Energy consumption of standard and contrast-enhanced mammography: a step towards sustainable breast imaging

Objectives: To quantify and compare the energy consumption of standard digital mammography (DM) and contrast-enhanced mammography (CEM), assess differences across manufacturers, and identify strategies to improve energy efficiency. Materials and methods: This prospective study measured direct energy consumption from three mammography systems across two vendors in a tertiary breast care centre. In total, 193 examinations were analysed: 79 on Machine A, 92 on Machine B, and 22 CEM exams on Machine C. Minute-by-minute power monitoring provided net and gross energy per exam. A multivariable regression model adjusted for machine type, exam characteristics, and patient variables. Daily-level analyses evaluated baseload energy relative to workload, and annual energy use was estimated via Monte Carlo simulations. Results: Machine B consumed more net energy per exam but achieved the lowest gross energy use due to minimal standby power. Machine A showed lower net but higher gross energy, primarily from greater idle consumption. Machine C had comparable net energy to A but higher gross energy per exam as a consequence of fewer daily exams. Machine type was the dominant determinant of energy use, while exam type, breast thickness, and density had no significant impact. Higher daily exam volumes improved energy efficiency across all systems, particularly for C. Annual energy estimates ranged from ~1660 to 2300 kWh per machine, with B consistently most efficient. Conclusion: Mammography exhibits modest energy consumption, largely driven by standby operation rather than imaging activity. Vendor-specific differences exist, but DM and CEM show comparable net energy use. Key Points: Question Measure the energy use of standard digital and CEM, evaluate energy efficiency across vendors, and identify ways to reduce energy consumption. Findings Mammography uses relatively little energy, mostly during idle time; energy efficiency varies by manufacturer, and CEM does not increase net energy demand. Clinical relevance Optimizing scheduling appointments, powering down machines after hours, and considering vendor efficiency can significantly cut the environmental footprint of breast imaging without compromising patient care.