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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (28 February 2026) | Viewed by 19608

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Dr. Serena Carriero

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Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy
Interests: breast radiology; interventional radiology; diagnostic radiology

Special Issue Information

Dear Colleagues,

We would like to invite you to contribute to the Special Issue “Recent Advances in Diagnostic and Interventional Radiology”. This field is rapidly evolving, driven by the development of innovative imaging techniques and minimally invasive procedures, which have significantly enhanced our ability to diagnose and treat a wide range of conditions. Diagnostic and interventional radiology plays a critical role in modern clinical practice, offering substantial benefits in terms of patient outcomes and healthcare efficiency.

This Special Issue aims to show the latest advancements in imaging technologies, interventional procedures, and clinical applications in the context of diagnostic and interventional radiology. This focus aligns with the journal’s scope by encouraging submissions that explore novel methodologies, breakthrough technologies, and innovative approaches to treatment and diagnosis. The collection of papers will highlight how these advancements are reshaping this research field and improving patient care.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

Advanced imaging techniques;
Innovations in minimally invasive procedures;
Applications of AI in radiology;
Image-guided therapies;
Emerging technologies in diagnostic radiology.

We welcome contributions that present cutting-edge research, address current challenges, and suggest future directions in this exciting and significant area of radiology.

We look forward to receiving your contributions and sharing these advancements with the broader scientific and medical community.

Best regards,

Dr. Serena Carriero
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

diagnostic radiology
interventional radiology
medical imaging
image-guided therapy
AI
minimally invasive procedures

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Published Papers (10 papers)

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Research

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16 pages, 1777 KB

Open AccessArticle

Quantifying Radiation Exposure Across Cardiac Catheterization Procedures

by Md Fakhrul Islam Khaled, Mohammad Walidur Rahman, S M Ear E Mahabub, Sharmin Ahmed, Mohammad Moynul Hoque Munna, Md Mazharul Islam, Mahmud Hasan Mostofa Kamal, S M Mustafa Zaman, Sajal Krishna Banerjee and Mohammad Rayhan Masum Mandal

Diagnostics 2026, 16(11), 1636; https://doi.org/10.3390/diagnostics16111636 - 27 May 2026

Viewed by 1882

Abstract

Background: Coronary angiography and percutaneous coronary intervention are essential procedures for managing coronary artery disease but expose patients and healthcare personnel to ionizing radiation. Radiation exposure varies with procedural complexity and vascular access route, and repeated occupational exposure in catheterization laboratories (cath-labs) has been linked to serious health hazards among operators. Objectives: Given the high procedural volume and limited routine monitoring at Bangladesh Medical University (BMU), Bangladesh, this study aimed to quantify operator radiation exposure and identify factors influencing radiation dose. Methods: This analytical cross-sectional study was conducted from November 2023 to April 2024 in two cardiac cath-labs at BMU using two Siemens Axiom Artis angiography systems. Patient, operator, and procedural data, including demographics, operator experience, procedure type, vascular access route, fluoroscopic view, procedure duration, and radiation exposure, were collected from randomly selected routine procedures. Operator radiation exposure was measured at four working positions using a dosimeter, and cumulative annual exposure was estimated based on procedural workload. Descriptive, univariable, and multivariable analyses were performed to identify factors associated with radiation exposure. Results: The study analyzed 776 procedures, in which most patients were aged 46–65 years and male. The majority of procedures were coronary angiography performed via the femoral route. On average, each procedure required 14.28 fluoroscopic views and lasted 8.16 min, with a mean radiation exposure of 1034.5 mGy. Procedural complexity, radial access, and stent use were associated with higher fluoroscopic views, longer procedure time, and increased radiation exposure. Multivariable analysis showed that procedure type and stent number are primarily determinants for the number of fluoroscopic views, while procedure time was mainly driven by imaging demand and vascular access route. Radiation exposure was strongly associated with both procedure time and the number of views, and was higher among male and older patients but slightly lower with femoral access and among older operators. Direct measurements showed higher radiation levels near the operator’s X-ray beam, while estimated annual operator exposure remained low inside the lead apron (0.03–0.05 mSv) compared with outside the lead apron (0.6–1.1 mSv), which is within the limit of internationally accepted cumulative absorbed radiation. Conclusions: This study provides the first comprehensive evaluation of operator radiation exposure in a cardiac cath-lab in the country and the wider region. Procedural characteristics, particularly fluoroscopy use and procedural complexity, were the primary determinants of radiation exposure, while effective shielding and increased distance substantially reduced operator dose. These findings highlight the importance of imaging optimization and consistent implementation of the ALARA principle through structured radiation safety training and careful procedural planning to further minimize occupational exposure. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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9 pages, 1513 KB

Open AccessArticle

Prediction of Treatment Response by Thyroid Bed Uptake on Post-Ablative Whole-Body Scan in Intermediate-Risk Patients with Papillary Thyroid Cancer

by Eunkyoung Choi, Yong-An Chung, Soo Jin Kwon and Jinkyoung Oh

Diagnostics 2026, 16(1), 19; https://doi.org/10.3390/diagnostics16010019 - 20 Dec 2025

Cited by 1 | Viewed by 1294

Abstract

Background/Objectives: This study aimed to evaluate the prognostic significance of thyroid bed uptake on post-ablative whole-body scan (PAWBS) in predicting treatment response in intermediate-risk papillary thyroid carcinoma (PTC) patients undergoing high-dose radioactive iodine (RAI) therapy following total thyroidectomy. Methods: This retrospective study included 148 intermediate-risk PTC patients who underwent high-dose RAI therapy after total thyroidectomy. PAWBS was performed 7 days post-therapy, and thyroid bed uptake was visually graded. Treatment response was assessed using stimulated thyroglobulin (sTg) levels, imaging studies, and clinical follow-up. Responses were classified into excellent, indeterminate, biochemical incomplete, or structural incomplete categories. Logistic regression analyses were conducted to identify predictors of treatment response. Results: Among the 148 patients, 126 (85.1%) achieved an excellent response (ER), while 22 (14.9%) showed a non-excellent response (NER), which included indeterminate, biochemical incomplete, and structural incomplete responses. Patients with NER exhibited significantly higher thyroid bed uptake on PAWBS compared to ER patients (p = 0.001). Multivariate analysis revealed that higher thyroid bed uptake was an independent negative prognostic factor for achieving an excellent response (p < 0.001), along with sTg (p < 0.001). Conclusions: The intensity of thyroid bed uptake on PAWBS independently predicts treatment response in intermediate-risk PTC patients receiving high-dose RAI therapy, with higher uptake indicating a worse prognosis. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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17 pages, 2025 KB

Open AccessArticle

Breast Organ Dose and Radiation Exposure Reduction in Full-Spine Radiography: A Phantom Model Using PCXMC

by Manami Nemoto and Koichi Chida

Diagnostics 2025, 15(21), 2787; https://doi.org/10.3390/diagnostics15212787 - 3 Nov 2025

Cited by 1 | Viewed by 1351

Abstract

Background/Objectives: Full-spine radiography is frequently performed from childhood to adulthood, raising concerns about radiation-induced breast cancer risk. To assess such probabilistic risks as cancer, accurate estimation of equivalent and effective organ doses is essential. The purpose of this study is to investigate X-ray imaging conditions for radiation reduction based on breast organ dose and to evaluate the accuracy of simulation software for dose calculation. Methods: Breast organ doses from full-spine radiography were calculated using the Monte Carlo-based dose calculation software PCXMC. Breast organ doses were estimated under various technical conditions of full-spine radiography (tube voltage, distance, grid presence, and beam projection). Dose reduction methods were explored, and variations in dose and error due to phantom characteristics and photon history number were evaluated. Results: Among the X-ray conditions, the greatest radiation reduction effect was achieved by changing the imaging direction. Changing from the anteroposterior to posteroanterior direction reduced doses by approximately 76.7% to 89.1% (127.8–326.7 μGy) in children and 80.4% to 91.1% (411.3–911.1 μGy) in adults. In addition, the study highlighted how phantom characteristics and the number of photon histories influence estimated doses and calculation error, with approximately 2 × 10⁶ photon histories recommended to achieve a standard error ≤ 2%. Conclusions: Modifying radiographic conditions is effective for reducing breast radiation exposure in patients with scoliosis. Furthermore, to ensure the accuracy of dose calculation software, the number of photon histories must be adjusted under certain conditions and used while verifying the standard error. This study demonstrates how technical modifications, projection selection, and phantom characteristics influence breast radiation exposure, thereby supporting the need for patient-tailored imaging strategies that minimize radiation risk while maintaining diagnostic validity. The findings may be useful in informing radiographic protocols and the development of safer imaging guidelines for both pediatric and adult patients undergoing spinal examinations. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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11 pages, 781 KB

Open AccessArticle

Influence of Aortoiliac Geometry on Non-Occlusive Thrombotic Risk Following Endovascular Repair of Abdominal Aortic Aneurysms

by Jeong In Lee, Dac Hong An Ngo, Hong Pil Hwang, Young Min Han and Hyo Sung Kwak

Diagnostics 2025, 15(17), 2134; https://doi.org/10.3390/diagnostics15172134 - 24 Aug 2025

Cited by 2 | Viewed by 1133

Abstract

Objectives: This study investigated the impact of aortoiliac geometry on thrombotic complication following aortic endovascular aneurysm repair (EVAR). Methods: Data from 54 patients who received abdominal EVAR between January 2015 and December 2023, in which 18 developed unilateral iliac limb in-stent thrombus, were retrospectively reviewed. Clinical data, including cardiovascular risk factors, laboratory findings, and geometrical factors, including iliac diameter, sectional area, limb angles, and tortuosity, were collected. Aortoiliac geometry analyses were performed on the 3D model reconstructed from abdominal aortic computed tomography angiography (CTA) using semi-automated software (MIMICS version 25.0). Results: Compared to non-thrombotic limbs, thrombotic iliac limbs showed larger maximum diameters (17.48 ± 0.95 mm vs. 14.14 ± 0.62 mm, p = 0.006), lower graft limb angles (117.52° ± 5.61° vs. 148.54° ± 4.31°, p < 0.001), lower aortoiliac angles (123.48° ± 4.66° vs. 141.96° ± 4.76°, p = 0.009), and higher iliac tortuosities (0.2 ± 0.03 vs. 0.12 ± 0.02, p = 0.02). Paired comparisons between normal and diseased limbs in 18 patients with thrombotic events also showed statistical differences in terms of iliac limb maximum diameter, graft limb angle, aortoiliac angle, and iliac tortuosity. Conclusions: Thrombosis formation following EVAR in iliac limbs was associated with limb diameter, graft limb angle, aortoiliac angle, and tortuosity. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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13 pages, 2502 KB

Open AccessArticle

Real-Life Clinical Use and Outcomes of Fusion Imaging-Guided Percutaneous Microwave Ablation of Hepatocellular Carcinoma: Experience from Two Italian Centers

by Pierpaolo Biondetti, Francesco Cicchetti, Gaetano Valerio Davide Amato, Velio Ascenti, Niccolò Finardi, Jacopo Tintori, Francesco Ugo Iovino, Carolina Lanza, Salvatore Alessio Angileri, Pierluca Torcia, Anna Maria Ierardi, Giacomo Vignati, Lorenzo Giovanni Monfardini and Gianpaolo Carrafiello

Diagnostics 2025, 15(13), 1573; https://doi.org/10.3390/diagnostics15131573 - 20 Jun 2025

Cited by 3 | Viewed by 1769

Abstract

Background: Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. Percutaneous thermal ablation is an effective treatment, but standard ultrasound (US) guidance is limited in cases of inconspicuous nodules. Ultrasound fusion imaging (USFI), which overlays cross-sectional imaging onto real-time US is an emerging technique that improves tumor visibility and technical feasibility. This study reports real-life outcomes of USFI-guided microwave ablation (MWA) for HCC in two Italian centers. Materials and Methods: In this multicentric retrospective study, 56 patients with 73 poorly or non-visible HCC nodules underwent USFI-guided percutaneous MWA with no visibility or poor visibility on B-mode US. Technical success, complications, and local tumor control were evaluated, with follow-up imaging at 1 month and every 3 months thereafter. Results: Complete response (CR) at 1 month was observed in 78.1% of nodules, with residual disease (RD) more common in poorly visible nodules than non-visible nodules (18.1% vs. 4.2%, p = 0.019). During a median 13-month follow-up, local tumor progression (LTP) occurred in 9.6% of patients. No significant association was found with difficult tumor location. Conclusions: USFI-guided MWA is a safe and effective option for treating HCC nodules not adequately visualized with conventional US, expanding eligibility to complex cases. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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15 pages, 3469 KB

Open AccessArticle

Radiology Access in Rural Germany: A Nationwide Survey on Outpatient Imaging and Teleradiology

by Philipp Reschke, Leon D. Gruenewald, Vitali Koch, Jennifer Gotta, Christian Booz, Scherwin Mahmoudi, Simon Bernatz, Aynur Gökduman, Elena Höhne, Katrin Eichler, Jörg Schlüchtermann, Thomas J. Vogl and Ibrahim Yel

Diagnostics 2025, 15(8), 962; https://doi.org/10.3390/diagnostics15080962 - 10 Apr 2025

Cited by 7 | Viewed by 4932

Abstract

Background/Objectives: This study examines the role of teleradiology and outpatient imaging in addressing gaps in rural radiology, analyzing the perspectives of referring physicians and radiologists. Methods: An online survey was conducted with a primary focus on evaluating the perspectives of referring physicians, including practicing surgeons, internists, and general practitioners. Their responses were then compared with those of radiologists. The survey consisted of multiple sections covering demographics, attitudes toward teleradiology, and outpatient imaging. It employed Likert scales, semantic differential scales, multiple-choice questions, and weighted ranking systems. Results: A total of 171 participants were included in the survey, consisting of 50 internists, 40 surgeons, 48 general practitioners, and 33 radiologists. A total of 79.2% of referring physicians rated teleradiology positively (at least 4 out of 5 stars), although its adoption in Germany remains limited, with 80.4% of referring physicians and 55.6% of radiologists reporting minimal to no use in their regions. Key concerns among referring physicians included the “lack of communication of teleradiologists with requesting physicians” (50%) and “lack of diagnostic consultations of radiologists with patients” (26.7%). In contrast, radiologists expressed significantly greater concern about technical failures (28.6% vs. 3.3%, p < 0.05). Additionally, 59.5% of referring physicians identified teleradiology as a crucial factor for improving access to radiology in rural areas. With regard to outpatient imaging, referring physicians valued continuity of care most highly, while radiologists prioritized minimizing wait times. Conclusions: Referring physicians view teleradiology and outpatient imaging as promising solutions for bridging the gap in radiology access between urban and rural areas. Addressing concerns like communication barriers and ensuring technical reliability are critical to its broader adoption and implementation. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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12 pages, 2400 KB

Open AccessArticle

Ultrasound-Guided Vacuum-Assisted Excision (VAE) in Breast Lesion Management: An Experimental Comparative Study of Two Different VAE Devices Across Various Aspiration Levels and Window Sizes

by Serena Carriero, Maurizio Cè, Matilde Pavan, Mariassunta Roberta Pannarale, Giulia Quercioli, Sveva Mortellaro, Alessandro Liguori, Maria Cosentino, Maria Iodice, Marta Montesano, Giulia Querques, Carolina Lanza, Salvatore Alessio Angileri, Pierpaolo Biondetti, Filippo Pesapane, Gianpaolo Carrafiello and Sonia Santicchia

Diagnostics 2025, 15(3), 272; https://doi.org/10.3390/diagnostics15030272 - 24 Jan 2025

Cited by 1 | Viewed by 4106

Abstract

Background/Objectives: Vacuum-assisted excision (VAE) is a minimally invasive technique for breast tumor treatment, offering precision, comfort, and quick recovery. It is widely used for benign breast lesions and is playing an increasingly important role in the therapeutic management of non-surgical patients or patients who refuse surgery. Optimal outcomes require an understanding of device features to tailor treatment to each lesion. The Mammotome^® Elite 10G operates in a fixed mode, while the Mammotome^® Revolve EX 8G offers multiple aspiration levels and aperture windows for greater versatility. This study analyzed the specimen features (weight and length), comparing the weight obtained from two different VAE systems to aid the appropriate selection of a device based on the clinical setting. It also determined the number of specimens needed to achieve the 4 g diagnostic threshold. Methods: The Mammotome^® Elite 10G and the Mammotome^® Revolve EX were evaluated under controlled conditions. For Mammotome^® Revolve EX, combinations of five aspiration levels and three aperture lengths (12 mm, 18 mm, and 25 mm) were tested. Twelve samples were collected from a chicken breast phantom for each setting. Specimen weights and the minimum excisions required to reach the 4 g threshold were analyzed. Results: The mean weight per sample for the Mammotome^® Elite 10G was 0.16 ± 0.04 g. For the Mammotome^® Revolve EX, the weights increased with aperture size and aspiration level, ranging from a minimum of 0.132 ± 0.028 g (a window length of 12 mm and aspiration level 1) to a maximum of 0.407 ± 0.055 g (a window length of 25 mm and aspiration level 5). The 25 mm window at aspiration level 5 achieved the 4 g threshold in as few as 10 samples. By comparison, the Mammotome^® Elite required up to 26 samples. Conclusions: Compared to the Mammotome Elite, Mammotome^® Revolve EX offers superior versatility and efficiency, reducing patient discomfort by minimizing the required samples. Its technical advantages make it a valuable tool for both diagnostic and therapeutic applications. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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Review

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24 pages, 948 KB

Open AccessReview

Why Radiomics Rarely Reaches the Clinic: Reproducibility, Validation, and Evidence Gap—A Critical Narrative Review

by Jacopo Pozzi, Jacopo D’Argenzio, Serena Carriero, Maurizio Cè, Dario D’Arrigo, Pierpaolo Biondetti, Carolina Lanza, Salvatore Alessio Angileri, Matilde Pavan, Rossella Catona and Gianpaolo Carrafiello

Diagnostics 2026, 16(14), 2266; https://doi.org/10.3390/diagnostics16142266 - 20 Jul 2026

Viewed by 845

Abstract

Radiomics has produced tens of thousands of publications yet almost no handcrafted radiomic signatures in routine clinical use, and the reasons are increasingly understood to be problems of reproducibility and clinical translation rather than of algorithms. This critical narrative review argues that the field systematically generates paper-grade evidence—findings sufficient to publish—far faster than decision-grade evidence—findings sufficient to change clinical practice. Drawing on meta-scientific research, we describe seven fragility mechanisms (publication bias, analytical flexibility, underpowering, HARKing [hypothesizing after the results are known], citation distortion, cognitive bias, and misaligned incentives) and show why radiomics is structurally exposed to all of them simultaneously: high-dimensional feature spaces, acquisition-dependent measurement instability, segmentation variability, retrospective single-centre data, small samples, and leakage-prone validation. We then summarise empirical evidence on the radiomics literature, which remains pervaded by suboptimal methodological quality, near-absent negative results, limited external validation, sparse calibration and clinical-utility assessment, low data and code sharing, and a measurable retraction signal. We interpret these patterns as the output of a self-reinforcing system rather than isolated errors, and argue that better algorithms alone cannot resolve them. Finally, we argue that closing this gap requires not better models but evidentiary discipline: the consistent, enforceable application of standards the field already has, and the calibration of published claims to the strength of the underlying evidence. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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Other

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16 pages, 346 KB

Open AccessSystematic Review

Explainable Artificial Intelligence in Mammography: A Systematic Review of Methods, Evaluation Practices, and Clinical Readiness

by Filippo Pesapane, Anna Rotili, Silvia Penco, Valeria Dominelli, Francesca Priolo, Irene Marinucci, Luca Nicosia, Roberto Grasso, Gabriella Pravettoni and Enrico Cassano

Diagnostics 2026, 16(9), 1412; https://doi.org/10.3390/diagnostics16091412 - 6 May 2026

Cited by 2 | Viewed by 560

Abstract

Background: Explainable artificial intelligence (XAI) is increasingly proposed to improve trust in mammography-based artificial-intelligence systems, but the validity and clinical readiness of published explanations remain unclear. We aim to systematically review XAI methods applied to mammography and synthesize how explanations are evaluated for validity, robustness, and clinical usefulness. Methods: We conducted a systematic review according to PRISMA 2020. MEDLINE/PubMed, Embase, Scopus, Web of Science Core Collection, and the Cochrane Library were searched from 1 January 2015 to 15 January 2026. Two reviewers independently screened records and extracted data; disagreements were resolved by consensus with a third reviewer. Included studies used mammography as the primary input and reported an explicit explanation or interpretability mechanism. Because the literature was methodologically heterogeneous, we performed a structured narrative synthesis and an adapted XAI-specific appraisal of explanation claims, quantitative evaluation, external validation, human-factor assessment, and reporting transparency. Results: Fourteen studies were included. Ten studies addressed detection or lesion classification and four addressed risk or outcome prediction. Primary XAI families were interpretable-by-design architectures (6/14), post hoc saliency or attribution methods (5/14), and feature-level explanation methods (3/14). Five studies remained at tier-1 qualitative plausibility only, seven reached tier-2 internal quantitative explanation evaluation, two reached tier-3 external or cross-dataset interpretability assessment, and none reported reader or workflow studies. In the dedicated mammography saliency benchmark, Pointing Game scores for Grad-CAM, Grad-CAM++, and Eigen-CAM ranged from 0.30 to 0.41, indicating only modest lesion-pointing reliability despite acceptable classifier performance. Conclusions: Mammography XAI remains dominated by visually plausible explanations that are inconsistently validated. The literature is moving toward task-aligned and intrinsically interpretable designs, yet external validation and clinician-centered evaluation remain rare. Future studies should pre-specify explanation claims, use task-appropriate quantitative metrics, report explanation robustness under distribution shift, and test whether explanations improve human decision-making. Full article

(This article belongs to the Special Issue Recent Advances in Diagnostic and Interventional Radiology)

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2 pages, 140 KB

Open AccessComment

Comparing Iliac Artery Sizes to Explain Post-EVAR Non-Obstructive Thrombosis. Comment on Lee et al. Influence of Aortoiliac Geometry on Non-Occlusive Thrombotic Risk Following Endovascular Repair of Abdominal Aortic Aneurysms. Diagnostics 2025, 15, 2134

by Wouter Kok

Diagnostics 2025, 15(20), 2551; https://doi.org/10.3390/diagnostics15202551 - 10 Oct 2025

Viewed by 575

Abstract

In the paper by Lee et al [...] Full article

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