0:00

After all of the preparation

0:02

and planning, I then go into the procedure

0:04

room to consent the patient.

0:06

Um, in most cases, this is the

0:07

first time I'm meeting the patient.

0:09

In a minority of cases, I may have met

0:11

that particular patient, um,

0:13

during the diagnostic evaluation,

0:15

but I go over the procedure in detail.

0:18

Um, I show them the table, I go step

0:20

by step what's going to happen.

0:23

And then we talk about complications.

0:25

The most common, although not common in

0:28

and of itself, the bleeding and infection.

0:30

Those are the most, um,

0:31

likely problems if there're going to be any.

0:34

And then I talk about clip placements.

0:36

Uh, it's surprising how many patients hesitate

0:39

regarding the clip

0:41

because they don't like the idea

0:43

of something metal in their body.

0:46

Most of the time, after discussion of the importance

0:49

of the clip, patient's acquiesce to having the clip placed.

0:53

Um, if a patient refuses, it depends on the particular

0:58

situation and the size of the target and whether

1:00

or not there would likely be a residual target, um,

1:04

for localization for surgery if necessary,

1:09

the patient then climbs up a few steps

1:11

to get onto the biopsy table.

1:12

Not as high as this, but this,

1:14

the table starts maybe about this height.

1:17

The patient gets up on the table, lies prone,

1:20

then the table is elevated, um, so

1:22

that we can work underneath.

1:25

The breast is positioned

1:27

between the paddles coming from a lateral approach here.

1:30

This is her right breast coming from a lateral approach.

1:34

And we start taking our images.

1:38

The scout image shows

1:39

that the calcifications come into focus at a Z of 25.

1:45

And, um, importantly the,

1:47

the technologist got it on the first try.

1:49

So it was easy. We found the target 1, 2, 3,

1:52

and then I place my cursor right over the target

1:57

and then, uh, make one check on my workstation.

2:01

And the targets are transferred over to the screen, adjacent

2:05

to the needle, showing that these are our coordinates, X

2:08

of positive 13.3 Y of 19.5,

2:12

and Z of 25.0.

2:15

We then clean the breasts and proceed with local anesthetic.

2:20

We use 1% buffered lidocaine for a skin wheel

2:24

and lidocaine 1% with epinephrine.

2:27

For deeper anesthesia, I usually re-image

2:31

following lidocaine

2:33

because sometimes the target can move, um,

2:36

after the lidocaine bolus.

2:38

So in this case, here's the pre lidocaine image showing a Z

2:42

of 25 and following lidocaine.

2:45

Um, there's a two millimeter difference, not significant,

2:48

but sometimes they can actually move a little bit more than

2:51

two millimeters and they can move not only in the Z plane,

2:54

but the X and the Y as well.

2:56

So we may need to retarget.