Background: Localization of breast lesions for excision by radar reflector placement is becoming increasingly popular. The radiologist uses imaging guidance to place the reflector in advance of surgery. The reflector can be percutaneously detected by the surgeon in the operating room to guide excision.
The reflector is preloaded in a sterile 16-guage needle. There are two techniques to place it with mammographic guidance. The first is using an alphanumeric grid (two-view method) with imaging in orthogonal planes, similar to wire localization. Alternatively, the reflector may be placed using tomosynthesis guidance (single view method). This method may be preferable as it is faster and does not require imaging during the procedure in the orthogonal view.
Learning Objectives: 1. Describe planning considerations and the procedural technique for tomosynthesis-guided reflector placement (Scout Radar Localization System, Merit Medical Systems, South Jordan, UT). 2. Illustrate tomosynthesis-guided technique using both typical and challenging cases. 3. Discuss the advantages of this technique with respect to workflow, accuracy and staff satisfaction compared to the two-view method.
Abstract Content/Results: This is a case-based illustration of the technique for tomosynthesis guided placement of a reflector. Straightforward cases, such as targeting a biopsy clip, will be used to describe the basic technique. Challenging cases, such as targeting residual calcifications in the setting of clip migration, will be used to demonstrate more advanced procedure planning and troubleshooting. In addition, we will share our experience with 111 patients who underwent reflector placement and feedback from technologists assisting with localization. Tomosynthesis guided method saves on average 7 minutes per procedure (15 minutes for two-view versus 8 minutes for one-view method) without increased risk of migration/complications. All of the technologists assisting with localizations prefer the tomosynthesis guided method to the two view method.
Conclusion: In this exhibit, we described how to place a reflector with tomosynthesis guidance. The single view, tomosynthesis guided, technique for pre-operative reflector placement is an accurate and efficient way to localize lesions for excision. It may be particularly helpful in challenging cases where the target is difficult to see in two orthogonal views. This technique may be preferred by radiologists to the traditional two view procedure, and is readily accepted by technologists.
