What’s new at RSNA: risk from the image itself

RSNA’s breast-imaging preview highlights sessions on image-only, 5-year breast cancer risk models, external validation work, and how MRI adds value in multi-modal AI. It also calls out global screening updates and a deeper look at background parenchymal enhancement (BPE) on MRI. RSNA

In parallel, the FDA granted De Novo authorization to the first image-only AI risk platform that predicts 5-year risk directly from a screening mammogram—an inflection point that makes risk-adjusted pathways far more scalable. Coverage from Radiology Business and BCRF explains the authorization and clinical intent. Radiology Business

Why it matters: average-risk guidance in the U.S. now begins screening at age 40 (USPSTF, 2024). Programs can layer image-based risk on top of that baseline to triage who needs annual vs. short-interval follow-up and who merits supplemental imaging. USPSTF

CEM is earning a seat next to MRI

Expect exhibits and sessions positioning CEM as a cost-effective, accessible adjunct—particularly for dense-breast populations and diagnostic workups. RSNA News recently framed CEM as a practical alternative to MRI in some screening/diagnostic scenarios, and new peer-review literature is refining technique (e.g., lower volume/higher-iodine contrast while preserving diagnostic performance). RSNA

On outcomes, the RACER trial in The Lancet Regional Health – Europe reported that using CEM as primary imaging for recalled women improved the accuracy and efficiency of the work-up compared with conventional imaging—evidence that will influence protocols beyond the show floor. The Lancet

MRI still leads for sensitivity—BPE is your underused signal

Breast MRI remains the sensitivity champion for high-risk patients and for problem solving. This year’s RSNA content spotlights BPE—how the level of background enhancement relates to tumor biology and outcomes. Recent reviews (2024–2025) synthesize BPE’s predictive/prognostic value, including associations with pathologic complete response after neoadjuvant therapy and survival in certain subtypes. SpringerLink

Practical move: standardize how you document BPE and incorporate it into structured reports and risk conferences; it’s becoming more than a descriptive footnote.

What to ask vendors at RSNA

1. Risk engine proof: “Show external validation and calibration plots by density and race; how does your image-only model integrate into our mammography worklist and letters?”
2. CEM logistics: “Demonstrate CEM acquisition workflows, contrast protocols, and how your viewer handles subtraction/kinetics alongside priors.”
3. MRI + BPE analytics: “Can we standardize BPE capture in structured reports and trend it across treatment?”

As risk-first screening, CEM, and MRI gain real traction, the winners will be the programs that operationalize them quickly and consistently. If you’re planning your 2026 breast-imaging playbook, stop by Vesta at RSNA to see how our subspecialists, standardized templates, and overflow routing make risk-adjusted pathways usable on day one.

The post Breast Imaging 2025–26: Risk Models, CEM/MRI Momentum — RSNA Preview first appeared on Vesta Teleradiology.

1) AI that graduates from pilot to practice

This year’s agenda emphasizes real outcomes over proofs of concept: reader-in-the-loop tools, bias monitoring, and governance. In breast imaging alone, RSNA previews spotlight external validation for image-only risk models and integration of MRI signals into multimodal AI—clear signals that “personalization” is landing in routine workflows. Bring vendor questions that force specifics: external validation cohorts, drift detection, and how metrics (TAT, recalls, rework) appear in your dashboard. RSNA

What to set up before RSNA: define 3–5 outcome metrics and insist every demo shows pre/post performance tied to those measures. Use QIBA concepts to push for standardized inputs/outputs so results are reproducible across scanners and sites. QIBA Wiki

2) Personalization that reaches the reading room

Personalization isn’t only radiogenomics. RSNA’s preview points to risk-stratified pathways you can actually run: e.g., image-only 5-year breast cancer risk at the point of screening to route patients into annual vs. short-interval follow-up or supplemental imaging (CEM/MRI). That pairs well with updated U.S. recommendations: screening beginning at age 40 for average-risk women, then adjusting based on risk and local policy. Build routing rules, templates, and letters now, so RSNA demos can plug into your plan.

Operational checklist:

• Map risk thresholds → next steps (annual vs. short-interval, CEM/MRI).
• Standardize templates so risk outputs appear consistently in reports and patient letters.
• Decide who reviews outlier risk flags and how quickly (SLA).

3) Equity you can instrument—not just endorse

RSNA is foregrounding health equity, with sessions on encoding equity in AI and addressing access gaps for underserved communities. Equity becomes real when you can see it in your data: turnaround times by language, missed-appointment patterns by zip code, recall rates by screening site, and AI performance by subgroup. Build those slices into your analytics now; then ask vendors to show subgroup performance in their dashboards.

Practical moves:

• Add demographic and language filters to your TAT and recall reports.
• Require AI vendors to show calibration and error analysis by subgroup.
• Stand up multilingual patient letter templates to support new screening starts at 40. USPSTF

4) CEM/MRI momentum: choose the lever that fits your service line

RSNA coverage calls out CEM as an increasingly practical adjunct—especially useful for dense-breast populations and diagnostic workups where capacity or cost limits MRI. The RACER trial reported higher accuracy and efficiency for CEM as the primary exam for recalled women vs. conventional imaging—evidence that can justify protocol changes and equipment planning. Meanwhile, MRI retains the sensitivity crown, with renewed attention on background parenchymal enhancement (BPE) as a signal worth documenting consistently.

Action items:

• Decide where CEM fits: diagnostic recall pathway, dense-breast supplemental strategy, or both.
• Add BPE level to structured MRI reports and trend it during therapy response clinics.

5) Governance, not guesswork

If personalization is the “what,” governance is the “how.” Use QIBA ideas—claim definitions, acquisition standards, and profile adherence—to control variability across devices and shifts. Tie RSNA learnings to a written governance plan with three parts: 1) protocol book (who owns it, update cadence), 2) quality book (metrics, subgroup views), and 3) AI book (approval process, monitoring, rollback).

6) Where teleradiology extends your capacity

Personalization increases complexity at peaks (recalls, dense-breast seasons, MR backlogs). A teleradiology partner helps you keep individualized pathways moving: standardized templates, subspecialty over-reads, and after-hours coverage that adheres to your risk rules and equity metrics—so “Imaging the Individual” doesn’t stop at 5 p.m.

Headed to RSNA?

Visit Vesta at Booth 1346 (South Hall) to see how we make “Imaging the Individual” work in real clinics—then enter to win a 1-year Medality CME subscription. Don’t wait: email “RSNA CME Entry” to info@vestarad.com now for a reserved entry, and show your confirmation at the booth for a bonus entry.

The post Imaging the Individual — In the Trenches: AI, Personalization & Equity at RSNA 2025 first appeared on Vesta Teleradiology.