Behind the scan: From warehouse to patient in Maastricht

For a woman in the Netherlands, breast screening can begin barely twenty steps from home. To follow that journey, imagine a woman we will call Margriet. A mobile mammography unit has stopped in her Maastricht neighborhood. She walks out of the familiar residential streets and into the bus for an examination that takes only minutes. The Dutch screening model takes mammography units to market squares, shopping centers and neighborhoods across the country.

Dr. Thiemo van Nijnatten is a radiologist at Maastricht UMC+, with a focus on breast imaging and nuclear medicine.Bayer

“They do not come to the hospital, we actually go to them,” said Dr. Thiemo van Nijnatten, breast and nuclear radiologist at Maastricht UMC+. The nationwide screening program dates back to 1989 and invites women aged 50 to 75 for mammography, normally every two years. Due to a shortage of screening technologists, the interval has temporarily increased to an average of 29 months. In 2023, 842,256 women participated, representing 70.3% of those invited.

For many women, their journey ends here. They have attended screening, but they have not become patients yet. For Margriet, our illustrative patient journey continues because the mammogram reveals something else: extremely dense breast tissue. Dense tissue can mask tumors on mammography because both appear white on the image. It is also itself associated with a higher risk of breast cancer.

This is exactly the group being studied in DENSE-2, an ongoing Dutch trial in which women with extremely dense breasts and a negative screening mammogram may be invited for additional imaging with abbreviated MRI or contrast-enhanced mammography (CEM). Maastricht UMC+ is one of the participating centers.

Maastricht UMC+ in MaastrichtBayer

A few weeks later, Margriet finds herself at Maastricht UMC+. The hospital's light panels, high ceilings and broad glass surfaces make it easy to forget for a moment that this is a hospital. Much of breast imaging here is outpatient care.

An intravenous line is placed in her arm. She waits for contrast-enhanced imaging. Minutes later, contrast medium runs through her veins and the clock starts. For CEM, the team waits around two minutes after contrast administration before beginning acquisition. The images then have to be obtained within a defined time window.

“We always use a power injector because it allows us to have, in a reproducible manner, always the sufficient amount of contrast being injected,” van Nijnatten explained during a tour of the breast unit. Beside the examination table are the injector, tubing and other equipment needed for the procedure. 

Inside CEVA Logistics’ healthcare warehouse in Heerlen, where Bayer radiology products, consumables, and spare parts are stored and distributed to international markets.Bayer

Some kilometers outside Maastricht, components like these sit on shelves. At CEVA Logistics' healthcare warehouse in Heerlen, the sound atmosphere changes. Material-handling vehicles weave between tall shelves, signaling their path with lights and warning sounds. Drivers move through the aisles while pallets rise high above them and disappear into racks. Automated systems wrap shipments. A vertical lift retrieves trays containing everything from small screws to spare parts for contrast injectors.

Bayer’s logistics partner in radiology sits within more than 11,000 sq m of warehouse space and serves customers internationally. Pallets carrying syringes, tubing, injector systems and accessories are scanned into individually assigned locations, their “home addresses.” Yet the warehouse can practice what staff call “chaotic storage.”

Meaning: Products do not need to occupy the same shelf each time because the digital system knows exactly where they are. Fast-moving products are stored closer to the front; slower-moving ones farther back. The warehouse-management system also considers dimensions, so a pallet 1.2 meters high is not unnecessarily placed in a space designed for something much taller.

The fragile goods are handled carefully. Temperature is maintained at roughly 20°C to 21.2°C, while humidity is continuously monitored by sensors across the warehouse. While the display of machinery seems impressive in itself, it is not the full picture.

CEVA Logistics’ healthcare warehouse.Bayer“Much of the innovation is invisible. It’s really in the system,” Mario Francesco Indaco, Managing Director Bayer Medical Care & Regional Marketing Lead, said. Transport and warehouse-management software now coordinate processes that once involved Excel sheets and calls to individual carriers.

CEVA is also examining AI-assisted stock checks. Cameras mounted on reach trucks could, in future, check whether pallets are stored in the correct locations while employees carry out their normal work.

For the hospital, the result should be simple: the right product in the right place at the right time. For the patient, none of this should be noticeable at all.

Hidden infrastructure

Maastricht itself provides a strategic setting for this chain. Belgium and Germany are only a short distance away, making the region naturally cross-border. Bayer representatives described the location as useful for an international operation not only because of its geography, but because of its multilingual workforce and access to several airports within a relatively short distance.

By Geert Budenaerts, CC BY 3.0On an autumn afternoon, however, the city is quiet enough to hear leaves scratch across the pavement. Bicycles pass along the lanes outside Bayer Radiology's red-brick-and-glass building. Even much of the road traffic has disappeared from sight: since the opening of the King Willem-Alexander Tunnel, a large share of traffic along the former A2/N2 corridor runs underneath the city.

It is another place where infrastructure disappears from view. Bayer's radiology presence in Maastricht also has historical roots. MEDRAD became part of Bayer through Bayer's 2006 acquisition of Schering, and Bayer today lists the Maastricht site as its radiology HQ in the Netherlands.

Behind the red brick and glass, Bayer says 25 nationalities work at the Maastricht site, with around 35 languages spoken. Functions including demand and supply, quality, regulatory affairs, service, marketing and commercial operations are centralized here.

And immediately to the left of the entrance hides another part of the radiology ecosystem: the repair shop.

When something breaks

Loek Jansen, Technical Operations Lead, Radiology, Bayer, leads through Bayer's repair shop in Maastricht.Bayer

Across Europe, Bayer's service team said it has around 100 field engineers who install equipment, perform preventive maintenance and respond when injectors fail. They travel with spare parts in their cars, but not every fault can be resolved inside a hospital.

If the problem lies in an injector head, display or base, the field engineer can request a replacement module from Maastricht. The request is registered in Bayer's ERP system, transferred to logistics, taken from the CEVA warehouse and shipped into the field.

The replacement is preconfigured so that, according to the service team, it can be installed as “plug-and-play.” That keeps the hospital working while the defective module travels in the opposite direction.

Components that cannot be repaired in the field can travel from the CEVA warehouse back to Bayer's repair operation in Maastricht. Rather than leaving the hospital waiting while the original part completes that circuit, Bayer can send a swap part first, allowing procedures to continue while the returned module is repaired.

Inside the repair center, one device shows clearly where it has been. It is scratched and marked, with traces of contrast on the outside. Technicians open it, repair what is damaged, update hardware and software, test and calibrate it and replace worn external parts.

The right imaging modality for the right patient at the right time

Bayer described the finished modules as being returned in an “as-new” condition, regardless of whether the serial number is one day old or ten years old. Customers returning a defective module can buy the replacement at what Bayer calls an “exchange price” - a reduced price linked to returning the old unit.

Dr. Joana Reis, Medical Affairs Breast Imaging Solutions Lead for Radiology at Bayer.BayerBack upstairs at Bayer Radiology’s Maastricht hub, the discussion moves to deciding what imaging may look like next. Dr. Joana Reis, Medical Affairs Breast Imaging Solutions Lead for Radiology at Bayer pointed to dense breasts as one example of why screening may increasingly need to move away from a one-size-fits-all approach.

Mammography remains the first-line screening method, but it does not perform equally well in every woman. “At Bayer, we are very committed to helping advance breast imaging, trying to find the right imaging modality for the right patient at the right time,” Reis said.

She highlighted the earlier DENSE trial, which showed the benefit of supplemental MRI in women with extremely dense breast tissue, as well as the ongoing DENSE-2 study. DENSE-2 is now asking a more practical question: if women with extremely dense breasts need supplemental imaging, which approach works best in a real screening system?

Van Nijnatten described Maastricht UMC+'s participation in the trial and said the earlier DENSE trial found around 17 to 18 additional cancers per 1,000 women through supplemental imaging in women with extremely dense breasts and no suspicious findings on mammography.

DENSE-2 is comparing abbreviated MRI and CEM as additional techniques. “We do need contrast,” van Nijnatten said when discussing the evidence in this selected group. DENSE-2 is an independent Dutch study funded by ZonMw with support from Bayer, Hologic and Siemens Healthineers. The question is increasingly which contrast-enhanced technique can combine detection performance with the capacity to actually implement it.

Reis stressed that evidence alone does not make a screening strategy work. Equipment, trained radiologists and radiographers, reimbursement and patient information all have to follow. She also pointed to research showing limited awareness among women of breast density and what it means.

The Netherlands is now implementing a temporary supplemental MRI offer for women with extremely dense breasts from 2030. DENSE-2, whose results are now expected in 2031, continues to investigate whether abbreviated MRI or CEM could provide a different long-term screening approach.

A fast-track for patients

An MRI system at Maastricht UMC+. Abbreviated MRI is being evaluated in the DENSE-2 trial as supplemental imaging for women with extremely dense breast tissue.BayerBack at Maastricht UMC+, if mammography reveals something requiring further investigation, the patient can move directly to an adjacent ultrasound room. If a biopsy is required, it can in some cases be performed immediately rather than scheduled for another appointment. 

“If it's three or four o'clock in the afternoon, the next morning the patient will have an initial result already, whether it's a malignant or a benign diagnosis,” van Nijnatten said. He resists looking at breast imaging as simply a sequence of technologies. “It's not breast imaging,” he said. “It's actually the whole breast cancer care pathway.” One floor away, in nuclear medicine, logistics and timing are dictated by physics.

An FDG tracer used for PET is radioactive and starts decaying before it ever reaches the patient. The amount has to be calculated according to the patient's body weight and the planned examination time. Maastricht receives tracers from facilities including Eindhoven and Liège, with transport time already taken into account.

A patient arriving 45 minutes late can therefore create an entirely different problem than being late for a conventional appointment. “It's all about thinking in advance and thinking of next steps,” van Nijnatten said.

Twenty steps and kilometers behind them

Margriet's visit is eventually over. If her supplemental examination shows no suspicious finding, she leaves the department, travels the short distance back across Maastricht and returns home. 

The devices, liquids and information around her have traveled farther. Behind them are kilometers of shelving, temperature and humidity sensors, warehouse systems, transport schedules, engineers, spare parts, refurbished injectors, regulatory processes, researchers and clinical teams.

The Bayer team described what needs to come together behind a hospital scan: injectors, consumables, spare parts, service support, documentation, transport and time.

Margriet, meanwhile, sees a mobile mammography unit parked near her home, perhaps later an IV line in her arm, an ultrasound probe or a biopsy needle and, within hours or days, an answer. Behind her, the system links one station to the next, smoothly and without pause. And when it works well, remains almost entirely hidden from the patient.

This article was conducted during a Bayer-sponsored press trip to Maastricht. Travel and accommodation were provided by Bayer. Maastricht UMC+ did not receive any payment or other compensation for hosting the journalists or providing substantive input.