Search Results (496)

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

Background/Objectives: Interstitial lung disease (ILD) is frequently complicated by pulmonary hypertension (PH), which is associated with reduced exercise capacity and poor prognosis. Early and accurate non-invasive detection of PH remains a clinical challenge. This study evaluated whether combining quantitative CT analysis of lung fibrosis with cardiac MRI-derived measures of right ventricular (RV) function improves the diagnostic accuracy of PH in patients with ILD. Methods: We retrospectively analyzed 72 ILD patients who underwent chest CT, cardiac MRI, and right heart catheterization (RHC). Lung fibrosis was quantified using a Gaussian Histogram Normalized Correlation (GHNC) software that computed the proportions of diseased lung, ground-glass opacity (GGO), honeycombing, reticulation, consolidation, and emphysema. MRI was used to assess RV end-systolic volume (RVESV), ejection fraction, and RV longitudinal strain. PH was defined as a mean pulmonary arterial pressure (mPAP) ≥ 20 mmHg and pulmonary vascular resistance ≥ 3 Wood units on RHC. Results: Compared to patients without PH, those with PH (n = 21) showed significantly reduced RV strain (−13.4 ± 5.1% vs. −16.4 ± 5.2%, p = 0.026) and elevated RVESV (74.2 ± 18.3 mL vs. 59.5 ± 14.2 mL, p = 0.003). CT-derived indices also differed significantly: diseased lung area (56.4 ± 17.2% vs. 38.4 ± 12.5%, p < 0.001), GGO (11.8 ± 3.6% vs. 8.65 ± 4.3%, p = 0.005), and honeycombing (17.7 ± 4.9% vs. 12.8 ± 6.4%, p = 0.0027) were all more prominent in the PH group. In receiver operating characteristic curve analysis, diseased lung area demonstrated an area under the curve of 0.778 for detecting PH. This increased to 0.847 with the addition of RVESV, and further to 0.854 when RV strain was included. Combined models showed significant improvement in risk reclassification: net reclassification improvement was 0.700 (p = 0.002) with RVESV and 0.684 (p = 0.004) with RV strain; corresponding IDI values were 0.0887 (p = 0.03) and 0.1222 (p = 0.01), respectively. Conclusions: Combining CT-based fibrosis quantification with cardiac MRI-derived RV functional assessment enhances the non-invasive diagnosis of PH in ILD patients. This integrated imaging approach significantly improves diagnostic precision and may facilitate earlier, more targeted interventions in the management of ILD-associated PH. Full article

Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm × 10 cm × 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with “suspicious” cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor’s measurements had increased to DMax: 16 cm × 9 cm × 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a “BEP” (Bleomycin^®/Cisplatin^®/Etoposide^®) scheme, which needed to be modified to a “VIP” (Cisplatin^®/Etoposide^®/Ifosfamide^®) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor’s size continued to increase significantly (DMax: 28 cm × 25 cm × 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary “T-Shaped” mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL “en-bloc” segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient’s postoperative status progressively improved, allowing therapeutic management to continue with six “TIP” (Cisplatin^®/Paclitaxel^®/Ifosfamide^®) sessions, currently under his regular “follow-up” from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted. Full article

Background/Objectives: To assess quantitatively the correlation between the lung ultrasound severity scores (LUSSs) and chest CT severity scores (CTSSs) derived from low-dose computed tomography (LDCT) for evaluating pulmonary inflammation in COVID-19 patients. Methods: In this prospective observational study, from an initial cohort of 1000 patients, 555 adults (≥18 years) with confirmed COVID-19 were enrolled based on inclusion criteria. All underwent LDCT imaging, scored by the CTSS (0–25 points), quantifying involvement across five lung lobes. Lung ultrasound examinations using standardized semi-quantitative scales for the B-line (LUSS B) and consolidation (LUSS C) were performed in a subgroup of 170 patients; 110 had follow-up imaging after one week. Correlation analyses included Spearman’s and Pearson’s coefficients. Results: Significant positive correlations were found between the CTSS and both the LUSS B (r = 0.32; p < 0.001) and LUSS C (r = 0.24; p = 0.006), with the LUSS B showing a slightly stronger relationship. Each incremental increase in the LUSS B corresponded to an average increase of 0.18 CTSS points, whereas a one-point increase in the LUSS C corresponded to a 0.27-point CTSS increase. The mean influence of the LUSS on CTSS was 8.0%. Neither ultrasound score significantly predicted ICU admission or mortality (p > 0.05). Conclusion: Standardized lung ultrasound severity scores show a significant correlation with low-dose CT in assessing pulmonary involvement in COVID-19, particularly for the B-line artifacts. Lung ultrasound represents a valuable bedside tool, complementing—but not substituting—CT in predicting clinical severity. Integrating both imaging modalities may enable the acquisition of complementary bedside information and facilitate dynamic monitoring of disease progression. Full article

Coronary computed tomography angiography (CCTA) has emerged as the leading noninvasive imaging modality for the assessment of coronary artery disease (CAD), offering high-resolution visualization of the coronary anatomy and plaque characterization. The development of fractional flow reserve derived from CCTA (FFR-CT) has further transformed the diagnostic landscape by enabling the simultaneous evaluation of both anatomical stenosis and lesion-specific ischemia. FFR-CT has demonstrated diagnostic accuracy comparable to invasive FFR. The combined use of CCTA and FFR-CT is now pivotal in a broad range of clinical scenarios, including the evaluation of stable and acute chest pain, assessment of high-risk and complex plaque features, and preoperative planning. As evidence continues to mount, CCTA and FFR-CT are positioned to become the primary gatekeepers to the cardiac catheterization laboratory, potentially reducing the number of unnecessary invasive procedures. This review highlights the growing clinical utility of FFR-CT, its integration with advanced plaque imaging, and the future potential of these technologies in redefining the management of CAD, while also acknowledging current limitations, including image quality requirements, cost, and access. Full article

The rapid spread of COVID-19 increased the need for speedy diagnostic tools, which led scientists to conduct extensive research on deep learning (DL) applications that use chest imaging, such as chest X-ray (CXR) and computed tomography (CT). This review examines the development and performance of DL architectures, notably convolutional neural networks (CNNs) and emerging vision transformers (ViTs), in identifying COVID-19-related lung abnormalities. Individual ResNet architectures, along with CNN models, demonstrate strong diagnostic performance through the transfer protocol; however, ViTs provide better performance, with improved readability and reduced data requirements. Multimodal diagnostic systems now incorporate alternative methods, in addition to imaging, which use lung ultrasounds, clinical data, and cough sound evaluation. Information fusion techniques, which operate at the data, feature, and decision levels, enhance diagnostic performance. However, progress in COVID-19 detection is hindered by ongoing issues stemming from restricted and non-uniform datasets, as well as domain differences in image standards and complications with both diagnostic overfitting and poor generalization capabilities. Recent developments in COVID-19 diagnosis involve constructing expansive multi-noise information sets while creating clinical process-oriented AI algorithms and implementing distributed learning protocols for securing information security and system stability. While deep learning-based COVID-19 detection systems show strong potential for clinical application, broader validation, regulatory approvals, and continuous adaptation remain essential for their successful deployment and for preparing future pandemic response strategies. Full article

Background: Computed Tomography (CT) imaging is widely recognised for its high capability in assessing multiple organs. However, concerns about patient radiation exposure, particularly in children, pose significant challenges. Objective: This study aimed to establish diagnostic reference levels (DRLs) for paediatric patients in the most common CT examinations to monitor and better control radiation doses. Methods: Dosimetry records from 5956 patients’ scans for the four most common CT imaging examinations—Head, Chest, Abdomen Pelvis (AP), and Chest Abdomen Pelvis (CAP)—were considered. The CT dosimetric quantities (CT dose-index volume (CTDI_vol) and dose-length product (DLP)), along with patient demographics (age and weight), were collected from radiology data storage systems. DRLs for CTDI_vol and DLP were determined for each imaging examination, stratified by patient age and weight groups, in accordance with ICRP recommendations. Results: The derived DRLs are presented as [median CTDI_vol (mGy): median DLP (mGy·cm)]. For (<1 yr): Head: 13:187, Chest: 0.4:7, AP: 0.9:19, CAP: 0.4:10. For (1–5 yrs): Head: 16:276, Chest: 1:22, AP: 1.5:58, CAP: 1.6:63. For (6–10 yrs): Head: 19:332, Chest: 1.4:35, AP: 1.9:74, CAP: 2:121. For (11–15 yrs): Head: 21:391, Chest: 3:86, AP: 4.1:191, CAP: 3:165. We observed that both the CTDI_vol and DLP DRL values increase with patient age. Weight-based DRLs follow similar trends for CTDI_vol, while DLP values show noticeable variations in Chest and AP examinations. Conclusions: The study findings highlight the need for review and optimisation of certain scanning protocols, particularly for chest and AP examinations. The derived DRLs are consistent with findings from other studies. The study recommends establishing national paediatric DRLs to enhance radiology practice across the country and ensure adherence to international safety standards. Full article

Background: Pulmonary embolism (PE) increases right ventricular (RV) afterload, potentially leading to myocardial stress and electrocardiographic abnormalities. Although QTc prolongation has been suggested as a marker of RV dysfunction, its prevalence, clinical significance, and prognostic value in acute PE remain poorly defined. Objective: The objective of this study is to evaluate the prevalence and clinical implications of QTc prolongation in patients with intermediate–high and high-risk acute PE. Methods: We retrospectively analyzed 95 consecutive patients admitted with intermediate–high or high-risk PE between September 2021 and December 2023. QTc prolongation was defined as ≥470 ms in males and ≥480 ms in females. Clinical, imaging, and laboratory data were compared between patients with normal and prolonged QTc intervals. QTc was assessed at admission, after treatment, and prior to discharge. Results: QTc prolongation was observed in 28.4% of patients at presentation. This group had significantly higher lactate levels (2.3 vs. 1.8 mmol/L, p = 0.03) and a non-significant trend toward elevated troponin and lower oxygen saturation. No differences were observed in echocardiographic or CT-based RV dysfunction parameters. QTc values normalized by discharge irrespective of treatment modality. There was no association between QTc prolongation and in-hospital or long-term mortality. A trend toward more aspiration thrombectomy was noted in the prolonged QTc group (29.6% vs. 11.8%, p = 0.06). Conclusions: QTc prolongation is common in acute intermediate–high and high-risk PE and may reflect transient myocardial stress. While not predictive of clinical outcomes, it should be considered in the differential diagnosis of QTc prolongation in patients presenting with dyspnea and chest pain. Full article

Background/Objectives: The long-term sequelae of COVID-19 pneumonia, particularly the persistence of imaging abnormalities and their relationship to clinical symptoms, remain unclear. While the acute radiologic patterns are well-documented, the transition to chronic pulmonary changes—and their implications for long COVID symptoms—require systematic investigation. Methods: Our study included 93 patients with moderate to severe COVID-19 pneumonia who were admitted to Istanbul Medical Faculty Hospital, each having one follow-up CT scan over a ten-month period. Two thoracic radiologists independently calculated semi-quantitative initial chest CT scores to evaluate lung involvement in pneumonia (0–5 per lobe, total score 0–25). Two radiologists and one pulmonologist retrospectively examined the persistence of follow-up imaging findings, interpreting them alongside the relevant clinical and laboratory data. Additionally, in a subcohort (n = 46), mid-term (5–7 months) and long-term (≥10 months) scans were compared to assess temporal trajectories. Results: Among the 93 patients with long-term follow-up imaging, non-fibrotic changes persisted in 34 scans (36.6%), while fibrotic-like changes were observed in 70 scans (75.3%). The most common persistent non-fibrotic changes were heterogeneous attenuation (29%, n = 27) and ground-glass opacities (17.2%, n = 16), and the persistent fibrotic-like changes were pleuroparenchymal bands or linear atelectasis (58%, n = 54), fine reticulation (52.6%, n = 49), and subpleural curvilinear lines (34.4%, n = 32). Both persistent non-fibrotic and fibrotic-like changes were statistically correlated with the initial CT score (p < 0.001), LDH (p < 0.001), and ferritin levels (p = 0.008 and p = 0.003, respectively). Fatigue (p = 0.025) and chest pain (p < 0.001) were reported more frequently in patients with persistent non-fibrotic changes, while chest pain (p = 0.033) was reported more frequently among those with persistent fibrotic-like changes. Among the 46 patients who underwent both mid- and long-term follow-up imaging, 47.2% of those with non-fibrotic changes (17 out of 36) and 10% of those with fibrotic-like changes (4 out of 40) exhibited regression over the long term. Conclusions: Initial imaging and laboratory findings may indicate persistent imaging findings related to long-term sequelae of COVID-19 pneumonia. Many of these persistent imaging abnormalities, particularly non-fibrotic changes seen in the mid-term, tend to lessen over the long term. A correlation exists between persistent imaging findings and clinical outcomes of long COVID-19, underscoring the need for further research. Full article

Background/Objectives: The aims of this study were to re-evaluate the necessity routine post-biopsy chest X-rays by evaluating the incidence, timing, and clinical relevance of pneumothorax (PTX) following CT-guided lung biopsies, and to determine whether symptom-based monitoring can safely replace routine imaging. Methods: This retrospective, single-center study included 112 patients (mean age: 69.3 years; 55% male) who underwent CT-guided lung biopsy between 9 January 2020 and 16 April 2025. PTX occurrence was assessed both intraprocedurally and during follow-up within 7 days. The primary outcome was the development of PTX; secondary outcomes were chest drainage need and delayed PTX identification. Logistic regression analysis and descriptive statistics were used to identify predictors and associations. Results: Intra-procedural PTX occurred in 43.8%, of whom 10.7% required immediate drainage. Clinically silent PTX that did not require intervention occurred in 25.9%. Routine chest X-rays were obtained 4 h post-biopsy for all patients. Importantly, no asymptomatic patient required any intervention. These results suggest that routine 4 h imaging may be unnecessary in the absence of symptoms. Conclusions: PTX is frequent after CT-guided lung biopsy but is often asymptomatic and self-limiting. The absence of clinically significant findings among asymptomatic patients supports a shift toward symptom-based monitoring. Implementing this strategy may help reduce unnecessary post-biopsy imaging and optimize healthcare resource utilization without compromising patient safety. Full article

Background: Acute Aortic Syndrome (AAS), encompassing aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU), presents diagnostic challenges due to its varied manifestations and the critical need for rapid assessment. Methods: We developed a multi-stage deep learning model trained on chest computed tomography angiography (CTA) scans. The model utilizes a U-Net architecture for aortic segmentation, followed by a cascaded classification approach for detecting AD and IMH, and a multiscale CNN for identifying PAU. External validation was conducted on 260 anonymized CTA scans from 14 U.S. clinical sites, encompassing data from four different CT manufacturers. Performance metrics, including sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), were calculated with 95% confidence intervals (CIs) using Wilson’s method. Model performance was compared against predefined benchmarks. Results: The model achieved a sensitivity of 0.94 (95% CI: 0.88–0.97), specificity of 0.93 (95% CI: 0.89–0.97), and an AUC of 0.96 (95% CI: 0.94–0.98) for overall AAS detection, with p-values < 0.001 when compared to the 0.80 benchmark. Subgroup analyses demonstrated consistent performance across different patient demographics, CT manufacturers, slice thicknesses, and anatomical locations. Conclusions: This deep learning model effectively detects the full spectrum of AAS across diverse populations and imaging platforms, suggesting its potential utility in clinical settings to enable faster triage and expedite patient management. Full article

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressive interstitial lung disease with an unknown etiology. It is often accompanied by skeletal muscle mass loss. Chest wall muscles play a crucial role in respiratory movements and form part of the skeletal muscles. The aim of this study is to evaluate the relationship between chest wall muscle thickness and pulmonary function test (PFT) results, as well as other prognostic markers, in patients with IPF. Materials and Methods: A retrospective analysis was conducted on 108 patients diagnosed with IPF and 53 control subjects. Chest wall muscle thickness was measured on thoracic computed tomography (CT) images at specific anatomical levels. PFT parameters, the Gender-Age-Physiology (GAP) index, number of acute exacerbations, and mortality data were evaluated in relation to muscle thickness. Results: IPF patients had significantly reduced thickness in the bilateral external scapular muscles at both the aortic and pulmonary trunk levels compared to controls. Bilateral pectoral muscle thickness at the aortic level was positively correlated with forced vital capacity (FVC) and negatively correlated with the number of exacerbations. Internal scapular muscle thickness at the aortic level showed a significant positive correlation with diffusion capacity of the lung for carbon monoxide (DLCO) and a negative correlation with both GAP scores and exacerbation frequency. External scapular muscle thickness at the pulmonary trunk level was positively associated with PFT parameters and inversely correlated with the GAP index, exacerbations, and mortality. Conclusions: In patients with IPF, the bilateral external scapular muscle thickness at the aortic and pulmonary trunk levels was significantly reduced compared to controls. Significant associations were found between some chest wall muscle thicknesses and the GAP index, pulmonary function, acute exacerbations, and mortality, underscoring the prognostic value of baseline muscle measurements. Measurement of chest wall muscle thickness using routine thoracic CT scans may offer additional prognostic value in IPF. Incorporating this parameter into clinical evaluation may help identify patients who could benefit from supportive interventions, such as nutritional therapy or pulmonary rehabilitation. Full article

Pulmonary neuroendocrine proliferations and neoplasms represent a broad spectrum of diseases, ranging from neuroendocrine cell hyperplasia and tumorlets to carcinoid tumors. Carcinoid tumorlets are most commonly located in the peripheral airways and are often incidentally detected as pulmonary micronodules on chest CT. We report the radiological, bronchoscopic, and pathological findings of a case of carcinoid tumorlets presenting as endobronchial nodules in the left main bronchus. The patient had previously undergone a left lower lobectomy five years earlier for a typical carcinoid tumor. Follow-up imaging revealed new endobronchial nodules, which were subsequently confirmed as carcinoid tumorlets through histopathologic analysis. This case highlights the rare presentation of carcinoid tumorlets in the central airways, emphasizing the importance of recognizing their potential for late recurrence and atypical localization. It underscores the necessity for physicians to be aware that pulmonary neuroendocrine tumors can recur over the long term and may present in a multicentric fashion within the disease spectrum. Full article

Background: Effective early risk stratification in COVID-19 remains a critical challenge in emergency care, particularly due to the limitations of RT-PCR testing, including delayed processing and false negatives. There is an unmet need for imaging tools that are fast, reliable, and safe for repeated use in acute clinical settings. Methods: In this prospective, multicenter study, over 1000 patients hospitalized with suspected or confirmed COVID-19 were initially screened. A total of 555 patients with PCR-confirmed infection were ultimately included for analysis. All participants underwent low-dose chest CT (LDCT) at admission. Pulmonary involvement was assessed using the chest CT severity score (CTSS) based on a unified protocol. CTSS values were analyzed in relation to ICU admission, in-hospital mortality, demographic data, oxygen saturation, dyspnea scores, and laboratory markers (CRP, LDH, lymphocyte, and neutrophil counts). Imaging was interpreted by board-certified radiologists under harmonized reporting standards. Results: CTSS values ≥13 and ≥15 were significantly associated with ICU admission and in-hospital mortality, respectively (p < 0.01). Strong correlations were observed between the CTSS and CRP, LDH, and dyspnea scores, with negative correlations to oxygen saturation and lymphocyte count. The standardized LDCT protocol ensured consistent image quality and minimized radiation exposure. Conclusions: LDCT combined with the CTSS provides a robust, reproducible, and radiation-sparing method for emergency risk stratification in COVID-19. Its high clinical utility supports deployment in frontline triage systems and future AI-enhanced diagnostic workflows. Full article

Background/Objectives: The objective of this study was to clinically validate the performance of the Nanox.AI HealthOST software in detecting incidental vertebral compression fractures (VCFs) on outpatient chest and abdomen CT scans using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A secondary aim was to assess the rate of missed VCFs using initial radiologist reports. Methods: A retrospective analysis was performed on 590 outpatient CT scans. HealthOST, an artificial intelligence solution from Nanox.AI that allows for automated spine analysis using CT images was evaluated against a consensus ground truth established by two radiologists, including a senior musculoskeletal radiologist. Two vertebral body height reduction thresholds were tested: mild (>20%) and moderate (>25%). Original radiologist reports were reviewed to identify missed VCFs. Results: At the 20% threshold, the AI achieved a sensitivity of 92.0%, a specificity of 52.7%, a PPV of 16.5%, and an NPV of 98.5%. At the 25% threshold, sensitivity decreased to 78.0%, while specificity improved to 94.2%, with a PPV of 51.1% and an NPV of 98.2%. The AI identified 88% and 92% of fractures missed by radiologists at the 20% and 25% thresholds, respectively. Conclusions: The Nanox HealthOST AI solution demonstrates potential as an effective screening tool, with threshold selection adaptable to clinical needs with a secondary review by a radiologist that is advisable to ensure diagnostic accuracy. The study further indicates that radiologists often overlook VCFs in reporting non-indicated cases and that AI has a role in enhancing the detection and reporting of vertebral compression fractures in routine clinical practice. Full article