CAR Practice Guidelines on Breast Imaging and Interventions: Contrast-Enhanced Mammography

This guideline presents Part II of the Canadian Association of Radiologists (CAR) Practice Guidelines on Breast Imaging and Intervention and addresses the clinical application of contrast-enhanced mammography (CEM). Reflecting the expanding evidence base and increasing clinical adoption of CEM since 2016, this guideline provides updated recommendations on indications, examination technique, contrast administration, image interpretation, reporting standards, quality control, and patient safety. Particular emphasis is placed on the role of CEM in diagnostic problem-solving, preoperative staging, and selected screening scenarios when breast MRI is unavailable or contraindicated. This guideline is intended to be used in conjunction with the other 4 components of the CAR Breast Practice Guidelines series, which together replace the previous consolidated guidelines and align with national and international best practices. While establishing minimum standards and best practices, this guideline recognizes the influence of evolving technology, regional resources, and patient-specific considerations, and affirms that clinical judgment remains the responsibility of the supervising radiologist.