Despite the use of ever-increasingly advanced technology to diagnose breast cancer, the role of the clinical breast examination is as important as ever. To further advance the hands-on technique, a new sensor-based tool has been designed to improve the technique.

Carla Pugh, MD, PhD, and her group at the University of Wisconsin (UW) Health Clinical Simulation Program are known for innovating the use of simulation-based tools for teaching and evaluating surgical and examination techniques. They have explored sensor-based techniques for cast placement and removal, for learning ultrasound examination of the thyroid, and for teaching pelvic examinations in the developing world.1-3 Recently, Pugh’s team focused on refining the clinical breast examination. Pugh, a surgeon, is clinical director of the UW Health Clinical Simulation Program and director of patient safety and education at the University of Wisconsin Hospital and Clinics. She is a proponent of using haptic skills in medicine, and to that end she has created a variety of simulative models for teaching clinicians effective manual examination techniques.


In a talk at TedMed 2014, Pugh described haptics as “the art and science of touch. Knowing how to touch something. Knowing how things are supposed to feel.” It is the ability to discern the difference between what is normal and what is not normal. The tricky thing about haptics is that we do not have a sure-fire way of teaching it; nor do we have a way of measuring it. Therefore, we have no way of measuring an operator’s competency in the technique, Pugh explained.4

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“How could clinicians learn the technique? How can a body of knowledge be mastered when some of its most important aspects cannot be taught in a lecture, read in a book, or even be experienced—such as in an emergency, when situation can change so quickly?”4


The current method for training a clinician to perform a clinical breast examination is to have an experienced practitioner observe the trainee palpate the breast. Visual observation, however, does not convey the degree of pressure the trainee is using to palpate the breast and whether it is enough to detect a mass, which is the crucial point of the examination. To this end, Pugh and her team devised a sensor system that registers the amount of force applied. The device creates a map of the trainee’s palpation that shows blue where the least pressure was applied and red where the most pressure was applied.

The UW group conducted a study in 2013 and 2014 to see how much more accurate the haptic sensor-equipped training device is compared with an examination conducted by an experienced clinician.5 For the project, practicing physicians performed simulated clinical breast examinations exactly the way they would on a symptomatic patient who presents in an office visit. The fictional patient claims to have felt a mass on self-examination but is currently unable to locate the lesion.