Assistant Instructions

PRE-SESSION INSTRUCTIONS

The radiologists will inform the assistants of suitable sites for hanging both the large digital films and the small analog films for this study.

Prior to the session, an assistant will either hang both the films and the clear overlays, or just the clear overlays for the session. Both film and overlay will need to be hung if this is the first sitting of this session. However, if the films are being re-used for another radiologist, they should have remained hanging and only the overlays will need to be hung.

After the films and the overlays are hung, the assistant should use a wax pencil and label the overlays in the upper outer portion of the image where the patient label is. You will put the session number, case number and reader initials. The most important information is the case number since it indicates which patient and which rate is being read. The other information can be added later, but the case number should be on the overlays prior to the session.

If there is a good place in the reading room to leave the envelopes for the films, that is fine. Otherwise, return the envelopes to the office. The films will be placed back into these envelopes after all the radiologist sittings for this session have occurred.

SESSION INSTRUCTIONS

Session Preparation

Make sure you have one completed cover sheet per case and many main sheets for the findings. You may want to take extra cover sheets, just in case something happens. You should also have your sheet of questions and a prompt sheet for the radiologist to reference.

The top portion of the cover sheet should be completed for each case in the session. If different people are hanging the films and conducting the session, you should coordinate the ordering of the films so that you do not have to hunt for the correct cover sheet during the session.

Besides the forms, you will need a pen to fill out the forms, a stapler and a magnifying glass for the radiologist. He/she may come with one, but we should have one for them, just in case. (This has been a request here, but the radiologists at your location may not have this same request.)

Session Prompting

  1. Pause and let the radiologist have time to look over the case. They will give you some indication that they are ready to begin with the questioning for this patient.
  2. Using the cover sheet for the case being viewed, complete the portion below the dotted line. Remember this is prompted for ONCE per patient case during the session. The following questions will be asked:
    1. What is the quality of the films, 1 through 5, where 1 is bad and 5 is good?
    2. Is this true for all views?
      YES
      - Write rating in all four boxes and continue
      NO
      - To radiologist: Please tell me the rating for each view.
    3. If any view is rated 1,2 or 3 then ask:
      Please identify the reason you have given a rating less than four as being either sharpness, contrast, position, compression, noise, artifact or penetration.
      Would you recommend a repeat?
    4. What is the breast density?
    Notice that we
    • Do not prompt for subjective rating for each view. We will obtain this information with the second question. If they answer `no,' we will then ask for the rating for each view.
    • Do not ask for the density of the left and right breasts individually. Typically the density will be the same in both. If it is not, the radiologist will automatically give you two densities.
    • Do not read the density types, each radiologist will have a list to reference. If they give you a type not listed, simply let them know that they need to choose one of the options listed on their sheet.
  3. Let's see if we need to go to the main section of the data forms. We will get this information with the following question: Are there any dominant or incidental findings?
    NO
    - Circle NO for findings and proceed to the next case. Only the cover sheet will be completed for this case.
    YES
    - Circle YES for findings.
    • If they mention one type, go to that line of questioning.
    • If they either do not mention the type of finding or they say that both types exists, go to the following question:
      Are there any specific, dominant, important findings?

      YES
      - go to QD.
      NO
      - go to QI and replace the question
      "What is it?" with "What is the incidental finding?"
  4. [QD]  Dominant Findings
    Start filling out a findings sheet; this is the two page main section of the data sheet. There will be ONE sheet for each finding.
    1. [QD1]  If the radiologist has NOT already done so, ask them:
      Please outline the finding, number it and mark the nipple.
      • Many times the radiologist will outline the area while they are getting familiar with the image. However, they may not mark the nipple or number the finding(s). In addition, if there are multiple findings on one side, the breast marking will only be asked once.
    2. What and where is the finding?
    3. Is it definite or possible?
    4. What views do you see it in?
    5. Are there any (other) associated findings?
      YES
      - What is it? Is it possible or definite?
      • If the associated finding is "calcs associated with mass" say:
        Please label the finding as xA and the associated finding as xB (where x is the finding number). Please outline the associated finding.
      • Repeat.
      NO
      - Continue.
    6. What is your assessment?
      indeterminant or incomplete - ask the following
      • What would you request?
      • What is your best guess of an assessment? <pause> or are you uncertain if the finding exists?
    7. Are there any other specific, dominant, important findings?
      YES
      - Return to QD1 and begin the questions for the next finding.
      NO
      - Go to QI.
  5. [QI]  Incidental Findings Start filling out a findings sheet; this is the two page main section of the data sheet. There will be ONE sheet for each finding.
    • [QI1]  Are there (other) incidental findings that you would mention in your report, either focal or diffuse?
    NO
    - Staple forms to the cover sheet and proceed to the next case.
    YES & FOCAL
    1. What and where is it?
    2. Is it definite or possible?
    3. If they have NOT already done so, ask the radiologist:
      Please outline the incidental finding, number it and mark the nipple.
    4. What views do you see it in?
    5. Are there any (other) associated findings?
      YES
      - What is it? Is it possible or definite?
      • If the associated finding is "calcs associated with mass" say:
        Please label the finding as xA and the associated finding as xB (where x is the finding number). Please outline the associated finding.
      • Repeat
      NO
      - Continue.
    6. Are there any comments accompanying the benign assessment you would include in your report?
    7. Return to QI1.
    YES & DIFFUSE
    1. What and where is it?
    2. Is it definite or possible?
      They should indicate the finding side, the type, location and views. If any of these are not answered, ask for specifics.
    3. Are there any comments accompanying the benign assessment you would include in your report?
    4. Return to QI1.
POST-SESSION INSTRUCTIONS

After the session, measure the size of the findings and the distance to the nipple. The measurements will be recorded at the end of the findings sheet, the main section of the data form. The only findings that are not measured are the diffuse incidental findings.

Place the overlays and the data package in envelopes for safe keeping. There should be one envelope per case. Remember to bring a set of envelopes for the overlays.

If these films are to be viewed by another radiologist, leave them hanging. If this is the last session with these films, take them down and return them to their designated envelope. The envelopes for the films may have been left in a designated area. However, if they were not, remember to bring these envelopes with you.