Breast Written Comp

Student Name: April McDade Date Submitted: 3/29/16

Directions:

Students are required to complete each area based on the scan comp completed to
receive maximum points.
There are 10 sections; each section is worth a maximum of 5 points. Answers
provided must relate to specific information requested. Additional information
including non-applicable information will result in point deduction

Before the exam: Patient Interview, Chart Review, Possible Pathology, Patient Set
Up, and Preparation

Section 1:
Identify the patients age, sex, ethnicity, current symptoms and pertinent history relevant to
the exam.
Answer: 25 year old Caucasian female presented with a palpable lump on her right breast.
She is one month post partum, otherwise no previous history.

Identify the patients labs relevant to the exam (as high, low, or normal) and explain what
the patients lab values indicate.
If the patient had no labs, identify the labs relevant to the exam and explain what deviations
from normal values indicate.
Answer: The patient had no labs. One lab value to keep in mind is white blood cell count
because it could indicate some type of infection.

Identify the patients previous exams and results relevant to this exam.
If the patient had no previous exams, identify one other imaging modality that could be used
to evaluate your patients symptoms. Explain why this modality would be used in
conjunction with sonography.
Answer: The patient had no previous imaging. Normally a mammogram would be another
helpful imaging modality to look at so that you know what to expect on ultrasound or at
least what area of the breast to image. Since this patient is young and has dense breast
tissue, a mammogram would not be helpful. Ultrasound is really the first choice for someone
her age.

Grade for
Section 1

Section 2:
Based on the patients clinical history, labs, and previous exams and results, what did you
expect to find during this exam and why?
Answer: Since the patient has a history of being one month post partum and is young, I
knew she was going to have densely glandular breast tissue. With there being no previous
imaging and no labs, I went by what the patient stated. She said her doctor felt a lump on
her right breast. With a combination of her age, glandular tissue, recently post partum, and
a palpable lump I expected to find a cyst.
 Breast Written Comp

Grade for
Section 2

Section 3:
Describe how you identified the patient and educated the patient on the exam being
performed. Identify the patient set up and exam preparation.
Answer: I called the patients name in the waiting room and verified her information by
looking at her wrist band. The patient was already undressed from the waist up and was in a
gown so once in the room I had her take her right arm out of the gown and asked her to lie
on her back. Once on the bed, I verified her information one more time to make sure I had
the correct patient on my machine. I then had her uncover her right breast so I could see
which way I needed to position her so that her breast was as flat as possible. I had her raise
her right arm above her head and relax it on the pillow. I also had her roll towards her left
side so I could even the breast out a bit more. Once positioned, I had her point to the
palpable area and asked her if she had any questions before I started. She said no, so I
began feeling the area she pointed to then I began scanning.

Grade for
Section 3

During the Exam: Sonographic findings of structures, pathologies,

measurements, and instrumentation
Section 4:
Identify the sonographic features of the breast in its entirety. If both breasts were scanned,
describe the sonographic features of both breasts.
Answer: The patients right breast tissue was examined. Her skin was hyperechoic to the fat
and was a thin echogenic line. Her subcutaneous fat was medium-levels of gray. Her
coopers ligaments were thin echogenic lines. Her connective tissue was thin and
hyperechoic. She had dense, glandular mammary tissue that was bright and hyperechoic.
Her pectoralis muscles were hypoechoic with echogenic striations. Her ribs were also seen
and were echogenic with posterior shadowing.

Grade for
Section 4

Section 5:
Identify any protocol measurements obtained and identify if each measurement is normal or
abnormal. If abnormal, what is indicated? If no measurements were obtained due to the
exam being normal, identify the normal measurement ranges for breast skin, intramammary
ducts, and axillary lymph nodes.
Answer: Multiple pathologies were present. A gray scale image in sagittal and transverse
with from nipple measurements, gray scale images with measurements in all three planes,
and images with color Doppler were all taken to document the pathologies present.

Grade for
Section 5
 Breast Written Comp

Section 6:
Identify the pathology documented during the exam including location, size, vascularity, and
sonographic features.
If no pathology is seen, identify a common pathology seen with this exam and how you
would need to modify your protocol to document this pathology.
Answer: The patients breast was very cystic in appearance. There were four main cysts of
interest. At 12:30-1:00 there was a septated, anechoic area measuring 1.9x1.3x1.7cm and
5.1cm from the nipple. Another anechoic are at 12:30-1:00 measured 5mm and was 4.7cm
from the nipple. An anechoic area at 10:00 measured 1.5x0.6x1.0cm. A septated, anechoic
area at 10:00 measured 1.2x1.4x0.8cm and was 4.2cm from the nipple. None of these areas
demonstrated internal vasculature while utilizing color Doppler.

Grade for
Section 6

Section 7:
Identify the ultrasound preset, transducer, and frequency utilized to provide diagnostic
images and explain why the specific instrumentation was correct.
Answer: The exam was performed under small parts with the breast preset. A linear
transducer was used. The frequency was set at 14MHz. These settings were correct because
they all allowed me to properly examine the tissue in its entirety.

For your areola/ nipple image, identify the depth and focal zone(s) used and explain why
they were correct.
Answer: The depth was at 4.5cm and the focal zones were located at 1.7cm, 1.85cm, and
2cm. The depth was correct because it allowed me to examine the proper amount of breast
tissue. The focal zones were correct because there were enough to clear up my image so I
could examine the breast for any pathology I might of seen. They were also correctly placed
in the center of the screen so that I could examine the breast tissue without focusing too
much on the ribs in the posterior portion of the screen and the skin on the anterior portion of
the screen.

For your axillary tail image, identify the depth and focal zone(s) used and explain why they
were correct.
Answer: The depth was at 4.5cm and the focal zones were located at 1.7cm, 1.85cm, and
2cm. The depth was correct because it allowed me to examine the proper amount of breast
tissue. The focal zones were correct because there were enough to clear up my image so I
could examine the breast for any pathology I might of seen. They were also correctly placed
in the center of the screen so that I could examine the breast tissue without focusing too
much on the ribs in the posterior portion of the screen and the skin on the anterior portion of
the screen.

Grade for
Section 7
 Breast Written Comp

Exam Findings: Students Preliminary Report and Physicians Interpretation

Section 8:
What did you report to the sonographer and/or physician regarding the exam? Describe
your interaction.
Answer: I reported to the physician that the patients breast were very cystic. I told him that
I only took images of the ones with septations and a few that were large. I also told him that
the patient was one month post partum. He stated that the septations needed to be followed
but other than that the exam was within normal limits.

Grade for
Section 8

Section 9:
What was the physicians interpretation of the exam?
Answer: The physician gave the exam a BIRADs category 3. This means that the cysts were
probably benign and are recommended a 6 month follow-up.

Grade for
Section 9

Section 10:
Do you agree or disagree with the physicians interpretation of the exam? Why or why not?
(This must be supported by current literature)
Answer: I agree with the physician because we personally reviewed the images together and
agreed that they were probably benign but that the ones with septations may need to be
followed.

Grade for
Section 10

Clinical Site: BMH Desoto

Sonographer with credentials Victoria Pyles, RDMS (BR) (OB/GYN), RVT (VT)
and specialties:
Patient MRN: 1C12491264
Exam order on request: Mammo US Breast Include Axilla Limited Right
Performance date of final scan 3/21/16
comp:
Is this a second attempt written No
comp?

Points Description
5 No errors were identified
 Breast Written Comp

4 One error was identified

3 Errors identified In less than the of the components required
2 Errors identified In up to s of the components required

1 Immediate action required

errors identified in more than s of the components required
evidence of an unsafe event (unsafe events may result in
failure of the competency)
required image not included

Point Value Conversion Chart

50=100 49=98 48=97 47=96 46=95 45=93 44=92 43=91 42=90 41=89
40=88 39=86 38=85 37=84 36=82 35=80 34=79 33=78 32=77 31=76
30=75 29=74 28=73 27=72 26=71 25=70 24=68 23=66 22=64 21=61
20=60 19=57 18=55 17=45 16=40 15=45 14=35 13=30 12=25 11=20
10 or less = 0

Section Points Received

1
2
3
4
5
6
7
8
9
10
Total/Final score

Instructor:

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