• TQM
• Breast Unit

Topic of the thesis is the analysis of three key aspects of diagnostic and interventional radiology in a Breast Center: 1 - monitoring of the radiation dose delivered by mammography; 2 – integrated diagnostic approach conducted together by radiologists and surgeons (joint CORD; 3 - interdisciplinary meetings.

Radiation dose monitoring

Mammography is still considered the most effective imaging technique for the early detection of breast cancer and for mortality reduction. The parameter for estimating the absorbed dose is the average glandular dose.

The purpose of this section of the thesis is to present the data collected from three mammography units in the period from January 1 to May 31.

A dose monitoring software (TQM) was used that was able to automatically detect relevant indices from X-ray equipments and to analyze the data in terms of variability of dosimetric behaviours.

The “joint CORD”

In the period from January 16 to April 11, a weekly session handled by a junior breast surgeon and a senior Radiology resident (joint CORD) was established.

The aim of this session was to optimize the path within the Breast Centre of the patients with urgent referral and nonspecific symptoms. In fact, for these patients it is likely that the final diagnosis can be already reached with a clinical breast examination and a breast ultrasonography.

Twelve sessions of joint CORD were performed, that included 95 patients (average: 7.9 patients for each session).

Of the 95 patients who had access to this service, 33 had an examination performed elsewhere with detection of suspicious nodules or were controls at 6 months of multiple fibroadenomatosis; 20 came for palpable lumps; 16 for unilateral or bilateral breast pain; 5 for mastitis; 5 for swelling / hyperemia or collection after QUART; 4 for secretion (milky); and 12 for various reasons (axillary swelling, screening prior hormonal therapies, skin nodule, adenoma of the nipple).

Of the 95 patients, besides ultrasound and clinical breast examination, 24 (25.2%) underwent mammography, 6 (6.3%) underwent MRI, and 2 (2, 1%) underwent stereotactic biopsy.

Twentythree US-guided cytological examinations were performed (24.2%): in 21 cases of nodules and in 2 cases of mammary secretions.

The results of cytology were: 15 C2 (benign findings) with the conclusion of the diagnostic iter; 2 C3 (probably benign findings); 4 C1 (inadequate sampling).

The joint CORD allowed patients to finish their diagnostic workup in a single access, thus dramatically reducing the time they spent in the breast imaging center.



Interdisciplinary meetings

Were conducted interdisciplinary meetings (with breast radiologists and surgeons) on a weekly basis starting from January 17.
This section of the thesis analyzes the period from January 17 to March 27.

The cases discussed were tabulated to analyze the most frequent causes of problems, possible solutions and improvements for clinical practice.

Eleven meetings were held, discussing a total of 48 cases (average: 4.36 cases discussed per meeting).

Of the 48 cases discussed, 11 (22.9%) did not reach a cyto-histological conclusive diagnosis, 9 (18.7%) had an underlying lack of communication between radiologists and surgeons, 8 (16.6%) required a further biopsy, 6 (12.5%) had an improper use of MRI , 5 (10.4%) required additional MRI, 3 (6.25%) required a shared decision between radiologists and surgeons, 2 (4.1%) had a PET inappropriately performed, 2 (4.1%) were considered inappropriate for surgical evaluation, and 1 (2.07%) required a new mammography.