Dr. Raluca Dinu discusses the challenges of imaging dense breasts, the potential of 3D ultrasound and the evidence needed to expand access to supplemental breast imaging.
Breast cancer remains a major global health challenge, with an estimated 2.4 million women diagnosed and 694,000 deaths worldwide in 2024, according to the World Health Organization (WHO). Early detection plays an important role in improving outcomes, making breast imaging an essential component of preventive healthcare.
Mammography remains the cornerstone of breast cancer screening, but limitations persist, particularly for women with dense breast tissue. According to the FDA, about half of women over 40 have dense breasts, which can make abnormalities more difficult to detect through mammography. Magnetic resonance imaging (MRI) can provide additional diagnostic information for selected patients, although cost and limited accessibility can present challenges.
These limitations, alongside concerns about patient comfort, are driving interest in supplemental breast imaging technologies that could improve the screening experience and provide clinicians with additional diagnostic information.
CEO
QT Imaging
In this Xtalks Clinical Edge feature, Dr. Raluca Dinu, CEO of QT Imaging, discussed how 3D ultrasound-based breast imaging, quantitative biomarkers and AI could help address existing limitations. She also explored the importance of reimbursement, clinical evidence and a more personalized approach to breast health.
Why Dense Breast Tissue Creates Screening Challenges
Detecting abnormalities in women with dense breast tissue is an important consideration in breast imaging.
Breast density refers to the proportion of fibroglandular tissue relative to fatty tissue in the breast. On a mammogram, dense tissue and certain abnormalities can appear similarly white, making suspicious findings more difficult to distinguish from surrounding tissue.
This phenomenon, known as the masking effect, can reduce mammographic sensitivity. Dense breast tissue is also an independent risk factor for breast cancer, making effective imaging particularly important for this population.
Dr. Dinu explained that the combination of increased risk and reduced visibility creates an opportunity for additional imaging approaches.
“It’s all about improving the adherence to screening. You want all the women to come to screening and not run away.”
– Dr. Raluca Dinu
MRI is highly sensitive for detecting breast abnormalities, although its cost, infrastructure requirements and use of contrast agents can limit accessibility. Ultrasound-based technologies offer another approach, particularly when evaluating breast tissue that is difficult to assess through mammography alone.
QT Imaging is developing 3D ultrasound technology designed to provide additional information without breast compression or ionizing radiation. This technology aims to expand the information available to clinicians.
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Making Breast Imaging More Comfortable and Accessible
Although mammography is widely used, breast compression can cause discomfort. Anxiety about screening procedures, previous negative experiences and concerns about radiation exposure may also influence whether patients return for recommended examinations.
Raluca emphasized that patient comfort should be considered alongside diagnostic performance because it can influence screening participation.
“It’s all about improving the adherence to screening. You want all the women to come to screening and not run away,” she said.
Developing more comfortable imaging approaches could help address some of these concerns. QT Imaging’s technology uses ultrasound to generate 3D images without requiring breast compression or exposure to ionizing radiation.
“We’re not replacing anything. We’re trying to contribute to the standard of care,” emphasized Dr. Dinu.
“We are always trying to move radiologists from the subjective way that they’re looking at the images today to an objective way where we can measure.”
– Dr. Raluca Dinu
Moving From Images to Quantitative Breast Health Data
Beyond improving comfort, emerging breast imaging technologies are creating opportunities to generate more measurable information about breast tissue.
Traditional medical imaging relies heavily on visual interpretation. Radiologists evaluate differences in tissue appearance, structure and other characteristics to identify abnormalities.
Quantitative imaging aims to complement this interpretation with objective measurements that may help characterize tissue and monitor changes over time.
QT Imaging’s ultrasound-based approach can generate parameters such as speed of sound, reflection intensity and attenuation. These measurements may provide additional information about breast tissue characteristics.
“We are always trying to move radiologists from the subjective way that they’re looking at the images today to an objective way where we can measure,” explained Dr. Dinu.
Such information could become valuable when combined with AI-based analysis.
Dr. Dinu described this direction as a move from observing anatomy toward measuring biological characteristics.
Exploring the Role of 3D Ultrasound in Treatment Monitoring
For patients undergoing breast cancer treatment, quantitative breast imaging can help clinicians evaluate whether a tumor is responding to therapy. Changes in tumor size and volume can inform treatment response, but clinicians must interpret these measurements alongside other clinical findings.
Dr. Dinu discussed how 3D ultrasound imaging could potentially support more frequent monitoring of tumor volume during treatment.
Because ultrasound does not use ionizing radiation, it may offer practical advantages for repeated examinations when clinically indicated.
Monitoring changes at shorter intervals could help researchers determine whether quantitative imaging measurements provide earlier indications of treatment response.
QT Imaging is collaborating with researchers at Sunnybrook in Toronto on research examining changes in tumor volume during neoadjuvant therapy and exploring how quantitative ultrasound could contribute to evaluating therapeutic response.
Why Reimbursement and Clinical Evidence Matter
Reimbursement policies, healthcare infrastructure and the availability of supporting clinical evidence can all influence whether new diagnostic approaches become widely accessible.
Mammography has well-defined reimbursement structures in the US. Certain ultrasound examinations and breast MRI procedures are also covered under specific circumstances, although access and coverage can vary.
Obtaining a procedural billing code represents an important step, but it does not guarantee insurance coverage or reimbursement.
During the interview, Raluca discussed QT Imaging’s Category III Current Procedural Terminology (CPT) code, which she said was scheduled for release on October 1, 2026.
The company plans to use clinical data collected across participating centres to support discussions with payers and demonstrate the technology’s potential value.
Dr. Dinu mentioned that QT Imaging is working with Mayo Clinic to compare its ultrasound-based technology with MRI. The company is also collaborating with Sunnybrook in Toronto to investigate the technology’s potential for monitoring treatment response, particularly by measuring changes in tumour volume during neoadjuvant therapy.
These collaborations are part of the company’s efforts to generate clinical evidence supporting the use of its technology in supplemental breast imaging and treatment monitoring.
“The imaging has to be multimodal, quantitative, personalized.”
– Dr. Raluca Dinu
A More Personalized Future for Breast Imaging
Looking ahead, Raluca envisions a breast imaging landscape that integrates different technologies according to individual patient needs.
Factors such as breast density, cancer risk, clinical history, imaging findings and treatment status may all influence which imaging approaches are most appropriate.
AI and quantitative biomarkers could eventually provide clinicians with additional tools to interpret imaging findings and track changes over time.
However, expanding access will also require evidence demonstrating clinical usefulness, appropriate reimbursement pathways and practical integration into existing healthcare systems.
“The imaging has to be multimodal, quantitative, personalized,” Raluca said.
As research progresses, technologies such as 3D ultrasound may help expand the range of options available for supplemental breast imaging and treatment monitoring.
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