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Performing biopsies with the Elite Breast Clinical Solution

Application Tip
Rijckaert, Yvonne Philips Healthcare

This application tip presents an overview of the workflow for performing biopsies using the Elite Breast Clinical Solution. Biopsies are performed using the MammoTrak 7ch coil with unilateral or bilateral breast immobilization. Needle placement can be done with lateral, medial, or cranial access using either a biopsy grid or a pillar device.

Step 1: Preparing the immobilization device

Set up the needle placement system of choice: either the grid or the pillar device. Needle insertion is perpendicular to the grid. The pillar device allows needle insertion under an angle, which may be an advantage if the lesion is close to the chest wall. Both systems enable lateral, medial, or cranial biopsy access. Fill the fiducial markers and place them in the immobilization system

Step 2: Preparing the patient

Position the patient on the MammoTrak dockable patient support. This can be done in a dedicated preparation room, outside the scanner room. The patient can use the special grips on the sides of the patient support to position herself easily on the breast coil. Adjust the height of the head support for a comfortable position.

 

The patient may hold her arms next to her head, or downwards next to the body. Ensure that the breasts are hanging freely in the coil, and that breast and axilla areas are free of skin folds. Apply compression in the mediallateral or cranial-caudal direction, depending on the immobilization device used. Do not over-compress, as this could constrict the arteries and reduce flow.

Positioning on MammoTrak 7ch coil

Step 3: Moving the patient to the magnet

Transport the patient to the scanner room in position on the MammoTrak. Slide the MammoTrak over the patient support with the patient's feet towards the scanner and dock it. Slide the patient feet-first into the scanner.

Step 4: Starting ExamCard Breast

Select the corresponding ExamCard and start it via the MR console. A first scan is initiated to locate the fiducial markers. A 3D T1w sequence is initiated, containing three dynamic acquisitions, to locate the lesion to be biopsied. The first dynamic may serve as a mask. Proceed as usual with dynamic breast imaging.

Step 5: Biopsy planning on console

The acquired image data sets are automatically loaded onto the DynaCAD client on the console. The lesion to biopsy can be selected by positioning the crosshairs on the lesion. The crosshairs are visible in all image directions. The needle entry point and depth needed to target the lesion are automatically calculated and displayed in the bottom left corner of the screen.

Step 6: Viewing biopsy planning on the in-room display

The images and needle entry coordinates are shown on the in-room display near the magnet. This display avoids the need to make extra notes for use in the exam room. If an in-room display is not present at the site, a printout of the screen can be made and taken into the magnet room.
 

Step 7: Inserting the needle

Insert the needle according to the coordinates calculated by DynaCAD. The needle depth can be marked by fixing the blue distance ring. The needle used depends on the preferred biopsy procedure.
Biopsy grid Pillar device
Biopsy grid
Pillar device
 

Step 8: Checking needle position

Repeat the 3D T1w sequence to verify that the needle is at the right location. The images in the right column show the needle placement

Pre-biopsy                                 Pre-biopsy                              Post-biospy

Subtraction                                3D T1w                                   3D T1w

 

Step 9: Performing the biopsy

Once the needle is in the correct position, the biopsy can be performed. Depending on the estimated time needed for the biopsy, the biopsy can be done at the scanner or the patient can be moved out of the scanner room on the MammoTrak so that the actual VAB (vacuum assisted biopsy) procedure can be performed in the preparation room. The scanner is then available for the next patient.

More information

For detailed instructions on setup of the biopsy devices, refer to



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Application Tip
Achieva 1.5T
Release 2
Biopsy, Body, Breast, Women's health
 

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