Masperi Andrea, Girlando Cristiano Michele, Cubadda Valerio, Pesenti Aurora, Muscettola Giuseppe, Buonsanti Giuseppe, Aurora Gaeta, Gandini Sara, Petralia Giuseppe
Division of Radiology, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
Radiol Med. 2025 Sep 3. doi: 10.1007/s11547-025-02082-z.
Assessing bone metastases in metastatic breast cancer is challenging. Due to rising concerns over energy use and emissions, energy-efficient imaging is essential. This study aimed to compare three diagnostic imaging approaches used in therapy monitoring of MBC patients, evaluating both their environmental impact-quantified by energy consumption and related greenhouse gas emissions-and their biological cost, defined as patient exposure to ionizing radiation and contrast media volume.
We retrospectively analysed 70 patients with bone-dominant metastatic breast cancer who underwent WB-MRI (DL1) and either FDG-PET/CT (DL2) or bone scintigraphy (BS) with CT of chest, abdomen, and pelvis (CT-CAP) (DL3). We compared scan time, energy consumption, greenhouse gas emissions (kgCO2e), radiation dose, and contrast media usage across these diagnostic pathways. Energy consumption was calculated using protocol-defined active and idle phases, while biological exposure was assessed from institutional RIS-PACS records.
DL1 had the highest energy consumption (10.36 ± 0.11 kWh/patient) and GHG emissions (2.53 ± 0.03 kgCO2e). DL2 showed moderate energy use (4.08 ± 0.38 kWh/patient) and GHG emissions (0.99 ± 0.09 kgCO2e), which significantly increased with repeat scans. DL3 exhibited the lowest environmental impact (7.60 ± 1.07 kWh; 1.85 ± 0.26 kgCO2e), though required multiple visits and higher contrast media and radiation doses.
WB-MRI offers a biologically safer alternative for treatment monitoring in metastatic breast cancer, yet its environmental footprint is substantial. FDG-PET/CT represents a more sustainable imaging option if repeated scans are minimized. Integrated imaging pathways and low-energy technologies should guide future diagnostic strategies.
评估转移性乳腺癌中的骨转移具有挑战性。由于对能源使用和排放的担忧日益增加，节能成像至关重要。本研究旨在比较用于转移性乳腺癌患者治疗监测的三种诊断成像方法，评估它们的环境影响（通过能源消耗和相关温室气体排放量化）以及它们的生物学成本，生物学成本定义为患者接受的电离辐射和造影剂用量。
我们回顾性分析了70例以骨转移为主的转移性乳腺癌患者，这些患者接受了全身MRI（DL1）以及氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT，DL2）或骨闪烁显像（BS）联合胸部、腹部和骨盆CT（CT-CAP，DL3）。我们比较了这些诊断途径的扫描时间、能源消耗、温室气体排放（kgCO2e）、辐射剂量和造影剂使用情况。能源消耗使用协议定义的活跃和空闲阶段进行计算，而生物学暴露则根据机构的放射信息系统-图像存档与通信系统记录进行评估。
DL1的能源消耗最高（10.36±0.11 kWh/患者）和温室气体排放最高（2.53±0.03 kgCO2e）。DL2显示出中等程度的能源使用（4.08±0.38 kWh/患者）和温室气体排放（0.99±0.09 kgCO2e），随着重复扫描显著增加。DL3的环境影响最低（7.60±1.07 kWh；1.85±0.26 kgCO2e），尽管需要多次就诊且造影剂和辐射剂量更高。
全身MRI为转移性乳腺癌的治疗监测提供了生物学上更安全的替代方法，但其环境足迹很大。如果尽量减少重复扫描，FDG-PET/CT是一种更可持续的成像选择。综合成像途径和低能量技术应指导未来的诊断策略。
