Radiologists’ and radiographers’ considerations regarding the implementation of targeted ultrasound as primary imaging modality in patients with focal breast complaints: A concept mapping study

INTRODUCTION: Emerging evidence indicates that breast ultrasound can function as an effective stand-alone diagnostic tool for focal breast complaints, with digital breast tomosynthesis (DBT) reserved for inconclusive cases. This study identifies and prioritizes radiologists' and radiographers' professional considerations regarding an ultrasound-first approach. METHODS: Using digital concept mapping, radiologists and radiographers independently generated, categorized, and rated statements related to the implementation of ultrasound as the initial modality. Thematic clusters were derived and prioritized based on participant ratings (7-point scale). RESULTS: Radiologists produced 43 statements across seven clusters: 1) Diagnostic accuracy, 2) Logistics and planning, 3) Communication, 4) Guidelines, 5) Patient satisfaction, 6) Age and screening, and 7) Accessibility of approach, prioritizing the clusters Diagnostic accuracy (rating 5.41), Guidelines (rating 5.21), and Logistics and planning (rating 4.88). Radiographers produced 35 statements in four clusters: 1) Communication, 2) Logistics and planning, 3) Organization and responsibilities, and 4) Patient satisfaction, placing greatest emphasis on the clusters Organization and responsibilities (rating 4.91) and Communication (rating 4.74). These patterns indicate that radiologists primarily emphasized diagnostic and clinical feasibility, whereas radiographers focused more on operational and role-related considerations. CONCLUSION: Radiologists and radiographers identified both shared and profession-specific considerations related to an ultrasound-first approach. Differences in prioritized themes reflect distinct professional roles and highlight the complexity of changing established imaging pathways. These findings may inform future research and implementation efforts by drawing attention to profession-specific considerations relevant to the adoption of such pathways.