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The aim of this consensus statement was to develop evidence-based recommendations on perioperative fasting, taking the growing global awareness of the negative effects of prolonged fasting before surgery into account, particularly with respect to clear liquids. A systematic literature search was conducted, including assessments of the risk of bias and the overall level of evidence using GRADE methodology to develop 13 preliminary recommendations on perioperative fasting. This was followed by a 3-stage Delphi process involving an international, multidisciplinary panel of 68 experts and nonexperts. Experts on perioperative fasting were selected via a focused literature search, while nonexperts were selected via relevant organizations. The panel comprised anesthetists, surgeons, nurses, cardiologists, gastroenterologists, other physicians, patient representatives and members of international organizations related to the topic, including patient safety organizations and enhanced recovery after surgery (ERAS) societies. The panel of 68 stakeholders subsequently agreed on 8 recommendations. These recommendations are intended for all healthcare professionals as guidance for perioperative fasting in adults undergoing sedation or anesthesia. The consensus statement supports current preoperative fasting practices for solid food and non-clear liquids, reflecting the lack of meaningful new evidence. Patients should fast for 6h with respect to non-clear liquids, including milk, milk products, meal replacement drinks and enteral feeding formulas. They should fast for at least 6h with respect to solid food; for large fatty meals fasting for 8h or longer may be necessary; however, with respect to clear liquids it reflects a fundamental shift towards more liberal liquid regimens. It is recommended that institutional protocols should be implemented to reduce liquid fasting times. These protocols can either encourage patients to drink clear liquids until 2 h before the start of anesthesia or sedation or permit the intake of clear liquids less than 2 h before the start of anesthesia or sedation within institutional protocols. Clear liquids include water, tea or coffee with sugar or honey (including a small amount of milk, up to one fifth of the total volume), clear juices, lemonade and clear carbohydrate drinks. The consensus statement further recommends that oral intake should be resumed as soon as clinically feasible and that preprocedural gastric ultrasound performed by a trained provider can be used to guide clinical decisions when additional information is required. These consensus-based recommendations are not an official guideline issued by any national or international professional society. Nevertheless, they are currently regarded as the most comprehensive and up-to-date review of the available evidence, based on robust methodology. The broad international consensus suggests that the recommendations published in Die Anaesthesiologie provide a reliable basis to improve the quality of patient care by minimizing periprocedural fasting times, within safe margins. To achieve this, preoperative liberal clear liquid regimens can be implemented with institutional protocols. EINLEITUNG: Ziel des vorgestellten Konsensus-Statements war es, evidenzbasierte Empfehlungen zur perioperativen Nüchternheit zu entwickeln, die dem weltweit wachsenden Bewusstsein für die negativen Auswirkungen verlängerter präoperativer Karenzzeiten – insbesondere für klare Flüssigkeiten – Rechnung tragen. Auf Grundlage einer systematischen Literaturrecherche wurden 13 vorläufige Empfehlungen zur perioperativen Nüchternheit entwickelt. Von diesen wurden nach Überarbeitung in einem dreistufigen Delphi-Prozess durch ein internationales, multidisziplinäres Gremium 8 Empfehlungen konsentiert. Insgesamt nahmen 68 Vertreter:innen verschiedener Interessengruppen – darunter Patient:innen, Anästhesist:innen, Chirurg:innen, Ärzt:innen weiterer Fachrichtungen, Pflegekräfte sowie Mitglieder:innen relevanter internationaler Organisationen – aus 5 Kontinenten teil. Das Konsensus-Statement bestätigt im Wesentlichen die Empfehlungen früherer Leitlinien zu nichtklaren Flüssigkeiten, fester Nahrung, Kaugummi und postoperativer oraler Nahrungsaufnahme. Hinsichtlich klarer Flüssigkeiten spiegelt es jedoch ein grundlegendes Umdenken hin zu liberaleren Flüssigkeitsregimen wider. Es wird empfohlen, institutionelle Protokolle zur Verkürzung der Flüssigkeitskarenzzeiten zu implementieren. Diese können entweder eine feste Mindestkarenzzeit von 2 h vor dem Eingriff vorsehen oder das Trinken klarer Flüssigkeiten bis zum Abruf in den OP erlauben. Diese internationale, multidisziplinäre Konsenserklärung zielt darauf ab, die Qualität der Patientenversorgung zu verbessern, indem präoperative Nüchternheitszeiten innerhalb sicherer Grenzen minimiert werden. Die Umsetzung liberalisierter präoperativer Flüssigkeitsempfehlungen durch klar definierte institutionelle Protokolle stellt hierfür einen zentralen Ansatz dar.

We present RadGazeGen, a framework for integrating experts' eye gaze patterns and radiomic feature maps as controls within text-to-image diffusion models to enable high-fidelity medical image generation. Although recent text-to-image diffusion models have achieved impressive success, textual descriptions alone often fail to capture disease-specific details necessary for generating clinically accurate and anatomically faithful images. To address these limitations, RadGazeGen leverages radiologists' eye gaze trajectories and radiomics feature descriptors as spatial and semantic controls in the diffusion process. Eye gaze patterns encode visuo-cognitive attention and spatial localization of subtle disease cues, whereas radiomics features capture subvisual phenotype characteristics such as texture, intensity, and shape. By combining these multimodal cues, the proposed framework guides the generative model toward anatomically consistent and disease-aware image synthesis. The quality of the generated images were evaluated using a board-certified radiologist. RadGazeGen was evaluated on the REFLACX dataset for image generation quality and diversity. Furthermore, to assess its downstream clinical utility, the generated images were used for disease classification tasks on the CheXpert test set ( n = 500 ) and for long-tailed learning evaluation on the MIMIC-CXR-LT test set ( n = 23,550 ), demonstrating high fidelity and diagnostic relevance of the synthesized images. By jointly conditioning on gaze and radiomic representations, RadGazeGen bridges the gap between human visual cognition and machine perception, improving both realism and clinical validity in medical image generation. This framework underscores the importance of incorporating anatomically grounded and disease-aware controls in diffusion-based medical image synthesis.

IntroductionHealthcare contributes 4-6% of global CO2 emissions due to energy use, pharmaceuticals, and waste. Ophthalmology plays a significant role, particularly in managing dry eye disease (DED), which is a leading cause of eye care visits. DED affects up to 50% of people worldwide, with its incidence increasing with age, climate-related factors, and screen use. This study aims to gather insights from DED experts on their opinions toward sustainability in ophthalmic care.MethodsAn online survey was distributed to attendees of the European Dry Eye Society conference, running from June to September 2024. The survey consisted of 10 questions related to sustainability practices in DED management. Data on demographics were collected and analyzed using percentages.ResultsOf the 372 respondents, 83.7% expressed concerns about global warming, and 78.5% believed that ophthalmic care produces excessive waste. Most respondents (79.7%) considered that single-use preservative-free vials generate significantly more waste than multidose alternatives. Additionally, 89.2% supported recycling methods. Ophthalmologists also recognized the rising impact of digital eye strain and saw potential in using apps to manage DED more sustainably.ConclusionsThe survey highlights a strong consensus among DED experts about the need for more sustainable practices in ophthalmology. Key findings include concerns about waste, especially from single-use vials, and the potential for digital solutions to improve sustainability in DED management. The results suggest an opportunity to integrate environmentally friendly actions into ophthalmic care.

Stroke is a challenging global public health concern, disproportionately affecting people in rural communities. Stroke care is challenging in low and middle-income countries as it requires a coordinated multidisciplinary approach integrating pre-hospital recognition; acute stroke care, and long-term rehabilitation. Multiple barriers exist in LMICs: lack of community awareness; geographical and financial barriers; poor health systems; absence of standardized care pathways; and inadequate training among primary health care workers. Based on this background, this descriptive implementation-focused retrospective program evaluation describes the implementation and early impact of a collaborative, telemedicine supported multi-component health system intervention for stroke care in a rural government hospital in Nepal. A non-government organization "Nepal Stroke Project (NSP)" partnered with Province Hospital Surkhet (PHS), a community-based tertiary center in remote western Nepal strengthening the stroke care capacity in the region via formation of a multidisciplinary stroke team, infrastructure development and capacity strengthening. NSP experts also provided telemedicine supported clinical guidance to the local stroke team through free digital platform such as WhatsApp. The program evaluation was guided by the RE-AIM framework and interpreted through a health systems strengthening perspective. Baseline assessment identified major system-level barriers, including the absence of a dedicated stroke pathway, thrombolysis services, stroke-specific infrastructure, and specialist support. Following implementation, annual stroke admissions increased from 154 to 178 cases per year, and 10 healthcare personnel were trained. Intravenous thrombolysis, previously unavailable, was successfully administered to two patients, supported by telemedicine-guided decision-making and subsequent ICU transfer. Over the implementation period, 20 stroke patients received telemedicine consultations, routine stroke pathway activation was achieved for thrombolysis cases, and NIHSS documentation improved from absent at baseline to approximately 50% of cases. Service readiness was further strengthened through establishment of two dedicated stroke beds and provision of essential monitoring equipment. The collaborative model has a potential for sustainable impact by strengthening long term capacity building, and enabling the local team to deliver comprehensive stroke care independently. This implementation model highlights the importance of maximizing existing resources through task-shifting, integrating stroke care within existing health systems, and fostering local ownership to ensure sustainability.

Mental health and substance use-related emergency department visits are increasingly common among youth (ages 12-24 years); however, there are no standards or guidelines for providing quality care and referral to appropriate services. Based on existing evidence and insights from a technical committee of 14 Canadian experts (youth, caregivers, service providers and decision-makers), we outline four key priority areas for improving care in emergency department settings and recommendations for implementation. This includes improving the care environment; appropriate and timely mental health and substance use assessment; treatment based on youths' goals, needs, preferences and circumstances; and referral to appropriate services.

The advent of bioceramic materials has shifted the focus of conservative dentistry and endodontics from passive restorations to active biological tissue repair. This position statement is developed by the panel of experts in conservative dentistry and endodontics based on the symposium on bioceramics in conservative dentistry and endodontics at the 39th Indian Association of Conservative Dentistry and Endodontics National Conference, Jio World Convention Centre, Mumbai, November 28 to December 1, 2024, outlining the available literature regarding clinical applications and future directions for bioceramic materials and their role as material of choice in vital pulp therapy procedures, apexification, perforation repair, and regenerative endodontics. Their superior properties, including but not limited to biocompatibility, bioactivity, antimicrobial effects, and hard-tissue formation, have made clinical outcomes more predictable with materials such as mineral trioxide aggregate and other newer formulations of calcium silicate. The development of premixed, light-cured, and resin-modified bioceramics has improved the handling characteristics while also sustaining the biological performance. This statement highlights context-specific considerations in India, including the Indian climate and the factors affecting material selection, while underscoring the need for standardization guidelines and multicentric research. While bioceramics symbolize a significant advancement in dental materials and clinical practice, their rational and evidence-based application remains crucial to enhance clinical outcomes and long-term success.

The aim of this study was to assess the quality and readability of ChatGPT and Gemini's responses to frequently asked questions about early intervention for individuals with at-risk infants. Ten frequently asked questions about early intervention were selected by three researchers (a child development specialist, a physiotherapist, and a midwife) from a list generated by ChatGPT and Gemini. Questions were sent to ChatGPT version 4.0 and Gemini 1.5, and initial responses were recorded without follow-up queries. Ten independent experts (two special education specialists, two child development specialists, two physiotherapists, two midwives, and two pediatricians) The quality of ChatGPT and Gemini's responses was assessed using a four-grade rating system. Readability levels were analyzed using the Flesch-Kincaid Grade Level through WordCalc software. One of the answers given by ChatGPT was of higher quality than Gemini (p=0.025), while one answer given by Gemini was of higher quality than ChatGPT (p=0.033). The answers to the other questions were of similar quality, with Gemini having a lower level. This study compares the quality and readability of the answers given by artificial intelligence-based language models to demonstrate their potential to appeal to different user groups. While the models generally provided answers of similar quality, quantitative differences in readability were observed, suggesting potential suitability for different audiences. These findings contribute to understanding the role of AI tools in health communication.

Early-phase oncology trials involve complex protocols and extensive documents, making timely resolution of study queries challenging. We developed the Study Document Assistant (SDA), a retrieval-augmented generation (RAG) system that integrates semantic search with large language models to generate context-specific answers from clinical trial documentation. SDA processes study documents and delivers responses through a secure, conversational interface. A two-arm experiment was conducted in which sponsor clinical study team members answered protocol-related queries either with or without SDA. Questions were stratified by difficulty and assessed by blinded subject matter experts (SMEs) and artificial intelligence (AI) models. The primary endpoint was mean response time. Main secondary endpoints included response time as a time-to-event outcome and overall accuracy. SDA user satisfaction was also assessed. Data were analyzed using Welch t-test for the primary endpoint, Kaplan-Meier method and log-rank test for time-to-event analysis, Mann-Whitney U test for accuracy, and descriptive statistics for satisfaction. In the experiment (N = 10 per arm), SDA users achieved a mean response time of 14.9 [95% confidence interval (CI) 9.3-20.6] versus 26.5 (95% CI 16.8-36.1) minutes in controls, corresponding to a 43.8% reduction (95% CI 11.9% to 64%, P = 0.0347). A similar reduction for median time to response was observed. Accuracy, measured as the median SME score (scale 1-4), was ∼3 ("Mostly Correct") for both arms, with no statistically significant difference. Evaluation by AI models showed similar results. Our findings demonstrate that SDA accelerates query resolution without compromising answer quality, highlighting the potential of RAG-based digital assistants to streamline clinical trial operations and enhance research efficiency.

Children and adolescents frequently experience fractures related to accidental injuries; however, fractures may also result from non-accidental trauma in abused children or from underlying bone fragility due to primary or secondary osteoporosis. In pediatric patients with fragility fractures diagnosis and treatment may be delayed. This document aims to provide clinicians with a practical approach to the diagnosis and management of fragility fractures in children and adolescents. Between November 2024 and June 2025, a group of Italian pediatric endocrinologists with expertise in bone and mineral metabolism held regular online meetings to discuss key issues related to the diagnosis and management of pediatric bone fragility and developed experts opinion statements based on clinical experience and a review of the relevant literature. The expert panel formulated consensus statements on the clinical management of children and adolescents with fragility fractures. Seven main areas were addressed: 1) definition of fragility fractures and pediatric osteoporosis; 2) diagnostic approach; 3) main causes of primary and secondary osteoporosis; 4) assessment of the potential for spontaneous recovery from bone fragility; 5) management of bisphosphonate therapy; 6) other therapeutic options; 7) conservative measures. The diagnosis of osteoporosis in pediatric patients should follow a clinically oriented approach. Genetic testing plays a crucial role in identifying primary forms of osteoporosis. Vertebral reshaping may occur in some patients with secondary osteoporosis. Bisphosphonates represent the mainstay of treatment in children and adolescents with bone fragility. Conservative measures aimed at optimizing bone strength may be beneficial in selected cases.

Existing skin health assessments predominantly focus on single topics or diseases, making it difficult to cover the complete "Knowledge-Self-efficacy-Attitudes-Behaviors (KSAB)" continuum. To develop and validate a skin health knowledge, attitudes, and behaviors questionnaire for the general population. A cross-sectional online survey was conducted among the general population between October and November 2025. The questionnaire was developed based on a conceptual structure incorporating four dimensions: knowledge, self-efficacy, attitudes, and behaviors. Content validity was assessed by 13 experts, and the Item-level Content Validity Index (ICVI) and modified Kappa (K*) were calculated. Construct validity was examined using confirmatory factor analysis (CFA). Item-level evaluation was performed using item response theory (IRT), including the two-parameter logistic (2PL) model for dichotomous items and the graded response model (GRM) for ordered items. A total of 865 individuals were enrolled (men: women = 1.24:1). Content validity was good (ICVI = 0.846-1.000, K* = 0.845-1.000). The five-factor model from CFA showed a good fit (CFI = 0.969, TLI = 0.960, RMSEA = 0.070, SRMR = 0.095). IRT analysis indicated that K1-K5 had acceptable discrimination (a = 0.59-2.40) and difficulty parameters ranging from -3.63 to -1.33. However, items K6, K7 and S1 were excluded due to insufficient threshold coverage. The proportion of women reporting frequent sunscreen use was higher than that of men. Self-efficacy levels showed a decreasing trend with age. Furthermore, individuals in service/manual labor occupations exhibited lower proportions on certain items. This study developed and validated a KSAB questionnaire on skin health knowledge, attitudes, and behaviors, showing good validity and item-level performance. The findings support targeted health promotion for men, older adults, and service/manual workers.

To establish age- and time-specific recommendations for the treatment of traumatic anterior shoulder instability (TASI) and for return-to-sport (RTS) decision-making through a formal consensus process among European experts. The European Society of Sports Medicine, Knee Surgery and Arthroscopy-European Shoulder Associates (ESSKA-ESA) formal consensus methodology was followed. A steering group formulated 35 clinically relevant questions, 23 of which addressed treatment and RTS and are reported in Part 2. A structured literature review was conducted. Statements were drafted and graded based on the level of scientific support. Then, the rating group reviewed and refined the statements, followed by validation from the reader group for cultural adaptability. Recommendations were tailored by age group (adolescents, young adults and older adults) and timing of instability (first-time vs. recurrent). The final global median (range) of the 23 questions was 9 (8-9). Eleven questions achieved strong agreement, 11 relative agreement and 1 uncertain agreement. The grades of recommendations were: A in 0 (0%) statements, B in 30 (35.3%) statements, C in 24 (28.2%) statements and D in 31 (36.5%) statements (each statement could have more than one grade of recommendation). Bone loss and soft tissue lesions were key factors in decision-making. The consensus emphasized individualized thresholds for surgical versus conservative management, highlighting the role of bone augmentation in subcritical (bone loss 10%-15%) (especially in bipolar bone loss) and critical defects (bone loss >20%), lesion-specific soft tissue repair and the limited role of immobilization. RTS criteria included pain-free full range of motion, shoulder stability, strength and sport-specific readiness, typically achieved between 4 and 6 months depending on the procedure and sport demands. This ESSKA-ESA European Formal Consensus delivers practical, evidence- and experience-based recommendations for treatment and RTS following TASI according to age- and time-specific (first time and recurrent) scenarios. By integrating recurrence status, bone loss, soft tissue injury and sport type, the consensus provides a clinically valuable framework for individualized decision-making. Level II.

Accurate prediction of mortality in critically ill patients admitted to the ICU is essential for clinical decision-making and resource allocation. Conventional scoring systems such as Acute Physiology and Chronic Health Evaluation (APACHE), Sequential Organ Failure Assessment (SOFA), and Simplified Acute Physiology Score (SAPS) are widely used but are limited by their static structure and linear assumptions. Artificial intelligence (AI)-based models offer more flexible, data-driven approaches; however, their comparative performance remains uncertain. This systematic review evaluated the performance of AI-based models compared with conventional ICU scoring systems for predicting in-hospital mortality. A systematic search of PubMed, the Excerpta Medica database (Embase), Web of Science, and Scopus was conducted from January 2015 to August 2025. Based on predefined eligibility criteria, studies comparing AI-based models with conventional scoring systems and reporting performance metrics such as area under the receiver operating characteristic curve (AUC), sensitivity, or specificity were included. Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST; Cochrane Prognosis Methods Group and the PROBAST Steering Group, University of Bristol, Bristol, United Kingdom, and collaborating international experts under the Cochrane Collaboration). A descriptive synthesis of discriminative performance was performed, along with a quantitative diagnostic test accuracy synthesis using a bivariate random-effects (Reitsma) model. Exploratory subgroup analyses using inverse variance-weighted random-effects meta-analysis with the DerSimonian-Laird estimator were conducted based on model type, dataset characteristics, and temporal modeling. Ten studies involving approximately 500,000 ICU admissions were included. AI-based models demonstrated higher discriminative performance than conventional scoring systems, with reported AUC values ranging from 0.83 to 0.97 and ΔAUC ranging from 0.04 to 0.19. Eight studies contributed to the quantitative diagnostic test accuracy synthesis, yielding a pooled sensitivity of 0.845 (95% CI: 0.815-0.871) and a pooled specificity of 0.791 (95% CI: 0.728-0.843). Subgroup analyses demonstrated progressively higher pooled AUC values among tree-based/ensemble and deep learning models compared with classical machine learning (ML) approaches. Temporal and longitudinal models demonstrated pooled performance comparable to static variable-based models, while single-center cohorts demonstrated higher pooled AUC values than multicenter datasets. Calibration reporting was heterogeneous and not suitable for quantitative synthesis. Overall, AI-based models show improved discriminative performance for mortality prediction in critically ill patients; however, substantial heterogeneity in study design, validation methodology, and reporting standards highlights the need for further external validation before routine clinical implementation.

Immunological risk prediction in solid organ transplantation has long depended on threshold-based representation of histocompatibility data: donor-specific antibodies (DSA) reported as positive or negative, mean fluorescence intensity (MFI) assessed by fixed cutoffs, molecular mismatch assigned at transplantation, and assays interpreted at a single time point. Although practical, these conventions simplify the complex and dynamic nature of the immune response. In this perspective, we argue that as machine learning (ML) algorithms and computational approaches enter the field of transplant immunology, we need to focus on whether the inputs that feed into these tools and models reflect how alloimmunity actually behaves. We propose treating alloimmune risk as a time-indexed alloimmune state, updated whenever new data are available, across four domains: antibody profile, molecular mismatch and predicted immunogenicity, recipient immune context, and graft context. Within this framework, the features that experienced clinicians and histocompatibility experts already track (e.g., DSA velocity, persistence, epitope spreading, concordance with graft injury) become computable rather than implicit. We discuss how moving from thresholds to trajectories impacts model design, why HLA laboratory expertise becomes more important rather than less, and why interpretability, regulation, and external validation should precede clinical adoption.

Temporomandibular disorders are among the most common causes of orofacial pain, often leading patients to seek information online. The increasing use of large language models such as chat generative pre-trained transformer in healthcare communication has raised questions about the reliability and readability of artificial intelligence-generated patient information. The aim of this study was to evaluate the accuracy, comprehensiveness, readability, and inter-rater reliability of chat generative pre-trained transformer-generated responses to common patient questions regarding temporomandibular disorders. ChatGPT (version 4.0) was prompted to generate 50 potential patient questions about temporomandibular disorders. Ten representative questions were selected and independently evaluated by five experts (two oral and maxillofacial surgeons, two physiotherapists, and one physical medicine specialist). Responses were rated using a four-point quality scale assessing accuracy and completeness. Readability was calculated using the Flesch-Kincaid method, and inter-rater reliability was assessed using the Intraclass Correlation Coefficient. The responses demonstrated variable but generally acceptable quality. The overall Intraclass Correlation Coefficient value was 0.862, indicating good inter-rater agreement. Readability levels ranged from grade 6.2-10.7 (mean 8.0), corresponding to middle-to-high school comprehension. While most responses were rated satisfactory, several lacked sufficient clinical detail, particularly in differentiating professional consultation pathways. chat generative pre-trained transformer provides moderately reliable and readable information about temporomandibular disorders, supporting its potential role in patient education. However, reliance on artificial intelligence-generated frequently asked questions introduces methodological limitations and authority bias. Future studies should incorporate real patient data and external fact-checking to enhance clinical relevance.

BackgroundPoor dietary habits due to inappropriate nutritional knowledge are becoming a major contributor to the development of chronic diseases, and these habits usually develop in the university years.AimsThis study aims to investigate the influence of nutritional knowledge on eating patterns and the barriers inhibiting the adoption of healthy eating practices among university students in Lahore, Pakistan.MethodsA cross-sectional study was conducted among university students enrolled in various disciplines. Data on sociodemographic characteristics, eating practices, nutrition knowledge, and barriers to healthy eating were collected using a structured questionnaire validated through rigorous reviews by experts and pilot-tested to ensure its clarity, relevance, and reliability.ResultsOut of 397 students, about half reported consuming fast food (52.4%), snacks (66.2%), and sugary drinks (62.2%). Many students mentioned following a vegetarian (27.9%) and gluten-free diet (11.8%). There was a low consumption of fruits (10.1%) and vegetables (10.1%) daily. Most students demonstrated moderately healthy eating practices with moderate nutrition knowledge (75.8%), while a relatively small proportion (15.9%) practiced healthy eating with good nutrition knowledge. Nevertheless, barriers like lack of time (30%), less availability of healthy food on campus (61.2%), and high cost of healthy foods (75.8%) hindered the implementation of nutrition knowledge into practice.ConclusionThe results support that incorporating nutrition knowledge in health education campaigns for students will encourage healthy eating practices. However, to achieve meaningful outcomes, efforts should be made to address the behavioral and environmental barriers that hinder the translation of nutrition knowledge into actual practice.

Pancreatic cystic lesions represent an increasingly common clinical finding due to the widespread use of cross sectional imaging, encompassing a heterogeneous spectrum ranging from benign entities to premalignant and malignant neoplasms. Their rising incidence poses significant challenges in diagnosis, risk stratification, and management, requiring a careful balance between avoiding unnecessary interventions and preventing malignant progression. This position paper, developed by an intersocietal multidisciplinary panel of experts in pancreatic disease, aims to provide a comprehensive and evidence-based overview of these lesions. Current classifications, imaging features, and differential diagnosis are discussed, with particular emphasis on the role of magnetic resonance imaging. Key entities including serous cystic neoplasms, mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, and rarer cystic tumors are analyzed in terms of biological behavior and radiological characteristics. Furthermore, the document reviews available international guidelines and proposes a pragmatic approach to clinical management, including indications for surveillance, endoscopic evaluation, and surgical treatment. Special attention is given to risk stratification based on high-risk stigmata and worrisome features, as well as to individualized patient management. In conclusion, this paper provides a shared expert perspective to support standardized and personalized management of pancreatic cystic lesions in clinical practice.

Myelopathy, a clinical diagnosis of spinal cord dysfunction, necessitates appropriate imaging to differentiate between extrinsic and intrinsic pathologies. This document outlines evidence-based guidelines for imaging evaluation of acute, chronic, and vascular etiologies for myelopathy. These criteria provide an imaging framework to guide surgical or medical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Chronic knee pain is prevalent in the adult population and is the most common musculoskeletal complaint in the primary care setting. Although osteoarthritis is the most common etiology of chronic knee pain, other sources include osteochondral lesion, subchondral insufficiency fracture, patellofemoral maltracking, or chronic tendon, meniscus, or ligament abnormalities. Imaging plays a key role in the evaluation of chronic knee pain, noting that the etiology cannot be reliably diagnosed or excluded via physical examination alone. Radiographs are the initial imaging modality of choice for chronic knee pain. If radiographs demonstrate osteoarthritis, this document outlines specific scenarios in which additional imaging may be warranted. This document also discusses the appropriate imaging workup for the other entities described above, including soft tissue abnormalities and subchondral insufficiency fracture. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.