0:00

Challenge number six.

0:03

Okay, this is the opposite from the poster lateral lesion.

0:05

This is the poster medial lesion.

0:07

Now, luckily we found this one by ultrasound

0:09

because I think this would've been extremely difficult

0:13

to have biopsied by mr.

0:14

But we do get lesions that are way out here

0:16

that produce a similar situation.

0:19

Well, for poster medial lesions, we do exactly the same

0:23

as we would for poster lateral.

0:25

We're going to remove the padding.

0:26

We're going to pull the medial side of the breast down.

0:30

In this case, we can roll up the ipsilateral side

0:32

and I'll show you a diagram in a minute.

0:34

And then again, the same as previously, you want

0:37

to check those sagittal pre gad images to make sure

0:41

that the expected position of the grid

0:43

of the lesion will be within the grid and not behind it.

0:47

Again, you'll need to remove the coil to be able

0:51

to get into those, uh, most posterior roll, most chest wall

0:55

row of biopsy spaces,

0:58

and put that coil below the needle.

1:01

And then again, if necessary,

1:03

you can do an MR guided needle lo

1:04

just angling that needle up.

1:06

So it's a sort of more freehand approach.

1:09

So let's look here.

1:10

This time, we have a medial lesion in the left breast,

1:13

and you can see that it's posterior to the grid.

1:15

We can't come up here.

1:16

We can, this is the most posterior layer

1:18

of grid holes we can come into.

1:20

So we pull the medial side down this case,

1:24

we put a little triangular bolster under the, um,

1:27

ipsi lateral side, and that helps us get more tissue down.

1:32

We can also, with some of these posterolateral

1:34

and posterior medial lesions, try, um,

1:37

putting the patient's arms

1:38

above their head versus down by their side.

1:41

And it just depends very much on

1:43

how tight the patient's pectoral muscles are,

1:46

how small their breast is, how large,

1:48

how dense their breast is.

1:50

Some patients you can get more posterior tissue down

1:53

with their hands above their head.

1:55

Sometimes it needs to be their arms by the side.