title: Mammography in females with an implanted medical device: impact on image quality, pain and anxiety.
abstract: OBJECTIVE
  To assess the image quality of mammograms in females with an implanted medical device (IMD), to evaluate pain and anxiety during mammography in these females and to investigate the experience of radiographers.
  
  
  METHODS
  Image quality was evaluated by two radiographers and one radiologist in the images of females with an IMD participating in the Dutch screening programme (clients). Pain and anxiety were scored using a Numeric Rating Scale in both clients visiting a screening organization and patients from the Isala Hospital, Zwolle. Experience of screening radiographers was collected with a questionnaire.
  
  
  RESULTS
  Images of the breast with IMD showed reduced contrast in craniocaudal (CC) and mediolateral-oblique (MLO) views [by both the radiographers and radiologist (range: 11-29%)], less projected breast tissue [only radiographers; CC lateral side: 25.5%, 95% confidence interval (CI): 18.7-32.2] and reduced projection of the pectoral muscle (only radiographers; MLO width pectoral muscle: 31.5%, 95% CI: 24.4-38.7). Clients experienced more pain and anxiety during mammography in the breast with IMD compared to the breast without IMD in the breast (pain difference CC: 0.48 ± 0.16, p = 0.003; pain difference MLO: 0.46 ± 0.16, p = 0.004; anxiety difference 1.30 ± 0.22; p < 0.001). Patients experienced more pain (1.05 ± 0.12; p < 0.001) and anxiety (1.22 ± 0.15; p < 0.001) after placement of IMD. Radiographers are more cautious, more anxious and use less compression during mammography of breasts with IMD.
  
  
  CONCLUSIONS
  Image quality in a breast with an IMD could be improved by projecting more breast tissue on the mammogram, thereby including (part of) the IMD between the paddles, if required. In addition, radiographers should pay sufficient attention to reducing discomfort both before and during the screening examination.
  
  
  CONCLUSIONS
  Little is known about the quality of mammography in females with an IMD or how these females and radiographers experience the screening examination. The results of our study showed that having an IMD could result in a suboptimal mammogram and increased discomfort.
authors.affiliation: 1 Dutch Reference Centre for Screening, Nijmegen, Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Paap
authors.affiliation: 1 Dutch Reference Centre for Screening, Nijmegen, Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: Witjes
authors.affiliation: 1 Dutch Reference Centre for Screening, Nijmegen, Netherlands.
authors.forename: Cary
authors.initials: C
authors.lastname: van Landsveld-Verhoeven
authors.affiliation: 1 Dutch Reference Centre for Screening, Nijmegen, Netherlands.|2 Department of Radiology, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: Ruud M
authors.initials: RM
authors.lastname: Pijnappel
authors.affiliation: 3 Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands.
authors.forename: Angela H E M
authors.initials: AH
authors.lastname: Maas
authors.affiliation: 1 Dutch Reference Centre for Screening, Nijmegen, Netherlands.|4 Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
authors.forename: Mireille J M
authors.initials: MJ
authors.lastname: Broeders
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D009426:Netherlands; D059408:Pain Management; D010147:Pain Measurement; D019736:Prostheses and Implants; D058996:Quality Improvement; D011795:Surveys and Questionnaires