1. Module 4.1: Patient Interaction and Positioning Sara Siavoshi & Wendy Tanamai Beckman Laser Institute University of California, Irvine

2. NTROI DOS Workshop, 2007 Module 4.1 Overview Patient Etiquette Patient Orientation/Positioning Marking the Measurement Area Holding the Probe

3. NTROI DOS Workshop, 2007 Module 4.1 Patient Etiquette –Conversation: Helps relax patient and reduce nervousness. Great conversation starters: Food, job, kids You are not the doctor: –Do not comment on strange data to patient…can scare them –Do not attempt to diagnose. If needed, refer to physician –Remember HIPAA: Only individuals on the protocol are to know specifics about a patient. Otherwise, refer to patient by subject #, not by name. –Do not make the patient wait Instrument warm-up and making sure instrument is working properly should happen before patient arrives

4. NTROI DOS Workshop, 2007 Module 4.1 Patient Orientation/Position Patient Position should allow for optimal DOS measurement Arm should be raised over head if: –Lower quadrants of the breast are going to be measured –Lesion will become more palpable Position should not be uncomfortable –All position adjustments should be made before measurement begins…position should not change during measurement. –If needed, Place pillow behind the subject’s head, back, or arm. To reduce error in DOS measurements, position should stay consistent for all follow-up measurements –Record exact arm position and pillow placement

5. NTROI DOS Workshop, 2007 Module 4.1 Breast Mapping Methods of mapping the breast include: - Quadrants - Clock - Coordinates Quadrants and Clock positions are used in diagnostic reports Coordinates are used in FDPM breast measurements

6. NTROI DOS Workshop, 2007 Module 4.1 Quadrants Upper Outer (RUO) Upper Inner (RUI) Lower Outer (RLO) Lower Inner (RLI) Upper Outer (LUO) Upper Inner (LUI) Lower Inner (LUI) Lower Outer (LLO)

7. NTROI DOS Workshop, 2007 Module 4.1 Clock 12:00 9:00 3:00 6:00 12:00 3:00 6:00 9:00

8. NTROI DOS Workshop, 2007 Module 4.1 Coordinates Nipple: (0,0) (+,+)(-,+) (-,-)(+,-) (+,+)(-,+) (+,-)(-,-) = (-30, 20)= LN030P020 = (30, 30) = LP030P030 = (10, -20)= LP010N020

9. NTROI DOS Workshop, 2007 Module 4.1 Marking Measurement Area Identify your region of interest. –No Lesion: Draw grid over your region of interest (ROI). –Lesion: Check diagnostic reports and ask patient where lesion is. Palpate it yourself, note the size and location of the mass as you palpate it (e.g. 2x2cm mass located at Left breast (30,20)). Draw grid to completely cover lesion and surrounding normal tissue

10. NTROI DOS Workshop, 2007 Module 4.1 Marking Measurement Area Grid: –Either square or rectangle (Cannot make an image out of a circle/cross/oval…etc.) –Should cover entire lesion along with some surrounding normal tissue –Mirror the grid onto contra-lateral breast –Drawn with surgical marker

11. NTROI DOS Workshop, 2007 Module 4.1 Marking Measurement Area Some Important Notes –Grids are drawn differently for each patient: depending on breast size, type of measurement, lesion location, lesion size…etc. –If the lesion area coincides with an area of bruising, scarring, or the areolar region, do NOT avoid these areas. The grid can overlap into these areas. –Exact coordinates of lesion, areola, bruising, or scarring should be recorded –If measuring a patient several times within one week, you may ask patient to try to keep dots on by not scrubbing over the area when showering.

12. NTROI DOS Workshop, 2007 Module 4.1 Holding the Probe Probe placement should allow for optimal source and detector contact with the skin –Place probe over “Extreme” points (Points at the outer edges of the grid) –Determine which probe orientation would accommodate these points best –Position dot should be situated between the source and the detector fibers. –Using light pressure, make sure that the source and detector fibers are in contact with the skin. The same probe placement should be used: –Throughout the whole measurement –For all subsequent measurements on the same patient.