The practice parameter was revised collaboratively by the American College of Radiology (ACR), the American Brachytherapy Society (ABS), the American College of Nuclear Medicine (ACNM), the American Radium Society (ARS), the Society of Interventional Radiology (SIR), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). Epidural steroid injections (ESI) are widely used procedures for managing spinal pain and radiculopathy in patients who do not respond to conservative therapy. This multidisciplinary practice parameter reviews evidence for the efficacy and safety of ESI and provides best practice recommendations. This practice parameter was revised according to the process described under the Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Interventional and Cardiovascular Radiology of the ACR Commission on Interventional and Cardiovascular, Committee on Practice Parameters and Technical Standards - Nuclear Medicine and Molecular Imaging of the ACR Commission on Nuclear Medicine and Molecular Imaging and the Committee on Practice Parameters - Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ABS, the ACNM, the ARS, the SIR, and the SNMMI. Epidural steroid injections can provide meaningful improvements in pain, mobility, function, and quality of life for appropriately selected patients with neck and low back pain, particularly when degenerative changes or radiculopathy are present. This document advises that ESI be performed with image guidance, meticulous technique, and detailed knowledge of spinal anatomy, particularly in light of rare but serious neurologic risks highlighted by the FDA. The parameter specifies absolute and relative contraindications, encourages integrating ESI within a multidisciplinary care pathway rather than as stand-alone therapy, and recommends that only appropriately trained and credentialed physicians who understand the indications, relevant pharmacology, and complication management perform these procedures. This multidisciplinary practice parameter provides recommendations on indications, contraindications, patient selection, and technical execution to optimize the therapeutic benefit of epidural steroid injections while reducing the risk of serious neurologic and other complications.
Comprehensive cancer centres depend on nuclear medicine, diagnostic radiology and radiation therapy for diagnosis, staging, treatment planning, image guidance, treatment delivery, response assessment and follow-up. Although these services are clinically interdependent, they are often governed through separate departmental structures, budgets, information systems, quality routines and performance reports. This fragmentation can limit the ability of cancer-centre leaders to balance access, clinical quality, patient safety, workforce capacity, equipment sustainability, innovation and data stewardship. This policy analysis proposes a Balanced Scorecard and Strategy Map for integrated radiation medicine governance in comprehensive cancer centres. The framework adapts the classical Balanced Scorecard by making six domains explicit: patient access and experience, clinical quality and safety, integrated care pathways, resources and sustainability, workforce learning and innovation, and data, digital infrastructure and decision support. It also proposes a two-tier governance dashboard, with a concise strategic scorecard for executive and cancer-centre leadership and more detailed operational scorecards for nuclear medicine, diagnostic radiology and radiation therapy teams. The framework is intended to complement, not replace, discipline-specific audit, accreditation, quality assurance and incident-learning systems. Its purpose is to align these systems within a shared governance architecture that supports transparent investment prioritisation, workforce planning, access improvement, technology adoption and quality improvement. The scorecard should not be used as a punitive performance system. Its value depends on co-design, precise indicator definitions, trusted data sources, contextual interpretation and recurring non-punitive review. Future work should pilot the framework and evaluate feasibility, acceptability, data burden and influence on leadership decisions.
Background Deep learning (DL) models have shown promise in diagnosing pancreatic cancer (PC); however, models that simultaneously detect both direct and indirect imaging findings associated with PC are lacking. Purpose To develop and evaluate DL models that detect direct and indirect imaging findings on noncontrast CT (NCCT) and contrast-enhanced CT (CECT) images for PC diagnosis. Materials and Methods This retrospective study from August 2007 to December 2022 included patients with PC and control patients. Two DL models were developed using NCCT and CECT to detect direct (pancreatic mass) and indirect (parenchymal atrophy, main pancreatic duct [MPD] dilatation, and MPD stenosis) imaging findings and diagnose PC based on these findings. For training and validation, CT scans from multiple institutions were manually annotated. Model evaluation was performed using two external test sets (CECT and NCCT sets). Receiver operating characteristic curve analysis was used to assess diagnostic performance. Model performance in detecting imaging findings and PC was compared with the performance of six physicians. The reference standard for PC diagnosis was histopathologic confirmation. Results This study included 2251 patients (mean age, 66 years ± 13.3 [SD]; age range, 20-96 years; 850 men). DL models demonstrated area under the receiver operating characteristic curve (AUC) values of 0.94, 0.90, 0.94, and 0.94 in the CECT set and 0.88, 0.88, 0.95, and 0.93 in the NCCT set for detecting pancreatic masses, parenchymal atrophy, MPD dilatation, and MPD stenosis, respectively. For PC diagnosis, DL models performed similarly to or better than the mean of six readers in the CECT (AUC, 0.99 vs 0.99; P = .84) and NCCT (AUC, 0.93 vs 0.91; P = .03) sets. For PCs that were 20 mm or smaller, the DL models demonstrated higher sensitivity than the reader mean in both the CECT (98% vs 82.6%; P < .001) and NCCT (86% vs 41.1%; P < .001) sets. Conclusion DL models detected direct and indirect imaging findings on CT images and diagnosed PC with performance comparable to or better than that of physicians, particularly for small PCs. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Bhayana and Rajpurkar in this issue.
The scientific benefits gained from studying research biopsies in oncology clinical trials depend on sample quality, and there are concerns that participant risks might outweigh any benefits. We conducted this study to determine the safety and quality of research biopsies conducted in the context of oncology clinical studies. This is a retrospective cohort study of patients with solid cancers participating in oncology clinical trials at a single institution who underwent a biopsy procedure between January 2017 and December 2020. Complications were retrieved from medical records, and tumour content (TC) was extracted from pathology reports. Rates of complications, determinants of safety, and quality of research biopsies were investigated. The study included 3104 research biopsy procedures from 1983 patients. Any grade complications occurred in 462(15%) procedures and major complications (≥G3) in 28(0.9%). A total of 6805 tissue samples (2.2 samples/procedure) were obtained. Median TC was 70% (95% CI:70-70) with 68% showing high-quality (>50% TC). In multivariate models, image-guided methods (ultrasound OR=2.48, 95% CI:1.88-3.27, P < 0.001, and computed tomography OR=1.56, 95% CI:1.07-2.29, P = 0.02) and collecting multiple samples per procedure (OR=1.71, 95% CI:1.43-2.05, P < 0.001) were determinants of high-quality biopsies. Biopsies of visceral organs (OR=9.09, 95% CI:3.23-31.3, P < 0.001) and collected after screening/baseline timepoints (OR=2.61, 95% CI:1.22-5.52, P = 0.014) increased the risk of major complications, while the use of ultrasound (OR=0.31, 95% CI:0.12-0.81, P = 0.01) was independently associated with a lower risk of procedure-related major adverse events. By identifying factors that affect the safety and quality of research biopsies, our data may allow investigators to minimise participant risk and maximise biopsy quality for meaningful correlative science.
Response to anti-programmed cell death protein-1 (anti-PD-1) immunotherapy remains limited in patients with metastatic non-small cell lung cancer (NSCLC), whose tumors exhibit low or absent programmed death-ligand 1 (PD-L1) expression, and subsequent second-line therapy has poor efficacy. To address this limitation, we evaluated the efficacy and safety of combined ipilimumab and nivolumab (IPI/NIVO) with subablative radiotherapy (RT) in patients with metastatic NSCLC with negative or low PD-L1 expression, who had progressed on prior anti-PD-1 therapy. This single-arm, prospective phase II trial aimed to enroll 30 evaluable patients with metastatic NSCLC exhibiting low (1-49%) or negative (<1%) PD-L1 tumor expression who had progressed after first-line anti-PD-1 therapy. Primary endpoints were safety, disease control rate (DCR), and objective response rate (ORR) at 6 and 12 weeks, assessed in non-irradiated tumor lesions. Treatment consisted of IPI 1 mg/kg every 6 weeks (Q6W) and NIVO 240 mg every 2 weeks for 6 weeks combined with subablative RT (3×8 Gy to 1-4 lesions). Thereafter, IPI 1 mg/kg Q6W and NIVO 360 mg every 3 weeks were continued. In 31 patients of the intention-to-treat population, ORR was 7% and 10% at 6 and 12 weeks, and reached 29% as the best response. DCR was 58% and 39% at 6 and 12 weeks. Overall survival (OS) differed significantly by best response, with a median OS of 3.1, 13.5 and 22.5 months for progressive disease, stable disease and partial/complete response (p<0.001). Baseline sum of longest diameters, together with age, blood inflammatory markers and albumin levels, were prognostic of treatment response. All patients experienced treatment-related adverse events (AEs), with grade 3 as the highest severity in eight patients (26%). Immune-related AEs led to treatment discontinuation in five patients (16%). Early T-cell activation in peripheral blood samples (day 8) was detectable and more pronounced in responders than in progressors. In patients with metastatic NSCLC and low or negative tumor PD-L1 expression, IPI/NIVO/RT was able to induce objective clinical responses in a subset of patients who had progressed after first-line anti-PD1 therapy. Treatment was associated with a strong T-cell activation, improved OS and an acceptable safety profile. 2020-001097-29.
Clinical medical physics is a profession that intersects with various groups as part of a broader healthcare team, including dosimetrists, radiation therapists, radiologic and MRI technologists, IT specialists, and physicians. Success in this field requires academic and technical excellence as well as comprehensive skills for working effectively within an interdisciplinary healthcare team. When hiring medical physics residents, the selection of well-rounded and highly qualified candidates can be facilitated through a holistic review process that ensures consideration of traditional metrics such as academic performance while also accounting for the importance of various experiences, personal attributes, and intrinsic motivations that impact clinical performance and patient care. The Association of American Medical Colleges (AAMC) emphasizes an overall consideration of Experiences, Attributes, Competencies, and Metrics (EACM) as important for the search process. As part of the healthcare community, medical physics shares the same commitment to high-quality patient care. By adopting the AAMC's EACM framework, medical physics residency programs can strengthen the fairness, rigor, and overall effectiveness of their application review processes-ultimately benefiting applicants, the medical physics community, and the patients we serve. This Society of Directors of Academic Medical Physics Programs (SDAMPP) task report aims to provide information and resources for applying holistic review to the applicant selection process for medical physics residency programs. Our objective is to enable program directors to reevaluate their selection methods in the context of institutional and program missions and goals and to improve the quality and specificity of recruitment by integrating holistic review concepts into their residency recruitment processes. This initiative can inspire change in recruitment practices, aid programs in hiring well-rounded and well-qualified residents, and support the professional growth of our trainees in healthcare. This report provides an overview of holistic reviews and its core principles. We review the current literature and provide evidence from successful implementations of holistic review in other medical fields to illustrate how it can benefit our field. Furthermore, we outline actionable recommendations to facilitate transitioning to a holistic review framework and address potential barriers with practical solutions. A supplemental workbook is provided to guide residency programs in developing their own holistic application review and interview processes. With this report, we aim to provide practical implementation guidelines that will allow residency program directors to implement a selection methodology that comprehensively assesses the full qualifications of individual candidates and ultimately fosters the development of versatile and competent clinical medical physicists who are best equipped to advance the field, meet patient needs, and improve patient care.
Fibroblast activation protein (FAP) is an attractive target for molecular precision imaging and therapy, given its specific tumor expression across various cancer types. We report first-in-human results using a FAP-targeted cyclic peptide, 3BP-3940, labeled with 177Lu, 90Y, and 225Ac for FAP-targeted radiopharmaceutical therapy (FRT) in patients with end-stage cancer. Methods: Eighty-eight patients with 21 distinct advanced metastatic solid tumor types received 227 cycles of 177Lu-, 90Y-, 225Ac-labeled 3BP-3940, either alone or as tandem treatment, FRT between March 2021 and January 2025, after confirmation of tumor uptake by [68Ga]Ga-3BP-3940 PET/CT. Toxicity was graded using Common Terminology Criteria for Adverse Events version 5.0. Treatment response was assessed, and survival from treatment initiation was calculated using Kaplan-Meier analysis. Results: Administrations of [177Lu]Lu-, [90Y]Y-, and [225Ac]Ac-3BP-3940 were well tolerated, and most adverse events were mild (pain 16%, pain flare 13%, nausea 13%, vomiting 7%, partial alopecia 8%, intensified fatigue 5%, diarrhea 3%, headache 2%, and transient fever 5%). No other clinically relevant adverse symptoms or pharmacologic effects were reported. Dosimetry in a patient with pancreatic cancer receiving 9.73 GBq of [177Lu]Lu-3BP-3940 showed absorbed doses of 37 mGy in the brain, 168 mGy in the lungs, 86 mGy in healthy liver tissue, 142 mGy in the pancreas, 265 mGy in the kidneys, and 2200 mGy for the primary tumor. Some patients underwent additional treatments as their standard of care. After 2 cycles of FRT, tumor responses were complete remission (3.0%), partial remission (51.5%), stable disease (15.2%), and progressive disease (30.3%). The best tumor response observed after any FRT cycle was 2 of 51 (3.9%) with complete remission, 32 of 51 (62.7%) with partial remission, 7 of 51 (13.7%) with stable disease, 8 of 51 (15.7%) with progressive disease, and 2 of 51 (3.9%) with a mixed response, yielding an objective response rate of 66.7% and a disease control rate of 80.4%. For the entire cohort, median overall survival was 7.0 mo from FRT initiation. Conclusion: 3BP-3940 FRT is feasible with 177Lu, 90Y, or 225Ac alone or as tandem treatment for patients with end-stage cancer. Treatments were relatively well tolerated without serious adverse effects. 3BP-3940 FRT demonstrated favorable biodistribution (exceptionally very low renal accumulation), significant tumor uptake, and long retention with very high tumor-to-background ratios, demonstrating objective responses in advanced, aggressive, and heavily pretreated metastatic adenocarcinomas and sarcomas. The observed survival benefit appears to be highly promising. Further prospective randomized analysis in a larger cohort with longer follow-up is warranted.
Soft tissue metastases are rare lesions seen in the course of systemic malignancies and pose diagnostic challenges. Radiological findings are heterogeneous, and standardized criteria are needed for reliable differentiation from benign lesions. While the diagnostic importance of perilesional changes is emphasized in the current literature, comprehensive analyses considering the clustered data structure are lacking. In this study, we aimed to determine effective radiological parameters for distinguishing soft tissue metastases from benign soft tissue lesions and to reveal the independent predictive value of perilesional findings. Soft tissue lesions detected by computed tomography (CT) and magnetic resonance imaging (MRI) between January 2015 and December 2023 were retrospectively evaluated in this single-center study. The study included 57 benign lesions (55 patients) and 139 metastatic lesions (65 patients). Lesion size, contour characteristics, morphological shape, anatomical localization, perilesional edema, and perilesional vascularity were evaluated. Due to the clustered data structure, the Generalized Estimating Equations (GEE) methodology was used. Model performance was evaluated using ROC curve analysis, precision-recall curve, and Brier score. Statistical analyses were performed using Jamovi v2.6.44, JASP v0.19.3, and R v4.5.1 software. Metastatic lesions were significantly smaller than benign lesions (median 17.0 mm vs. 33.3 mm; p<0.001). In the GEE analysis, the presence of perilesional edema increased the likelihood of metastasis by 35 times (OR=35.25; 95% CI: 7.58-164.00; p<0.001), and perilesional vascularity increased the likelihood of metastasis by 45 times (OR=44.54; 95% CI: 1.86-1066.00; p = 0.016). Abdominal-pelvic localization showed a 133- fold (OR=133.00; 95% CI: 10.90-1622.00; p<0.001) higher likelihood of metastasis compared to the extremities, while thoracic-anterior chest wall localization showed a 35-fold (OR=35.22; 95% CI: 2.41-514.00; p = 0.007). Each unit increase in standardized size reduced the likelihood of metastasis by 90% (OR=0.10; 95% CI: 0.02-0.42; p = 0.001). The model demonstrated excellent discrimination (AUC-ROC=0.947) and calibration (Brier score=0.075) performance. Our results show that perilesional edema and perilesional vascularity are key diagnostic signs of metastatic lesions. The combined assessment of perilesional findings and anatomical localization can significantly enhance diagnostic accuracy in daily practice. Furthermore, the relationship between lesion size and the metastatic process emphasizes the need for more careful evaluation of smaller lesions. Perilesional edema, perilesional vascularity, and trunk region localization were associated with soft tissue metastasis. These findings may be helpful in the radiological differentiation of metastasis and benign soft tissue lesions.
Relapsed/metastatic anaplastic thyroid carcinoma (R/M ATC) is associated with poor prognosis. Approximately 40% of ATCs harbor the BRAFV600E mutation, for which targeted therapy is available. However, the clinical characteristics of BRAFV600E-mutant versus wild-type ATC and the role of liquid biopsy (LB) for molecular assessment and monitoring remain incompletely defined. Consecutive patients with R/M ATCs treated at a tertiary referral center were stratified as BRAF wild-type (Cohort A) or BRAFV600E-mutant (Cohort B). Patients received chemotherapy, dabrafenib and trametinib (BRAF/MEKi), immune checkpoint inhibitors (ICI) or best supportive care. Tumor tissue (TB) was analyzed by RT-PCR and/or next-generation sequencing (NGS). Circulating cell-free DNA was assessed by droplet digital PCR (ddPCR) and/or a 52-gene NGS panel on LB at baseline in both cohorts and longitudinally in Cohort B. Clinical characteristics, treatment outcomes, and concordance between TB and LB were evaluated. Between 2018 and 2021, 24 patients were included (13 Cohort A, 11 Cohort B). BRAFV600E tumors more frequently presented with metastatic disease at diagnosis (81.8% vs. 15.4%, p = 0.003). Overall, 79% received first-line therapy and 41.6% second-line treatment. All patients in Cohort B received BRAF/MEK inhibitors, achieving a median progression-free survival of 3.2 months (95% CI 1.2-17.5). Concordance for BRAFV600E status between TB and LB assessed by ddPCR was 93.7% (specificity 100%, sensitivity 85.7%). Among 12 paired TB/LB NGS analyses, overall mutation concordance was 30%. In longitudinal assessment, LB anticipated disease progression in 3 of 6 cases and, in one case, identified emerging secondary alterations during BRAF/MEK inhibitor therapy. BRAFV600E-mutant ATC displays distinct clinical features and improved survival when treated with targeted therapy; ddPCR-based liquid biopsy provides a rapid and sensitive method for BRAFV600E detection and may support timely therapeutic decision-making. Serial LB analysis may contribute to disease monitoring and detection of resistance mechanisms in selected patients.
Older breast cancer survivors are susceptible to cancer- and treatment-related losses in physical function that can negatively affect daily living activities, mobility, and independence. Although physical activity can improve physical function, few studies have focused on older survivors or explored interrelationships between physical activity and physical function. Longitudinal bidirectional relationships between physical activity and physical function in breast cancer survivors and noncancer controls aged 60+ years were evaluated. Survivors (aged 67 ± 7 years; n = 357) newly diagnosed with nonmetastatic breast cancer (stages 0-III) and noncancer controls (aged 67 ± 9 years; n = 254) were assessed at baseline (postsurgery and pre-systemic therapy among survivors) and annual visits for up to 36 months. Physical activity (steps per day) was assessed via actigraphy. The Timed Up and Go test (longer time indicates lower function) and 12-item Short Form Health Survey Physical Component Score evaluated physical function. Data were analyzed via random-intercepts cross-lagged panel models, with controlling for covariates; p values of ˂.05 were considered statistically significant. Starting from the 12-month visit, higher daily steps predicted better subsequent Timed Up and Go time among survivors and controls, and the magnitude of effect was stronger for survivors than controls at 24 months (post hoc comparison, p = .036; survivors: β = -0.420; p = .003; controls: β = -0.211; p = .032). Timed Up and Go time did not predict later daily steps. Associations between steps and the Physical Component Score showed similar patterns. Higher daily steps predicted better subsequent physical function, especially in survivors. These results highlight the importance of promoting physical activity during cancer survivorship care to maintain functional independence.
Intracranial hemorrhage is life-threatening and requires prompt and accurate diagnosis. Non-contrast head computed tomography is the standard first-line examination, but detecting small hemorrhages and classifying multiple subtypes require substantial expertise. Workforce shortages and increasing diagnostic workloads, especially in emergency settings, further challenge timely decision-making. Artificial intelligence (AI)-assisted interpretation has shown promise for improving accuracy and efficiency. This retrospective study evaluated the effect of AI assistance on the diagnostic performance of radiologic technologists (RTs). We analyzed the data for 100 non-contrast head computed tomography examinations (50 positive and 50 negative for hemorrhage) obtained from the Japan Medical Image Database. The interpretations of the five RTs (5-12 years of experience) with and without AI assistance were compared with those of two radiologists. The detection targets were intraparenchymal, intraventricular, subarachnoid, subdural, epidural, and any hemorrhages. We calculated the Area Under the Receiver Operating Characteristic Curve (AUC), accuracy, sensitivity, and specificity. The differences in the AUC for the AI-assisted and unassisted readings were tested using the DeLong method with Bonferroni correction. Significant AUC improvements were observed for five of the 30 reader-task comparisons (17%) after Bonferroni correction. These improvements were all related to intraventricular (p = 0.0001 to 0.0071) and subdural (p = 0.0022 to 0.0071) hemorrhages. AI assistance significantly improved RT detection of challenging subtypes such as intraventricular and subdural hemorrhages. However, it did not improve the diagnostic accuracy for detecting any hemorrhage overall (p = 0.0689 to 0.9669). AI can strengthen the role of RTs within task-sharing models and help stabilize preliminary assessments, especially in emergency care and resource-constrained environments.
The urgent need for innovative cancer therapies has driven increasing interest in repurposing drugs originally developed for non-oncological diseases. Several FDA-approved and clinically investigated agents, including mesalamine, celecoxib, gliclazide, metformin, itraconazole, and doxycycline, have shown anticancer potential through diverse mechanisms. However, despite their therapeutic potential, many of these drugs suffer from limited tumor selectivity, suboptimal bioavailability, and off-target toxicity when used in oncology. Nanocarrier-based delivery systems offer a promising strategy to address these limitations by improving drug solubility, enhancing tumor accumulation, and enabling more selective delivery to cancer cells and the tumor microenvironment. In this context, nanocarriers not only serve as delivery vehicles but also provide opportunities for controlled release, combination therapy, and stimulus-responsive treatment strategies. This review summarizes recent progress in repurposing non-oncologic drugs for cancer therapy with a particular focus on nanocarrier-enabled delivery approaches. We discuss the molecular mechanisms underlying the anticancer activity of repurposed drugs, as well as their targeting of tumor cells, the tumor microenvironment, and cancer stem cells. In addition, we highlight advances in integrating these agents into nanocarrier platforms for combination therapy, photodynamic therapy, dual-drug delivery, and stimuli-responsive systems. Finally, we address translational challenges, including regulatory and intellectual property considerations, and discuss future perspectives involving artificial intelligence and personalized medicine to accelerate clinical implementation.
Neoadjuvant systemic therapy (NST) enables early systemic disease control and assessment of treatment response in breast cancer. Survival after NST may also be influenced by subsequent local-regional treatment. We evaluated clinical and selected nonclinical factors associated with survival among Brazilian women treated with NST followed by surgery and radiotherapy. This subanalysis of the LACOG 0115 Amazona III cohort included women aged ≥18 years with nonmetastatic breast cancer treated with NST, surgery, and radiotherapy at 22 Brazilian centers from 2016 to 2018. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier methods and assessed using multivariable Cox regression. Among 2,972 enrolled patients, 582 met inclusion criteria. Median age was 49 years; 74.1% were treated in the public health care system, 57.2% were non-White, and 58.9% had stage III disease. Stage III disease was associated with worse OS (hazard ratio [HR], 1.96; 95% CI, 1.05-3.70; P = .034) and DFS (HR, 1.69; 95% CI, 1.02-2.86; P = .041) compared with stage II disease. Absence of pathologic complete response was associated with inferior OS (HR, 3.53; 95% CI, 1.27-9.77; P = .015) and DFS (HR, 2.24; 95% CI, 1.11-4.52; P = .024). Educational level, race, and insurance status were not independently associated with OS or DFS. Tumor stage and achievement of pathologic complete response were the principal independent prognostic factors. Socioeconomic and health care-related variables were not independently associated with survival after adjustment.
The sacroiliac joint (SIJ) is a critical anatomic structure that connects the axial skeleton with the lower limbs. Compared with its adult counterpart, the pediatric SIJ exhibits unique anatomic features, and imaging evaluation may then present significant challenges due to overlapping features between normal developmental manifestations, anatomic variants, and true pathologic conditions. Two frequently observed developmental findings can resemble pathologic conditions: subchondral irregularities and subchondral flaring. These are commonly seen on MR images of the developing pelvis. A diverse range of anatomic variations has been documented in both the cartilaginous and ligamentous components of the SIJ. Though overall innocuous, some variations are linked to mechanical overload and pain. True sacroiliitis can arise from inflammatory, infectious, or traumatic causes. Inflammatory conditions may exhibit similar imaging characteristics and are best differentiated through MRI. The presence of unilateral sacroiliitis should prompt consideration of an infectious cause, with imaging indicators such as capsular edema and abscess formation suggesting infection. Traumatic injuries to the SIJ are uncommon in children and usually occur in the context of high-energy trauma. Mechanical overload or repetitive stress in the pediatric population can result in bone marrow edema in the weight-bearing regions of the SIJ and, less commonly, in sacral stress fractures, most often involving the sacral ala. It is crucial to accurately differentiate these imaging features to avoid functional impairments, morbidity, and unnecessary interventions. The authors aim to enhance radiologists' understanding of the pediatric SIJ by examining its unique anatomic characteristics, key imaging features, and pertinent differential diagnosis. © RSNA, 2026 Supplemental material is available for this article.
Background: Breast cancer treatment is often hampered by the immunosuppressive tumor microenvironment (TME). To improve therapeutic efficacy, this study developed a folic acid-chitosan (FA-CS)-modified liposomal formulation co-delivering doxorubicin (DOX) and resiquimod (R848) for combined chemotherapy and immune modulation. Methods: The FA-CS-R848/DOX@Lip liposomes were prepared by rotary evaporation and characterized for morphology, particle size, zeta potential, drug encapsulation efficiency (EE), drug loading (DL) capacity, and drug release profiles. Cellular uptake and cytotoxicity were determined to assess the biological effects of the formulation. Antitumor efficacy and biosafety were assessed in an EO771 tumor-bearing mouse model. The macrophage phenotype, TME composition, and CD8+ T cell cytotoxic function were evaluated by flow cytometry. Results: The FA-CS-R848/DOX@Lip exhibited a relatively uniform spherical morphology, with an average size of 221.53 nm and a zeta potential of 5.06 mV. The EE (%) of R848 and DOX were over 70% and 80%, respectively, while the DL (%) capacities were 4.6% and 3.1%. Drug release studies showed a slow release profile. In vitro, FA-CS-R848/DOX@Lip showed greater cytotoxicity than non-targeted liposomes (p < 0.01) and higher uptake in EO771 cells and RAW264.7 macrophages. In vivo, treatment with FA-CS-R848/DOX@Lip significantly inhibited tumor growth compared with saline (p < 0.0001) without causing significant hematological or biochemical toxicity (p > 0.05). In addition, FA-CS-R848/DOX@Lip increased the MHC II/CD206 ratio of tumor-associated macrophages (TAMs), elevated the proportions of CD8+ and CD4+ T cells, reduced the proportion of myeloid-derived suppressor cells (MDSCs), and enhanced the percentages of IFNγ+ and Ki67+ CD8+ T cells in vivo. Conclusions: FA-CS-R848/DOX@Lip exerts potent antitumor activity with favorable biosafety in vivo. Its therapeutic effect may be associated with improved immune activation and remodeling of the TME, supporting its potential as a chemo-immunotherapeutic strategy for breast cancer.
To systematically evaluate the diagnostic performance of miRNA panels for endometrial cancer. PubMed, Web of Science, CNKI, Embase, and VIP were searched for eligible studies published through 2025. Study quality was assessed using QUADAS-2. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic curve (AUC) were calculated using Meta-Disc 1.4, Review Manager 5.3, and Stata 17.0. Nine primary studies involving 531 participants and 9 independent diagnostic models were included. The pooled diagnostic score was 4.78 (95% CI: 3.86-5.71), and the pooled DOR was 119.50 (95% CI: 47.49-300.70). The pooled sensitivity and specificity were 0.90 (95% CI: 0.81-0.95) and 0.93 (95% CI: 0.89-0.96), respectively. The AUC was 0.94 (95% CI: 0.92-0.96). Subgroup analyses indicated that geographic region and sample type might contribute to heterogeneity. miRNA panels show good diagnostic accuracy for endometrial cancer, with high sensitivity, specificity, and overall discriminatory ability. However, substantial heterogeneity and methodological limitations require cautious interpretation, and further large-scale prospective studies are needed before routine clinical application.
Terminally ill immigrant patients may wish to return to their homeland to die. However, the challenges and repatriation experiences faced by terminally ill Latinx immigrants who return to their country of origin (COO) remain underexplored. This study examines bereaved caregiver accounts of end-of-life (EOL) care and repatriation experiences of Latinx immigrants who returned to their COO following a terminal diagnosis. Bereaved caregivers were interviewed via telephone. Primary outcomes were patient repatriation prior to death and caregiver perceptions of patient quality of death (QOD). Secondary outcomes included repatriation barriers, symptom burden and management, health-care utilization, and location of death. Caregivers of deceased patients treated at a U.S. urban tertiary medical center from 2013 to 2020 who requested and returned to their COO for death were included. Deceased patient clinical and sociodemographic information was obtained from the chart review. Nineteen caregivers of patients who returned to their COO were included, most (n = 15/19, 78.9%) from the Dominican Republic. Two patients experienced logistical challenges during travel to their COO. None received supplementary nutrition or ventilatory support. Most patients had well-controlled symptoms (12/19 had pain, 11/12 pain was controlled) and died peacefully with dignity (84.2%) at their preferred location (73.7%). Most caregivers reported that their loved one was happy with repatriation (89.5%) and that repatriation improved EOL quality of life (84.2%). QOD was rated favorably (average score of 4.2/5). QOD was favorable after repatriation. Successful repatriation is feasible and an important component of QOD that should be included in goals of care discussions.
Sarcopenia and treatment-related muscle loss are associated with increased toxicity and reduced resilience in cancer patients. HyperSight™ cone-beam CT (CBCT) provides improved soft-tissue contrast compared with conventional CBCT and may enable reliable longitudinal skeletal-muscle monitoring during image-guided radiotherapy (IGRT). This study evaluated the feasibility of HyperSight™ CBCT-based muscle assessment in prostate cancer patients and explored the clinical relevance of intratreatment muscle decline. Eighty-eight patients with non-metastatic prostate cancer were treated on an Ethos® system with HyperSight™ CBCT. Patients received ultrahypofractionated (UHF) or normo-/moderately hypofractionated (NF/MHF) radiotherapy; 28% received androgen-deprivation therapy. Cross-sectional muscle area (CSA) and radiodensity (HU) were assessed on planning CT (PCT) and serial CBCTs (first, second, last fraction [FF, SF, LF]); HU values were z-standardized to subcutaneous fat (zHU). Agreement between PCT and CBCT was evaluated using concordance correlation coefficients (CCC), regression, and Bland-Altman analysis. Longitudinal changes were analyzed using mixed-effects models, and associations with acute genitourinary/gastrointestinal (GU/GI) toxicity (RTOG ≥ 2) using regression models. HyperSight™ CBCT showed excellent agreement with PCT for CSA (CCC = 0.981). The NF/MHF cohort showed a significant longitudinal CSA decline (FF-LF: -153.0 mm², p = 0.021), whereas no significant within-cohort change was observed in UHF. Muscle density (zHU) decreased significantly in both cohorts (NF/MHF: p < 0.001; UHF: p = 0.0017). Weight loss and age were independently associated with zHU change, while no independent predictors of CSA decline were identified. In the NF/MHF cohort, CSA loss > 5% was associated with acute GU toxicity in univariate analysis (OR 4.90, p = 0.033; Fisher's exact p = 0.014), but not after adjustment for age, weight loss, ECOG performance status, and ADT; no associations were found for GI toxicity or in the UHF cohort. HyperSight™ CBCT enables quantitative skeletal-muscle assessment during prostate radiotherapy and detects intratreatment reductions in muscle density, which may represent an early imaging marker of muscle decline. Muscle loss showed an exploratory association with acute GU toxicity in NF/MHF patients in univariate analysis, but not after adjustment. These findings support the feasibility of CBCT-based muscle monitoring and warrant further evaluation in larger cohorts. Not applicable.
Cholangiocarcinoma (CCA) is high prevalent in Asia. Emerging evidence indicates gut and tissue microbiota are involved in CCA carcinogenesis and progression. This study investigated the potential role of gut and tissue microbiota as prognostic biomarkers associated with treatment outcomes in advanced intrahepatic CCA (ICCA) patients. This prospective study comprised two cohorts: hepatocellular carcinoma (HCC) or ICCA patients undergoing surgery or biopsy, and unresectable ICCA patients treated with cisplatin and gemcitabine. Gut bacterial profiles were characterized from pre-treatment fecal samples using 16S rRNA and analyzed with clinical outcomes. Tissue bacterial profiles were determined by real-time qPCR. In 30 ICCA patients receiving chemotherapy, gut microbiota differed based on chemotherapy response, PFS, overall survival, and Opisthorchis viverrini infection. An increase in Acidaminococcus and Sutterella, along with a decrease in NK4A214_group, Lachnospiraceae_FCS020_group, and UCG-010, were associated with poor clinical outcomes. Notably, Intestinimonas levels were significantly associated with less progression of disease within six months (aOR 0.92). Of total 70 patients, bacterial profiles of ICCA and HCC tissues did not significantly differ. Advanced ICCA patients with poor outcomes following chemotherapy exhibited the distinct pattern of gut microbiota, which might be used as potential prognostic biomarkers.
Background and Objectives: Sarcopenia is a major geriatric condition associated with functional decline and adverse outcomes. Cardiac fat depots exhibit metabolic activity and are linked to cardiometabolic risk; however, the extent to which epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) quantified on standard thoracic computed tomography (CT) scans are associated with sarcopenia in older inpatients remains inadequately explored. This study investigated the associations of EAT and PCAT thickness with sarcopenia. Materials and Methods: This is a retrospective observational study using CT data obtained for clinical purposes and routine geriatric assessment data. In this single-center retrospective study, 101 inpatients aged ≥65 years who underwent unenhanced thoracic CT and bioelectrical impedance analysis within 3 months were included. EAT and PCAT thicknesses were measured using standardized methods. Sarcopenia status was based on a previously established clinical diagnosis according to EWGSOP2 criteria. Multivariable logistic regression, body mass index (BMI)-stratified analyses, and ROC curve evaluations were performed. Results: The participants had a mean age of 78.5 ± 7.6 years; 54.5% were female. Fifty-five patients (54.5%) met the diagnostic criteria for sarcopenia. PCAT was significantly thicker in sarcopenic participants relative to non-sarcopenic ones (12.25 ± 2.50 vs. 11.17 ± 2.32 mm, p = 0.028), while no corresponding difference was observed for EAT (p = 0.959). After controlling for age, sex, and BMI, each 1 mm increase in PCAT thickness was independently associated with an increased odds of sarcopenia (OR 1.399, 95% CI 1.133-1.727, p = 0.002). With the addition of the PCAT, the discriminatory power was modest (AUC 0.637 overall and 0.715 for BMI ≥25 kg/m2). In exploratory stratified analyses, the association was numerically larger in the BMI ≥25 kg/m2 subgroup (OR 1.48, p = 0.008); however, the formal BMI-by-PCAT interaction was not statistically significant (p = 0.290), so this subgroup finding is considered hypothesis-generating. Conclusions: PCAT thickness measured on routine non-contrast thoracic CT was associated with prevalent sarcopenia, whereas EAT thickness was not. ROC analyses showed modest discrimination; therefore, any proposed cut-offs should be considered exploratory and require prospective validation and external confirmation before clinical use.