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Advanced practice (AP) for medical radiation technologists (MRTs) has not yet found the same traction in medical imaging in Canada as it has in radiation therapy over the past 15 years. This has been attributed informally to differences in professional identity, traditional interprofessional relationships, and practice settings, and lack of dedicated internal champions and concerted efforts to lay related groundwork within the profession. In an effort to mirror the success in radiation therapy while providing a clear example of a systematic approach to exploring evidence-based AP opportunities in the interest of efficient and quality patient care, an exploratory process mapping study was undertaken using the established PEPPA framework at three interrelated breast imaging (BI) clinics at large urban academic hospitals in Toronto, Canada. BI represents a complex multimodality setting with a well-defined role in the healthcare system. BI holds great potential as a setting to consider opportunities to leverage the MRT role to optimize patient-centered service. This study involved three phases; mapping BI processes and workflows, identification and characterization of care delivery problems (CDPs) within these process maps, and prioritization of opportunities where task shifting might engage MRTs to optimize care. The PEPPA framework - a systematic planning tool for AP nursing roles more recently used in radiation therapy in Canada - was used, with the first five of nine steps considered within project scope. Twelve distinct BI processes were mapped; a single clerical workflow and 11 subsequent clinical processes. Each map included swimlanes for MRTs, radiologists, and clerical staff and included processes ranging from routine mammogram and ultrasound orders to stereotactic-guided core biopsies and rapid diagnostic workflows. Across maps, nine CDPs were identified; scheduling, radiologist availability, incorrect orders, and coordination of externally-acquired imaging and consults. Characterization of the root causes of each CDP led to common reflections on team and task factors, including inefficiencies in communication or division of responsibilities, or availability of resources or team members to support workflows. Consultations based on the resultant maps and CDPs led to identification of potential advanced roles for MRTs; review and decision-making relating to imaging acquired externally prior to patient appointments, exam ordering and protocoling in defined scenarios, and task-shifting of certain clinical procedures such as screening ultrasounds and contrast-enhanced mammography. Independent of formal study results, important lessons were gleaned from the response to the academic output of this work. While the study prioritized interprofessional consultation at key intervals, physicians expressed reluctance to consider or pilot identified roles in a subsequent funded project, based on concerns about radiologist commitment to mentoring, impact on radiology trainees, and medicolegal considerations. AP for MRTs holds great potential to address system inefficiencies in BI, if approached systematically and with the primary objective to optimize care. This study in medical imaging followed the lead of similar work in radiation therapy, and while preliminary results indicated opportunities deemed by MRTs to be worth investigating, there remains work to be done to engage radiology colleagues as key stakeholders to define and advance related objectives. [ABSTRACT FROM AUTHOR]