# Environmental sustainability of ultrasound-guided core-needle breast biopsy: a survey on current practices by the European Society of Breast Imaging (EUSOBI)

## TL;DR

This study surveyed European breast imaging experts to assess how ultrasound-guided breast biopsy practices affect environmental sustainability.

## Contribution

The study identifies opportunities to reduce resource use and environmental impact without compromising infection control in breast biopsies.

## Key findings

- Most respondents used minimal disposable materials per procedure, but few used recycling bins.
- No significant link was found between perceived hygiene levels and post-procedural infections.
- Resource-intensive communication methods for benign results are commonly used.

## Abstract

In the context of a global appraisal of the environmental impact of radiology, this survey among members of the European Society of Breast Imaging (EUSOBI) investigated procedural aspects of ultrasound-guided core-needle breast biopsy that may impact its environmental sustainability.

A 25-item online questionnaire, developed by a panel of nine breast imaging experts, was distributed from September 25th to December 25th, 2024, within the EUSOBI mailing list and social media platforms. The survey investigated materials routinely used for ultrasound-guided core-needle biopsies, waste disposal practices, the relationship between perceived procedural hygiene levels and self-reported frequency of post-procedural infectious complications, and results’ communication methods. Replies were analysed with descriptive and non-parametric statistics.

Among the 787/823 respondents (95.6%) who routinely perform ultrasound-guided core-needle biopsy, most (460/787, 58.4%) perceived to attain aseptic conditions, without significant associations (p = 0.334) of hygiene levels with post-procedural infectious complications (never seen by 549/776 respondents, 70.7%). For most disposable materials, the majority of respondents used no more than one unit per procedure, including sterile gloves (551/787, 70.0%), sterile drapes (651/787, 82.7%), and sterile gel packets (729/787, 92.6%), also avoiding to use prepackaged biopsy kits (424/787, 53.9%). However, most respondents did not use recycling bins (404/787, 51.3%) and employed at least one resource-intensive modality to communicate benign results (in-person or by letter, 584/787, 74.2%).

Procedural aspects of ultrasound-guided core-needle biopsy carrying an environmental impact vary widely. In the absence of significant associations between perceived hygiene levels and post-procedural infectious complications, resource-intensive habits could be safely streamlined to improve sustainability.

This EUSOBI survey demonstrates that, despite widely varying procedural aspects in ultrasound-guided core-needle breast biopsy, higher perceived sterility levels are not associated with fewer infections, highlighting opportunities to safely reduce resource use and environmental impact.

This EUSOBI survey investigated how procedural habits and the use and amount of material in ultrasound-guided core-needle breast biopsy impact its environmental sustainability.Procedural aspects varied widely among the 787/823 respondents who routinely perform ultrasound-guided core-needle breast biopsy.While some economically driven sustainable behaviours are already in place, there are several opportunities to reduce materials use and waste.As no association was found between perceived hygiene levels and post-procedural infections, resource-intensive hygiene-related practices could be streamlined to improve sustainability.

This EUSOBI survey investigated how procedural habits and the use and amount of material in ultrasound-guided core-needle breast biopsy impact its environmental sustainability.

Procedural aspects varied widely among the 787/823 respondents who routinely perform ultrasound-guided core-needle breast biopsy.

While some economically driven sustainable behaviours are already in place, there are several opportunities to reduce materials use and waste.

As no association was found between perceived hygiene levels and post-procedural infections, resource-intensive hygiene-related practices could be streamlined to improve sustainability.