Outcomes of Simulation in Resident Imaging-Guided Breast Biopsy Training.

Introduction We evaluate diagnostic radiology residents' perceptions of an ultrasound-guided and stereotactic breast biopsy simulator used at an academic medical center. This simulator is low-cost and easily reproducible. We aim to understand if this simulator improves residents' self-reported confidence in performing breast biopsy procedures on live patients. Methods Twenty-eight diagnostic radiology residents were instructed in how to perform ultrasound-guided breast biopsies and stereotactic breast biopsies using real biopsy and imaging equipment, but with tissue models in lieu of live persons. The hands-on experience was preceded by a didactic lecture. The ultrasound-guided tissue model was created with blueberries that were inserted in tofu, and the stereotactic tissue model was created by placing crushed calcium carbonate tablets into cored eggplant. Residents were asked to fill out a survey before and after participating in the simulation, where they self-reported their confidence level at performing ultrasound-guided and stereotactic breast biopsies. Results Twenty-eight diagnostic radiology residents participated in the simulation. All residents completed the pre-simulation survey and of these residents, twenty-one completed the post-simulation survey. Prior to the simulation residents reported a median confidence level of 3.5 out of 10 in performing ultrasound-guided breast biopsies, and a median confidence level of 1.0 out of 10 in performing stereotactic-guided breast biopsies. After the simulation, residents reported a median confidence level of 7.0 out of 10 in performing ultrasound-guided breast biopsies, and a median confidence level of 3.0 out of 10 in performing stereotactic-guided breast biopsies. Increases in resident confidence level were statistically significant for both biopsy types (p < 0.01).  Conclusion Simulated biopsies can increase the confidence of diagnostic radiology residents that are learning to perform breast biopsies before they perform real biopsies on live patients. Providing simulation training and thereby improving resident confidence may help reduce physician error and patient harm due to poor biopsy techniques.

Patient Compliance in the Setting of BI-RADS Category 3: What Factors Impact Compliance With Short-Term Follow-Up Recommendations?

The study aims to define how imaging findings, patient demographics, patient-provider interactions, and health care practices may affect a woman's decision to follow-up in the setting of a BI-RADS Category 3. A total of 398 women from the University of Arizona Breast Imaging Center with a BI-RADS Category 3 assessment for mammography and/or ultrasound findings were evaluated between February 2012 and June 2014. Demographic information was analyzed for all patients, regardless of follow-up. Women who returned for follow-up within the recommended time period were given one survey at the time of their follow-up appointment, and women who returned for follow-up, but later than recommended, were given a separate survey to complete. Age, palpability of a lesion, and menopause status were related to follow-up. Self-rated general health was the only factor found to be associated with the decision to follow-up on time. The majority of patients who followed up on time reported that mailed reminder cards were the primary practice that prompted follow-up. Of patients who followed up later than recommended, the major reason was "no time." The findings suggest that additional counseling regarding the benefits of short-interval imaging follow-up might be advantageous for patients.