Sustainability of contrast-enhanced breast imaging: a review of current evidence
Cet article compare le profil de durabilité de la mammographie avec rehaussement de contraste et de l'IRM mammaire, en particulier au niveau de l’écotoxicité des produits de contraste, de la consommation d’énergie, du stockage des données, de l’infrastructure numérique, de l’accès des patientes à l'examen de dépistage et des émissions liées aux déplacements
Breast cancer is the most commonly diagnosed malignancy among women worldwide. Contrast-enhanced imaging is central to diagnosis, staging, and treatment monitoring, yet its increasing use raises important environmental concerns. This review critically compares the sustainability of contrast-enhanced mammography (CEM) and breast magnetic resonance imaging (bMRI), focusing on contrast medium ecotoxicity, energy consumption, data storage, digital infrastructure, patient access, and travel-related emissions. Both iodinated and gadolinium-based contrast media persist in aquatic environments and contribute to water pollution. Although standard wastewater treatment removes a higher proportion of iodinated contrast, the injected dose is substantially larger, resulting in a greater overall environmental load. Gadolinium-based media are used in smaller quantities but are poorly removed by conventional treatment processes and may release toxic free gadolinium ions after excretion. While CEM involves ionizing radiation and a smaller field of view, it consumes markedly less energy per examination, generates smaller data volumes, and can be integrated into existing mammography infrastructure—enhancing accessibility, enabling decentralized deployment, and reducing patient travel. CEM is also faster, more cost-effective, and often preferred by patients due to greater comfort and shorter examination time. In contrast, bMRI, though radiation-free and offering wider anatomical coverage, has a significantly higher energy demand and digital footprint. Overall, CEM demonstrates advantages in environmental, economic, and social sustainability without compromising diagnostic performance in selected clinical indications. Radiology departments can meaningfully reduce healthcare’s carbon footprint by incorporating sustainability principles into modality selection, contrast-media management, and workflow optimization.
Insights into Imaging , article en libre accès, 2026