Search Results (468)

Introduction: Ultrasound elastography is increasingly used across medical imaging, yet its role in thoracic disease remains poorly defined. While both transthoracic ultrasonography (TUS) and endobronchial ultrasound (EBUS) offer real-time assessment of pleural and pulmonary structures, the diagnostic and clinical value of elastography in this context remains uncertain. Materials and Method: A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted according to PRISMA guidelines (April 2023; updated January 2025). Original studies evaluating transthoracic or endobronchial elastography for pleural or pulmonary conditions were included. Data extraction and quality assessment were performed independently by three reviewers, with QUADAS-2 used to evaluate risk of bias. Results: Thirty studies met inclusion criteria. Twenty-eight evaluated TUS elastography and two examined EBUS. Shear wave elastography was most frequently applied, particularly for differentiating malignant from benign pleural effusion or subpleural lesions. Surface wave elastography demonstrated consistently higher stiffness values in patients with interstitial lung disease compared with healthy controls, correlating with radiological and functional disease severity. Elastography-guided pleural biopsy improved diagnostic yield compared with conventional ultrasound-guided biopsy. Overall, substantial methodological variation existed among scanning techniques, elastography modalities, reporting methods, and diagnostic thresholds, limiting cross-study comparison. Conclusions: Ultrasound elastography shows promise for evaluating pleural effusion and pulmonary lesions, procedural guidance, and interstitial lung disease possibly improving diagnostic possibilities with bedside evaluation and reducing patient exposure to radiation. However, methodological variation and limited high-quality evidence preclude clinical implementation. Standardized acquisition protocols and multicentre validation studies are necessary to define its diagnostic utility in thoracic imaging. Full article

The identification of caveolin-1 (CAV1) as a universal pathophysiological factor and target for treating various cutaneous conditions and the recognition of its role as a universal factor and target in the protection of cells from genotoxic stress have opened new avenues for protecting skin against radiation-induced skin injuries (RISIs). A significant and rapid increase in CAV1 content in irradiated cells, reaching a maximum at 30–60 min after irradiation, coupled with internalization of epidermal growth factor receptors involved in the activation of homologous recombination and non-homologous end-joining repairing of double-strand breaks in affected cells, can protect the cells from irradiation to some degree. However, a higher level of protection can be achieved when the CAV1 content in the skin is increased before irradiation. Such an enhancement in the expression and translocation of CAV1 can be induced by the local application of thermo-mechanical stress with parameters inducing reinforcement of the actin cytoskeleton in treated cells. The application of very-high-frequency ultrasound waves with frequencies above 10 MHz or combined multi-frequency ultrasound waves can provide new means of protecting against RISIs during radiation therapy without reducing the radiosensitivity of cancer cells. Full article

Head and neck cancer surgery has evolved from radical organ-sacrificing procedures to function-preserving approaches integrated within multidisciplinary frameworks. This comprehensive literature review, concentrating on studies from the past five years while incorporating relevant publications from the last three decades and landmark historical papers, examines the evolving role of surgery emphasizing diagnostic methodologies including comprehensive genomic profiling, validated imaging biomarkers, and their clinical integration for treatment selection and response prediction. Modern surgical practice demonstrates a paradigm shift toward precision medicine through validated diagnostic technologies. Comprehensive genomic profiling identifies clinically actionable alterations in over 90% of head and neck squamous cell carcinomas, with tumor mutational burden serving as a validated predictive biomarker for immunotherapy response. Programmed death-ligand 1 (PD-L1) combined positive score functions as a validated diagnostic biomarker for immunotherapy efficacy, demonstrating significant clinical benefit in biomarker-selected populations. Radiomics-based predictive models utilizing machine learning algorithms achieve diagnostic accuracies exceeding 85% for treatment response prediction when validated across independent cohorts. Quantitative ultrasound spectroscopy combined with magnetic resonance imaging radiomics demonstrates high sensitivity and specificity for radiation response prediction. Habitat imaging techniques characterizing tumor microenvironmental heterogeneity predict pathologic complete response to neoadjuvant chemoimmunotherapy with area under the curve values approaching 0.90 in validation studies. Integration of these diagnostic methodologies enables response-adaptive treatment strategies, with neoadjuvant chemotherapy facilitating mandibular preservation and adjuvant therapy omission in over half of human papillomavirus (HPV)-associated cases following surgical downstaging. Clinical validation of these diagnostic platforms enables accurate treatment response prediction and informed surgical decision-making, though standardization across institutions and demonstration of survival benefits through prospective trials remain essential for broader implementation. Full article

Ultrasound-stimulated microbubble (USMB) therapy, in combination with radiotherapy (XRT), represents a promising approach to enhancing the efficacy of conventional cancer treatments by targeting tumor vasculature. Recent preclinical studies using MRI-guided focused ultrasound have demonstrated that USMB enhances radiation effects in tumor blood vessels, resulting in significantly greater tumor cell death than radiation alone. Dynamic contrast-enhanced MRI (DCE-MRI) has been instrumental in this methodology in mapping tumor perfusion heterogeneity, allowing for precise targeting of additional USMB and XRT to specific vascular regions. This study employed four advanced texture analysis methods, GLCM, GLDM, GLSZM, and NGTDM, to quantitatively assess changes in the cellular structure of prostate tumors following different treatments, including combinations of USMB and XRT targeted to low- and high-perfusion regions. Texture features, particularly those derived from GLCM, GLDM, and GLSZM, revealed significant differences in cell structure patterns across treatment groups. The GLSZM methodology was identified as the most sensitive method for detecting treatment-induced structural changes, effectively identifying regions of necrosis and varied stages of cell death. Texture-derivative analyses further highlighted intra-tumoral heterogeneity, especially in response to additional USMB + XRT treatments. These results align with findings in other tissue models, underscoring the value of texture analysis for monitoring treatment response. Full article

Ultrasound is the primary, non-invasive imaging modality for evaluating renal anatomy and function in both acute and chronic settings. Familiarity with normal kidney morphology, cortical and parenchymal thickness, echogenicity, and Doppler parameters is essential for differentiating normal findings from early manifestations of disease. This review summarizes established reference ranges and anatomical variants from the 1950s to 2025, highlighting differences related to age, sex, body habitus, and ethnicity. Practical emphasis is placed on the interpretation of renal size, cortical thickness, echogenicity, and resistive indices in clinical scenarios such as chronic kidney disease, renovascular hypertension, acute obstruction, and renal transplantation. By integrating sonographic measurements with clinical and laboratory findings, clinicians can achieve timely diagnosis, monitor disease progression, and guide therapeutic decisions while minimizing the need for invasive or radiation-based imaging. Full article

This paper provides a comprehensive overview of the application of various radiological modalities, with a critical comparison between human and veterinary medicine. The modalities discussed include conventional radiography, dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), quantitative ultrasound (QUS), positron emission tomography-computed tomography (PET-CT) and micro and nano computed tomography (micro-CT, nano-CT) in clinical practice and basic research of skeletal system. Radiological imaging plays a crucial role in the diagnosis, monitoring and research of skeletal system disorders in both human and veterinary medicine. In preclinical research, advanced diagnostic imaging modalities such as micro-CT and nano-CT allow for 3D quantification of trabecular and cortical bone microarchitecture for studies in bone biology, regenerative medicine and pharmacological research. Furthermore, the integration of artificial intelligence is advancing image interpretation, precision diagnostics and disease tracking. Despite their broad utility, imaging modalities must be selected based on clinical indication, species, age and anatomical region with consideration of radiation dose, cost and availability, especially in remote regions. For this reason, clinicians and radiologists remain an irreplaceable part of diagnostic imaging. Full article

Objectives: Current guidelines for pulmonary surfactant (PS) administration in preterm infants with respiratory distress rely on clinical signs and FiO₂ thresholds. Lung ultrasound offers a promising alternative for accurately diagnosing neonatal respiratory distress syndrome (NRDS) and assessing its severity. This randomized controlled trial aimed to evaluate whether a lung ultrasound-guided strategy for NRDS diagnosis and lung ultrasound scores (LUS)-guided PS administration could improve respiratory outcomes in preterm infants (<32 weeks’ gestation), compared to conventional methods. Methods: In this non-blinded randomized controlled trial, 89 preterm infants (≤32 weeks’ gestation) with respiratory distress after birth were enrolled. Participants were randomly assigned to either the ultrasound group (PS administration based on ultrasound-confirmed NRDS and LUS criteria) or the control group (PS administration according to standard clinical signs and FiO₂ requirements). Results: The ultrasound group demonstrated a significantly lower rate of invasive mechanical ventilation (p = 0.007) and a shorter duration of ventilation (p = 0.005) compared to the control group. Furthermore, the ultrasound group required less PS (p = 0.03), received their first dose at an earlier time (p = 0.017), and experienced fewer radiation exposures both before surfactant treatment and within the first week after birth (p = 0.023 and p = 0.019, respectively). Conclusions: The integration of lung ultrasound for NRDS diagnosis and LUS-guided surfactant therapy facilitates more precise and timely PS use. This strategy reduces the need for and duration of invasive mechanical ventilation and limits early radiation exposure in very preterm infants. Full article

Radiology services play a vital role in modern healthcare, yet disparities in access and concerns about occupational radiation exposure remain understudied in many countries, including Kazakhstan. This study evaluates national trends in diagnostic imaging services, workforce distribution, and radiation-related anxiety among medical personnel. We analyzed national diagnostic imaging infrastructure and workforce data from 2018–2024. Individual radiation exposure data (n = 177) were obtained from dosimetry records in Astana’s medical facilities. Additionally, a cross-sectional survey (n = 324) was conducted using the Spielberger–Hanin Anxiety Scale to assess radiation-related anxiety and associated factors. Between 2018 and 2024, the number of CT rooms in Kazakhstan more than doubled from 162 to 358 (+121%), while X-ray examinations declined from 20.6 to 14.6 million (−29.2%) and fluorography dropped by 67.7%. CT scans increased over threefold, from 491,738 to 1.6 million. Radiologists grew from 3529 to 4511 (+27.8%), and ultrasound doctors from 1396 to 2178 (+56.1%). Interventional physicians had the highest quarterly radiation dose (0.65 ± 0.58 mSv, p = 0.001). Among radiology professionals, 32% reported anxiety related to occupational exposure. Anxiety was significantly associated with not using aprons (58% vs. 27%, p < 0.001), lack of dosimeter use (27% vs. 12%, p = 0.001), and inadequate safety training (27% vs. 6%, p < 0.001). Spielberger–Hanin scores ≥ 45 indicated high levels of situational (58%) and personal (56%) anxiety in this group. Kazakhstan’s diagnostic radiology capacity has grown rapidly, especially in CT availability, yet regional disparities and occupational anxiety remain critical concerns. Targeted workforce distribution, improved protective practices, and enhanced radiation safety education are urgently needed. Full article

Background/Objectives: Skeletal impairment has been reported as a common finding in Hyperphenylalaninemia (HPA)/Phenylketonuria (PKU) patients regardless of age and method of diagnosis, both in children and adults. Quantitative Ultrasound (QUS) is a radiation-free and low-cost method for assessing bone quality, used in various chronic conditions. Methods: Bone quality was evaluated using a calcaneal QUS device. Auxological parameters, nutritional intakes, and plasma levels of key bone biomarkers were also registered. The population was divided into four groups: PKU patients under diet therapy and HPA patients on a free diet, both divided into receiving or not receiving single vitamin D supplementation. Results: All HPA/PKU patients had median bone quality index (BQI) Z- and T-score values lower than −1, with slightly better values in HPA children and PKU-supplemented adults. Dietary vitamin D intake in PKU patients was significantly higher than in HPA subjects (p < 0.001), due to protein substitute supplementation. However, plasma 25(OH) vitamin D levels, although increased compared to baseline, were still overlapping among groups (p = 0.845) after supplementation. Approximately a quarter of both pediatric and adult non-supplemented PKU patients had Z-score and T-score levels below −2, and this percentage decreased with vitamin D supplementation in all groups. In PKU-supplemented patients, the Broadband Ultrasound Attenuation (BUA) was significantly higher than in the other groups (p = 0.040). Conclusions: The improvement in BUA may represent preliminary evidence of the effect of vitamin D on bone architecture, which could encourage this supplementation to prevent the worsening of bone structure and reduce the risk of fractures. Full article

Intraoperative ultrasound (IOUS) has developed from a rudimentary adjunct into a versatile modality that now plays a crucial role in neurosurgery. Offering real-time, radiation-free and repeatable imaging at the surgical site, it provides distinct advantages over intraoperative magnetic resonance (MRI) and computed tomography (CT) in terms of accessibility, workflow integration and cost. The clinical spectrum of IOUS is broad: in cranial surgery it enhances the extent of resection of gliomas and metastases, supports dissection in meningiomas and enables localization of MRI-negative pituitary adenomas; in spinal surgery, it guides resection of intradural and intramedullary tumors, assists in myelotomy planning and confirms decompression in degenerative conditions such as cervical myelopathy and ossification of the posterior longitudinal ligament. IOUS also offers unique insights into cerebrospinal fluid disorders, including arachnoid webs, cysts, syringomyelia and Chiari malformation, where it visualizes cord compression and CSF flow restoration. In trauma and oncological emergencies, it provides immediate confirmation of decompression, directly influencing surgical decisions. Recent innovations, including contrast-enhanced ultrasound, elastography, three-dimensional navigated systems and experimental integration with artificial intelligence and robotics, are extending its functional scope. Despite heterogeneity of evidence and operator dependence, IOUS is steadily transitioning from an adjunctive tool to a cornerstone of multimodal intraoperative imaging, bridging precision, accessibility and innovation in contemporary neurosurgical practice. Full article

Background: Glioblastoma (GBM) remains refractory to chemoradiotherapy. Glial populations—microglia/monocyte-derived macrophages, reactive astrocytes, and the oligodendrocyte lineage—shape both treatment resistance and radiation-related brain injury. Scope: We synthesize how myeloid ontogeny and plasticity, astrocytic hubs (IL-6/STAT3, TGF-β, connexin-43/gap junctions), and oligodendrocyte precursor cells (OPCs)–linked programs intersect with DNA-damage responses, hypoxia-driven metabolism, and extracellular vesicle signaling to support tumor fitness while predisposing normal brain to radiotoxicity. Translational implications: Convergent, targetable pathways (IL-6/JAK–STAT3, TGF-β, chemokine trafficking, DDR/senescence) enable co-design of radiosensitization and neuroprotection. Pragmatic levers include myeloid reprogramming (CSF-1R, CCR2), astrocyte-axis modulation (STAT3, TGF-β, Cx43), and brain-penetrant DDR inhibition (e.g., ATM inhibitors), paired with delivery strategies that raise intratumoral exposure while sparing healthy tissue (focused-ultrasound blood–brain barrier opening, myeloid-targeted dendrimers; Tumor Treating Fields as an approved adjunct therapy). Biomarker frameworks (TSPO-PET, macrophage-oriented MRI radiomics, extracellular vesicle liquid biopsy) can support selection and pharmacodynamic readouts alongside neurocognitive endpoints. Outlook: Timing-aware combinations around radiotherapy and hippocampal/white-matter sparing offer a near-term roadmap for “glia-informed” precision radiotherapy. Full article

Background/Objectives: Umbilical venous catheters (UVCs) and umbilical artery catheters (UACs) are essential for neonatal care, facilitating medication delivery, nutritional support, and blood pressure monitoring. However, malposition and prolonged catheter dwell time can lead to severe complications, including central line-associated bloodstream infections (CLABSIs). This study aims to evaluate the benefits of ultrasound in confirming catheter tip location, which may impact infection risk, and to assess the effectiveness of modification of the securing method. Methods: This prospective randomized controlled study was conducted from May 2022 to December 2024 at an NICU in Taiwan. Neonates requiring umbilical catheters were randomly assigned to three groups. In Group 1, the catheter length was calculated using a formula, X-ray confirmation was used, and the catheter was secured with traditional tape. In Group 2, ultrasound confirmation was used and the catheter was secured with FoamLite™ sterile dressing and transparent film. In Group 3, ultrasound confirmation was used and the catheter was secured with traditional tape. The outcomes were the rate of complications of the catheters. Results: Groups 2 and 3 demonstrated significantly lower malposition rates, microbial colonization, and CLABSI incidence compared to Group 1 (p = 0.001, 0.006, and 0.026, respectively). No significant difference was observed between Groups 2 and 3, suggesting that accurate tip positioning was more influential in reducing CLABSIs than the securing method itself. Conclusions: Ultrasound guidance improves catheter placement accuracy, minimizes malposition, lowers CLABSI risk, and reduces radiation exposure, supporting its broader implementation in NICUs. Full article

Prostate cancer is one of the leading causes of cancer-related morbidity and mortality worldwide, and imaging plays a critical role in its detection, localization, staging, treatment, and management. The advent of artificial intelligence (AI) has introduced transformative possibilities in prostate imaging, offering enhanced accuracy, efficiency, and consistency. This review explores the integration of AI in prostate cancer diagnostics across key imaging modalities, including multiparametric MRI (mpMRI), PSMA PET/CT, and transrectal ultrasound (TRUS). Advanced AI technologies, such as machine learning, deep learning, and radiomics, are being applied for lesion detection, risk stratification, segmentation, biopsy targeting, and treatment planning. AI-augmented systems have demonstrated the ability to support PI-RADS scoring, automate prostate and tumor segmentation, guide targeted biopsies, and optimize radiation therapy. Despite promising performance, challenges persist regarding data heterogeneity, algorithm generalizability, ethical considerations, and clinical implementation. Looking ahead, multimodal AI models integrating imaging, genomics, and clinical data hold promise for advancing precision medicine in prostate cancer care and assisting clinicians, particularly in underserved regions with limited access to specialists. Continued multidisciplinary collaboration will be essential to translate these innovations into evidence-based practice. This article explores current AI applications and future directions that are transforming prostate imaging and patient care. Full article

Lung ultrasound (LUS) has emerged as a valuable diagnostic modality for the evaluation of respiratory disorders in neonates, infants and children. LUS has high diagnostic accuracy for identification of lung lesions in neonates, infants and children, where most lung lesions abut the pleura. Furthermore, LUS has the advantage of rapid execution and ease of use, and does not require ionizing radiation. Its sensitivity, cost-effectiveness, and clinical efficiency make it an important tool for supporting clinical decision-making and improving patient management. Moreover, LUS may represent a reliable alternative to chest radiography for the assessment of pediatric lung conditions and, in selected cases, could potentially replace routine chest X-rays (CXRs). Because LUS is a user-friendly technique that enables real-time imaging without radiation, it has increasingly been used in clinical practice in recent years. Here, we discuss the diagnostic role of LUS for the accurate identification of pulmonary lesions in pediatric patients. In addition, we present LUS sonographic findings associated with common pediatric lung diseases, including signs and artifacts that can be used during diagnosis and evaluation of pediatric patients. Full article

Background: Pneumothorax (PTX) requires rapid recognition in emergency and critical care. Lung ultrasound (LUS) offers a fast, radiation-free alternative to computed tomography (CT), but its accuracy is limited by operator dependence. Artificial intelligence (AI) may standardize interpretation and improve performance. Methods: This retrospective single-center study included 46 patients (23 with CT-confirmed PTX and 23 controls). Sixty B-mode and M-mode frames per patient were extracted using a Clarius C3 HD3 wireless device, yielding 2760 images. CT served as the diagnostic reference. Experimental studies were conducted within the framework of three scenarios. Transformer-based models, Vision Transformer (ViT) and DINOv2, were trained and tested under two scenarios: random frame split and patient-level split. Also, Random Forest (RF) and eXtreme Gradient Boosting (XGBoost) classifiers were trained on the feature maps extracted by using Video Vision Transformer (ViViT) for ultrasound video sequences in Scenario 3. Model performance was evaluated using accuracy, sensitivity, specificity, F1-score, and area under the ROC curve (AUC). Results: Both transformers achieved high diagnostic accuracy, with B-mode images outperforming M-mode inputs in the first two scenarios. In Scenario 1, ViT reached 99.1% accuracy, while DINOv2 achieved 97.3%. In Scenario 2, which avoided data leakage, DINOv2 performed best in the B-mode region (90% accuracy, 80% sensitivity, 100% specificity, F1-score 88.9%). ROC analysis confirmed strong discriminative ability, with AUC values of 0.973 for DINOv2 and 0.964 for ViT on B-mode images. Also, both RF and XGBoost classifiers trained on the ViViT feature maps reached 90% accuracy on the video sequences. Conclusions: AI-assisted LUS substantially improves PTX detection, with transformers—particularly DINOv2—achieving near-expert accuracy. Larger multicenter datasets are required for validation and clinical integration. Full article