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Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B...

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Carla M. Pugh, MD, PhD, FACS
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Page 1: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

Carla M. Pugh, MD, PhD, FACS

Page 2: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

GOALS• Sensor Technology

• Metrics and Breast Examination Accuracy

• Implications for Physicians & Patients

Page 3: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

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1 151 301 451 601 751 901 1051 1201 1351 1501 1651 1801 1951 2101 2251 2401 2551 2701 2851 3001 3151 3301

Time (1/30 Sec)

Pre

ssure

(P

U)

Page 4: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50
Page 5: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

Sensor Data 52 GBMotion Data 328 GBAudio Data 15 GBVideo Data 3,845 GB

Number of Physician Encounters - 16,479

Number of Different Clinical Simulations - 27

Page 6: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50
Page 7: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

They lined up to be tested.

They wanted feedback.

Page 8: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

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1 151 301 451 601 751 901 1051 1201 1351 1501 1651 1801 1951 2101 2251 2401 2551 2701 2851 3001 3151 3301

Time (1/30 Sec)

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ssure

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Page 9: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

How to Perform the

Clinical Breast Examination

RECOMMENDATIONS

Search PatternPalpation Pressure Search Technique

Saslow D, et. al (+20) Clinical breast examination: practical recommendations for optimizing performance and reporting.

CA Cancer J Clin. 2004 Nov-Dec;54(6):327-44.

Page 10: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50
Page 11: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

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1 151 301 451 601 751 901 1051 1201 1351 1501 1651 1801 1951 2101 2251 2401 2551 2701 2851 3001 3151 3301Time (1/30 Sec)

Pre

ssu

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Page 12: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

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1 151 301 451 601 751 901 1051 1201 1351 1501 1651 1801 1951 2101 2251 2401 2551 2701 2851 3001 3151 3301Time (1/30 Sec)

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ss

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(P

U)

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1 151 301 451 601 751 901 1051 1201 1351 1501 1651 1801 1951 2101 2251 2401 2551 2701 2851 3001 3151 3301Time (1/30 Sec)

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Page 13: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

Data Collection Method

Page 14: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

How to Perform the

Clinical Breast Examination

RECOMMENDATIONS

Search PatternPalpation Pressure Search Technique

Saslow D, et. al (+20) Clinical breast examination: practical recommendations for optimizing performance and reporting.

CA Cancer J Clin. 2004 Nov-Dec;54(6):327-44.

Page 15: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

PALPATION PRESSURE

Force Matters

Page 16: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

TED BREAST VIDEO

Page 17: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

15%

Page 18: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

SEARCH PATTERN

RESULTS

• Linear covers significantly more

breast tissue

• Despite 2004 recommendations

< 20% of (N=553) use the linear

strip technique

• 50-70% circular, 12-30% radialSearch Pattern

Page 19: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

How to Perform the

Clinical Breast Examination

RECOMMENDATIONS

Search PatternPalpation Pressure Search Technique

Saslow D, et. al (+20) Clinical breast examination: practical recommendations for optimizing performance and reporting.

CA Cancer J Clin. 2004 Nov-Dec;54(6):327-44.

Page 20: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50
Page 21: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

Rescuing the Clinical Breast Examination: Advances in Classifying Technique and

Assessing Physician Competency.Laufer, Shlomi PhD; DAngelo, Anne-Lise D. MD; Kwan, Calvin BS; Ray, Rebbeca D. PhD; Yudkowsky,

Rachel MD, MHPE; Boulet, John R. PhD; McGaghie, William C. PhD; Pugh, Carla M. MD, PhD

Page 22: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

Search Force vs Time by Simulator and Gender

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Simulator A – 2cm Superficial Mass (soft)

A Search F Mal A Search F Fem

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Simulator B – 1cm Superficial Mass (soft)

B Search F Mal B Search F Fem

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Simulator C – 2cm Deep Mass (hard)

C Search F Mal C Search F Fem

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Simulator B – 2cm Deep Mass (soft)

D Search F Mal D Search F Fem

Page 23: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

The Clinical Breast Examination?

15%45%

Page 24: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

Sensor Data Analytics

Page 25: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50
Page 26: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

Thank You!!

Page 27: Carla M. Pugh, MD, PhD, FACSA Search F Mal A Search F Fem 0 20 40 60 0 50 100 150 200 Simulator B –1cm Superficial Mass (soft) B Search F Mal B Search F Fem 0 10 20 30 40 50 0 50

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