To evaluate the impact of the Canadian Association of Radiologists (CAR) guidelines on MRI surveillance burden for incidental pancreatic cystic lesions compared with Fukuoka guidelines. This retrospective single-center study included 1000 asymptomatic patients aged ≥40 years with incidental pancreatic cystic lesions identified on abdominal MRI between January 2010 and March 2025. Patients with high-risk features, cysts ≥3 cm, or a history of pancreatic cancer were excluded. Surveillance recommendations were retrospectively simulated according to CAR and Fukuoka guidelines. The primary outcome was the mean number of recommended MRI examinations over 5- and 10-year follow-up periods. Comparisons were performed using paired t-tests. A total of 1205 consecutive patients were reviewed between January 1, 2010 and March 31, 2025. Of these, 205 patients were excluded based on study criteria, yielding a final cohort of 1000 patients for analysis. At 5 years, the mean number of recommended MRI examinations was lower under CAR guidelines compared with Fukuoka guidelines (1.45 ± 1.5 vs 3.89 ± 0.99; P < .001). At 10 years, the difference further increased (1.45 ± 1.5 vs 6.23 ± 1.64; P < .001). Application of CAR guidelines is associated with a reduction in MRI surveillance utilization over 5- and 10-year follow-up periods compared with Fukuoka guidelines. These findings have important implications in the setting of MRI resource constraints within the Canadian healthcare system.
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To evaluate the growth, structure, and evidentiary maturity of research related to environmental sustainability in radiology using bibliometric analysis and science mapping. A comprehensive bibliometric analysis was conducted to identify publications related to environmental sustainability in radiology. Performance metrics included temporal trends, publication types, journals, countries, and citation analysis. Science mapping techniques included co-authorship networks and thematic classification. Publications were categorized into non-mutually exclusive domains of mitigation, adaptation, and resilience. A total of 535 publications were included, with a marked increase in annual output after 2019; 54% of all publications were published in 2024 to 2025 alone. Publications had a median of 7 citations (IQR 2-24), with 2720 unique authors and a median of 6 authors per publication (IQR 3-10). Overall, 166 publications (31%) involved international collaboration. The field demonstrated substantial heterogeneity in evidentiary maturity: mitigation accounted for the largest proportion of publications (60%) but a minority were original research (39%), whereas adaptation (41%) was primarily composed of original research (83%) with higher citation impact. Resilience was minimally represented (2%). Publications were distributed across 252 journals, with a core group of journals and collaborative author networks indicating emerging structural consolidation. Environmental sustainability in radiology is a rapidly expanding and increasingly collaborative field. While adaptation research is embedded within broader environmental health literature, mitigation is transitioning toward data-driven implementation, and resilience remains a critical gap. These findings highlight the need to advance implementation-focused research, develop standardized metrics, and prioritize system resilience to support sustainable radiology practice.
This meta-review aims to evaluate meta-analyses on adherence of diagnostic test accuracy (DTA) studies to the STAndards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 checklist. We searched MEDLINE and EMBASE and included reviews using STARD 2015 to evaluate completeness of reporting of primary DTA studies in humans in any field of research and presented their results quantitatively. We extracted data independently, in duplicate. Random-effects meta-analysis models using restricted maximum likelihood estimation were used to determine overall mean and 95% confidence intervals (CI) of adherence to STARD 2015, compare fields of research, and evaluate adherence over time. Subgroup analyses to compare adherence across fields of research (diagnostic imaging, lab/biomarker, and other), were performed with pairwise differences between subgroups tested using meta-regression models with field of research as a categorical moderator. A total of 14 reviews evaluating 1115 primary DTA studies were included. The range of primary studies evaluated in each review was 6 to 158. Included reviews were from Canada (n = 6), Germany (n = 3), Australia (n = 1), USA (n = 2), Spain (n = 1), and South Korea (n = 1). Field of research of included reviews were diagnostic imaging (n = 7), lab/biomarker (n = 4), and other (n = 3). The overall mean STARD 2015 adherence was 53.2% (95% CI: 45.9-60.5). Mean adherence was higher among diagnostic imaging studies (61.7% [95% CI: 56.8-66.6]) compared to lab/biomarker studies (48.5% [95% CI: 33.5-63.4]; P = .02) and other fields of research (39.4% [95% CI: 23.9-54.9]; P < .001). Time trends analysis found that STARD adherence did not change over time (P = .28). Adherence of primary DTA studies to STARD 2015 was evaluated to be incomplete.
These practice guidelines, developed by the Canadian Association for Interventional Radiology (CAIR) and the Canadian Association of Radiologists (CAR) with input from hematology experts, provide evidence informed, practical recommendations for managing bleeding risk during image guided procedures. Building on the 2019 Society of Interventional Radiology guideline, they streamline decision making around anticoagulation, antiplatelet therapy, laboratory testing, and transfusion thresholds for use across Canadian radiology departments. A systematic review of post 2019 evidence and expert consensus-informed updates to procedural risk stratification and clarified INR and platelet thresholds. The guidance emphasizes that most radiologic procedures carry very low bleeding risk and generally do not require routine laboratory screening or interruption of anticoagulant or antiplatelet medications, while high risk procedures warrant targeted testing and standardized transfusion thresholds, including those tailored for chronic liver disease. Special sections address lumbar puncture, arterial access, and urgent or emergent procedures. Overall, the guideline highlights individualized clinical judgment, avoidance of unnecessary delays or consultations, and careful consideration of transfusion risks, with the goal of promoting streamlined, safe, and consistent care across Canadian imaging practices.
Axillary lymphadenopathy following vaccination has long been recognized as a benign, self-limited immune response, but its increased frequency during the COVID 19 vaccination campaign created diagnostic uncertainty and contributed to delays in breast imaging and unnecessary follow-up. Early conservative guidance, issued in the context of limited evidence, led to postponed screening examinations and increased patient anxiety. Since then, robust prospective and longitudinal data have demonstrated an extremely low, near-zero risk of malignancy in asymptomatic patients with isolated ipsilateral axillary lymphadenopathy following recent COVID 19 vaccination and no suspicious breast imaging findings, even when lymphadenopathy persists for many months. In response to this evolving evidence base, the Canadian Association of Radiologists (CAR) and Breast Radiologists of Canada (BRC) have developed updated, evidence-based recommendations for the management of axillary lymphadenopathy following COVID 19 vaccination. These recommendations emphasize that breast imaging examinations should not be delayed because of vaccination, outline the importance of documenting vaccination history, and provide clear guidance for classifying and managing ipsilateral, contralateral, palpable, and persistent lymphadenopathy across breast imaging modalities. Special considerations for patients with a personal history of breast cancer or other malignancies are also addressed. Adoption of these recommendations is intended to promote consistent national practice, reduce unnecessary imaging and biopsy, support patient reassurance, and maintain the effectiveness of breast cancer screening programs.
The primary outcome of this study was to determine the cancer detection rate (CDR) of surveillance mammography in the autologous reconstructed breast post mastectomy. In this research ethics board approved retrospective study, chart review was performed at a single academic centre to identify women who had undergone mastectomy with AR who underwent annual mammography surveillance of both ipsilateral (reconstructed) and contralateral breasts with a minimum 1 year of clinical and imaging follow-up between 2012 and 2020. Clinical information, imaging, method of detection, pathology and immunohistochemical findings, location of ipsilateral malignancy, and the interval between mastectomy and loco-regional recurrence (LRR) were calculated. The CDR of surveillance mammography, interval cancers, abnormal recall rate (ACR), and PPV1, PPV2, and PPV3 were determined. We included 2127 screening examinations in 371 patients median age was 58 years (25-86 years). The average number of screens per patient was 5.73 (range: 1-17). No screen-detected cancers (CDR 0/1000) were identified in the ipsilateral breast for an abnormal recall rate of 0.42% (9/2127) and 3 benign biopsies. Three interval cancers were detected clinically in the ipsilateral breast. No benefit was found for surveillance mammography and detection of non-palpable cancers in autologous reconstructed breasts post mastectomy in this study. Further multicentric studies with larger number of patients may be needed for confirmation of lack of benefit.
Breast arterial calcifications (BAC) are associated with increased cardiovascular risk and have been correlated with other methods of cardiovascular risk stratification. BAC are present in 12% to 43% of patients who undergo screening mammography, with incidence increasing with advancing age. BAC are also positively correlated with multiparity, menopausal status, metabolic syndrome, hyperlipidemia, hypertension, diabetes, and chronic renal disease. There are multiple methods to identify and quantify BAC including visual binary assessment, subjective severity grading, digital measurement and quantification, and artificial intelligence-based models. BAC reporting on mammography is heterogeneous across Canada, Europe, and the United States of America. North American survey studies suggest that referring physicians and patients prefer to be informed of the presence of BAC on mammography. Given the overlap in populations of perimenopausal and postmenopausal women at risk for cardiovascular disease and those undergoing screening mammography, there is an opportunity to use BAC to identify women at increased cardiovascular risk, particularly as current cardiovascular risk assessment models are known to underserve this population.
Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy arising from the adrenal cortex. This tumor shows suggestive imaging features on computed tomography (CT), which include a large size, internal heterogeneity and various degrees of internal necrosis. Accurate characterization of ACC with imaging is essential to ensure prompt and appropriate management and avoid useless biopsy or delayed surgery. Magnetic resonance imaging (MRI) provides additional information with respect to the internal content of ACC by comparison with CT. Recent studies evaluating the capabilities of radiomics have shown encouraging results in the characterization of ACC and differentiation from other adrenal masses. Surgical resection remains the primary treatment for localized ACC. Complete surgical resection (i.e., R0 resection) offers the best chance for long-term survival for patients with ACC. Preoperative planning with imaging should be performed to identify local extent of ACC into the liver, the ipsilateral kidney, and the inferior vena cava as well as to exclude distant metastases. A precise preoperative assessment is critical to anticipate the radicality of surgery and best manage potential surgical complications. This review article aims to provide a thorough overview of the current role of CT and MRI in the diagnosis and preoperative planning of ACC.
Nondiagnostic results after thyroid fine-needle aspiration (FNA) are common and may delay diagnosis. To identify demographic and sonographic predictors of nondiagnostic cytology at repeat thyroid FNA and to report malignancy rates in this group. Single-center retrospective cohort including consecutive adult patients who underwent repeat ultrasound-guided FNA of thyroid nodules with prior nondiagnostic cytology (Bethesda I) between 2015 and 2023. Nodule-level ultrasound features were extracted from structured reports. The primary outcome was nondiagnostic cytology at repeat FNA. Multivariable logistic regression with generalized estimating equations was used to account for clustering of nodules. A total of 208 patients with 242 thyroid nodules were included. On repeat FNA, 77 of 242 nodules (31.8%) remained nondiagnostic. In multivariable analysis, older age (odds ratio [OR] per year, 1.03) and nodule composition were independently associated with a nondiagnostic result at repeat FNA. Solid nodules had lower odds of a nondiagnostic result than cystic or mixed cystic-solid nodules (OR, 0.30). Patient sex, maximum diameter, echogenicity, echogenic foci, calcifications, shape, and margins showed no significant association. Cytology suspicious for or diagnostic of malignancy (Bethesda V-VI) was found in 4 nodules (1.6%); however, this estimate may be affected by verification bias. Approximately one-third of nodules remained nondiagnostic at repeat FNA. Older age and cystic or mixed nodule composition were independently associated with a higher risk of repeat nondiagnostic cytology. Alternative diagnostic strategies (eg, rapid on-site evaluation, core-needle biopsy, or surveillance) can be considered early in the diagnostic workup of these nodules.
Hepatocellular carcinoma (HCC) has an uneven global distribution and a higher incidence in males. The Liver Imaging Reporting and Data System (LI-RADS) is a standardized imaging framework for HCC diagnosis. It is unclear whether the evidence used to inform LI-RADS reflects the global burden of HCC. To determine whether the geographic and sex distribution of studies assessing LI-RADS and those included in the LI-RADS individual participant data (IPD) database reflect the global burden of HCC. We conducted a cross-sectional meta-research study comparing the country- and sex-specific HCC prevalence from GLOBOCAN 2022 with the distribution of studies eligible for and included in the LI-RADS IPD database. Studies were identified through a systematic search of 4 databases. OSF page. We identified 470 eligible studies including 98 014 patients; of these, 76 studies comprising 11 924 patients were included in the IPD database. Asian and African countries, excluding Republic of Korea, were underrepresented in both the eligible and the IPD dataset. North America was overrepresented. Female patients were under-represented in LI-RADS eligible studies (Z = -21.95, P < .0001) and in studies included in the IPD (Z = -9.02, P < .0001) compared to the global prevalence of HCC in females. LI-RADS research is disproportionately reported from some countries relative to HCC burden. Asia, Africa, and female patients remain underrepresented. This may affect the generalizability and diagnostic equity of the LI-RADS system and underscore the need for improved global inclusivity in LI-RADS research.
Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological disorder characterized by the triad of gait disturbance, cognitive decline, and urinary dysfunction in association with ventriculomegaly and normal or mildly elevated cerebrospinal fluid (CSF) pressure. Although first described by Hakim in 1957, the condition remains underdiagnosed, partly because its clinical manifestations are common in the elderly population and are often attributed to more prevalent age-related conditions. The pathophysiology of iNPH is complex and incompletely understood, involving alterations in CSF dynamics, reduced vascular compliance, periventricular ischemia, and dysfunction of the glymphatic system, potentially leading to the accumulation of neurotoxic metabolites and neuronal impairment. Neuroradiological studies, particularly MRI, play a central role in diagnosis. MRI is essential to exclude alternative causes of ventriculomegaly and to identify characteristic imaging features such as a reduced callosal angle and the disproportionately enlarged subarachnoid space hydrocephalus (DESH) pattern, which support the diagnosis, although their predictive value for treatment response remains limited. Complementary non-imaging tests are often required to identify patients most likely to benefit from CSF shunting. Recent MRI advances have introduced biomarkers of glymphatic dysfunction, such as diffusion tensor imaging along perivascular spaces (DTI-ALPS), which may improve understanding of disease mechanisms and refine patient selection. Early recognition and accurate imaging assessment are crucial, given the potential reversibility of symptoms after shunt surgery.
Acute non-traumatic urinary tract emergencies are a frequent cause of emergency department presentation and may result in significant morbidity if not promptly diagnosed. Imaging plays a pivotal role in identifying the underlying pathology, assessing disease severity, and guiding patient management. This review provides a comprehensive imaging-based overview of the most common acute non-traumatic urinary tract emergencies. Obstructive, infectious, vascular, and hemorrhagic conditions, as well as urinary leaks, are discussed with emphasis on their characteristic imaging findings. The roles of ultrasound, computed tomography, and magnetic resonance imaging are reviewed, highlighting appropriate modality selection in the emergency setting. In addition, the emerging role of photon-counting computed tomography (PCCT) is discussed. Owing to its improved spatial resolution, enhanced tissue contrast, and spectral imaging capabilities, PCCT may allow better detection of subtle parenchymal abnormalities, small calculi, vascular alterations, and urinary leaks, while potentially enabling dose optimization. Key diagnostic features, common pitfalls, and practical reporting considerations are presented to assist radiologists in achieving timely and accurate diagnoses. This review aims to support a systematic and clinically relevant imaging approach to acute non-traumatic urinary tract emergencies.
Negative appendicectomies in children can be associated with morbidity. MRI has become a radiation-free alternative to CT to assist in the diagnosis of paediatric appendicitis, particularly when ultrasound is equivocal. A systematic review and meta-analysis were performed to assess the diagnostic accuracy of MRI for paediatric appendicitis and its role in reducing negative appendicectomy rates (NAR). Searches were performed across PubMed, Embase, Cochrane Library, Scopus, Web of Science, for studies from 1 January 2000 to 31 July 2025. The inclusion criteria were studies of children (<18 years) with suspected appendicitis undergoing MRI. Bivariate random-effects meta-analyses were performed. Meta-regression explored the impact of covariates for example, DWI, contrast use, image reviewer blinding, and magnetic field strength. Twelve studies (n = 3242) met inclusion. Pooled MRI sensitivity was 96.7% (95% CI: 93.4%-98.9%), specificity 97.9% (95% CI: 95.6%-99.3%). MRI NARs ranged from 0.66% to 11.1%, with 3/12 studies reporting NARs <5%. Meta-regression showed non-significant associations between NAR and DWI use (+3.12%, P = .264), MRI contrast use (-5.64%, P = .110), and magnetic field strength (-1.63% per Tesla, P = .361). No significant publication bias was detected (Deeks' P = .152). MRI demonstrates high diagnostic accuracy and is associated with low negative appendicectomy rates in children. Its use is particularly effective where ultrasound/clinical findings are inconclusive as MRI overcomes ultrasound limitations, poor appendix visualisation, operator-dependence, and inability to exclude alternate diagnoses. Given its radiation-free nature and CT-like diagnostic performance, wider adoption of MRI within paediatric appendicitis pathways may help avoid surgery and reduce exposure to ionising radiation.
The carbon footprint of imaging equipment in radiology is high, but the impact of patient travel for imaging is unclear. This study aimed to quantify distances traveled by ambulatory patients for outpatient MRI, determine the proportion traveling beyond their nearest MRI facility, and estimate the associated excess carbon dioxide equivalent (CO2e) emissions. With research ethics board approval, we retrospectively analyzed provincial MRI data from 2023. Distances from patient home address to the nearest and attended MRI facilities were calculated. CO2e estimates were derived using an online tool (www.carbonfootprint.com/calculator.aspx) with average vehicle size and emissions. In 2023, 40 062 provincial MRI scans were performed; isolating single visits for adult patients yielded 27 755 data points. Of these, 19.5% (n = 5400) traveled beyond their nearest MRI facility. Mean round-trip travel was 60.4 km for those attending their nearest site versus 295.6 km for those traveling further (P < .0001). The excess travel produced ~288 metric tons of additional CO2e, equivalent to emissions from 61 large-size gasoline-powered cars driven for 1 year or carbon sequestered by 4762 tree seedlings grown for 10 years. Nearly one-fifth of patients traveled farther than necessary for MRI, generating substantial avoidable emissions. Aligning MRI service distribution with population density could lessen the environmental impact of medical imaging.
Traumatic pancreatic injuries are uncommon but are associated with high rates of morbidity and mortality. Early detection is key for patient prognosis and clinical management, specifically as it relates to injuries to the main pancreatic duct (MPD). The 1990 version of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) presumed involvement of the MPD for lacerations spanning greater than 50% of pancreatic parenchymal depth on trauma computed tomography (CT) imaging. However, CT lacks specificity and sensitivity for MPD injuries. As such, the 2024 AAST-OIS revision for pancreatic injuries places increased emphasis on MPD evaluation with more sensitive modalities for duct injury, such as endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography. The goal of the 2024 revision is to improve concordance between pancreatic injury grade and patient outcomes, as well as to provide a more accurate description of injury to enhance the quality of future pancreatic trauma research. In this review, we will discuss the new 2024 AAST-OIS updates to pancreatic trauma grading, relevant pancreatic anatomy, incidence, mechanisms, imaging appearance and complications of pancreatic trauma, as well as opportunities for future avenues of study.
Radiology is among the most capital-intensive specialities in healthcare, relying on high-cost imaging equipment, complex information technology infrastructure, long-term vendor contracts, and increasingly, artificial intelligence systems. Decisions about these resources shape patient access, diagnostic quality, workforce sustainability, and the long-term resilience of imaging services. Despite this, most radiologists receive little formal training in key financial concepts, and financial decision-making is often perceived as external to clinical practice. This article positions foundational financial reasoning as a core competency for radiologists, introducing key concepts from financial management, including: liquidity, leverage, efficiency, profitability, risk, and capital budgeting, and translating them into clinically meaningful frameworks relevant to radiology. Using practical examples and mini-cases, this article demonstrates how commonly used financial ratios and investment appraisal tools can be interpreted as diagnostic tools for organisational health rather than abstract accounting exercises. Interpreting financial metrics as an integrated system rather than as isolated indicators is important in demonstrating how short-term resilience, long-term commitments, operational efficiency, and sustainability interact in real-world radiology decision-making. Extending this framework to the measurement of value beyond volume and revenue, highlighting the potential role of patient-reported outcome measures (PROMs), as well as the relevance of implementation science and change management, is important in ensuring that financially sound investments deliver meaningful clinical impact. By equipping radiologists with a shared language and conceptual toolkit for engaging with financial decisions, this article aims to strengthen clinical leadership, support transparent resource allocation, and promote resilient, high-value imaging services aligned with patient-centred care.
Local tumor progression (LTP) after percutaneous ablation of small renal cell carcinoma (RCC) is suspected when new enhancing or enlarging soft tissue appears within the ablation zone. Benign post-treatment changes can mimic this finding. This study compares the incidence and imaging characteristics of non-malignant changes (NMC) versus LTP after renal ablation. In this single-center, retrospective study, all patients with RCC treated with radiofrequency ablation (RFA) from February 2004 to May 2016 were identified. Post-ablation imaging reports from through May 2017 were reviewed to detect findings suspicious for LTP. Patients with suspicious findings underwent clinical, imaging, and histopathologic follow-up through May 2025 to determine the reference diagnosis. Imaging features were categorized by morphology, location within the ablation zone, and enhancement pattern. Among 256 patients (mean age 65.6 years ± 10.8, 193 men) with 268 treated tumors, 18 tumors (6.7%) developed suspicious imaging findings. Eight tumors (3.0%) were classified as NMC and 10 tumors (3.7%) as LTP. NMC had significantly lower CT enhancement than LTP (31 vs 152 HU, P < .001). Lesions along the renal parenchymal margin were exclusively associated with LTP (9/9), whereas abnormalities at the extrarenal margin or centrally within the ablation zone were predominantly NMC (8/9). Enhancement with washout was seen only in LTP. Non-malignant post-ablation changes can mimic LTP and occur with similar frequency. Imaging features can help differentiate benign changes from local tumor progression and reduce unnecessary re-interventions.