The following presentation explores how — or if — an educational video could reduce patient anxiety prior to breast biopsy.

1. Ultrasound Guided Breast Biopsy
Patient Education Video and Patient
Anxiety
Katherine Patterson, M.D.
Division Chief of Breast Imaging at Indiana University
Director of Breast Imaging at St. Margaret's Hospital Guild
Diagnostic Breast Center at Eskenazi Health
Elise Miller, M.D.
PGY-4, Radiology Resident
Indiana University
Jaimie Howell, M.D.
Northwest Radiology

2. Disclosures
The authors have no financial interest or other
relationship with a commercial organization that
may have an interest in the content of the
educational activity.

3. Purpose
• To determine the effects of an educational
video about ultrasound guided breast biopsy
on patient anxiety
• This project aims to improve clinical practice
Standardize information
Cover all aspects of the biopsy so many patient
questions can be answered
Available on YouTube.com for patients to watch
again

4. Methods
7 Minute Video Filmed on an iPad
To make the biopsy look real, a few grapes were placed
into a pork roast, thus imitating a breast mass under
ultrasound imaging
The film was edited using Adobe Premiere Elements 14
Voiceover narration was used for better audio quality and
to easily create both English and Spanish versions of the
video
Staff radiologist played role of physician
Two technologists played the roles of technologist and patient

5. Film Highlights
- What is a biopsy and why is it necessary?
- What is ultrasound and what are the advantages of this
technique?
- What is a radiologist and a breast technologist?
- Procedural details: step-by-step from patient
positioning to what the biopsy needle sounds like
- Marker placement and what a marker is
- Post-biopsy mammogram
- When to remove bandage and Steri-Strips
- When to shower
- Lifting restrictions
- Risks of the procedure
- Reasons to seek medical attention after procedure
Educate
Inform
Instruct

6. Film Screenshots

7. Methods
Patients scheduled for
US guided breast
biopsy
(random assignment)
Control Group
- No video
- Verbal physician
consult only
Experimental Group
- Watched video
- Verbal physician
consult as well

8. Methods
• All participants filled out a State-Trait Anxiety
Inventory (STAI) both on the day that biopsy
was recommended and when they returned
for the biopsy appointment
• The STAI measures a patient’s “state” anxiety,
or temporary anxiety, compared to her “trait”
anxiety, or baseline anxiety
• Items are rated on a 4 point scale (e.g., from
“almost never” to “almost always”)
• Higher scores correlate with higher anxiety

9. Results:
Demographics

10. Results:
State Trait Anxiety Inventory
Experimental Group
(watched video)
N = 31
Average Anxiety
Score = 44
Control Group
(no video)
N = 27
Average Anxiety
Score = 42
Between the experimental and control groups,
there was no significant difference in state or
trait anxiety between:
• Spanish speaking (N=13) and English
speaking patients (N=45)
• Patients younger than 45-years-old
(N=24) or older than 45-years-old (N=30)
• Patients with an educational level
beyond high school (N=24) or high
school diploma and below (N=30)
• Internal comparison of anxiety levels
also did not significantly differ between
the first and second surveys in either
group.

11. Discussion
 No significant difference
in overall anxiety levels
between the video and
no video groups or in the
subset comparisons
based on language, age,
or education level.
 Patient comments from
the video group,
however, were
overwhelmingly positive.
Sample of Patient Comments:
“Felt more comfortable”
“Very informative on the procedure”
“It was very informative. It explained the process
in so much detail. Watching the people/pictures
really goes beyond a voice/explanation”
“Very helpful, it put your mind at ease”
“It was very interesting”
“Very helpful because I didn't understand how it
was done or what it actually was”
“The info presented was very helpful”

12. Brief Literature Review
Phillippe, F., et al. Effects of video information in patients undergoing coronary angiography. Arch Mal Coeur Vaiss 99(2): 95-101. Feb 2006.
•200 patients
•100 watched video, 100 received verbal physician
consult
•Patients who watched the video were significantly less
anxious and had lower heart rate
•Procedure tolerability was higher in video group
•Satisfaction of information for informed consent process
was higher in the video group
“Effects of video information
in patients undergoing
coronary angiography”
•67 patients
•33 watched the movie
•Level of anxiety was measured with a state-trait anxiety
questionnaire
•Patient understanding and satisfaction with the
information was also measured
•Results: Increased understanding and satisfaction, no
effect on anxiety level
“Patient information for liver
biopsy: impact of a video
movie”
Obled, S., et al. Patient information for liver biopsy: impact of a video movie. Gastroenterol Clin Biol 32(3): 274-278. Mar 2007.

13. Limitations
Fatigue
- 40 STAI questions
- Plus demographic
questions
- 10 typed pages
Education Level
- STAI 6th grade
reading level
- 36% patients
without high school
diploma
Small Sample Size
- Difficult to recruit for
long survey
- Technical errors (no
follow up survey given
to some patients)

14. Conclusions
Why is this
important?
- Patient-focused care is one of the key components
of the American College of Radiology’s “Imaging 3.0”
initiative
- While anxiety levels were unaffected in our study,
patient comments about the video were
overwhelmingly positive
- Non-English speaking patients may derive the most
benefit as multilingual standardized videos can save
time and ensure communication consistency
- Educational videos may be one way for radiologists
to empower patients through education and
improve patient experience

15. Correspondence
Katherine Patterson, M.D.
khwalker@iupui.edu
Elise Miller, M.D.
milleeli@iupui.edu
Jaimie Howell, M.D.
howelljaimie@gmail.com
bit.do/engmammoeske
US Guided Biopsy Video – English
bit.do/spanmammoeske
US Guided Biopsy Video – Spanish