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Background and purpose: Breast ultrasound is commonly used in conjunction with mammography (FFDM) in the investigation of symptoms or screening of women at increased risk, particularly in the presence of dense breast tissue. Evidence suggests that its use as an adjunct to contrast enhanced mammography (CEM) with normal appearances does not add benefit. We examined the change in use of breast ultrasound following the introduction of CEM. Methods: The frequency of use of bilateral and unilateral ultrasound examination prior to and after the introduction of CEM into an integrated multidisciplinary clinic was identified in women who underwent mammography without contrast (FFDM) and those who had CEM. Pre-CEM clinical protocols recommended the use of ultrasound (US) following mammography in women with increased risk, dense (Cat C/D) breast tissue, symptoms, and significant 2D/3D abnormalities. Results: 771 patients had mammography, all FFDM, in August and September 2022, and 794 in February and March 2023 post introduction of CEM ,430 FFDM and 364 CEM. Usage of US was 93% pre-CEM (99% bilateral) and 60% overall post CEM (37% in the CEM group of which 59% were unilateral).Tabled 1CasesRisks-Density-Symptoms US number (%)All PatientsUS number (%)FFDMPre-CEM646 / 659 (98)714 / 771 (93)FFDMPost- CEM298 / 325 (92)343 / 430 (80)CEM121 / 319 (38)134 / 364 (37) Open table in a new tab Conclusions: The introduction of CEM into an integrated breast clinic has a significant impact on the use of breast ultrasound following mammography and consequently on workflow and staffing. References: 1. Contrast-Enhanced Spectral Mammography in Women With Intermediate Breast Cancer Risk and Dense Breasts 2. Vera Sorin, Yael Yagil, Ady Yosepovich, Anat Shalmon, Michael Gotlieb, Osnat Halshtok Neiman, and Miri Sklair-Levy, American Journal of Roentgenology 2018 211:5, W267-W274