Room Set Up and Patient Care during Ultrasound of the Female Breast
Imaging of the breast is a sensitive area and therefore all efforts must be made by all who come in to
contact with the patient to make sure that they feel comfortable throughout the examination. The
following is an explanation of my normal practice in room set up.
Normal Room Set Up and Preparation
It is important that your patient feels safe and secure throughout the examination. Therefore it is
important that you have everything clean and ready before calling the patient into the room.
For me this means:
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The bed is moved into the appropriate position to allow for ergonomic comfort.
The bed is clean and tidy with a new sheet and that the pillow is correctly place at the head
of the bed. As well as making this more inviting for the patient it means that they are more
likely to lie in the correct position avoiding excessive movements around the bed.
The machine is set up with correct transducers in attached and additional transducers
nearby if needed.
If there is a television in the room, ensure that the remote is working and easily accessible.
Ensure that the gel is in the gel warmer if available.
Ensure that a blanket is nearby.
Ensure that wipes or towels are readily available.
Ensure that the worksheet is ready to write down any necessary information.
Any previous images and reports have been obtained and examined.
Gel has been placed in the warmer.
Wipes are located to the left of the monitor for ease.
New sheet on bed with pillow in the correct position.
Bed in the appropriate position for comfort.
There is no chair as I most often perform
these examinations in the standing position.
12Mhz Linear transducer connected.
Image 1: Ultrasound Room Set Up
Obtaining the Request Form
When I have obtained the request form I like to read it carefully as not only does it give the
necessary clinical information, it may also give insight into how the patient might be feeling. The
following is a table of common phases used on request forms and how I find this reflects the
demeanour of the patient.
Clinical Information
General check-up or
routine check-up
Previous history of Ca
Family history of breast
Ca
New lump
Demeanour
These patients have often had previous breast imaging so this
examination is just another routine examination that needs to be done
like 2 yearly mammograms, pap-smears or blood tests.
Dependant on their experiences patients may either interpret this as a
general check-up and therefore may not be worried, while others may
be more anxious at the possibility of recurrence.
Family history of breast cancer is often very liberally assigned as a
clinical indication. While we are more concerned about mothers and
sisters, patients and referrers may often include cousins and great
grandmothers as family history.
Given this I often find it hard to interpret these patients as they have
similar patients with a personal history of breast Ca.
These patients are often nervous or anxious. With breast awareness so
prominent in the community it is common that patients are under the
impression that you feel a lump, go to the GP, and have examinations to
check if its cancer. I find that these patients often have cancer at the
forefront of their minds not cyst, glandular ridge or fibroadenoma as we
do accounting for the nervousness.
Despite these generalisations I think that it is important to never stereotype and therefore I simply
use this as a guide to prepare me for the patient.
First Contact with the Patient
The first contact with the patient is very important. They need to feel comfortable with you.
For me this means:
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Calling the patient by both first and last name. Once I have made contact with the patient
dependant on age and initial approach I try and gage if it is best to use their first name or to
be more formal Mrs, Ms or Miss. If unsure I use the more formal until corrected by the
patient.
Watching the patient as they stand and make their way over. I was always taught that body
language is one of the best forms of communication. I use this time to assess if the patient is
nervous, anxious or calm.
Introducing myself to the patient by name. I also like to ensure that I have my name badge
on the right side of my chest. This means that throughout the examination the patient can
always call me by my first name creating a calming sense of familiarity.
Walking the patient to the change room and giving them clear instruction on how to put on
the gown. At our practice we have three armed gown which can be confusing, however
putting them on ensures that the patient is well covered. Breast imaging places the patient
in a vulnerable position and therefore feeling covered can help to reduce that vulnerability.
In the Examination Room
When the patient enters the examination room they are in unfamiliar territory. I think it is important
to initially direct them to where the need to be and where they can place their belongings.
Once they are settled, and I have checked identification, I like to inform the patient of the procedure
and delivery of results. This way they know what will be happening, again reducing any anxiety that
they may have.
Positioning
Once the patient is on the bed, I ask them to turn either left or right depending on which breast I am
examining. I place a sponge underneath the shoulder and upper back and ask the patient place the
necessary arm above their head. I ask the patient uncover the breast with their opposite arm and
then place a blanket over any unnecessarily bare skin (upper abdomen). I have found that doing
things in this manner means that the breast is uncovered at the last instance which again reduces
the extent to which the patient is in a vulnerable position.
Pillow in the correct position.
Blanket across the chest and upper abdomen.
Sponge underneath the shoulder and upper back.
Image 2 and 3 – Set up for a Right breast ultrasound
Throughout the Examination
Several things that I do throughout the examination to improve patient comfort include:
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Ask the patient if they would like the television on. I find that often seeing the examination
reduces patient anxiety and stress. However, this is not true for all patients so consider the
circumstances in each case.
Talk to the patient where possible. I find asking the patient questions may distract them
from the examination as they think of something more enjoyable. It also allows you to
conduct vocal fremitis without alarming the patient.
Check that the arm is not too sore. In older patients or patients who have previously
undergone shoulder surgery I often place another sponge, towel or pillow below the elbow
for extra support and comfort.
Confirm with the patient before touching the breast. This included when the patient points
out the region of concern. I first have them identify the site then ask if I can feel.
Allow the patient to clean up their own breast with tissue.
Explain what I am doing at each step of the scan.
For example:
o “I am going to start by having a general look around”
o “Now I am going to start taking the images”
o “Just looking over the nipple now”
o “Now I am going to look at the under arm”
This way the patient knows what I am doing and when so there are no surprises.
Use the patient’s name. I think this reminds the patient that they are not just a number and
that you are looking after them.
At the conclusion of the examination
At the conclusion of the examination I like to walk the patient to the changing area and check that
they are okay before leaving the department. Often I find that following the above routine leaves
the patient in a better way than when they came in. I like to think that if they have had a good
experience with me that they will not be as nervous if they have to return in the future. I understand
that not all patients leave with good news but I like to think I do my part to make the whole process
a little easier.