A transparent take on mammograms: is this contraption designed for me?

As we closed out Breast Cancer Awareness Month in October here, in Australia, it seemed pertinent to focus on a topic that is close to a lot of people’s hearts: Mammograms or, more specifically, the equipment used to do them.

First, to be absolutely clear: I love that we dedicate a month to breast cancer awareness and am diligent in my screening. Nothing below is meant to sway anyone from their regular check-ups. One in eight women will develop breast cancer in their lifetime and over 3,200 will die from breast cancer this year in Australia alone. This is a real and present risk, and we need to take screening seriously. Indeed, having lost both mother and grandmother to cancer, I am convinced of the merits of early detection. Having just gone for my own mammogram though, I was once again struck by just how ill-adapted the equipment I was exposed to was to my body — or any body, for that matter, and was simply left asking myself:

Who and what did the manufacturers of mammography equipment have in mind when they design these contraptions?

For those who haven’t done it, getting a mammography can be an uncomfortable and invasive process where radiographer and patient become don’t-wanna-be contortionists. It reminds me of that game Twister that we played as kids: You’d have just settled a left hand on the top right red dot and right hand on the back corner green when the spinner would tell you to take the left leg to the yellow dot on opposite side! It was a tricky exercise. It’s a fraught analogy as the game stopped there, with someone falling and giggling. Being positioned for a mammogram and getting squeezed isn’t quite as much fun.

(Without wanting to be too graphical though, I do wonder, in passing, what wonderful contraptions we might be using if this were more of a male problem. And I find myself musing about what amazing gear might have been invented if men were regularly asked to have their tender bits squished between two plates at a pressure of around 44 psi!).

Anyway, coming back to last week’s mammogram, I asked lots of questions of the radiographer as she (wo)manhandled me into place and requested that I hold my head back just a bit more in the most unnatural position. She was working with what looked like a brand-new piece of gear, yet she heartily agreed that it was less than optimal and was very clearly keen to see someone call for change.

There is a lot wrong with the design of the equipment I experienced but, for me, these are the big three that I would love to see addressed and generalised across all models:

1. Composition & Form: The plates are hard, cold, and flat. We are warm (and like to stay that way), soft and, to varying degrees, curvy.

I understand that they need to squeeze the breast tissue hard but who says that soft things can’t squeeze effectively? We humans have very few hard surfaces on the outside and yet we manage to exert substantial pressure, when required. As my erudite engineer friend Streicher Louw said “one could consider an inflatable silicon gland.”

2. The ergonomics: Being squished between two hard plates is painful! Pain is personal. So is breast size. I don’t know if the latter has an impact on the former but there must be a better way. As always, there is something intrinsically dehumanising about technology to which we have to adapt — rather than the reverse. Then, of course, there are the ergonomics for the radiographer. There are a range of articles on the punishing postures that radiographers need to get into for short stature patients. This is not only leading to discomfort but the potential occurrence of errors and work-related musculoskeletal disorders (WRMSDs). [Search: Costa, S., Oliveira, E., Reis, C. et al. Mammography equipment design: impact on radiographers’ practice. Insights Imaging.]

3. Agency: The equipment I was exposed to gave no agency to the patient. Why wouldn’t we have control of the pressure? I recall seeing in Time Magazine an article of the 2019 Best Inventions and learnt that GE Healthcare had come up with the Senographe Pristina with self-compression (the name is French because I believe it was designed by a team of women near Paris). I looked this up and found that reporter Guy Boulton in the Milwaukee Journal Sentinel wrote in October 2017:

“Here’s what happens when women design a new system for mammography:

Sharp edges and corners are eliminated, making the machine look less industrial and less intimidating. The bar that women are asked to grab, at times so tightly that it affects the quality of the mammogram, is replaced with arm rests.

And you get a wireless remote control that lets the woman, rather than a technician, adjust how much the breast is compressed, or pinched, for the scan.”

The patients can use the remote to adjust the amount of compression after the breast is positioned for the mammogram. Jamie Ducharme added in the Time mag article that counter-intuitively, “the company’s research shows that women actually apply more pressure than a technician would, improving image quality.”

Has anyone experienced something of this standard?

Until I have, here is my design challenge:

Could we design a mammography unit that puts the patient and the technician in the centre? Something that is at once accurate, functional, and comfortable while addressing the concerns of form and composition, ergonomics and agency?

In the meantime, I will continue to be diligent encourage others to do so too.

Be sure to read a brilliant book that many discovered in 2019: Invisible Women. Caroline Criado Perez provides a highly researched body of work on the absence of data on women in many designs and processes and in the creation of many societal norms. Brilliant!

#DIA #breastcancerawarenessmonth #designchallenge #designaroundwomen#GEHealthcare #Invisiblewomen @GuyBoulton

Rachel is a bias buster and creative thinking trainer and facilitator. She is based in Melbourne, Australia.