Tomography, Volume 11, Issue 10 (October 2025) – 11 articles

Objective: This study aimed to evaluate the diagnostic accuracy of two cone beam computed tomography (CBCT) devices using 18 imaging modalities in detecting root fractures—vertical, horizontal, and oblique—in teeth with intracanal post systems. Materials and methods: Ninety-six were extracted; single-rooted mandibular premolars were endodontically treated and restored with Bundle, Reforpost, or Splendor Single Adjustable posts. Controlled fractures of different types were induced using a universal testing machine. Each tooth was scanned with NewTom 7G and NewTom Go (Quantitative Radiology, Verona, Italy) under nine imaging protocols per device; varying in dose and voxel size, yielding 1728 CBCT images. Three observers (a professor of endodontics; a specialist; and a postgraduate student in endodontics) independently evaluated the images. Results: Observers demonstrated almost perfect agreement (κ ≥ 0.81) with the gold standard in fracture detection using NewTom 7G. No significant differences were found in sensitivity, specificity, or accuracy across voxel size and dose parameters for both devices in detecting fracture presence (p > 0.05). Similarly, both devices displayed comparable performance in identifying horizontal and oblique fractures (p > 0.05). However, in NewTom Go, regular and low doses with different voxel sizes showed reduced sensitivity and accuracy in detecting vertical fractures across all post systems (p ≤ 0.05). Conclusions: NewTom 7G, with its advanced detector system and smaller voxel sizes, provides superior diagnostic accuracy for root fractures. In contrast, NewTom Go displays reduced sensitivity for vertical fractures at lower settings. Clinical relevance: CBCT device selection and imaging protocols significantly affect the diagnosis of vertical root fractures. Full article

Objective: Medical Visual Question Answering (Med-VQA), a key technology that integrates computer vision and natural language processing to assist in clinical diagnosis, possesses significant potential for enhancing diagnostic efficiency and accuracy. However, its development is constrained by two major bottlenecks: weak few-shot generalization capability stemming from the scarcity of high-quality annotated data and the problem of catastrophic forgetting when continually learning new knowledge. Existing research has largely addressed these two challenges in isolation, lacking a unified framework. Methods: To bridge this gap, this paper proposes a novel Evolvable Clinical-Semantic Alignment (ECSA) framework, designed to synergistically solve these two challenges within a single architecture. ECSA is built upon powerful pre-trained vision (BiomedCLIP) and language (Flan-T5) models, with two innovative modules at its core. First, we design a Clinical-Semantic Disambiguation Module (CSDM), which employs a novel debiased hard negative mining strategy for contrastive learning. This enables the precise discrimination of “hard negatives” that are visually similar but clinically distinct, thereby significantly enhancing the model’s representation ability in few-shot and long-tail scenarios. Second, we introduce a Prompt-based Knowledge Consolidation Module (PKC), which acts as a rehearsal-free non-parametric knowledge store. It consolidates historical knowledge by dynamically accumulating and retrieving task-specific “soft prompts,” thus effectively circumventing catastrophic forgetting without relying on past data. Results: Extensive experimental results on four public benchmark datasets, VQA-RAD, SLAKE, PathVQA, and VQA-Med-2019, demonstrate ECSA’s state-of-the-art or highly competitive performance. Specifically, ECSA achieves excellent overall accuracies of 80.15% on VQA-RAD and 85.10% on SLAKE, while also showing strong generalization with 64.57% on PathVQA and 82.23% on VQA-Med-2019. More critically, in continual learning scenarios, the framework achieves a low forgetting rate of just 13.50%, showcasing its significant advantages in knowledge retention. Conclusions: These findings validate the framework’s substantial potential for building robust and evolvable clinical decision support systems. Full article

Objective: This study aimed to retrospectively evaluate the anatomical structure, dimensions, and variations in the nasopalatine canal using cone beam computed tomography (CBCT) in patients undergoing implant treatment in the maxillary anterior region. The goal was to identify potential risks and complications that may arise during surgical procedures. Additionally, canal shape, number, and its relationship with gender and nasal septa were assessed as secondary parameters. Methods: This retrospective study included CBCT scans of 185 patients who applied for implant treatment in the anterior maxilla between January 2021 and December 2023. Patients with edentulous anterior maxillae and no pathological lesions in the implant region were included. CBCT images were analyzed in sagittal, axial, and coronal planes using standardized measurement protocols. The shape, number, dimensions, and angulation of the nasopalatine canal were evaluated by two blind observers with high inter-rater agreement. Morphological classifications and canal–implant relationships were recorded as primary and secondary outcome parameters. Results: Among the 185 CBCT scans analyzed, the nasopalatine canal was most frequently observed as a single structure (87.6%), typically located in the central incisor region, with a cylindrical morphology in the sagittal plane (44.9%) and a single shape in the coronal plane (52.4%). While no significant differences were found in morphometric parameters by age or sex, accessory canal locations differed significantly between sexes (p = 0.040). Conclusions: The anatomical characteristics and morphometric measurements of the nasopalatine canal exhibit considerable variability, underscoring the importance of individualized CBCT assessment during implant planning in the anterior maxilla. Recognizing accessory canal positions, particularly their sex-related differences, is critical for minimizing surgical complications and optimizing outcomes. Full article

Objective: Non-contrast computed tomography (CT) remains the gold standard for diagnosing ureteral stones, with excellent sensitivity and specificity. However, reliance on CT alone raises concerns regarding cumulative radiation exposure, particularly in recurrent stone formers. Clinical scoring systems such as CHOKAI, STONE, and modified STONE have been developed to provide practical bedside tools for diagnostic decision-making. This study prospectively compared these three clinical scores for their ability to predict urinary-stone disease in the emergency department. Study Design: Prospective study. Methods and Duration of the Study: Between 6 August 2024 and 15 February 2025, 130 consecutively enrolled adults with flank pain underwent bedside scoring and reference-standard non-contrast CT. Associations were analysed with Chi-Square Tests and multivariable logistic regression. Model calibration was assessed with the Hosmer–Lemeshow test; overall accuracy was calculated. Results: When the variables used in different stone scoring formulas were compared according to the computer tomography results, there was a statistically significant difference (p < 0.01) between patients with and without a history of stone and hydronephrosis. Patients with nausea, history of stone, and hydronephrosis were 11, 4.2, and 5 times more highly to have a stone on computer tomography than those without, respectively. Conclusions: In this Turkish cohort, CHOKAI and modified STONE demonstrated superior predictive performance compared to the original STONE score. These findings suggest that clinical scoring systems, when incorporating predictors such as nausea, prior stone history, and hydronephrosis, may serve as practical alternatives to CT-first diagnostic approaches. Multicenter validation studies are required before routine clinical adoption. Full article

Background/Objectives: The recent development of four-dimensional X-ray velocimetry (4DXV) technology (three-dimensional space and time) provides a unique opportunity to obtain preclinical quantitative functional lung images. Only single-scan measurements in non-survival studies have been obtained to date; thus, methodologies enabling animal survival for repeated imaging to be accomplished over weeks or months from the same animal would establish new opportunities for the assessment of pathophysiology drivers and treatment response in advanced preclinical drug-screening efforts. Methods: An anesthesia protocol developed for animal recovery to allow for repetitive, longitudinal scanning of individual animals over time. Test–retest imaging scans from the lungs of healthy mice were performed over 8 weeks to assess the repeatability of scanner-derived quantitative imaging metrics and variability. Results: Using a murine model of fibroproliferative lung disease, this longitudinal scanning approach captured heterogeneous progressive changes in pulmonary function, enabling the visualization and quantitative measurement of averaged whole lung metrics and spatial/regional change. Radiation dosimetry studies evaluated the effects of imaging acquisition protocols on X-ray dosage to further adapt protocols for the minimization of radiation exposure during repeat imaging sessions using these newly developed image acquisition protocols. Conclusions: Overall, we have demonstrated that the 4DXV advanced imaging scanner allows for repeat measurements from the same animal over time to enable the high-resolution, noninvasive mapping of quantitative lung airflow dysfunction in mouse models with heterogeneous pulmonary disease. The animal anesthesia and image acquisition protocols described will serve as the foundation on which further applications of the 4DXV technology can be used to study a diverse array of murine pulmonary disease models. Together, 4DXV provides a novel and significant advancement for the longitudinal, noninvasive interrogation of pulmonary disease to assess spatial/regional disease initiation, progression, and response to therapeutic interventions. Full article

Breast cancer detection remains a significant challenge, with traditional mammography presenting barriers such as discomfort, radiation exposure, high false-positive rates, and financial burden. Moreover, younger women frequently fall outside routine mammographic screening guidelines, leaving critical gaps in early detection. Objectives: This study investigates the potential of quantitative transmission breast acoustic computed tomography scanner imaging (QT3D) as an innovative, non-invasive imaging modality for characterizing and evaluating breast masses. Methods: A comparative analysis between QT3D imaging and magnetic resonance imaging (MRI) was conducted in a cohort of patients with biopsy-proven benign or malignant breast lesions, comparing key metrics in quantifying breast masses for the purposes of breast mass characterization. Results: The findings in this study highlight its capability in identifying relatively small tumors, multiple lesions, satellite lesions, intraductal extensions, and calcifications, in addition to offering valuable diagnostic insights. Conclusions: This work is a first step toward studies essential for confirming its clinical feasibility, establishing its role in breast cancer tumor characterization, and potentially improving patient outcomes. Full article

Background/Objectives: Children with adolescent idiopathic scoliosis (AIS) require repeated imaging, primarily standing spine radiography, while CT may be required for surgical planning, resulting in higher radiation exposure. Spectral shaping using a tin filter can reduce radiation dose in non-contrast chest CT. This study evaluated the efficacy of spectral shaping using a tin filter for reducing radiation dose in CT imaging in AIS and its impact on image quality. Methods: We retrospectively analyzed 51 AIS patients who underwent spine CT between February 2017 and March 2022, and divided them into two groups: normal-dose CT (NDCT) and low-dose CT with spectral shaping with a tin filter (LDCT). Radiation doses and image quality were compared between the groups. Radiation dose was recorded as the volume CT dose index (CTDIvol) and the dose length product emitted from the device, and effective and equivalent doses obtained from simulations. Results: The use of spectral shaping with a tin filter resulted in a 75% reduction in radiation dose compared to conventional CT without any reduction in image quality. Conclusions: Spectral shaping CT with a tin filter can substantially reduce radiation dose while maintaining image quality. It may be considered a safer alternative to conventional CT when clinically indicated in AIS patients. Full article

Objective: This study aimed to evaluate the hepatic volume, iodine concentration, and extracellular volume (ECV) of each hepatic segment in cirrhotic patients using three-dimensional (3D) volumetric iodine mapping of the liver segment derived from contrast-enhanced dual-energy CT (DECT) superimposed on extracted color-coded CT liver segments in comparison with non-cirrhotic patients. Methods: The study population consisted of 66 patients, 34 with cirrhosis and 32 without cirrhosis. Using 3D volumetric iodine mapping of the liver segment derived from contrast-enhanced DECT superimposed on extracted color-coded CT liver segments, the volume and iodine concentration of each hepatic segment in the portal venous phase (PVP) and equilibrium phase (EP), the difference in iodine concentration between PVP and EP (ICPVP-liver—ICEP-liver), and ECV fractions were compared between cirrhotic and non-cirrhotic groups. Results: The iodine concentration was not significantly different in all hepatic segments between the cirrhotic and non-cirrhotic groups. Conversely, the difference in iodine concentration between PVP and EP (ICPVP-liver—ICEP-liver) was significantly smaller in the cirrhosis group than in the non-cirrhosis group for all hepatic segments (p < 0.001). The ECV fraction of the left medial segment was significantly higher in the cirrhosis group than in the non-cirrhotic group ([26.4 ± 7.6] vs. [23.1 ± 5.1]; p < 0.05). Conclusions: The decreased difference in iodine concentration between PVP and EP calculated from 3D volumetric iodine mapping of the liver segment using DECT may be a clinically useful indicator for evaluating patients with compensated cirrhosis, suggesting a combined effect of a reduced portal venous flow and increased interstitial space associated with fibrosis. Full article

Purpose: This study aimed to evaluate the diagnostic performance of GPT-4 Omni (GPT-4o) in emergency abdominal computed tomography (CT) cases compared to radiology residents with varying levels of experience, under conditions that closely mimic real clinical scenarios. Material and Methods: A total of 45 emergency cases were categorized into three levels of difficulty (easy, moderate, and difficult) and evaluated by six radiology residents with varying levels of experience (limited: R1–R2; intermediate: R3–R4; advanced: R5–R6) and GPT-4o. Cases were presented sequentially to both groups with consistent clinical data and CT images. Each case included 4 to 7 CT slice images, resulting in a total of 243 images. The participants were asked to provide the single most likely diagnosis for each case. GPT-4o’s CT image interpretation performance without clinical data and hallucination rate were evaluated. Results: Overall diagnostic accuracy rates were 76% for R1–R2, 89% for R3, 82% for R4–R5, 84% for R6, and 82% for GPT-4o. Case difficulty significantly affected the diagnostic accuracy for both the residents and GPT-4o, with accuracy decreasing as case complexity increased (p < 0.001). No statistically significant differences in diagnostic accuracy were found between GPT-4o and the residents, regardless of the experience level or case difficulty (p > 0.05). GPT-4o demonstrated a hallucination rate of 75%. Conclusions: GPT-4o demonstrated a diagnostic accuracy comparable to that of radiology residents in emergency abdominal CT cases. However, its dependence on structured prompts and high hallucination rate indicates the need for further optimization before clinical integration. Full article

Background: Small bowel obstruction (SBO) accounts for 12–16% of surgical hospital admissions and can lead to complications such as bowel ischemia. Traditional management requires transporting patients to the Radiology Department (RD) for a fluoroscopic small bowel series, occupying resources and time. This study evaluates the efficacy and efficiency of the Small Bowel Challenge Exam, a bedside alternative. Methods: A retrospective analysis was performed on 85 SBO patients from January 2018 to December 2023 at an academic tertiary care facility, comparing the traditional fluoroscopic series (37 patients) to the bedside Small Bowel Challenge Exam (48 patients). Key metrics analyzed included hospital resource utilization, overall costs, and length of stay. Results: Gender and race distributions were similar between groups (p = 0.268 and p = 0.808, respectively). Median total costs were lower in the challenge group (USD 1243 vs. USD 1472; p = 0.1229), significantly so when excluding CT scan costs (USD 993.5 vs. USD 1270; p = 0.0500). Core costs also significantly favored the challenge group (USD 389.6 vs. USD 615; p < 0.0001). Length of stay and variable costs showed no significant differences (p = 0.3846 and p = 0.8065, respectively). Additional imaging frequencies were comparable (p = 0.96 for CT scans; p = 0.97 for XR exams). Conclusions: The Small Bowel Challenge Exam reduces certain costs and logistical burdens without prolonging length of stay, suggesting more efficient use of hospital resources. Further research is recommended to evaluate broader implementation and long-term impacts. Full article

Background/Objectives: Diffusion-weighted imaging (DWI) of the liver is prone to cardiac motion-induced signal dropout, which can be reduced using flow-compensated (FloCo) instead of monopolar (MP) diffusion encodings. This study examined differences in lesion detection capabilities between FloCo and MP DWI and whether visibility depends on lesion size and position. Methods: Forty patients with at least one known or suspected focal liver lesion (FLL) underwent FloCo and MP DWI. For both sequences, b = 800 s/mm² images were used to manually segment FLLs, which were then sorted by size and location (liver segment). The number of detected lesions, the sensitivity, and the contrast-to-noise ratio (CNR) were calculated and compared across sequences, sizes, and locations. Results: Significantly more lesions were detected using FloCo DWI compared to MP DWI (1211 vs. 1154; p < 0.001). In total, 1258 unique lesions were detected, 104 of which were identified only by FloCo DWI, and 47 of which only by MP DWI. The sensitivities of FloCo DWI and MP DWI were 96.3% (95% CI: 95.1–97.2%) and 91.7% (95% CI: 90.1–93.2%), respectively. The largest additional lesion found with only one of the two sequences measured 10.9 mm in FloCo DWI and 8.2 mm in MP DWI. In relative numbers, more additional FloCo lesions were found in the left liver lobe than in the right liver lobe (6.4% vs. 3.5%). The lesion CNR was significantly higher for FloCo DWI than for MP DWI (p < 0.05) for all evaluated size intervals and liver segments. Conclusions: FloCo DWI appears to enhance the detectability of FLLs compared to MP DWI, particularly for small liver lesions and lesions in the left liver lobe. Full article