Establishing an Evidence-based Modern Breast MRI Program

Abstract Breast MRI has evolved over the past several decades into a cornerstone of breast imaging. Historically, dynamic contrast-enhanced (DCE) MRI has served as the foundation of breast MRI protocols for differentiation of benign and malignant lesions and was supplemented by additional sequences to refine diagnostic accuracy. More recently, advanced techniques, such as diffusion-weighted MRI, ultrafast DCE-MRI, and deep learning models, have further expanded capabilities of breast MRI. These innovations, however, have also contributed to substantial variability in breast MRI protocols across institutions. At the same time, the expanding indications for screening and diagnostic breast MRI are driving higher patient volumes, creating operational challenges for breast imaging centers tasked with balancing efficiency, accuracy, and limited resources. This review outlines the key elements and considerations of modern breast imaging protocols, discusses strategies for protocol optimization, and explores emerging technologies and future trends that are shaping the next generation of breast imaging.