 Now we're going to discuss stereotactic biopsy, troubleshooting, and micromarkers. So sometimes when we do stereotactic breast biopsies, we run into roadblocks. I would say 90% of the time, stereotactic biopsies are super simple, super straightforward, and flow very well. But when they don't, they're really difficult. So what are some problems we can run into? One, the breast can be too thin, and that means we aren't able to have an adequate stroke margin. The ways we can fix this is bolsters can be used such as towels, foam, and other material to give the breast a bulge. Tape can also be wrapped around the breast near the chest wall to push more tissue anteriorly. Another issue can be lesions are too close to the chest wall. When this happens, and we need to get more posterior, you can put the patient's arm through a hole and have them hold on to something below to drop the breast further into the image. Sometimes the needle is in and the lesion is still too far away from it. Sometimes the lesion moves when the needle is fired. Positioning the trough above or below the lesion can help for this. When we're done our biopsy, we do the specimen radiograph, and we're supposed to see calcifications within the specimen radiograph. However, once in a while, we do multiple samples and don't see calcifications. So when we don't see calcifications, we should relook at a scout image and then we should reposition the needle if necessary and rebiopsy. Here's a specimen radiograph and we can see there's multiple specimens and we can see calcifications in this specimen here and probably some up here. So this is adequate and does not require rebiopsy. Micromarkers, before placing a micro marker, you want to confirm that there are no other micro markers in the breast. So before I go in to do a biopsy, I always look at the patient's last mammogram to ensure there are no other micro markers. If there are, I ensure that I use a different shaped micro marker for each different biopsy so that there's no confusion in the event that something needs to be excised. You want to really remember that the micro marker is something that stays in the breast and needs to avoid contamination at all costs because if it does get contaminated, it can be a nitice of infection. So I always make sure not to uncover the micro marker until I'm ready to put it in the breast and then while I'm putting it in, I make sure it doesn't touch anything before it gets into the introducer. You want to try to place the biopsy marker in the center of the lesion. And it's really important to remember the introducer for the micro marker is longer than the biopsy device and the introducer. So what happens is you can hub your biopsy device in your biopsy device introducer and you don't have to worry about going further than the introducer tip. With the micro marker introducer, it's longer. So you always want to make sure because what you don't want to do is just hub it and end up in the lung. So really important to go slowly and watch the tip of your introducer come out of the biopsy introducer. Then you want to do a post clip mammogram to confirm click placement and you want to make sure the clip correlates with the mammographic finding if applicable. And if it does not correlate, you can stereotypically biopsy the asymmetry or you can do a follow up depending on the suspicion of the finding. Here are the biopsy micro markers. So they're in this device here and they're inside and you use a plunger mechanism to plunge them out. And here's what they look like. There's ribbons, wings, coils, and here's what they look like in the breast. We actually at our institution call them breast bling. Makes them sound much more attractive to patients having them. So another issue now that we're talking about clips is clip migration. So you can have clip migration after biopsy. So this is a good example. We have a patient who had biopsy, these calcifications in the medial breast. And after we put the clip in, we see the biopsy changes in the medial breast, but we see the clip has migrated laterally. And so this can be a problem. You want to always hope that there are some residual calcifications. So in the event that this comes back as malignant or sign that needs to be excised, you can just localize the calcifications and not worry about the clip. And that is that for Stereotactic Biopsy.