Search Results (610)

Background and Clinical Significance: Mechanical complications and intracavitary thrombus are both recognized causes of clinical deterioration following acute myocardial infarction, yet they require fundamentally different therapeutic approaches. Distinguishing between these entities is critical, as misdiagnosis may lead to unnecessary surgical intervention or delayed anticoagulation with serious consequences. Left ventricular (LV) thrombus typically appears as a well-defined mass; however, atypical and highly mobile morphologies may closely mimic catastrophic post-infarction mechanical complications, creating significant diagnostic uncertainty. This case highlights the pivotal role of contrast-enhanced echocardiography in resolving such ambiguity and guiding appropriate management in a high-stakes clinical setting. Case Presentation: A 60-year-old man presented with acute dyspnea and pulmonary edema ten days after an anterior myocardial infarction treated with percutaneous coronary intervention, complicated by ischemic stroke. Transthoracic echocardiography demonstrated severe LV systolic dysfunction with moderate-to-severe mitral regurgitation and an unexpected, highly mobile, irregular mass protruding into the LV apex. The mass exhibited a shredded, tissue-like appearance, raising urgent concern for post-infarction mechanical complications, including papillary muscle rupture or apical myocardial disruption, and prompting immediate consideration of surgical intervention. Contrast-enhanced echocardiography was performed and revealed a mobile LV apical thrombus. Surgical management was avoided, and systemic anticoagulation was initiated, followed by transition to rivaroxaban in combination with ongoing dual antiplatelet therapy. The patient demonstrated rapid clinical improvement with optimized heart failure treatment and was discharged after four days, with planned follow-up imaging to assess thrombus resolution. Conclusions: Left ventricular thrombus may present with atypical, misleading morphologies that closely resemble life-threatening mechanical complications after myocardial infarction. Full article

Patients with heavily calcified coronary arteries represent a challenge in percutaneous coronary intervention (PCI), as severe calcification impairs device delivery and limits optimal stent expansion, leading to higher risks of stent thrombosis, restenosis, and adverse clinical outcomes. Approximately 20% of patients undergoing PCI exhibit severe coronary calcification, which independently predicts incomplete revascularization, increased mortality, and higher rates of major adverse cardiovascular events over mid-term follow-up. Recent advances have focused on improving the assessment and management of calcified lesions. Intracoronary imaging modalities, including intravascular ultrasound and optical coherence tomography, allow precise detection and characterization of calcium burden, overcoming the limitations of angiography. These tools play a pivotal role in guiding procedural strategy, enabling tailored selection of calcium-modifying techniques based on lesion morphology, and optimizing stent deployment. Technological innovations have significantly expanded therapeutic options. While non-compliant balloon angioplasty alone is often insufficient, adjunctive devices such as cutting and scoring balloons improve plaque modification in focal disease. Atherectomy techniques, including rotational and orbital systems, are effective for more complex lesions but require technical expertise and carry procedural risks. Intravascular lithotripsy has emerged as a promising, less aggressive modality capable of fracturing deep calcium, while excimer laser atherectomy offers an alternative for resistant lesions. Despite these advances, current evidence supporting calcium-modifying strategies is largely based on procedural outcomes rather than definitive improvements in long-term clinical endpoints. Meta-analyses and randomized trials have not demonstrated clear superiority of any single technique, and most studies remain underpowered. Intriguingly, recent data suggest that outcomes in treated calcified lesions may approximate those of non-calcified disease, raising the hypothesis that these technologies could mitigate the adverse impact of calcification. However, this remains unproven, highlighting the urgent need for adequately powered randomized trials to determine their true clinical benefit. Full article

Myositis ossificans (MO) is a benign, self-limiting heterotopic ossification process that typically develops within soft tissues following trauma, although non-traumatic forms have also been described. Despite its benign nature, MO frequently represents a diagnostic challenge, particularly in its early stages when imaging findings may mimic aggressive soft-tissue tumors, leading to unnecessary biopsies or surgical interventions. This narrative review provides an updated overview of the classification, pathophysiology, and imaging features of myositis ossificans, with a specific focus on the time-dependent evolution of radiologic appearances across different imaging modalities. Radiologic findings are discussed according to disease stage, highlighting key diagnostic clues such as the zonal phenomenon and peripheral maturation pattern. In addition, the main entities included in the differential diagnosis are reviewed, with particular emphasis on imaging features that help distinguish myositis ossificans from soft-tissue sarcomas and other calcified or ossified lesions. Finally, current management strategies and the role of imaging in patient follow-up are summarized. A thorough understanding of the evolving imaging spectrum of myositis ossificans is essential for radiologists and clinicians to achieve an accurate diagnosis, guide appropriate management, and avoid overtreatment. Full article

Fetal therapy has evolved into a rapidly advancing field with the potential to alter the natural history of many severe congenital and genetic disorders before irreversible injury occurs. Progress in prenatal imaging, molecular diagnostics, and fetal intervention techniques now enables the earlier identification of disease and, in select settings, targeted prenatal treatment. This review synthesizes the current landscape of fetal therapies, spanning established surgical interventions for structural anomalies and emerging biologic and molecular approaches, including enzyme replacement therapy, stem cell-based strategies, gene therapy, and gene editing. The intrauterine environment provides a distinct therapeutic context, with developmental plasticity, immune immaturity, enhanced tissue accessibility, and relatively permissive central nervous system exposure that together define a time-sensitive window for intervention. Preclinical studies and early clinical experience across both structural anomalies and genetic disorders, including lysosomal storage disorders, osteogenesis imperfecta, and spinal muscular atrophy, support the premise that prenatal treatment can preserve organ development and improve pediatric outcomes. However, translation remains constrained by procedural risks, uncertainty regarding long-term safety and durability, ethical and regulatory complexities, and challenges with equitable access, alongside the need for robust comparative evidence versus early postnatal therapy. As the field advances, multidisciplinary collaboration, rigorous trial design with meaningful developmental endpoints, and ethically grounded implementation frameworks will be essential to guide responsible clinical adoption and maximize benefit for children and families. Full article

Background: Artificial intelligence (AI) is increasingly applied in pulmonary endoscopy, including diagnostic bronchoscopy, interventional pulmonology and endobronchial imaging. Advances in computer vision, machine learning and robotic systems have expanded the potential for automated lesion detection, navigation to peripheral pulmonary lesions, and real-time procedural support. However, the current evidence base remains heterogeneous, and translational challenges persist. Methods: This review summarizes current applications and developments of AI across white-light bronchoscopy (WLB), image-enhanced bronchoscopy (e.g., narrow-band imaging and autofluorescence imaging), endobronchial ultrasound (EBUS), virtual and robotic bronchoscopies, and workflow optimization and training. The authors also examine the methodological limitations, regulatory considerations, and implementation barriers that affect translation into routine practice. Results: Reported developments include deep learning-based models for mucosal abnormality detection, lymph-node characterization during EBUS-guided transbronchial needle aspiration (EBUS-TBNA), improved lesion localization, and reduction in operator-dependent variability. Additionally, AI-assisted simulation platforms and decision-support tools are reshaping training paradigms. Nevertheless, most studies remain retrospective or single-center, with limited external validation, dataset heterogeneity, unclear model explainability, and incomplete integration into clinical workflows. Conclusions: AI has the potential to support lesion detection, navigation, and training in pulmonary endoscopy. However, robust prospective validation, standardized datasets, transparent model reporting, robust data governance, multidisciplinary collaboration, and careful integration into clinical practice are required before widespread adoption. Full article

Background: This narrative review introduces the “From Plaque to Perfusion” framework, a clinically pragmatic approach that maps multimodality imaging technologies to critical decision points in the acute coronary syndrome (ACS) patient journey. By integrating non-invasive assessment, invasive procedural guidance, and post-event tissue characterisation, this framework provides a structured pathway for deep phenotyping of ACS. Artificial intelligence (AI) is highlighted as an essential enabling layer that enhances diagnostic precision, automates quantification, and supports scalable, data-driven care. Contemporary ACS management pathways, while effective, often leave residual clinical uncertainty. The diagnostic objective has evolved beyond confirming myocardial injury to comprehensively phenotyping the entire ACS cascade: defining the plaque substrate, identifying the culprit mechanism, and quantifying the myocardial consequence. This requires a systematic integration of advanced imaging modalities. Methods: This narrative review is based on a comprehensive literature search of major medical databases (PubMed/MEDLINE, Scopus, Embase, Google Scholar) for high-level evidence, including randomized controlled trials, meta-analyses, and international expert consensus documents published between January 2010 and February 2026. Results: The “From Plaque to Perfusion” framework consists of three core stages. First, non-invasive assessment with coronary computed tomography angiography (CCTA), fractional flow reserve (FFR-CT), and PET-CT defines plaque substrate and vascular inflammation. Second, invasive precision in the catheterization laboratory, guided by optical coherence tomography (OCT) and intravascular ultrasound (IVUS), resolves the culprit mechanism and optimizes percutaneous coronary intervention (PCI). Third, post-event tissue characterization with cardiac magnetic resonance (CMR) quantifies myocardial injury and refines prognosis. AI-driven platforms are shown to enhance each stage by automating analysis, standardizing interpretation, and providing actionable metrics for clinical decisions, including complex scenarios like Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA). Conclusions: The “From Plaque to Perfusion” framework, enabled by AI, reframes ACS imaging as an integrated, mechanism-driven pathway. This approach moves beyond isolated test interpretation toward a scalable model of precision, phenotype-led care that promises to improve diagnostic certainty and personalize patient management. Full article

Background/Objectives: Cysts are the most common kidney lesions identified in patients undergoing abdominal imaging, with ultrasound (US) typically serving as the initial diagnostic tool. Contrast-enhanced ultrasound (CEUS) has emerged as a highly effective modality for the evaluation of cystic renal lesions, particularly when conventional B-mode ultrasound (US) or CE-CT are inconclusive. While simple renal cysts are readily characterised on US, cystic renal lesions require further assessment. Methods: The Bosniak classification, originally developed for CE-CT, remains the cornerstone for categorising cystic renal lesions, guiding management from surveillance to surgical intervention. Recent efforts to standardise CEUS-specific imaging parameters and adapt the Bosniak criteria aim to improve interobserver agreement, reduce subjectivity, and enhance diagnostic accuracy. Results: CEUS offers superior sensitivity for detecting slow blood flow and minimal vascularity within septa, wall or solid components, often outperforming CE-CT in real-time vascular assessment. However, the high sensitivity of CEUS can reveal additional septa or subtle enhancement, potentially leading to lesion overscoring, if the different sensitivity of CEUS and CT/MRI for detecting enhancement is not taken into account. CEUS also plays a crucial role in the follow-up of non-surgical cystic lesions, providing a radiation-free and cost-effective alternative for long-term monitoring. Certain scenarios, such as post-interventional changes, traumatic cystic rupture, or infected cysts, fall outside the scope of the Bosniak system and require careful clinical correlation. Conclusions: By integrating CEUS into the diagnostic pathway, sonologists can achieve accurate lesion characterisation, optimise patient management, and minimise unnecessary invasive procedures, reinforcing CEUS as an essential tool in the evaluation and follow-up of complex renal cystic masses. Full article

Background: Current guidelines acknowledge that early discharge is not associated with late mortality and that in-hospital length of stay (LOS) of 48–72 h should be considered following successful primary percutaneous coronary intervention (PPCI) in low-risk patients. Recent studies have highlighted the safety of very early discharge after PPCI in highly selected low-risk patients; however, objective tools to guide discharge timing remain limited. The Index of Microcirculatory Resistance (IMR) offers a quantitative assessment of microvascular function and may help identify patients suitable for very early discharge. We aimed to evaluate the feasibility of using IMR to guide very early discharge in patients who underwent uncomplicated PPCI. Study design and objectives: The Safety of Early Discharge Using Index Microcirculatory Resistance in Patients with Acute Myocardial Infarction (SECURE) study is designed to assess the feasibility of using IMR, measured immediately following successful PPCI, to guide early discharge from hospital within 24 h. The SECURE study is a prospective, proof-of-concept, functional non-inferiority, single-centre, randomised, open-label trial to determine if patients with low IMR can be safely discharged when compared to standard discharge policy. The SECURE study will recruit 82 patients with low IMR following successful PPCI. Participants will be 1:1 randomised to either standard discharge timing or very early discharge (within 24 h). The left ventricle ejection fraction will be assessed using cardiac magnetic resonance imaging. A telephone follow-up at 3 months will be arranged. Clinical events are collected as secondary and exploratory safety endpoints. Conclusions: The SECURE study will provide proof-of-concept data about the feasibility of using IMR to guide very early discharge following PPCI. If successful, this study will provide data to plan for a larger study to determine the safety of this personalised approach. Full article

Episodic future thinking (EFT) has been confirmed as a promising cognitive intervention for enhancing prospective memory (PM), yet emerging evidence suggests its effects may depend on the specificity of induction. The current study investigated this issue by dichotomizing EFT into two distinct methods: specific (researcher-guided detailed mental simulations) versus non-specific (participants’ self-guided imagination), implemented through differentially structured future thinking instructions. We also analyzed the distinct cognitive strategies mainly employed under each EFT condition based on the Dynamic Multiprocess Framework. The latent profile analysis (LPA) was further conducted to characterize individual variability in responsiveness to EFT manipulations. Behavioral results revealed comparable PM accuracy improvements across both EFT methods relative to the control group; moreover, specific EFT uniquely accelerated response times for both PM and ongoing task execution. The LPA further identified three distinct EFT response patterns—self-competent, proactive, and reactive—each exhibiting unique state-dependent cognitive characteristics. These findings provide a refined understanding of the EFT-PM relationship: (1) specific EFT facilitates more automatic retrieval of PM intentions, whereas non-specific EFT predominantly engages strategic monitoring; (2) individual differences in baseline mental images influence the effectiveness of EFT methods, suggesting the potential benefits of personalized intervention approaches for PM enhancement. Full article

Introduction: The retropharyngeal carotid artery (RCA) is a rare anatomical variant where the carotid artery resides in the retropharyngeal space. The co-occurrence of RCA and significant atherosclerotic stenosis of the carotid bifurcation is even rarer. Recognizing this anatomy is crucial because of the increased risk of adverse events during procedures such as intubation or oropharyngeal surgery. Furthermore, differentiating between the fixed and dynamic forms is essential for guiding appropriate diagnostic and therapeutic strategies. A scoping review was undertaken, and two cases of RCA and significant internal carotid artery stenosis requiring a surgical approach were presented. Materials and Methods: EMBASE and OVID were systematically searched for studies reporting data on RCA and significant internal carotid artery stenosis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed, and we presented two case reports of RCA and significant internal carotid artery stenosis requiring surgical treatment, treated at the Division of Vascular Surgery, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy. Results and Discussion: Among the 22 papers identified by the scoping review, 6 case reports were ultimately included in the analysis, supplemented by our two cases. The review and the added cases highlight significant heterogeneity in the clinical presentation and management of RCA with stenosis. Therapeutic options include carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR). Also, the diagnostic with dynamic 3D-CT angiography during swallowing would be important in some symptomatic cases to document mechanical compression by the hyoid bone or thyroid cartilage (dynamic RCA), which standard static imaging failed to detect. Conclusions: Due to the rarity of the condition, no high-level evidence (RCTs) exists. Treatment decisions are based on the qualitative assessment of anatomical risk and isolated case reports. Standard interventions (CEA and TF-CAS) are generally considered high-risk. The final management choice must be individualized based on technical feasibility, neurological risk, and the determination of whether the pathology is fixed or dynamically compressive. Full article

Background/Objectives: MRI-guided neurovascular interventions could benefit from lower-field systems due to reduced magnetic and radiofrequency hazards. However, safety and practical visibility of commonly used neurointerventional devices at 0.55 T remain insufficiently characterized. We evaluated magnetic field interactions, RF-induced heating, and qualitative device visibility in 11 commercially available and commonly used neurovascular devices on a 0.55 T MRI system. Methods: Eleven devices, including stent retrievers, guidewires, catheters, and one embolization implant, were tested at 0.55 T. Magnetostatic interactions were quantified using the American Society for Testing and Materials (ASTM)-guided deflection methods for translational force (ASTM-F2052) and a two-string suspension apparatus for torque (adapted from Stoianovici et al.). RF-induced heating was measured in an in vitro perfused cerebral vessel phantom using a 15 min high-specific absorption rate spin echo sequence under static and flow conditions. Qualitative device visibility was assessed using a turbo spin echo (TSE) and balanced steady-state free precession (bSSFP) imaging on each device individually. Results: Eight of eleven devices passed the translational force test, while three devices (D, E, and G), containing significant ferromagnetic components, failed with deflection angles > 45°. Eight devices passed torque testing, remaining below the critical threshold in all rotation positions; three devices (D, G, and J) failed by exceeding the 54° criterion, including one guidewire and two devices with braided/coiled metallic structures. Under static conditions, RF-induced heating ranged from negligible to 10.4 °C (maximum in device D) and generally decreased under flow; in the flow configuration, temperature rise remained below 2 °C for 6/11 devices. Qualitative imaging performance differed by sequence, with bSSFP enabling improved delineation of device structure (best for devices A, C, and H), whereas devices D, E, F, and J produced extensive signal voids that precluded reliable visualization in both sequences. Overall, three devices satisfied all safety criteria while remaining clearly visible under MRI. Conclusions: Devices that pass safety thresholds at 0.55 T can serve as candidates for further sequence optimization and preclinical workflow development, enabling the design of low-SAR, device-compatible imaging protocols tailored for neurointerventional workflows. These results provide key safety data supporting the feasibility of MR-guided neurovascular procedures at 0.55 T. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article

Background: Breast cancer poses not only a physical health threat but also significant emotional and identity challenges for women, particularly regarding femininity and body image. Understanding how patients adapt psychologically can guide effective psychosocial interventions. Objective: This study aimed to evaluate psychological adaptation, coping strategies, illness acceptance, and body image in women with breast cancer and identify factors associated with better adjustment. Methods: A cross-sectional study was conducted among 30 women aged 22–66 undergoing treatment at the Wielkopolskie Centrum Onkologii, Poland. Standardized tools included the Mini-MAC scale (coping strategies), Acceptance of Illness Scale (AIS), and Body Image Scale (BIS). Descriptive statistics and correlations were analyzed. Results: Most participants exhibited a constructive coping style, with positive redefinition and fighting spirit being predominant. Some women simultaneously showed elements of a destructive coping style, including helplessness and hopelessness, indicating complex emotional reactions. Overall, participants demonstrated high illness acceptance, despite notable body image-related discomfort, particularly shame, reduced perceived attractiveness, and appearance-related anxiety. While age did not correlate significantly with coping or body image, a significant negative association was found between age and illness acceptance, with younger women showing better adjustment. Conclusions: Psychological adaptation to breast cancer is multidimensional and individualized, dependent on personality traits, internal resources, and social support. Findings highlight the need for holistic, patient-centered psychosocial care, addressing both emotional adaptation and body image-related distress, including support for intimacy and prosthetic interventions. Individualized strategies can improve quality of life and functional outcomes during and after cancer treatment. Full article

Background: Vascular malformations are congenital structural abnormalities of the blood vessels that may present at any age. In the vulvovaginal region, these lesions are uncommon and frequently misdiagnosed because their clinical appearance overlaps with common gynecologic conditions, particularly Bartholin’s gland cyst or abscess. Inappropriate surgical intervention without prior vascular evaluation may result in hemorrhage, incomplete treatment, and recurrence. Methods: A structured narrative review of the literature was performed using PubMed/MEDLINE and EMBASE databases (January 2000–April 2024) to summarize the classification, pathophysiology, clinical presentation, imaging characteristics, differential diagnosis, and management of vulvovaginal vascular malformations. Publications addressing vascular anomalies in other anatomical locations were also included when clinically relevant. A representative clinical case confirmed by histopathologic and molecular analysis is presented to illustrate the diagnostic pitfalls. Results: Vulvovaginal vascular malformations are predominantly low-flow venous lesions but may include high-flow arteriovenous malformations. A clinical examination alone is insufficient for diagnosis. Doppler ultrasonography is the recommended initial imaging modality, followed by magnetic resonance imaging to define the lesion extent and flow characteristics. Misdiagnosis most commonly occurs when lesions are treated as Bartholin’s gland pathology without prior imaging. Low-flow lesions are generally managed with sclerotherapy or planned surgical excision, whereas high-flow lesions require embolization and multidisciplinary care. Hormonal and hemodynamic changes, including pregnancy, may precipitate enlargement or thrombosis. Conclusions: Vascular malformations should be considered in the differential diagnosis of atypical vulvar masses. Preoperative imaging is essential in order to avoid inappropriate surgical procedures. A structured diagnostic approach combining clinical assessment and imaging enables correct classification and guides treatment. The presented case demonstrates a typical diagnostic pitfall and emphasizes the importance of recognizing vascular lesions in gynecologic practice. Full article

Background: Artificial intelligence-based computer-aided detection (AI-CAD) systems are increasingly being used in endovascular practice to support time-sensitive detection, triage and prioritization tasks in imaging and procedural workflows. Despite rapid technological advancements and expanding regulatory clearances, the translation to lasting clinical benefit varies. Objective: This narrative review synthesizes AI-CAD applications in endovascular interventions and proposes an evaluation-oriented framework to support responsible clinical translation; this framework emphasizes detection-specific metrics, external validation, bias-aware assessment, and workflow integration. Methods: A structured narrative review was conducted using targeted searches in PubMed, Google Scholar, and IEEE Xplore (2020–2026); this review was supported by an examination of US FDA device databases and citation tracking. Evidence was assessed using a pragmatic hierarchical classification framework based on regulatory status and validation rigor. Results: AI-CAD applications were mapped across four main endovascular domains: neurovascular interventions (e.g., large vessel occlusion triage), coronary interventions (CCTA-based stenosis detection and intravascular imaging support), aortic interventions/EVAR (endoleak detection and sac monitoring), and peripheral interventions (lesion detection and angiographic decision support). Across the domains, performance reporting was heterogeneous and often relied on retrospective, single-center assessments. Key barriers to clinical readiness included acquisition variability and dataset shift due to artifacts, limited multicenter validation, annotation variability, and human–AI workflow factors. Evaluation priorities included whether to assess at the lesion level or case level, false positive burden and calibration, external validation under real-world heterogeneity, and clinical impact measures such as treatment timing and procedural decision-making. Conclusions: AI-CAD systems hold significant potential for improving endovascular care; however, clinical readiness depends on rigorous, endovascular feature-specific assessment and transparent reporting, beyond retrospective accuracy. The proposed evidence level framework and assessment checklist provide practical tools for distinguishing mature technologies from research prototypes and guiding future validation, implementation, and post-market monitoring. Full article