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So there are a number of hurdles

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and challenges that may need

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to be overcome when you're doing breast Mr guided biopsies.

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As always, the simple ones are nice and straightforward

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and some of them can be a complete nightmare.

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So let's walk through some of the challenges I've come

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across since I've been doing this.

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So challenge number one, oops, do it.

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Challenge number one is

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whenever the coordinates come up on your software

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or on your manually targeting to find a lesion,

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for some reason it always seems to end up well.

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At least nine times outta 10 seems to end up right on one

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of the cross points of the plastic grid.

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So wherever you want to put your needle

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or you can't go in that spot and you have to go elsewhere.

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And it's quite remarkable considering how uh,

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little grid there is compared

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to space, how often that happens.

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So what are we gonna do?

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Well, we're gonna go into the nearest hole

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and then the most important thing is that we work out

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what direction that we're going to biopsy within.

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And when you do this, you need

0:58

to not think about clock faces.

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I'll show you in a minute. We need to think about do we need

1:02

to biopsy towards the nipple or the chest?

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Do we need to to biopsy towards the head or the feet

1:08

or some combination of the two.

1:09

So maybe you need to go sort

1:10

of nipple feet direction down at an angle.

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So you're going to take your coordinates like this

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and you're going to decide, do I wanna come in

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and C five here in the upper right corner of it, remembering

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that's gonna be upper bottom, uh, right corner

1:25

of it down here for C five, or do I want to come up here

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and biopsy backwards and so on.

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So if you're going to come in here at C five in the top

1:34

right hand corner, you're going

1:36

to biopsy up towards the chest and down towards the feet.

1:40

Don't think about clocks

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because if you think about clocks here,

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it's gonna be different on the screen here.

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This is your image I'm should have shown you on here.

1:47

This is your image guided view.

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And on the image guided view, it's going to look different

1:52

clock face than is in reality when you go in

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and look at that patient because it's going

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to be turned by 90 degrees.

1:58

That's one of the beauties of using this grid.

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Now, the software, most softwares will

2:03

automatically correct if it comes in onto a grid line

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and it's going to show you,

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but look very carefully at the directions.

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So it'll come up with a little, um, printout that will, uh,

2:15

vary depending on which particular type

2:17

of software you are using.

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And it's going to tell you which direction, nipple feet, uh,

2:22

nipple, um, chest wall, feet, or head to do it in.

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But make sure you read that.

2:28

Don't assume that it's right in the middle of the hole.

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So don't think c**k places like we do in stereos

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or we do in ultrasound 'cause it's gonna get you confused

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because it's different looking at the image

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than it is looking at the patient.

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So just reinforce.

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So your image is gonna be like this with head up to the top,

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feet to the bottom, nipple to the left, uh,

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chest wall to the right.

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Um, and then your, um, image,

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your patient when you go into scan is gonna be more like

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this.