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Copyright (c) 2024 Hind Abdualrahman Alatiq, Abdulrahman Yahya Ahmed Moafa, Wahaj Awadh Alsaadi, Seham Abdu Ali Khafy, Rashed Abdullah Al-Muhaini

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Nursing Roles in Advanced Breast Imaging Pathways: Patient Preparation, Education, Procedural Support, and Follow-Up for Contrast-Enhanced Mammography, Tomosynthesis, and Supplemental MRI
Corresponding Author(s) : Hind Abdualrahman Alatiq
Saudi Journal of Medicine and Public Health, Vol. 1 No. 2 (2024)
Abstract
Background: Advanced breast imaging, including contrast-enhanced mammography (CEM), digital breast tomosynthesis (DBT), and supplemental magnetic resonance imaging (MRI), is increasingly used for screening, diagnosis, and staging, yet the nursing contribution to these pathways is rarely described. Aim: To synthesize evidence on nursing roles in patient preparation, education, procedural support, and follow-up across these modalities. Methods: A narrative review of literature published from 2017 to 2024 was conducted, drawing on radiology, oncology, patient-safety, and health-communication sources, and organized into a pathway-based framework. Results: Nurses contribute to eligibility and risk screening, contrast safety, anxiety reduction, health-literacy-sensitive education, intravenous access and biopsy support, adverse-event management, result communication, and navigation. Nursing-specific evidence is limited; most support is extrapolated from imaging and navigation research. Conclusion: Structured nurse-led pathways may improve safety, experience, and continuity, but prospective evaluation is needed.
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- 1. ACR Committee on MR Safety:, Greenberg, T. D., Hoff, M. N., Gilk, T. B., Jackson, E. F., Kanal, E., ... & Hernandez, D. (2020). ACR guidance document on MR safe practices: Updates and critical information 2019. Journal of Magnetic Resonance Imaging, 51(2), 331-338.
- 2. Alabousi, M., Wadera, A., Kashif Al-Ghita, M., Kashef Al-Ghetaa, R., Salameh, J. P., Pozdnyakov, A., ... & Alabousi, A. (2021). Performance of digital breast tomosynthesis, synthetic mammography, and digital mammography in breast cancer screening: a systematic review and meta-analysis. JNCI: Journal of the National Cancer Institute, 113(6), 680-690.
- 3. Bakker, M. F., de Lange, S. V., Pijnappel, R. M., Mann, R. M., Peeters, P. H., Monninkhof, E. M., ... & van Gils, C. H. (2019). Supplemental MRI screening for women with extremely dense breast tissue. New England Journal of Medicine, 381(22), 2091-2102.
- 4. Berg, W. A., Rafferty, E. A., Friedewald, S. M., Hruska, C. B., & Rahbar, H. (2021). Screening algorithms in dense breasts: AJR expert panel narrative review. American journal of roentgenology, 216(2), 275-294.
- 5. Chhor, C. M., & Mercado, C. L. (2017). Abbreviated MRI protocols: wave of the future for breast cancer screening. American Journal of Roentgenology, 208(2), 284-289.
- 6. Comstock, C. E., Gatsonis, C., Newstead, G. M., Snyder, B. S., Gareen, I. F., Bergin, J. T., ... & Kuhl, C. K. (2020). Comparison of abbreviated breast MRI vs digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening. Jama, 323(8), 746-756.
- 7. Conant, E. F., Barlow, W. E., Herschorn, S. D., Weaver, D. L., Beaber, E. F., Tosteson, A. N., ... & Sprague, B. L. (2019). Association of digital breast tomosynthesis vs digital mammography with cancer detection and recall rates by age and breast density. JAMA oncology, 5(5), 635-642.
- 8. Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., McDonald, R. J., ... & Weinreb, J. C. (2020). Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294(3), 660-668.
- 9. Dixit, N., Rugo, H., & Burke, N. J. (2021, March). Navigating a path to equity in cancer care: the role of patient navigation. In American Society of Clinical Oncology Educational book. American Society of Clinical Oncology. Annual Meeting (Vol. 41, pp. 1-8).
- 10. Engmann, N. J., Golmakani, M. K., Miglioretti, D. L., Sprague, B. L., & Kerlikowske, K. (2017). Population-attributable risk proportion of clinical risk factors for breast cancer. JAMA oncology, 3(9), 1228-1236.
- 11. Fallenberg, E. M., Schmitzberger, F. F., Amer, H., Ingold-Heppner, B., Balleyguier, C., Diekmann, F., ... & Dromain, C. (2017). Contrast-enhanced spectral mammography vs. mammography and MRI–clinical performance in a multi-reader evaluation. European radiology, 27(7), 2752-2764.
- 12. Gilbert, F. J., & Pinker-Domenig, K. (2019). Diagnosis and staging of breast cancer: when and how to use mammography, tomosynthesis, ultrasound, contrast-enhanced mammography, and magnetic resonance imaging. Diseases of the Chest, Breast, Heart and Vessels 2019-2022: Diagnostic and Interventional Imaging, 155-166.
- 13. Gulani, V., Calamante, F., Shellock, F. G., Kanal, E., & Reeder, S. B. (2017). Gadolinium deposition in the brain: summary of evidence and recommendations. The Lancet Neurology, 16(7), 564-570.
- 14. Güneş, Y. C., & Cesur, T. (2024). Accuracy of large language models in ACR manual on contrast media-related questions. Academic Radiology, 31(7), 3074-3077.
- 15. Heller, S. L., & Moy, L. (2019). MRI breast screening revisited. Journal of magnetic resonance imaging, 49(5), 1212-1221.
- 16. Houssami, N., & Hunter, K. (2017). The epidemiology, radiology and biological characteristics of interval breast cancers in population mammography screening. NPJ Breast Cancer, 3(1), 12.
- 17. James, J. R., Pavlicek, W., Hanson, J. A., Boltz, T. F., & Patel, B. K. (2017). Breast radiation dose with CESM compared with 2D FFDM and 3D tomosynthesis mammography. American Journal of Roentgenology, 208(2), 362-372.
- 18. Jochelson, M. S., & Lobbes, M. B. (2021). Contrast-enhanced mammography: state of the art. Radiology, 299(1), 36-48.
- 19. Jochelson, M. S., Pinker, K., Dershaw, D. D., Hughes, M., Gibbons, G. F., Rahbar, K., ... & Sung, J. S. (2017). Comparison of screening CEDM and MRI for women at increased risk for breast cancer: a pilot study. European journal of radiology, 97, 37-43.
- 20. Keating, N. L., & Pace, L. E. (2018). Breast cancer screening in 2018: time for shared decision making. Jama, 319(17), 1814-1815.
- 21. Kemp, E., Trigg, J., Beatty, L., Christensen, C., Dhillon, H. M., Maeder, A., ... & Koczwara, B. (2021). Health literacy, digital health literacy and the implementation of digital health technologies in cancer care: the need for a strategic approach. Health Promotion Journal of Australia, 32, 104-114.
- 22. Lee-Felker, S. A., Tekchandani, L., Thomas, M., Gupta, E., Andrews-Tang, D., Roth, A., ... & Rahbar, G. (2017). Newly diagnosed breast cancer: comparison of contrast-enhanced spectral mammography and breast MR imaging in the evaluation of extent of disease. Radiology, 285(2), 389-400.
- 23. Long, H., Brooks, J. M., Harvie, M., Maxwell, A., & French, D. P. (2019). How do women experience a false-positive test result from breast screening? A systematic review and thematic synthesis of qualitative studies: Epidemiology. British journal of cancer, 121(4), 351-358.
- 24. Lowry, K. P., Coley, R. Y., Miglioretti, D. L., Kerlikowske, K., Henderson, L. M., Onega, T., ... & Lee, C. I. (2020). Screening performance of digital breast tomosynthesis vs digital mammography in community practice by patient age, screening round, and breast density. JAMA Network open, 3(7), e2011792.
- 25. Mainiero, M. B., Moy, L., Baron, P., Didwania, A. D., Green, E. D., Heller, S. L., ... & Newell, M. S. (2017). ACR appropriateness criteria® breast cancer screening. Journal of the American College of Radiology, 14(11), S383-S390.
- 26. Mann, R. M., Kuhl, C. K., & Moy, L. (2019). Contrast‐enhanced MRI for breast cancer screening. Journal of Magnetic Resonance Imaging, 50(2), 377-390.
- 27. Mann, R. M., Athanasiou, A., Baltzer, P. A., Camps-Herrero, J., Clauser, P., Fallenberg, E. M., ... & European Society of Breast Imaging (EUSOBI). (2022). Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). European radiology, 32(6), 4036-4045.
- 28. Monticciolo, D. L., Newell, M. S., Moy, L., Niell, B., Monsees, B., & Sickles, E. A. (2018). Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. Journal of the American College of Radiology, 15(3), 408-414.
- 29. Monticciolo, D. L., Newell, M. S., Hendrick, R. E., Helvie, M. A., Moy, L., Monsees, B., ... & Sickles, E. A. (2017). Breast cancer screening for average-risk women: recommendations from the ACR commission on breast imaging. Journal of the American College of Radiology, 14(9), 1137-1143.
- 30. Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annual review of public health, 42(1), 159-173.
- 31. Patel, B. K., Hilal, T., Covington, M., Zhang, N., Kosiorek, H. E., Lobbes, M., ... & Pockaj, B. A. (2018). Contrast-enhanced spectral mammography is comparable to MRI in the assessment of residual breast cancer following neoadjuvant systemic therapy. Annals of surgical oncology, 25(5), 1350-1356.
- 32. Patel, M. B. K., Lobbes, E. M., & Lewin, M. J. (2018, February). Contrast enhanced spectral mammography: a review. In Seminars in Ultrasound, CT and MRI (Vol. 39, No. 1, pp. 70-79). WB Saunders.
- 33. Phillips, J., Miller, M. M., Mehta, T. S., Fein-Zachary, V., Nathanson, A., Hori, W., ... & Slanetz, P. J. (2017). Contrast-enhanced spectral mammography (CESM) versus MRI in the high-risk screening setting: patient preferences and attitudes. Clinical imaging, 42, 193-197.
- 34. Sorin, V., Yagil, Y., Yosepovich, A., Shalmon, A., Gotlieb, M., Neiman, O. H., & Sklair-Levy, M. (2018). Contrast-enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. American journal of roentgenology, W267-W274.
- 35. Spak, D. A., Plaxco, J. S., Santiago, L., Dryden, M. J., & Dogan, B. E. (2017). BI-RADS® fifth edition: A summary of changes. Diagnostic and interventional imaging, 98(3), 179-190.
- 36. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
- 37. Suter, M. B., Pesapane, F., Agazzi, G. M., Gagliardi, T., Nigro, O., Bozzini, A., ... & Squizzato, A. (2020). Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis. The Breast, 53, 8-17.
- 38. Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PloS one, 15(4), e0231350.
- 39. Veenhuizen, S. G., de Lange, S. V., Bakker, M. F., Pijnappel, R. M., Mann, R. M., Monninkhof, E. M., ... & DENSE Trial Study Group. (2021). Supplemental breast MRI for women with extremely dense breasts: results of the second screening round of the DENSE trial. Radiology, 299(2), 278-286.
- 40. Weinreb, J. C., Rodby, R. A., Yee, J., Wang, C. L., Fine, D., McDonald, R. J., ... & Davenport, M. S. (2021). Use of intravenous gadolinium-based contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 298(1), 28-35.
- 41. Zackrisson, S., Lång, K., Rosso, A., Johnson, K., Dustler, M., Förnvik, D., ... & Andersson, I. (2018). One-view breast tomosynthesis versus two-view mammography in the Malmö Breast Tomosynthesis Screening Trial (MBTST): a prospective, population-based, diagnostic accuracy study. The Lancet Oncology, 19(11), 1493-1503.
- 42. Zanardo, M., Cozzi, A., Trimboli, R. M., Labaj, O., Monti, C. B., Schiaffino, S., ... & Sardanelli, F. (2019). Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights into imaging, 10(1), 76.
References
1. ACR Committee on MR Safety:, Greenberg, T. D., Hoff, M. N., Gilk, T. B., Jackson, E. F., Kanal, E., ... & Hernandez, D. (2020). ACR guidance document on MR safe practices: Updates and critical information 2019. Journal of Magnetic Resonance Imaging, 51(2), 331-338.
2. Alabousi, M., Wadera, A., Kashif Al-Ghita, M., Kashef Al-Ghetaa, R., Salameh, J. P., Pozdnyakov, A., ... & Alabousi, A. (2021). Performance of digital breast tomosynthesis, synthetic mammography, and digital mammography in breast cancer screening: a systematic review and meta-analysis. JNCI: Journal of the National Cancer Institute, 113(6), 680-690.
3. Bakker, M. F., de Lange, S. V., Pijnappel, R. M., Mann, R. M., Peeters, P. H., Monninkhof, E. M., ... & van Gils, C. H. (2019). Supplemental MRI screening for women with extremely dense breast tissue. New England Journal of Medicine, 381(22), 2091-2102.
4. Berg, W. A., Rafferty, E. A., Friedewald, S. M., Hruska, C. B., & Rahbar, H. (2021). Screening algorithms in dense breasts: AJR expert panel narrative review. American journal of roentgenology, 216(2), 275-294.
5. Chhor, C. M., & Mercado, C. L. (2017). Abbreviated MRI protocols: wave of the future for breast cancer screening. American Journal of Roentgenology, 208(2), 284-289.
6. Comstock, C. E., Gatsonis, C., Newstead, G. M., Snyder, B. S., Gareen, I. F., Bergin, J. T., ... & Kuhl, C. K. (2020). Comparison of abbreviated breast MRI vs digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening. Jama, 323(8), 746-756.
7. Conant, E. F., Barlow, W. E., Herschorn, S. D., Weaver, D. L., Beaber, E. F., Tosteson, A. N., ... & Sprague, B. L. (2019). Association of digital breast tomosynthesis vs digital mammography with cancer detection and recall rates by age and breast density. JAMA oncology, 5(5), 635-642.
8. Davenport, M. S., Perazella, M. A., Yee, J., Dillman, J. R., Fine, D., McDonald, R. J., ... & Weinreb, J. C. (2020). Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 294(3), 660-668.
9. Dixit, N., Rugo, H., & Burke, N. J. (2021, March). Navigating a path to equity in cancer care: the role of patient navigation. In American Society of Clinical Oncology Educational book. American Society of Clinical Oncology. Annual Meeting (Vol. 41, pp. 1-8).
10. Engmann, N. J., Golmakani, M. K., Miglioretti, D. L., Sprague, B. L., & Kerlikowske, K. (2017). Population-attributable risk proportion of clinical risk factors for breast cancer. JAMA oncology, 3(9), 1228-1236.
11. Fallenberg, E. M., Schmitzberger, F. F., Amer, H., Ingold-Heppner, B., Balleyguier, C., Diekmann, F., ... & Dromain, C. (2017). Contrast-enhanced spectral mammography vs. mammography and MRI–clinical performance in a multi-reader evaluation. European radiology, 27(7), 2752-2764.
12. Gilbert, F. J., & Pinker-Domenig, K. (2019). Diagnosis and staging of breast cancer: when and how to use mammography, tomosynthesis, ultrasound, contrast-enhanced mammography, and magnetic resonance imaging. Diseases of the Chest, Breast, Heart and Vessels 2019-2022: Diagnostic and Interventional Imaging, 155-166.
13. Gulani, V., Calamante, F., Shellock, F. G., Kanal, E., & Reeder, S. B. (2017). Gadolinium deposition in the brain: summary of evidence and recommendations. The Lancet Neurology, 16(7), 564-570.
14. Güneş, Y. C., & Cesur, T. (2024). Accuracy of large language models in ACR manual on contrast media-related questions. Academic Radiology, 31(7), 3074-3077.
15. Heller, S. L., & Moy, L. (2019). MRI breast screening revisited. Journal of magnetic resonance imaging, 49(5), 1212-1221.
16. Houssami, N., & Hunter, K. (2017). The epidemiology, radiology and biological characteristics of interval breast cancers in population mammography screening. NPJ Breast Cancer, 3(1), 12.
17. James, J. R., Pavlicek, W., Hanson, J. A., Boltz, T. F., & Patel, B. K. (2017). Breast radiation dose with CESM compared with 2D FFDM and 3D tomosynthesis mammography. American Journal of Roentgenology, 208(2), 362-372.
18. Jochelson, M. S., & Lobbes, M. B. (2021). Contrast-enhanced mammography: state of the art. Radiology, 299(1), 36-48.
19. Jochelson, M. S., Pinker, K., Dershaw, D. D., Hughes, M., Gibbons, G. F., Rahbar, K., ... & Sung, J. S. (2017). Comparison of screening CEDM and MRI for women at increased risk for breast cancer: a pilot study. European journal of radiology, 97, 37-43.
20. Keating, N. L., & Pace, L. E. (2018). Breast cancer screening in 2018: time for shared decision making. Jama, 319(17), 1814-1815.
21. Kemp, E., Trigg, J., Beatty, L., Christensen, C., Dhillon, H. M., Maeder, A., ... & Koczwara, B. (2021). Health literacy, digital health literacy and the implementation of digital health technologies in cancer care: the need for a strategic approach. Health Promotion Journal of Australia, 32, 104-114.
22. Lee-Felker, S. A., Tekchandani, L., Thomas, M., Gupta, E., Andrews-Tang, D., Roth, A., ... & Rahbar, G. (2017). Newly diagnosed breast cancer: comparison of contrast-enhanced spectral mammography and breast MR imaging in the evaluation of extent of disease. Radiology, 285(2), 389-400.
23. Long, H., Brooks, J. M., Harvie, M., Maxwell, A., & French, D. P. (2019). How do women experience a false-positive test result from breast screening? A systematic review and thematic synthesis of qualitative studies: Epidemiology. British journal of cancer, 121(4), 351-358.
24. Lowry, K. P., Coley, R. Y., Miglioretti, D. L., Kerlikowske, K., Henderson, L. M., Onega, T., ... & Lee, C. I. (2020). Screening performance of digital breast tomosynthesis vs digital mammography in community practice by patient age, screening round, and breast density. JAMA Network open, 3(7), e2011792.
25. Mainiero, M. B., Moy, L., Baron, P., Didwania, A. D., Green, E. D., Heller, S. L., ... & Newell, M. S. (2017). ACR appropriateness criteria® breast cancer screening. Journal of the American College of Radiology, 14(11), S383-S390.
26. Mann, R. M., Kuhl, C. K., & Moy, L. (2019). Contrast‐enhanced MRI for breast cancer screening. Journal of Magnetic Resonance Imaging, 50(2), 377-390.
27. Mann, R. M., Athanasiou, A., Baltzer, P. A., Camps-Herrero, J., Clauser, P., Fallenberg, E. M., ... & European Society of Breast Imaging (EUSOBI). (2022). Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). European radiology, 32(6), 4036-4045.
28. Monticciolo, D. L., Newell, M. S., Moy, L., Niell, B., Monsees, B., & Sickles, E. A. (2018). Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. Journal of the American College of Radiology, 15(3), 408-414.
29. Monticciolo, D. L., Newell, M. S., Hendrick, R. E., Helvie, M. A., Moy, L., Monsees, B., ... & Sickles, E. A. (2017). Breast cancer screening for average-risk women: recommendations from the ACR commission on breast imaging. Journal of the American College of Radiology, 14(9), 1137-1143.
30. Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annual review of public health, 42(1), 159-173.
31. Patel, B. K., Hilal, T., Covington, M., Zhang, N., Kosiorek, H. E., Lobbes, M., ... & Pockaj, B. A. (2018). Contrast-enhanced spectral mammography is comparable to MRI in the assessment of residual breast cancer following neoadjuvant systemic therapy. Annals of surgical oncology, 25(5), 1350-1356.
32. Patel, M. B. K., Lobbes, E. M., & Lewin, M. J. (2018, February). Contrast enhanced spectral mammography: a review. In Seminars in Ultrasound, CT and MRI (Vol. 39, No. 1, pp. 70-79). WB Saunders.
33. Phillips, J., Miller, M. M., Mehta, T. S., Fein-Zachary, V., Nathanson, A., Hori, W., ... & Slanetz, P. J. (2017). Contrast-enhanced spectral mammography (CESM) versus MRI in the high-risk screening setting: patient preferences and attitudes. Clinical imaging, 42, 193-197.
34. Sorin, V., Yagil, Y., Yosepovich, A., Shalmon, A., Gotlieb, M., Neiman, O. H., & Sklair-Levy, M. (2018). Contrast-enhanced spectral mammography in women with intermediate breast cancer risk and dense breasts. American journal of roentgenology, W267-W274.
35. Spak, D. A., Plaxco, J. S., Santiago, L., Dryden, M. J., & Dogan, B. E. (2017). BI-RADS® fifth edition: A summary of changes. Diagnostic and interventional imaging, 98(3), 179-190.
36. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
37. Suter, M. B., Pesapane, F., Agazzi, G. M., Gagliardi, T., Nigro, O., Bozzini, A., ... & Squizzato, A. (2020). Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis. The Breast, 53, 8-17.
38. Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PloS one, 15(4), e0231350.
39. Veenhuizen, S. G., de Lange, S. V., Bakker, M. F., Pijnappel, R. M., Mann, R. M., Monninkhof, E. M., ... & DENSE Trial Study Group. (2021). Supplemental breast MRI for women with extremely dense breasts: results of the second screening round of the DENSE trial. Radiology, 299(2), 278-286.
40. Weinreb, J. C., Rodby, R. A., Yee, J., Wang, C. L., Fine, D., McDonald, R. J., ... & Davenport, M. S. (2021). Use of intravenous gadolinium-based contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology, 298(1), 28-35.
41. Zackrisson, S., Lång, K., Rosso, A., Johnson, K., Dustler, M., Förnvik, D., ... & Andersson, I. (2018). One-view breast tomosynthesis versus two-view mammography in the Malmö Breast Tomosynthesis Screening Trial (MBTST): a prospective, population-based, diagnostic accuracy study. The Lancet Oncology, 19(11), 1493-1503.
42. Zanardo, M., Cozzi, A., Trimboli, R. M., Labaj, O., Monti, C. B., Schiaffino, S., ... & Sardanelli, F. (2019). Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights into imaging, 10(1), 76.