Radiology is increasingly examining how routine workflows contribute to environmental impact, with healthcare recognised as a significant source of greenhouse gas emissions. Breast imaging combines high patient volumes, standardised diagnostic pathways and frequent use of single-use consumables. Ultrasound-guided core-needle breast biopsy has largely replaced surgical biopsy as a safe, minimally invasive and cost-effective diagnostic approach, yet procedural habits differ across institutions and operators. A European Society of Breast Imaging (EUSOBI) survey examined biopsy preparation, material consumption, waste handling and communication practices, highlighting areas where sustainability considerations intersect with clinical routine while maintaining patient safety.
Practice Variation in Hygiene and Workflow
The survey included 823 respondents, of whom 787 reported routinely performing ultrasound-guided core-needle breast biopsy. Participants represented diverse geographic regions, with most based in Europe and additional representation from Asia, the Americas, Africa and Oceania. Practice environments included public hospitals, university hospitals, private hospitals and outpatient facilities, with some respondents working across multiple settings.
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Hygiene practices were self-classified as clean, aseptic or sterile. Most respondents reported working under aseptic conditions, while smaller groups described sterile or clean approaches. Assistants were present in most procedures and were often responsible for saving ultrasound images. When operators saved images directly using the ultrasound keyboard, sterile keyboard covers were rarely used.
Reported infectious complications following biopsy were uncommon. Most respondents indicated they had never encountered infections, while nearly all others reported them almost never. Only a very small number reported infections occurring often. Across hygiene categories, no significant association emerged between the reported procedural hygiene level and the reported occurrence of infectious complications.
Disposable Materials and Resource Use in the Procedure
Material consumption during biopsy preparation and sampling showed broadly consistent patterns. Most respondents reported using a single unit or packet for items such as sterile gloves, sterile drapes and sterile gel packets. Non-sterile glove use commonly involved one or two pairs per procedure, even when an assistant was present.
Probe covers were widely used and typically limited to a single item per procedure. Covers varied between sterile and non-sterile materials, including dedicated covers and gloves used as substitutes. Sterile gowns and hair caps were not routinely used by most respondents. A small proportion reported using more than one sterile gel packet per procedure, while others reported conserving opened packets for multiple procedures.
Sterile gauze was commonly used in small quantities per biopsy. Non-sterile gauze was used less frequently. Scalpels were typically limited to one per procedure. Local anaesthetic use varied by vial size, with 5 mL vials reported most frequently, followed by 10 mL and 2 mL. Some respondents reported opening more anaesthetic than was ultimately injected.
Plastic trays used for disinfectants, gauze or sharp materials were commonly reported, usually one per procedure, though some reported multiple trays or reuse across procedures. Many respondents indicated that prepackaged biopsy kits were not routinely used.
Waste Handling and Communication Practices with Environmental Implications
Waste management practices varied considerably. More than half of respondents reported not using recycling bins for non-sharp disposable tools, reflecting differences in infrastructure, workflow design and local policy implementation. These variations suggest that waste handling practices may influence the environmental footprint of routine biopsy procedures.
Communication of benign biopsy results also showed variation. In-person consultations and communication by letter were frequently used. These approaches require additional facility resources and may involve patient travel, contributing indirectly to resource use associated with care delivery. Many respondents reported using at least one of these methods for benign findings.
Ultrasound-guided core-needle breast biopsy remains a common and resource-intensive procedure within the preoperative breast cancer pathway. Compared with other parts of breast imaging, procedural standardisation appears limited. Variation in hygiene practice, material selection and disposal behaviour contributes to differences in waste generation and procurement needs. The absence of a measurable relationship between reported hygiene level and infection occurrence provides context for evaluating resource-intensive procedural habits.
The EUSOBI survey illustrates how ultrasound-guided core-needle breast biopsy combines clinical effectiveness with variable resource use across hygiene practices, consumables, waste management and communication pathways. Infectious complications were reported as extremely rare, and no association was identified between sterility level and infection occurrence. Opportunities for improved sustainability appear linked to procedural standardisation, material optimisation and waste-handling practices within existing clinical workflows. The findings emphasise that environmental considerations can be integrated into routine biopsy practice while maintaining established standards of patient care.
Source: Insights into Imaging
Image Credit: iStock
