Tomography

Background: This study aims to systematically evaluate the findings from computed tomography (CT) examinations conducted at least three months post-diagnosis of COVID-19 in patients diagnosed between 2020 and 2024. Objective: To determine the frequency and characteristics of CT findings in the post-COVID-19 period, analyze long-term effects on lung parenchyma, and contribute to the development of clinical follow-up and treatment strategies based on the collected data. Materials and Methods: Ethical approval was obtained for this retrospective study, and individual consent was waived. A total of 76 patients were included in the study, aged 18 and older, diagnosed with COVID-19 between March 2020 and November 2024, who underwent follow-up chest CT scans at 3–6 months, 6–12 months, and/or 12 months post-diagnosis. CT images were obtained in the supine position without contrast and evaluated by two experienced radiologists using a CT severity score (CT-SS) system, which quantifies lung involvement. Statistical analyses were performed using IBM SPSS 23.0, with significance set at p < 0.05. Results: The results indicated a mean CT-SS of 10.58 ± 0.659. Significant associations were found between age, CT scores, and the necessity for intensive care or mechanical ventilation. The most common CT findings included ground-glass opacities, reticular patterns, and traction bronchiectasis, particularly increasing with age and over time. Conclusion: This study emphasizes the persistent alterations in lung parenchyma following COVID-19, highlighting the importance of continuous monitoring and tailored treatment strategies for affected patients to improve long-term outcomes. Full article

Background: Deep learning (DL) reconstruction techniques have shown promise in reducing MRI acquisition times while maintaining image quality. However, the impact of different acceleration factors on diagnostic accuracy in shoulder MRI remains unexplored in clinical practice. Purpose: The purpose of this study was to evaluate the diagnostic accuracy of 2-fold and 4-fold DL-accelerated shoulder MRI protocols compared to standard protocols in clinical practice. Materials and Methods: In this prospective single-center study, 88 consecutive patients (49 males, 39 females; mean age, 51 years) underwent shoulder MRI examinations using standard, 2-fold (DL2), and 4-fold (DL4) accelerated protocols between June 2023 and January 2024. Four independent radiologists (experience range: 4–25 years) evaluated the presence of bone marrow edema (BME), rotator cuff tears, and labral lesions. The sensitivity, specificity, and interobserver agreement were calculated. Diagnostic confidence was assessed using a 4-point scale. The impact of reader experience was analyzed by stratifying the radiologists into ≤10 and >10 years of experience. Results: Both accelerated protocols demonstrated high diagnostic accuracy. For BME detection, DL2 and DL4 achieved 100% sensitivity and specificity. In rotator cuff evaluation, DL2 showed a sensitivity of 98–100% and specificity of 99–100%, while DL4 maintained a sensitivity of 95–98% and specificity of 99–100%. Labral tear detection showed perfect sensitivity (100%) with DL2 and slightly lower sensitivity (89–100%) with DL4. Interobserver agreement was excellent across the protocols (Kendall’s W = 0.92–0.98). Reader experience did not significantly impact diagnostic performance. The area under the ROC curve was 0.94 for DL2 and 0.90 for DL4 (p = 0.32). Clinical Implications: The implementation of DL-accelerated protocols, particularly DL2, could improve workflow efficiency by reducing acquisition times by 50% while maintaining diagnostic reliability. This could increase patient throughput and accessibility to MRI examinations without compromising diagnostic quality. Conclusions: DL-accelerated shoulder MRI protocols demonstrate high diagnostic accuracy, with DL2 showing performance nearly identical to that of the standard protocol. While DL4 maintains acceptable diagnostic accuracy, it shows a slight sensitivity reduction for subtle pathologies, particularly among less experienced readers. The DL2 protocol represents an optimal balance between acquisition time reduction and diagnostic confidence. Full article

Background/Objectives: Reviewing the entire history of imaging exams of a single patient’s records is an essential step in clinical practice, but it is time and resource consuming, with potential negative effects on workflow and on the quality of medical decisions. The main objective of this study was to evaluate the applicability of three open-source large language models (LLMs) for the automatic generation of concise summaries of patient’s imaging records. Secondary objectives were to assess correlations among the LLMs and to evaluate the length reduction provided by each model. Methods: Three state-of-the-art open-source large language models were selected: Llama 3.2 11B, Mistral 7B, and Falcon 7B. Each model was given a set of radiology reports. The summaries produced by the models were evaluated by two experienced radiologists and one experienced clinical physician using standardized metrics. Results: A variable number of radiological reports (n = 12–56) from four patients were selected and evaluated. The summaries generated by the three LLM showed a good level of accuracy compared with the information contained in the original reports, with positive ratings on both clinical relevance and ease of reference. According to the experts’ evaluations, the use of the summaries generated by LLMs could help to reduce the time spent on reviewing the previous imaging examinations performed, preserving the quality of clinical data. Conclusions: Our results suggest that LLMs are able to generate summaries of the imaging history of patients, and these summaries could improve radiology workflow making it easier to manage large volumes of reports. Full article

Background: When plotting data points corresponding to the contrast-agent-induced change in transverse relaxation rate from a dynamic gradient-echo (GRE) magnetic resonance imaging (MRI) study versus a corresponding spin-echo study, a loop or vortex curve rather than a reversible line is formed. The vortex curve area is likely to reflect vessel architecture and oxygenation level. In this study, the vortex effect seen when using only GRE-based estimates, i.e., contrast-agent concentration based on GRE transverse relaxation rate and contrast-agent concentration based on quantitative susceptibility mapping (QSM), was investigated. Methods: Twenty healthy volunteers were examined using 3 T MRI. Magnitude and phase dynamic contrast-enhanced MRI (DSC-MRI) data were obtained using GRE echo-planar imaging. Vortex curves for grey-matter (GM) regions and for arterial input function (AIF) data were constructed by plotting concentration based on GRE transverse relaxation rate versus concentration based on QSM. Vortex parameters (vortex area and normalised vortex width) were compared with QSM-based whole-brain OEF estimates obtained using 3D GRE. Results: An obvious vortex effect was observed, and both GM vortex parameters showed a moderate and significant correlation with OEF (r = −0.51, p = 0.02). The vortex parameters for AIF data showed no significant correlation with OEF. Conclusions: GRE-based GM vortex parameters correlated significantly with whole-brain OEF. In agreement with expectations, the corresponding AIF data, representing high fractions of arterial blood, showed no significant correlation. Novel parameters, based solely on standard GRE protocols, are of relevance to investigate, considering that GRE-based DSC-MRI is very common in brain tumour applications. Full article

Background: The radiological evaluation of the carotid sinus (CS) anatomy and its morphometry is essentially important for various surgical procedures involving the carotid bifurcation and the CS itself. Despite its tremendous clinical significance, studies dealing with the CS anatomy are seldom reported. Hence, the present study aimed to evaluate the frequencies of the CS positional variants and their morphometry and correlate them with age and body mass index (BMI). Methods: In this retrospective cross-sectional study, a total of 754 disease-free carotid arteries were examined using computed tomography angiography scans to determine the CS positional variations (such as types I to III) and its morphometry, including the CS diameter and length. Additionally, the association between these parameters and factors such as sex, age, and body mass index were explored using appropriate statistical tests. The inter-rater agreement of the collected dataset was evaluated using Cohen’s Kappa. Results: The CS type I was observed in 87.67% of the cases, and type II and type III were observed at lower frequencies with 9.02% and 3.32%, respectively. There were statistically significant (p < 0.001) differences observed in the mean diameter and length of the sinus between the sex and the type I CS variations. However, there was no significant and strong correlation between the age and BMI factors with sinus length and sinus diameter. The kappa values for inter-rater agreement ranged from 0.77 to 0.99 for all parameters. Conclusions: In type I, the CS length and carotid vessel’s diameter is significantly different between the sexes. However, age and BMI do not affect the CS anatomy in radiologically disease-free carotid arteries. Knowledge of the CS variant anatomy is clinically significant as it influences the patients’ surgical and physiological outcomes. Full article

Background: Rectal cancer represents a major cause of mortality in the United States. Management strategies are highly individualized, depending on patient-specific factors and tumor characteristics. The therapeutic landscape is rapidly evolving, with notable advancements in response rates to both radiotherapy and chemotherapy. For locally advanced rectal cancer (LARC, defined as up to T3–4 N+), the standard of care involves total mesorectal excision (TME) following neoadjuvant chemoradiotherapy (nCRT). Magnetic resonance imaging (MRI) has emerged as the gold standard for local tumor staging and is increasingly pivotal in post-treatment restaging. Aim: In our study, we proposed an MRI-based radiomic model to identify characteristic features of peritumoral mesorectal fat in two patient groups: good responders and poor responders to neoadjuvant therapy. The aim was to assess the potential presence of predictive factors for favorable or unfavorable responses to neoadjuvant chemoradiotherapy, thereby optimizing treatment management and improving personalized clinical decision-making. Methods: We conducted a retrospective analysis of adult patients with LARC who underwent pre- and post-nCRT MRI scans. Patients were classified as good responders (Group 0) or poor responders (Group 1) based on MRI findings, including tumor volume reduction, signal intensity changes on T2-weighted and diffusion-weighted imaging (DWI), and alterations in the circumferential resection margin (CRM) and extramural vascular invasion (EMVI) status. Classification criteria were based on the established literature to ensure consistency. Key clinical and imaging parameters, such as age, TNM stage, CRM involvement, and EMVI presence, were recorded. A radiomic model was developed using the LASSO algorithm for feature selection and regularization from 107 extracted radiomic features. Results: We included 44 patients (26 males and 18 females) who, following nCRT, were categorized into Group 0 (28 patients) and Group 1 (16 patients). The pre-treatment MRI analysis identified significant features (out of 107) for each sequence based on the Mann–Whitney test and t-test. The LASSO algorithm selected three features (shape_Sphericity, shape_Maximum2DDiameterSlice, and glcm_Imc2) for the construction of the radiomic logistic regression model, and ROC curves were subsequently generated for each model (AUC: 0.76). Conclusions: We developed an MRI-based radiomic model capable of differentiating and predicting between two groups of rectal cancer patients: responders and non-responders to neoadjuvant chemoradiotherapy (nCRT). This model has the potential to identify, at an early stage, lesions with a high likelihood of requiring surgery and those that could potentially be managed with medical treatment alone. Full article

Objectives: This study aims to assess the potential role of the ultrasound (US) monochromatic Superb Microvascular Index (mSMI) to predict malignancy of solid focal lesions, correlating the vascular index (VI) with bioptic histological results. Methods: In this single-center retrospective analysis, patients undergoing percutaneous US-guided biopsy of solid lesions were considered. Biopsy indication was given by a multidisciplinary team evaluation based on clinical radiological data. Exclusion criteria were: unfeasible SMI evaluations due to poor respiratory compliance, locations not appreciable with the SMI, previous antiangiogenetic chemo/immunotherapies, and inconclusive histological reports. The mSMI examination was conducted in order to visualize extremely low-velocity flows with a high resolution and high frame rate; the VI was semi-automatically calculated. All bioptic procedures were performed under sole US guidance using 16G or 18G needles, immediately after mSMI assessment. Results: Forty-four patients were included (mean age: 64 years; 27 males, 17 females). Liver (15/43), kidneys (9/43), and lymph nodes (6/43) were the most frequent targets. At histopathological analysis, 7 lesions were benign and 37 malignant, metastasis being the most represented. The VI calculated in malignant lesions was statistically higher compared to benign lesions (35.45% and 11% in malignant and benign, respectively; p-value 0.013). A threshold VI value of 15.4% was identified to differentiate malignant lesions. The overall diagnostic accuracy of the VI with the mSMI was 0.878, demonstrating a high level of diagnostic accuracy. Conclusions: In this study, the mSMI analysis of solid focal lesions undergoing percutaneous biopsy significantly correlated with histological findings in terms of malignant/benign predictive value, reflecting histological vascular changes in malignant lesions. Full article

Purpose: To evaluate the variability of oncogenic risk related to radiation exposure in patients frequently exposed to ionizing radiation for diagnostic purposes, specifically ICU patients, according to different risk models, including the BEIR VII, ICRP 103, and US EPA models. Methods: This was an IRB-approved observational retrospective study. A total of 71 patients (58 male, 13 female; median age, 66 years; interquartile range [IQR], 65–71 years) admitted to the ICU who underwent X-ray examinations between 1 October 2021 and 28 February 2023 were included. For each patient, the cumulative effective dose during a single hospital admission was calculated. Lifetime attributable risk (LAR) was estimated based on the BEIR VII, ICRP 103, and US EPA risk models to calculate additional oncogenic risk related to radiation exposure. The Friedman test for repeated-measures analysis of variance was used to compare risk values between different models. The intraclass correlation coefficient (ICC) was used to assess the consistency of risk values between different models. Results: Different organ, leukemia, and all-cancer risk values estimated according to different oncogenic risk models were significantly different, but the intraclass correlation coefficient revealed a good (>0.75) or even excellent (>0.9) agreement between different risk models. The ICRP 103 model estimated a lower all-cancer (median 69.05 [IQR 30.35–195.37]) and leukemia risk (8.22 [3.02–27.93]) compared to the US EPA (all-cancer: 139.68 [50.51–416.16]; leukemia: 23.34 [3.47–64.37]) and BEIR VII (all-cancer: 162.08 [70.6–371.40]; leukemia: 24.66 [12.9–58.8]) models. Conclusions: Cancer risk values were significantly different between risk models, though inter-model agreement in the consistency of risk values was found to be good, or even excellent. Full article

Introduction: An efficient pipeline for rosette trajectory magnetic resonance imaging reconstruction is proposed, combining the inverse Fourier transform with a vision transformer (ViT) network enhanced with a convolutional layer. This method addresses the challenges of reconstructing high-quality images from non-Cartesian data by leveraging the ViT’s ability to handle complex spatial dependencies without extensive preprocessing. Materials and Methods: The inverse fast Fourier transform provides a robust initial approximation, which is refined by the ViT network to produce high-fidelity images. Results and Discussion: This approach outperforms established deep learning techniques for normalized root mean squared error, peak signal-to-noise ratio, and entropy-based image quality scores; offers better runtime performance; and remains competitive with respect to other metrics. Full article

Background: The updated definition of a TIA emphasizes tissue characteristics rather than symptom duration, defining a TIA as a transient neurological episode without ischemic lesions in brain imaging, including in DWI. If imaging reveals a lesion, even in patients with transient symptoms, the event is reclassified as a minor ischemic stroke. Objective: This retrospective observational study aimed to determine the prevalence of ischemic lesions in DWI in patients with a TIA diagnosis. Results: Adults aged 18–90 years, diagnosed with a TIA by a neurologist and who underwent MRI-DWI at CMT hospital within the first week after symptom onset (May 2023–July 2024), were included. Ethical approval was obtained. Descriptive statistics summarized patient demographics, clinical features, Fazekas scale grades, and imaging findings. Conclusions: Among the 26 patients clinically diagnosed with TIAs, 7 (26.9%) exhibited ischemic lesions in DWI, reclassifying these cases as minor ischemic strokes under the updated definition. The prevalence of ischemic lesions was notably higher in patients with comorbidities such as hypertension and diabetes. These findings highlight the importance of early MRI-DWI to accurately distinguish TIAs from minor ischemic strokes. Routine urgent DWI within the first week of TIA symptoms enhances diagnosis and risk stratification and can guide targeted stroke prevention strategies, particularly when combined with the ABCD2 score. Full article

Cardiac computed tomography (CT) has rapidly advanced, becoming an invaluable tool for diagnosing and prognosticating various cardiovascular diseases. While echocardiography and cardiac magnetic resonance imaging (CMR) remain the gold standards for myocardial assessment, modern CT technologies offer enhanced spatial resolution, making it an essential tool in clinical practice. Cardiac CT has expanded beyond coronary artery disease evaluation, now playing a key role in assessing cardiomyopathies and structural heart diseases. Innovations like photon-counting CT enable precise estimation of myocardial extracellular volume, facilitating the detection of infiltrative disorders and myocardial fibrosis. Additionally, CT-based myocardial strain analysis allows for the classification of impaired myocardial contractility, while quantifying cardiac volumes and function remains crucial in cardiomyopathy evaluation. This review explores the emerging role of cardiac CT in cardiomyopathy phenotyping, emphasizing recent technological advancements. Full article

Background: Predictive models like Residual Neural Networks (ResNets) can use Magnetic Resonance Imaging (MRI) data to identify cervix tumors likely to recur after radiotherapy (RT) with high accuracy. However, there persists a lack of insight into model selections (explainability). In this study, we explored whether model features could be used to generate simulated images as a method of model explainability. Methods: T2W MRI data were collected for twenty-seven women with cervix cancer who received RT from the TCGA-CESC database. Simulated images were generated as follows: [A] a ResNet model was trained to identify recurrent cervix cancer; [B] a model was evaluated on T2W MRI data for subjects to obtain corresponding feature maps; [C] most important feature maps were determined for each image; [D] feature maps were combined across all images to generate a simulated image; [E] the final image was reviewed by a radiation oncologist and an initial algorithm to identify the likelihood of recurrence. Results: Predictive feature maps from the ResNet model (93% accuracy) were used to generate simulated images. Simulated images passed through the model were identified as recurrent and non-recurrent cervix tumors after radiotherapy. A radiation oncologist identified the simulated images as cervix tumors with characteristics of aggressive Cervical Cancer. These images also contained multiple MRI features not considered clinically relevant. Conclusion: This simple method was able to generate simulated MRI data that mimicked recurrent and non-recurrent cervix cancer tumor images. These generated images could be useful for evaluating the explainability of predictive models and to assist radiologists with the identification of features likely to predict disease course. Full article

Background/Objectives: This study aimed to investigate the predictive power of integrated longitudinal amyloid positron emission tomography (PET) and brain magnetic resonance imaging (MRI) data for determining the likelihood of conversion to Alzheimer’s disease (AD) in patients with mild cognitive impairment (MCI). Methods: We included 180 patients with MCI from the Alzheimer’s Disease Neuroimaging Initiative, with baseline and 2-year follow-up scans obtained using F-18 florbetapir PET and MRI. Patients were categorized as converters (progressing to AD) or nonconverters based on a 6-year follow-up. Quantitative analyses included the calculation of amyloid burden using the standardized uptake value ratio (SUVR), brain amyloid smoothing scores (BASSs), brain atrophy indices (BAIs), and their integration into shape features. Longitudinal changes and receiver operating characteristic analyses assessed the predictive power of these biomarkers. Results: Among 180 patients with MCI, 76 (42.2%) were converters, who exhibited significantly higher baseline and 2-year follow-up values for SUVR, BASS, BAI, and shape features than nonconverters (p < 0.001). Shape features demonstrated the highest predictive accuracy for conversion, with areas under the curve of 0.891 at baseline and 0.898 at 2 years. Percent change analyses revealed significant increases in brain atrophy; amyloid deposition changes showed a paradoxical decrease in converters. Additionally, strong associations were observed between longitudinal changes in shape features and neuropsychological test results. Conclusions: The integration of amyloid PET and MRI biomarkers enhances the prediction of AD progression in patients with MCI. These findings support the potential of combined imaging approaches for early diagnosis and targeted interventions in AD. Full article

Purpose: In cancers imaged using contrast-enhanced protocols, such as hepatocellular carcinoma (HCC), formal guidelines rely on measurements of lesion size (in mm) and radiographic density (in Hounsfield units [HU]) to evaluate response to treatment. However, the variability of these measurements across different contrast enhancement phases remains poorly understood. This limits the ability of clinicians to discern whether measurement changes are accurate. Methods: In this study, we investigated the variability of maximal lesion diameter and mean lesion density of HCC lesions on CT scans across four different contrast enhancement phases: non-contrast-enhanced phase (NCE), early arterial phase (E-AP), late arterial phase (L-AP), and portal venous phase (PVP). HCC lesions were independently segmented by two expert radiologists. For each pair of a lesion’s scan timepoints, one was selected randomly as the baseline measurement and the other as the repeat measurement. Both absolute and relative differences in measurements were calculated, as were the coefficients of variance (CVs). Analysis was further stratified by both contrast enhancement phase and lesion diameter. Results: Lesion diameter was found to have a CV of 5.11% (95% CI: 4.20–6.01%). About a fifth of the measurement’s relative changes were greater than 10%. Although there was no significant difference in diameter measurements across different phases, there was a significant negative correlation (R = −0.303, p-value = 0.030) between lesion diameter and percent difference in diameter measurement. Lesion density measurements varied significantly across all phases, with the greatest relative difference of 47% in the late arterial phase and a CV of 22.84% (21.48–24.20%). The overall CV for lesion density measurements was 26.19% (24.66–27.72%). Conclusions: Changes in tumor diameter measurements within 10% may simply be due to variability, and lesion density is highly sensitive to contrast timing. This highlights the importance of paying attention to these two variables when evaluating tumor response in both clinical trials and practice. Full article

Background/Objectives: The risk of hemorrhage during CT-guided lung biopsy has not been systematically studied in cases where ground-glass opacities (GGO) are present in the access route or when biopsies are performed in highly perfused, dependent lung areas. While patient positioning has been studied for pneumothorax prevention, its role in minimizing hemorrhage risk remains unexplored. This study aimed to determine whether GGOs in the access route and biopsies in dependent lung areas are risk factors for pulmonary hemorrhage during CT-guided lung biopsy. Methods: A retrospective analysis was conducted on 115 CT-guided lung biopsies performed at a single center (2020–2023). Patients were categorized based on post-interventional hemorrhage exceeding 2 cm (Grade 2 or higher). We evaluated the presence of GGOs in the access route and biopsy location (dependent vs. non-dependent areas) using chi square, Fisher’s exact, and Mann–Whitney U tests. Univariate and multivariate logistic regression analyses were conducted to evaluate risk factors for pulmonary hemorrhage. Results: Pulmonary hemorrhage beyond 2 cm occurred in 30 of 115 patients (26%). GGOs in the access route were identified in 67% of these cases (p < 0.01), and hemorrhage occurred more frequently when biopsies were performed in dependent lung areas (63% vs. 40%, p = 0.03). Multivariable analysis showed that GGOs in the access route (OR 5.169, 95% CI 1.889–14.144, p = 0.001) and biopsies in dependent areas (OR 4.064, 95% CI 1.477–11.186, p < 0.001) independently increased hemorrhage risk. Conclusions: GGOs in the access route and dependent lung area biopsies are independent risk factors for hemorrhage during CT-guided lung biopsy. Full article

Background/Objectives: Holotomography is an advanced imaging technique that enables high-resolution, three-dimensional visualization of microscopic specimens without the need for fixation or staining. Here we aim to apply holotomography technology to image live Hypsibius exemplaris in their native state, avoiding invasive sample preparation procedures and phototoxic effects associated with other imaging modalities. Methods: We use a low concentration of 7% ethanol for tardigrade sedation and sample preparation. Holotomographic images were obtained and reconstructed using the Tomocube HT-X1 system, enabling high-resolution visualization of tardigrade anatomical structures. Results: We captured detailed, label-free holotomography images of both external and internal structures of tardigrade, including the digestive tract, brain, ovary, claws, salivary glands, and musculature. Conclusions: Our findings highlight holotomography as a complementary high-resolution imaging modality that effectively addresses the challenges faced with traditional imaging techniques in tardigrade research. Full article

Rationale: Neoadjuvant chemotherapy (NAC) is a key element of treatment for locally advanced breast cancer (LABC). Predicting the response of NAC for patients with LABC before initiating treatment would be valuable to customize therapies and ensure the delivery of effective care. Objective: Our objective was to develop predictive measures of tumor response to NAC prior to starting for LABC using machine learning and textural computed tomography (CT) features in different level of frequencies. Materials and Methods: A total of 851 textural biomarkers were determined from CT images and their wavelet coefficients for 117 patients with LABC to evaluate the response to NAC. A machine learning pipeline was designed to classify response to NAC treatment for patients with LABC. For training predictive models, three models including all features (wavelet and original image features), only wavelet and only original-image features were considered. We determined features from CT images in different level of frequencies using wavelet transform. Additionally, we conducted a comparison of feature selection methods including mRMR, Relief, Rref QR decomposition, nonnegative matrix factorization and perturbation theory feature selection techniques. Results: Of the 117 patients with LABC evaluated, 82 (70%) had clinical–pathological response to chemotherapy and 35 (30%) had no response to chemotherapy. The best performance for hold-out data splitting was obtained using the KNN classifier using the Top-5 features, which were obtained by mRMR, for all features (accuracy = 77%, specificity = 80%, sensitivity = 56%, and balanced-accuracy = 68%). Likewise, the best performance for leave-one-out data splitting could be obtained by the KNN classifier using the Top-5 features, which was obtained by mRMR, for all features (accuracy = 75%, specificity = 76%, sensitivity = 62%, and balanced-accuracy = 72%). Conclusions: The combination of original textural features and wavelet features results in a greater predictive accuracy of NAC response for LABC patients. This predictive model can be utilized to predict treatment outcomes prior to starting, and clinicians can use it as a recommender system to modify treatment. Full article

Background: Digital tomosynthesis (DTS) is an advanced imaging modality that enhances diagnostic accuracy by offering three-dimensional visualization from two-dimensional projections, which is particularly beneficial in breast and lung imaging. However, this increased imaging capability raises concerns about patient exposure to ionizing radiation. Methods: This study explores the energy and angular dependence of thermoluminescent dosimeters (TLDs), specifically TLD100H, to improve the accuracy of organ dose assessment during DTS. Using a comprehensive experimental approach, organ doses were measured in both DTS and traditional RX modes. Results: The results showed lung doses of approximately 3.21 mGy for the left lung and 3.32 mGy for the right lung during DTS, aligning with the existing literature. In contrast, the RX mode yielded significantly lower lung doses of 0.33 mGy. The heart dose during DTS was measured at 2.81 mGy, corroborating findings from similar studies. Conclusions: These results reinforce the reliability of TLD100H dosimetry in assessing radiation exposure and highlight the need for optimizing imaging protocols to minimize doses. Overall, this study contributes to the ongoing dialogue on enhancing patient safety in diagnostic imaging and advocates for collaboration among medical physicists, radiologists, and technologists to establish best practices. Full article

Background: The discovery of novel antibody–drug conjugates for low-expression human epidermal growth factor receptor 2 (HER2-low) breast cancer highlights the inadequacy of the conventional binary classification of HER2 status as either negative or positive. Identification of HER2-low breast cancer is crucial for selecting patients who may benefit from targeted therapies. This study aims to determine whether qualitative and quantitative magnetic resonance imaging (MRI) features can effectively reflect low-HER2-expression breast cancer. Methods: Pre-treatment breast MRI images from 232 patients with pathologically confirmed breast cancer were retrospectively analyzed. Both clinicopathologic and MRI features were recorded. Qualitative MRI features included Breast Imaging Reporting and Data System (BI-RADS) descriptors from dynamic contrast-enhanced MRI (DCE-MRI), as well as intratumoral T2 hyperintensity and peritumoral edema observed in T2-weighted imaging (T2WI). Quantitative features were derived from diffusion kurtosis imaging (DKI) using multiple b-values and included statistics such as mean, median, 5th and 95th percentiles, skewness, kurtosis, and entropy from apparent diffusion coefficient (ADC), D_app, and K_app histograms. Differences in clinicopathologic, qualitative, and quantitative MRI features were compared across groups, with multivariable logistic regression used to identify significant independent predictors of HER2-low breast cancer. The discriminative power of MRI features was assessed using receiver operating characteristic (ROC) curves. Results: HER2 status was categorized as HER2-zero (n = 60), HER2-low (n = 91), and HER2-overexpressed (n = 81). Clinically, estrogen receptor (ER), progesterone receptor (PR), hormone receptor (HR), and Ki-67 levels significantly differed between the HER2-low group and others (all p < 0.001). In MRI analyses, intratumoral T2 hyperintensity was more prevalent in HER2-low cases (p = 0.009, p = 0.008). Mass lesions were more common in the HER2-zero group than in the HER2-low group (p = 0.038), and mass shape (p < 0.001) and margin (p < 0.001) significantly varied between the HER2 groups, with mass shape emerging as an independent predictive factor (HER2-low vs. HER2-zero: p = 0.010, HER2-low vs. HER2-over: p = 0.012). Qualitative MRI features demonstrated an area under the curve (AUC) of 0.763 (95% confidence interval [CI]: 0.667–0.859) for distinguishing HER2-low from HER2-zero status. Quantitative features showed distinct differences between HER2-low and HER2-overexpression groups, particularly in non-mass enhancement (NME) lesions. Combined variables achieved the highest predictive accuracy for HER2-low status, with an AUC of 0.802 (95% CI: 0.701–0.903). Conclusions: Qualitative and quantitative MRI features offer valuable insights into low-HER2-expression breast cancer. While qualitative features are more effective for mass lesions, quantitative features are more suitable for NME lesions. These findings provide a more accessible and cost-effective approach to noninvasively identifying patients who may benefit from targeted therapy. Full article