureTouch and Medical Tactile.

Invite you all to write in with your comments, questions and thoughts. If you want to be able to post comments and articles on this site, please send me an email at denis@medicaltactile.com and I will add you to the contributor's list.

I thank you all for your dedication and continuing support of our system

Best regards,
Denis O'Connor
CEO, Medical Tactile

Imaging Fibrocystic Breast Tissue with the SureTouch II System

Fibrocystic change of the breasts is characterized by lumpiness on physical exam and symptomatic discomfort in one or both breasts. It is a common benign problem for many women. It is estimated that over 50% of women have some sign of fibrocystic change and the condition typically diminishes after menopause. However, some women with benign breast disease are at higher risk for breast cancer.

Fibrocystic changes are often tender to touch and moveable to palpation. Lumpiness can vary in size and shape and can occur focally in one breast but are more often multiple and in both breasts. The nodularity often occurs in the upper outer area of the breast, but may be found throughout the breast. The cyclic tenderness and increased lumpiness that characterizes the fibrocystic breast condition usually becomes more evident one week to a few days before a menstrual cycle, and then decreases once flow has begun. The best time to perform a Clinical Breast and a SureTouch examination is a few days after a period as fluid-filled cysts and distended breast tissue typically will have decreased in size and be less tender.

Because of the dense nature of the fibrocystic breast, mammography (right) is less sensitive and effective in women with this condition. Although breast ultrasound (far right) does a better job of imaging cysts, it is more complex to use, documents only the cystic component of fibrocystic change, has a limited field of view and oftentimes is not readily available to clinicians performing clinical breast examinations

The SureTouch scan, in conjunction with a clinical breast examination, offers an objective method to establish baseline findings and document and monitor these changes in fibrocystic patients. The SureTouch exam may assist the physician in discerning fibrocystic patterns from other significant breast lesions. However due to the increased hardness and lumpiness of the breasts, it presents a challenge to differentiate firm fibrocystic change from true nodules. A modified SureTouch scanning technique needs to be employed for the fibrocystic breast.

Scanning Technique

Although this glandular tissue is lumpy and irregularly firmer than normal breast tissue, it is important to note that fibrocystic tissue will typically have a lower hardness profile from potential malignant lesions. It takes a more subtle review of the images to interpret the differences between benign lumpiness and potential malignancy. To that end, it is important as a first step that one achieves a baseline of the lumpiness of the breast by comparing it to the tissue of the opposite breast.

Keep in mind the women’s age and menopausal state when interpreting the SureTouch exam. It is unlikely that women will have multiple sites of breast cancer in both her breasts. Comparing the findings of both breasts for overall “lumpiness” is an important component to the SureTouch evaluation.

A common error in examining the fibrocystic breast is applying too much force (>1kg) during the examination and setting the color map too low (such as <20 style=""> When these occur the SureTouch image may look very concerning with high peaks and red images scattered over the entire breast. Multiple peaks in multiple areas suggest fibrocystic change and a need to re-adjust the SureTouch exam settings. For these cases, the examiner only needs to apply enough pressure such that the entire set of transducer sensors are in contact with the breast tissue. With this lower level of force, the examiner should look for peaks that stand out. The color map may need to be set to 25-35kPa to obtain a satisfactory image. Adjust the color map so that you don’t see diffuse red with such fibrocystic tissue so that when there is something harder than fibrocystic change, it’ll be easier to identify.

When a cancer is seen, it will be noticeable as a dominant peak and it will register hardness much different than the surrounding fibrocystic change. Examination of several patients with fibrocystic change will allow the examiner to gain familiarity with this particular type of breast tissue.