Timely radiology access is essential for accurate diagnosis, treatment planning, and efficient care delivery. U.S. academic health centers face distinctive pressures, including workforce shortages, complex workflows, health inequities, and the need to balance trainee education with increasing clinical demand. This article summarizes consensus conclusions and literature review findings from the Radiology Research Alliance task force on optimizing healthcare delivery in U.S. academic centers. Task force members reviewed operational and systemic contributors to delayed imaging access and radiology report turnaround time (RTAT), with attention to disparities, workflow design, trainee involvement, and emerging artificial intelligence (AI) applications. Delays in radiology care arise from social and insurance-related barriers, staffing shortages, workflow inefficiencies, and reporting delays. Underserved populations experience reduced access to preventive imaging, which may be improved through culturally tailored outreach, frontline staff engagement, and patient navigation. In academic settings, RTAT is influenced by image transmission, case complexity, reporting practices, and trainee participation. Evidence suggests that structured reporting, subspecialty or optimized workflow organization, critical results notification, and dual-reader trainee-attending models can improve efficiency while maintaining educational value. AI and machine learning (ML) show promise for clinical decision support (CDS), scheduling, no-show reduction, risk prediction, workflow optimization, and demand forecasting. Improving radiology delivery in academic centers requires coordinated system-level strategies that address equity, staffing, workflow, and reporting efficiency. Thoughtful integration of AI, alongside operational redesign that preserves trainee development, can help academic radiology advance timely, high-quality, and equitable care.
The global shortage of nursing and other health care professionals threatens the stability of health care systems. Generation Z (Gen Z), born between 1995 and 2010, represents a critical cohort for the future of the health care workforce. Educational institutions are adapting teaching strategies to address the learning preferences and expectations of this generation to teach effectively and prevent attrition. While some evidence exists regarding Gen Z nursing students, there is limited data on students in specialized health care fields, such as pediatric nursing, midwifery, physiotherapy, occupational therapy, radiology assistance, and paramedicine. Because students in these programs often focus on vulnerable patient populations and must navigate technologically complex environments, the development of targeted teaching methods should be informed by data from these cohorts. This scoping review aims to map the existing literature on the learning preferences of Gen Z students in selected health care disciplines. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy comprises 3 stages: a preliminary search in the PubMed database, a comprehensive search across multiple databases, and a reference list screening. Studies focused on Gen Z university students enrolled in pediatric nursing, midwifery, physiotherapy, occupational therapy, radiology assistance, and paramedicine programs were included. Studies that include other generations or disciplines such as medicine or general nursing were excluded. Data extraction and analysis follow the Joanna Briggs Institute guidelines, and both qualitative and quantitative findings will be synthesized narratively and descriptively. A broad research team provides multidisciplinary expertise, enabling a team approach and conflict resolution during the review process. The search was conducted on December 18, 2024, in Scopus, CINAHL, Google Scholar, PubMed, Web of Science, PsycInfo, ProQuest Dissertations & Theses, and Academic Search Ultimate databases. The study was funded in December 2024. Screening of 590 unique records identified 2 (0.3%) eligible studies. The search was extended, and the Open Science Framework registration was updated. Searches in Embase and Emcare databases (July 2025) yielded 51 records. Following duplicate removal, 38 (74.5%) records underwent title and abstract screening. At the time of reporting, the research team will review the full texts and reference lists of 8 (21.1%) studies, to be followed by data extraction and analysis. Results are expected to be published by the end of July 2026. This review is expected to generate an evidence-informed overview of the learning preferences of Gen Z students across the selected health care disciplines. By identifying gaps and opportunities, the review aims to guide future research, curriculum design, and policy initiatives that strengthen the preparedness and retention of the upcoming health care workforce via tailored educational approaches. OSF Registries 10.17605/OSF.IO/UMD7X; https://osf.io/umd7x/overview. DERR1-10.2196/88232.
Burnout among medical trainees is a significant challenge, with over half of physicians and trainees reporting high levels of stress and emotional exhaustion. Radiology training is particularly demanding due to high imaging volumes, time sensitive decision making, and the cognitive complexity required for accurate interpretation. This article examines the role of pacing and patience as essential pedagogical components in radiology education that can support trainee well-being while maintaining diagnostic quality and clinical urgency. Intentional instructional pacing and structure allow trainees to build foundational knowledge before progressing to more complex diagnostic tasks. Likewise, an educator's patience during training promotes reflective learning, resilience under pressure, and gradual development of clinical proficiency. Some strategies include introducing structured case exposures, protecting educational time, supporting brief reflective breaks, and improving time-management practices that support long term learning retention without curricular cognitive overload. Integrating these principles into radiology curricula can mitigate burnout, fostering more accurate, resilient, and empathetic physicians that can provide consistently high-quality patient care--even in the most challenging and fast-paced environments.
This study aimed to evaluate the correlation between Interventional Radiology (IR) trainees' clinical performance during residency and their final National Residency Matching Program (NRMP) rank order list (ROL) placement during the match application, and to identify application metrics predictive of strong clinical performance. A retrospective review of application data for IR residents and fellows graduating from a single academic center between 2020-2025 was conducted. Metrics included United States Medical Licensing Examination (USMLE) scores, number of clinical and research experiences, peer-reviewed publications, abstracts, awards and the final placement on the ROL. A structured survey aligned with Accreditation Council for Graduate Medical Education (ACGME) milestones was designed and distributed to faculty who directly worked with each trainee but were not involved in the program's NRMP rank order list formation to evaluate their clinical performance during IR training. Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs), and a composite clinical score was calculated. Associations between application metrics, NRMP rank, and clinical performance were evaluated using Spearman correlation and univariate linear regression. Moderate inter-rater reliability was observed for medical knowledge (ICC=0.60, p < 0.001), procedural competence (ICC=0.50, p < 0.001), and patient care (ICC = 0.50, p = 0.004). No significant correlation was found between NRMP rank list placement and clinical performance (Spearman ρ = 0.07, p = 0.82). USMLE Step 2 score was the only significant predictor of clinical performance (β = 0.17, p = 0.01), with the greatest separation observed at a cutoff score of 239. These findings suggest that interview-driven rank placement may not reliably identify high-performing residents, whereas Step 2 scores may provide better predictive value for clinical performance during IR training.
Four-dimensional flow magnetic resonance imaging (4D Flow MRI) enables time-resolved three-dimensional visualization and retrospective quantification of vascular hemodynamics within a single volumetric acquisition. Beyond morphology-based imaging, it provides comprehensive assessment of multidirectional flow patterns, collateral redistribution, and treatment-related hemodynamic changes across vascular territories. In abdominal interventional radiology (IR), 4D Flow MRI may offer incremental value in clinical scenarios where morphology alone is insufficient to characterize physiologically relevant hemodynamics. This review summarizes its applications in aortic interventions, portal venous interventions, and hepatic venous outflow disorders. In these settings, 4D Flow MRI may support functional assessment of endoleaks, evaluation of portal flow redistribution, and characterization of venous outflow obstruction and treatment response. Among current applications, endoleak characterization and early assessment of portal hemodynamic change after portal vein embolization, which may reflect subsequent liver hypertrophy, represent particularly promising use cases. However, current evidence remains limited and largely observational. Important technical considerations, including velocity encoding strategy, physiologic variability, metal-related artifacts, and workflow integration, must be addressed. In practical terms, 4D Flow MRI is best regarded as a complementary or problem-solving technique rather than a modality for routine clinical decision-making. Further multicenter validation and outcome-driven studies are required to define its clinical impact in IR practice.
Lumbar puncture (LP) remains a core emergency department (ED) procedure, though recent trends suggest a shift toward non-ED specialties. Within ED practice, trends in LP indications and procedural success are not well characterized. To evaluate longitudinal trends in LP procedural volume across departments within a tertiary care health system and to characterize trends in ED LP indications, success rates, and variables associated with success. We conducted a retrospective study at a single academic health system. LP volumes across clinical departments were assessed for calendar years (CYs) 2012-2024 using Poisson regression with incidence rate ratios (IRRs). ED-specific analyses included LPs performed from CYs 2014-2024, with temporal trends in indications evaluated using IRRs and multivariable logistic regression used to identify factors associated with LP success. Radiology performed the greatest number of LPs from 2012 to 2024, with a 4.4% annual increase (IRR 1.044, 95% CI 1.036-1.052). ED LP volume declined by 1.5% annually (IRR 0.985, 95% CI 0.972-0.999). A total of 1117 LPs were performed in the ED from 2014 to 2024 (mean 106 annually), with success decreasing from 93.1% to 76.3%. LPs for subarachnoid hemorrhage declined (IRR 0.78/year, p < 0.001), while those for idiopathic intracranial hypertension (IIH) increased (IRR 1.29/year, p < 0.001). Upright positioning was independently associated with higher odds of success compared with lateral decubitus (OR 2.2, 95% CI 1.2-4.0). LP volume shifted toward non-ED specialties, particularly Radiology, Internal Medicine, and Pediatrics. Within ED LP practice, indications shifted toward IIH and upright positioning was associated with greater LP procedural success.
Physician burnout remains a pervasive crisis in academic radiology, with social isolation-exacerbated by remote work, siloed reading rooms, and the fragmentation of large multidisciplinary departments-emerging as a key contributor. This commentary reflects on our departmental wellness team's implementation of a simple, low-cost intervention. A daily "Happy Birthday" email to all faculty, trainees, and staff. Over one year, this initiative fostered measurable improvements in departmental engagement, with wellness survey participation rising from 21% to 61%, and garnered 86% support for continuation. While not a comprehensive solution to burnout, the program demonstrates that consistent, personalized gestures of recognition can penetrate professional silos, rebuild interpersonal connections, and lay the foundation for broader cultural change. We offer this experience as a practical, scalable model for radiology departments seeking to combat isolation and enhance workplace cohesion in an increasingly digital era.
The primary aim of this study was to provide foundational anatomical knowledge that may be valuable when performing a cervical erector spinae plane block (ESPB) with or without ultrasound guidance in a paediatric sample. This included measuring the distance from the spinous process to the tip of the transverse process at the C6 and C7 vertebral levels, the depth from the skin to the most medial points of the erector spinae muscle, and the most posterior points of the sternocleidomastoid muscle at the C6 and C7 vertebral levels. Ninety axial computed tomography (CT) images were randomly selected from the database of radiographic images at the Department of Radiology, Steve Biko Academic Hospital. The age and sex of the patients were recorded. The 90 axial CT scans consisted of 30 scans for each of the age groups defined by the American Medical Association, i.e., neonates (age range: 0-2 months), infants (age range: 2 months-2 years), and children (age range: 2-12 years). Gridlines were placed over the tips of the left and right transverse processes to ensure that points were perpendicular to the structure, and various measurements were taken bilaterally. Significant differences were observed between the majority of the measurements for the different age groups. Statistically significant differences were observed between the measurements for males and females in some instances. These results provide pediatric anesthesiologists with useful anatomical reference data when performing a cervical ESPB at vertebral level C6 or C7, particularly where ultrasound guidance is not available.
To determine the frequency, laterality, diameter, and arterial origin of the corona mortis (CM) using computed tomography angiography (CTA) in a large consecutive cohort from two affiliated academic hospitals. A secondary objective was to assess demographic associations with CM, including age, sex, body mass index (BMI), and race or ethnicity. This retrospective study evaluated 988 consecutive abdominal and pelvic CTAs performed between 2020 and 2022 at Parkland Hospital and Clements University Hospital, representing 1976 hemipelvises. All patients aged be ≥ 18 years with diagnostic-quality CTA were included. Studies were not excluded for trauma indications or prior pelvic surgery, ensuring an inclusive, real-world imaging population. CM presence, laterality, vessel diameter, and arterial origin were recorded. Demographic variables were collected, and analyses were performed using the Wilcoxon rank-sum test, paired t-test, and sign test. Arterial CM was identified in 318 of 988 patients (32.2%). Among CM-positive cases, 53% were unilateral and 47% bilateral, with laterality distributed as 25% right-sided, 27% left-sided, and 47% bilateral. The median vessel diameter measured 2.40 mm (IQR, 2.00-2.50 mm). Most CMs originated from the inferior epigastric artery (98%), while 2.3% arose directly from the external iliac artery. CM was more common in females and in non-Hispanic Black individuals. Patients with CM were significantly older than those without (p = 0.035). Vessel diameter differed significantly between sexes (paired t-test, p = 0.004; sign test, p = 0.006). Across two major academic hospitals, this large consecutive CTA cohort-the largest reported to date-identified arterial CM in nearly one-third of patients and demonstrated meaningful demographic variability. Given its potential for clinically significant bleeding, systematic evaluation of CM on preoperative or preprocedural CTA may help reduce iatrogenic vascular injury during pelvic and acetabular surgery.
Adolescence is a critical developmental period during which parenting practices interact with temperament and sociocultural context to shape mental health and adaptation. Most parenting models are derived from Western settings, with limited evidence from India. This simultaneous mixed methods study drew on cross sectional data from the Indian Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA) cohort, including adolescents aged 12-17 years (parent report n = 931; child report n = 836). Exploratory factor analysis was conducted on parent and child versions of the Alabama Parenting Questionnaire. Qualitative data were obtained through in-depth interviews with 31 adolescents and their parents and analysed using thematic analysis. Findings were integrated at the interpretation stage. The original APQ structure did not replicate. Parent reports yielded three dimensions-Involvement/Positive Parenting, Poor Monitoring, and Corporal Punishment-while child reports yielded five, distinguishing father's and mother's involvement. Inconsistent disciplining did not emerge as a distinct construct. Qualitative findings indicated high involvement and behavioural and psychological control, largely driven by academic goals. Adolescents experienced these practices as both supportive and restrictive, with parental openness shaping communication. Contextual pressures, including resource constraints and urban stressors, contributed to a competency-control paradox. Parenting of adolescents in India must be understood within its relational and sociocultural ecology. While involvement and control function as primary supports, excessive control may constrain broader competency development. Integrating parent and adolescent perspectives is essential for culturally grounded research and intervention.
To evaluate whether comprehensive sampling of cervical lymphadenectomy tissue increases lymph node yield (LNY) and improves staging adequacy beyond standard grossing practice. At a single academic center, a comprehensive grossing protocol was introduced in which entire cervical lymphadenectomy specimens (levels I-V) were submitted for histologic evaluation rather than only grossly identified lymph nodes. Ninety-one cervical lymphadenectomy specimens from 22 HNSCC patients were analyzed. For each case, standard-protocol LNY was recorded; additional lymph nodes (positive and negative) recovered by the comprehensive protocol were counted, and changes in pathologic stage and adequacy relative to the 18-node benchmark were assessed. Additional prosection time, tissue block usage, and the correlation between standard and added nodes were also evaluated. The comprehensive protocol increased LNY by a mean of 15.9 ± 12.9 nodes per patient (median 13; 50.1% overall increase), and by 3.8 ± 5.2 nodes per specimen. Only two additional positive nodes (< 0.6%), measuring 1.4 and 4.1 mm, were identified and did not change staging. Two patients with LNY < 18 under the standard protocol exceeded 18 nodes with the comprehensive protocol. Implementation added a mean of 18.5 prosection minutes and 23 extra blocks per case, with poor correlation between standard and added nodes (r2 = 0.15). Comprehensive submission markedly increases lymph node counts and can convert some dissections from inadequate to adequate by numeric criteria. However, in this cohort it produced no staging changes and required substantial laboratory resources. These findings support selective rather than universal use of comprehensive sampling in neck dissection evaluation.
To examine the association between body composition metrics derived from preprocedural computed tomography (CT) angiography and all-cause mortality after transcatheter aortic valve replacement (TAVR). We included patients who underwent TAVR between September 1, 2011 and November 30, 2023 at a single academic center. Skeletal muscle (SM), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intermuscular adipose tissue areas (cm2), as well as SM index (SMI; cm2/m2), were quantified from CT angiography using a validated U-Net-based deep learning model. Associations between each parameter and 3-year all-cause mortality were assessed using multivariable Cox proportional hazards models adjusted for clinical covariates, with adjusted hazard ratios (aHRs) expressed per 1-SD increase. Among 2642 patients (median age, 80.0 years [interquartile range, 74.0-85.0 years]; 1572 were men [59.5%]), median follow-up was 2.8 years, and 74.8% survived to 3 years. Lower SM, SAT, VAT, and SMI (analyzed as continuous variables) were independently associated with higher 3-year all-cause mortality (SM: aHR, 0.831; 95% CI, 0.762-0.906; SAT: aHR, 0.847; 95% CI, 0.775-0.926; VAT: aHR, 0.826; 95% CI, 0.762-0.896; SMI: aHR, 0.832; 95% CI, 0.763-0.907; all P≤.001). Restricted cubic spline analysis showed increased mortality risk below threshold values of the following-SM<128 cm2, SAT<161 cm2, VAT<104 cm2, and SMI<41 cm2/m2; sex-specific thresholds were also derived. Reduced SM and adipose tissue reserves are independently associated with increased mortality after TAVR. Automated CT-derived body composition assessment may improve preoperative risk stratification and guide clinical decision making in TAVR candidates.
Moyamoya disease (MMD) is a progressive cerebrovascular disorder and an important cause of childhood stroke. Surgical revascularization is the established treatment for symptomatic disease. However, comparative data examining perioperative safety and long-term outcomes between pediatric and adult patients remain limited. This study hence aimed to evaluate whether age influences postoperative complications, early neurological outcomes, and long-term stroke risk following direct and/or indirect bypass surgery. We conducted a retrospective multicenter cohort study of patients with MMD who underwent surgical revascularization at 13 academic centers across North America between 2008 and 2022. The primary outcomes were overall postoperative complications and long-term stroke occurrence. Comparisons between pediatric (≤ 18 years) and adult (> 18 years) hemispheres were performed using overlap propensity score weighting (PSW) to adjust for differences in baseline characteristics. Sensitivity analyses were conducted in patients with ≥ 2 years of follow-up. A total of 567 hemispheres (523 adult, 44 pediatric) were included. Adults had higher rates of vascular comorbidities, whereas pediatric patients more frequently presented with congenital conditions and earlier Suzuki grades. Pre- and post-PSW analyses demonstrated no significant age-related differences in outcomes (p ≥ 0.05). On weighted regression, age was not associated with postoperative complications (OR 0.92; 95% CI 0.41-2.05), discharge neurological status (mRS: OR 1.08; 95% CI 0.52-2.21; and NIHSS: OR 0.97; 95% CI 0.45-2.10), or long-term cerebrovascular events (OR 0.88; 95% CI 0.28-2.74). On sensitivity analysis of patients with > 2 years of follow-up, no pediatric hemispheres experienced stroke compared with 12% of adult hemispheres, though this difference was not statistically significant (p = 0.14). Despite marked differences in baseline comorbidities and angiographic severity, pediatric and adult patients experienced similar perioperative outcomes and long-term stroke risk after bypass surgery. These findings support the durability and safety of both direct and indirect revascularization across age groups.
Juvenile idiopathic arthritis (JIA) results in pain, limited joint mobility, and a subsequent decline in quality of life, academic performance, and emotional health in children. Early diagnosis is essential for timely intervention and improving patient outcomes. Musculoskeletal ultrasound (MSUS) provides a safe and convenient management to assess disease and detect lesions and can be repeated easily. Despite its advantages, few studies have shown the role of ultrasound in the diagnostic framework for JIA in Taiwan. We reported the practical application of MSUS for early diagnosis and ultrasound-guided arthrocentesis in a patient with JIA. The procedure led to immediate improvement in the patient's symptoms without complications while also reducing the risk of repeated radiation exposure. These findings highlight the potential of utilizing MSUS as a valuable diagnostic and therapeutic modality in managing JIA.
Accurate preoperative planning is vital for successful surgical repair of pelvic fracture urethral injuries (PFUI). Magnetic resonance urethrography (MRU) offers a more detailed anatomical assessment of the posterior urethra than conventional urethrography. This study evaluates the role of MRU in PFUI repairs. This was a prospective, single-center observational study conducted at a tertiary academic institution between August 2022 and December 2024, aimed at correlating the surgical complexity of PFUI repairs with preoperative geometric parameters derived from MRU and conventional urethrography. Male patients aged ≥ 18 years diagnosed with PFUI were included. Twenty male patients were studied, with a median age of 26 years (IQR: 20.5-36). The bulbomembranous urethra was the most frequent site of disruption (80%). Mean urethral gap measured 2.68 cm (SD 1.13) on MRU and 3.09 cm (SD 1.19) on conventional urethrography. Thirteen patients (65%) underwent non-pubectomy urethroplasty (NPU), and 7 underwent urethroplasty with pubectomy (PU). Within the NPU group, urethral mobilization sufficed in five, while eight required additional corporal separation. On MRU, mean distraction defect was significantly greater in the PU group (3.55 vs 2.22 cm in the NPU group, p < 0.01). Both MRU and conventional urethrography performed well on concordance analysis against the true gap length, with concordance correlation coefficients of 0.969 and 0.894 respectively. Magnetic resonance urethrography (MRU) provides a more comprehensive and precise preoperative evaluation of PFUI compared to conventional urethrography, offering better visualization of the prostatic urethra, accurate gap measurement along with assessment of periurethral anatomic relationships.
This paper presents a reproducible, data-driven approach for prioritisation of AI-detected chest X-ray (CXR) findings to support faster lung cancer diagnosis in the NHS. The Annalise Enterprise CXR system was deployed in shadow mode across seven acute trusts in Greater Manchester. Two cohorts were used: a retrospective cancer cohort (n = 1,282) with confirmed lung cancer and visible CXR abnormalities, and a prospective cohort (n = 13,802) comprising consecutively acquired GP-referred CXRs. Prevalence ratios were calculated for 124 AI-detected abnormalities across both cohorts, and three prioritisation strategies were developed. Strategy 3, which combined prevalence analysis with expert clinical review, achieved optimal performance with a sensitivity of 95.87% and estimated specificity of 79.11%, while maintaining a negative predictive value of 99.95%, for identification of lung cancer. Findings most associated with cancer included solitary lung mass, mediastinal mass, and hilar lymphadenopathy. An Excel-based tool was developed to support rapid configuration and evaluation of categorisation. Application of this approach enabled safe deployment of AI using shadow mode to inform configuration prior to live use. This work provides a scalable model for AI implementation in radiology workflows that aligns with the National Optimal Lung Cancer Pathway and addresses real-world challenges of diagnostic capacity, safety, and reproducibility.
Accurate brain tumor detection in magnetic resonance imaging (MRI) is essential for clinical diagnosis and treatment planning. Annotating large datasets of each tumor type for supervised models is costly and time-consuming. Therefore, this study investigated unsupervised tumor detection with only healthy samples by leveraging multimodal MRI characteristics. 577 brain MRIs from healthy adults are used for training. 3788 multicenter MRIs encompassing three tumor types are used for validation. A modality translating network (MTN) and an anomaly discriminating network (ADN) were trained with only healthy T1WI and T2WI. The MTN was trained to translate healthy T1WI into healthy T2WI. The ADN learned to compare healthy T2WI with abnormal T2WI, which is manually synthesized from healthy T1WI and T2WI, to detect the synthetic abnormal regions. During validation, the MTN translated tumor-containing T1WI into T2WI that appeared free of lesions. The ADN then compared the translated lesion-free T2WI with the original tumor-containing T2WI to detect and segment tumor regions. Our proposed model achieved an average precision (AP) of 77% and a dice similarity coefficient (DSC) of 54%, outperforming state-of-the-art unsupervised methods 0.17 in AP and 0.06 in DSC. The proposed model only needs healthy MRI samples for training, which reduces the burden of manual annotating huge amounts of different kinds of brain tumors. The detection performance across multiple centers and tumor types demonstrated the generalizability of the proposed approach. Leveraging multimodal MRI characteristics can improve brain tumor detection with higher accuracy and better generalization.
To evaluate the association between genetic mutations and clinical outcomes, including response and time to progression, in patients with breast cancer liver metastasis treated with Y-90 radioembolization. This is a retrospective, single-institution study. 110 female patients with breast cancer liver metastasis who underwent Y-90 radioembolization were included. Genomic profiling was conducted using MSK-IMPACT. Patient demographics and treatment response were collected from electronic medical records and Picture Archiving and Communication System (PACS). Y-90 response was categorized as complete, partial, none, or progression. Time to progression was analyzed in patients with an initial response. Median survival using Kaplan Meier estimation was correlated to genetic mutations. 17 patients died before progression was assessed, and 6 patients were not yet evaluated post-procedure. Overall median survival was 32.8 months (1.3 - 173.0). Patients with the ERBB2 mutation showed the longest median survival (70.2 months [12.5 - 173.0]), while the RAD21 mutation had the shortest median survival (25.5 months [2.4 - 173.0]). KDM5C and CBFB mutations were associated with the highest response rates (100%, p=0.003 and p=0.014, respectively), while the H3C13 mutation was associated with the lowest response rate (0%, p=0.002). Median time to progression was 32.8 months (1.4 - 173.0) in patients with an initial treatment response. The H3F3B mutation was associated with the longest time to progression (105 months [50.2 - 105.0]), while the RUNX1 mutation was associated with the shortest time to progression (1.4 months [1.4 - 36.5]). Specific genetic mutations are associated with survival, response rate, and time to progression after Y-90 radioembolization. This study underscores the potential use of genetic profiling to individualize treatment plans.
The study aimed to investigate the prevalence of osteoporosis in children and adolescents with transfusion-dependent thalassemia (TDT) and evaluate the diagnostic value of different osteoporosis indicators. Clinical data were collected from children and adolescents with TDT treated with blood transfusion between March 2022 and January 2024 at Huizhou Central People's Hospital and Huizhou First Hospital. The patients were grouped according to the presence of osteoporosis (International Society for Clinical Densitometry [ISCD] criteria). Of 138 patients included in the study, 48 (34.8%) had osteoporosis. The patients with osteoporosis mainly had asymptomatic grade I fractures of the spine. Using the dual-X-ray absorptiometry (DXA) standards from the World Health Organization, height-corrected TBLH Z-score ≤-2 was associated with osteoporosis (30.4% vs. 14.9%, P = 0.035), displaying 30.4% sensitivity and 85.1% specificity. According to the Chinese DXA standards, height-corrected and age-specific Z-scores ≤-2 were not associated with osteoporosis. The prevalence of osteoporosis among children and adolescents with TDT was 34.8%, indicating the need for screening for osteoporosis in that population. In TDT, the diagnosis of osteoporosis requires early detection of spinal fractures because bone density assessed by DXA is of limited value.