CD Laboratory for Patient-Centered Breast Imaging

The aim of this CD Laboratory is to develop technological innovations in breast imaging using artificial intelligence, with a focus on acceptance, safety, diagnostic accuracy and optimising the cost-benefit profile.

Technical advances in breast imaging (BI) over the past few decades have focused primarily on solving the medical problem of diagnostic accuracy. Despite improvements in diagnosis and treatment, breast cancer is still the leading cause of cancer-related death in women. About 1% of breast cancer diagnoses affect men, and the trend is rising. Current imaging techniques are perceived as uncomfortable, even painful, by many individuals, as the breast must be compressed. As a result, breast cancer screening is insufficiently accepted, not only among women, but also, for example, among men with high-risk genetic mutations, transgender individuals and non-binary individuals. Technological innovations now allow us to focus not only on the well-being of women, but also on that of patients in general.

This CD Laboratory therefore pursues a Triple-S (Soft, Safe and Smart) approach: ensuring patient well-being (Soft), increasing the acceptance and effectiveness (Safe) of BI and integrating fundamental innovations (Smart).

The project is divided into three work packages: (i) mammography-based BI, (ii) magnetic resonance imaging of the breast, and (iii) evaluation of health economic and patient-related aspects.

(i) Mammography-based imaging: Since participation rates in population-based breast cancer screening are currently insufficient (<50% in Austria), this CD Laboratory will develop comfortable 2D and 3D mammography with low compression using new technologies and artificial intelligence. Furthermore, the detection of breast cancer in patients with dense breasts using conventional mammography is difficult and the diagnostic rate is currently ≤50%. Contrast-enhanced mammography (CEM), an X-ray-based BI technique, appears to overcome the underdiagnosis in patients with dense breasts. This CD Laboratory is investigating optimal and standardised image quality and diagnostic performance using an artificial intelligence-based model.

(ii) Magnetic Resonance Imaging (MRI) of the breast: Breast MRI is the most sensitive method for detecting breast cancer, but is considered technically complex and requires intravenous contrast agent. Another limitation of breast MRI is the coil array, which requires an uncomfortable prone position. This position also distorts the breast anatomy and limits the ability to translate breast MRI findings into clinical decision making. This CD Laboratory is therefore investigating a portable breast coil that allows for comfortable supine MRI scanning. Technological improvements, the introduction of a contrast agent with high relaxivity (a measure of the effectiveness of the contrast agent), and the use of artificial intelligence will enable low-contrast or possibly even contrast-free MRI.

(iii) Assessment of patient-centred BI: This CD Laboratory is investigating the extent to which the patient-centred approach demonstrates value in preventing patient harm and complaints while ensuring BI safety. The hope is that this will lead to increased participation in breast cancer screening programmes. To this end, the opinions of patients will be collected and the impact of BI on quality of life will be evaluated. Health economic aspects will also be considered. The interpretation of the results will provide insights into the comparative costs and benefits of the BI innovations pursued.