Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) often uses intensive oxaliplatin-based chemotherapy alongside standard radiotherapy to prevent metastatic progression. The optimal intensity of the chemotherapy component, given a contribution of radiotherapy to clonogenic cell elimination in the primary tumour, remains uncertain. We aimed to assess long-term outcomes of a TNT regimen with low-intensity induction chemotherapy before chemoradiotherapy, as evaluated in the LARC-RRP trial. Between 2005 and 2010, 87 LARC patients (36% with T4 organ-infiltrating tumour) were enrolled in the single-arm trial. Induction chemotherapy was given over four weeks prior to chemoradiotherapy and surgery. We report 10-year overall survival by tumour regression grade (TRG) and performed descriptive comparisons with contemporary trials whose experimental TNT arms used more intensive chemotherapy. At 10 years, overall survival was 83% (95% confidence interval, 71-90) for patients with complete or near-complete tumour cell elimination in the surgical specimen (TRG 1-2; 70% of the cohort) versus 52% (95% confidence interval, 31-69) for others (log-rank p = 0.0005). LARC-RRP survival outcomes were comparable with those reported in more contemporary TNT trials. The LARC-RRP results raise the possibility that shorter-duration chemotherapy combined with standard radiotherapy may suffice to protect against systemic recurrence of high-risk LARC. These long-term data support investigation of less intensive chemotherapy within TNT regimens and may guide the design of risk-stratified TNT trials.
This study aims to compare the potential of whole-body silicon photomultiplier positron emission tomography/computed tomography (WB SiPM PET/CT) in the prone position with dynamic magnetic resonance imaging (MRI) in determining the extent of breast cancer. This retrospective study included 77 patients with 84 breast cancers who underwent both PET/CT and MRI, excluding those who received neoadjuvant chemotherapy. Four tumour thresholds for 18F-fluorodeoxyglucose uptake were defined based on the mean standardised uptake value (SUVmean) and standard deviation (SD) of normal breast tissue: SUVmean+2SD, SUVmean+3SD, 1.5SUVmean+2SD, and 1.5SUVmean+3SD. Semiautomatic measurements of tumour size for each threshold and MRI were compared against pathological tumour size and analysed by menopausal status and Ki-67 expression. PET/CT failed to visualise two lesions. No significant differences in the image-to-pathological tumour size ratio were observed between MRI and the 1.5SUVmean+2SD. All MRI and SUV threshold measurements exhibited strong correlations with pathological size. The 1.5SUVmean+2SD demonstrated the highest pathological concordance rate, comparable to MRI. Subgroup analysis revealed that the 1.5SUVmean+2SD was superior for premenopausal patients (60.6%, p < 0.05), while MRI excelled in postmenopausal patients (61.2%). Both 1.5SUVmean+2SD and MRI achieved the highest concordance rates (62.2%) in the high-Ki-67 group. The 1.5SUVmean+2SD of prone WB SiPM PET/CT offers a diagnostic performance equivalent to MRI for assessing breast cancer extent, particularly in premenopausal patients, while MRI remains optimal for postmenopausal patients. Both modalities are also highly effective in high Ki-67 tumours. These findings highlight the potential of high-resolution semiconductor PET/CT for assessing breast cancer extent.
This investigation sought to assess whether integrating the Skeletal Muscle Index (SMI) and Systemic Immune-Inflammation Index (SII) could enhance prognostic stratification and improve survival prediction in patients with advanced, unresectable esophageal squamous cell carcinoma (ESCC). The study included 200 individuals with confirmed unresectable ESCC, all of whom received chemoradiotherapy either as monotherapy or combined with immunotherapy. Kaplan-Meier methods were used to generate overall survival (OS) and progression-free survival (PFS) curves, with survival differences between groups evaluated by the log-rank test. The prognostic value of the novel predictive scoring system, combining SMI and SII (SSG score), was analyzed using Cox proportional hazards regression models. In the overall cohort, the median OS and PFS were 18 months and 11 months, respectively. The prognostic significance of the SSG score was confirmed by receiver operating characteristic (ROC) curve analysis, which yielded an area under the curve (AUC) of 0.690 (P < 0.05), reflecting strong discriminative power for patient prognosis stratification. Multivariate Cox regression identified the SSG score as an independent prognostic factor for both OS (HR 2.955, 95%CI 1.351-6.465, P = 0.007) and PFS (HR 2.028, 95%CI 1.187-3.463, P = 0.010) in unresectable ESCC patients. We developed and validated the SSG scoring system, integrating SMI and systemic SII, for prognostic assessment in unresectable ESCC. The SSG score demonstrated independent prognostic value for both OS and PFS. These findings support its clinical applicability in risk stratification and individualized treatment decision making. The SSG score holds promise for improving treatment decisions and prognosis management in patients with unresectable ESCC.
Radiation segmentectomy (RS) utilizing Yttrium-90 (Y90) microspheres has emerged as a highly effective, minimally invasive locoregional therapy for hepatocellular carcinoma (HCC), particularly in early-stage disease. This precision treatment delivers ablative radiation doses directly to the tumor and its immediate surrounding parenchyma, thereby minimizing systemic toxicity and preserving healthy liver tissue. RS consistently demonstrates high objective and complete response rates, which often correlate directly with complete pathological necrosis (CPN) of the tumor, as rigorously assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST) and European Association for the Study of the Liver (EASL) criteria. This robust imaging response translates into durable local tumor control and prolonged time to disease progression. The safety and feasibility of RS are generally well-established. The procedure is typically well-tolerated, with common adverse events usually being mild and transient. Severe complications are rare, emphameasuring the procedure's precision and minimal invasiveness. Optimal outcomes are contingent upon meticulous patient selection, strict adherence to technical guidelines, and precise dosimetry. Beyond its role as a definitive therapy, RS plays a critical function in bridging and downstaging patients awaiting liver transplantation. By effectively controlling tumor burden, it enhances patient eligibility for transplantation and improves outcomes on transplant waiting lists. Furthermore, RS offers distinct advantages over other conventional locoregional therapies in specific clinical scenarios, solidifying its integral position within the comprehensive management paradigm for HCC.
The study aims to compare recurrent CT imaging practices across multiple centres in Europe using incidence and prevalence metrics, and to test the feasibility of establishing a new benchmarking tool for recurrent imaging practice across facilities. Data of CT exposure were collected in 31 facilities from 18 European countries. The incidence proportion in a single year (I  100; 1), cumulative incidence over 3 consecutive years (I  100; 3), and 3-year prevalence proportion (P  100; 3) of patients with cumulative effective dose (CED) ≥ 100 mSv were calculated, and statistical analyses performed to correlate them with other relevant indicators. The reference year for data collection was 2023, and the 3-year period covered 2022-2024. The database included 711,749 patients in the reference year who underwent 1,658,246 CT exams, with an average number of 1.5 ± 0.6 CT exams per patient in the reference year and 2.4 ± 0.6 exams per patient in three years. Across facilities, I  100; 1 ranged from 0 to 2.9%, I  100; 3 from 0 to 8.6%, and P  100; 3 ranged from 0% to 4.4%. Strong linear correlation was found between the 3rd quartile values of yearly CED and I  100; 1. Multiple linear relationship was identified between I  100; 3, 3rd quartile of yearly CED and percentage of recurrent patients. The facilities' 3rd quartiles of yearly CED varied between 7.5 and 29.5 mSv, and the 75th percentile of their distribution was 17.6 mSv, which are lower than in previous studies. Incidence proportion is recommended as the primary metric for future studies assessing recurrent imaging, since prevalence indexes substantially underestimate the rates of recurrent imaging. The 75th percentile of distribution of 3rd quartiles of yearly CED is a reasonable benchmark for facilities to trigger optimisation. Investigating the underlying factors and addressing high recurrent rates can contribute to enhanced patient care.
The trabecular bone of the medullary cavity is a complex three-dimensional lattice essential for skeletal load distribution and metabolic homeostasis. This article provides a narrative review of trabecular architecture, ranging from hierarchical nanoscopic fibrils to macroscopic stress trajectories. We analyze the radiological appearance of normal and pathological alterations, including thickening, breakage, faintness, rarefaction, and infiltration. Modalities such as high-resolution MRI, dual-energy CT, and the emerging photon-counting detector CT are evaluated for their diagnostic precision. Furthermore, we examine clinical indices like the Singh Index and the growing role of opportunistic CT screening. Understanding these morphological transitions is critical for the early detection of systemic metabolic diseases and the monitoring of localized mechanical failure.
Radiology occupational safety has historically centred on radiation protection. Although radiation safety remains essential, the digital transformation of imaging has expanded the occupational-health profile of the radiology workforce. Diagnostic radiologists now spend prolonged periods at PACS workstations; radiographers and reporting staff work in display-dependent environments; sonographers are exposed to sustained scanning postures and forceful transducer use; and interventional radiology teams face procedural ergonomic stressors related to standing posture, monitor position, table height, and personal protective equipment. This narrative review synthesizes evidence on musculoskeletal strain, digital eye strain, environmental design, circadian disruption, burnout, and emerging effects of artificial intelligence in radiology work environments. The available evidence is largely cross-sectional, survey-based, or extrapolated from broader occupational-health literature, with fewer longitudinal or intervention studies. Accordingly, causal claims should be interpreted cautiously. We propose a broader occupational-safety framework in which radiation protection is preserved while ergonomic, visual, environmental, organizational, and cognitive risks are addressed as complementary priorities. Practical interventions include evidence-informed workstation configuration, diagnostic display standards, sonography-specific ergonomic practices, interventional suite optimization, structured microbreaks, daylight-aware reading-room design, and institutional strategies to reduce excessive workload and burnout. Future research should evaluate whether these interventions improve health outcomes, diagnostic performance, absenteeism, retention, and long-term professional sustainability.
Despite significant advances in the treatment of childhood cancers, progress in improving outcomes of many paediatric solid tumours remains limited, particularly in patients with relapsed or metastatic disease. Current treatment strategies, including surgery, chemotherapy, and external beam radiotherapy, can achieve disease control but are often associated with substantial acute and long-term toxicities affecting long-term development, impacting the overall quality of life of survivors. Radioligand therapy (RLT) has emerged as a promising targeted therapeutic strategy that combines tumour-specific ligands with radioactive isotopes, enabling the selective delivery of radiation to cancer cells while minimising damage to surrounding healthy tissues. In adult oncology, RLT has demonstrated substantial clinical benefit in several malignancies, which has not (yet) translated into paediatric cancers. Early clinical studies have explored the use of RLT in paediatric solid tumours, particularly in neuroblastoma, but the available evidence remains fragmented and largely limited to small series. Therefore, this review aims to summarise the current clinical evidence on the use of RLT in paediatric solid tumours, including relevant molecular targets, radiopharmaceuticals, clinical outcomes, and safety profiles, and to discuss the key challenges and future directions for the development of RLT in paediatric oncology.
Perivascular epithelioid cell tumours (PEComas) are ultra-rare soft tissue tumours with heterogeneous treatment approaches. While surgery is the standard for localized disease, the role of radiotherapy (RT) remains unclear. This retrospective study aims to evaluate tumour volume response, as well as local outcomes and Overall Survival, in patients with PEComa treated with RT. The cohort included patients diagnosed with PEComa between 2005 and 2023 at a single sarcoma centre. Demographic, clinical, RT, and volumetric tumour data were collected. Response was assessed using RECIST v1.1. In total, 24 lesions in 12 patients were evaluable for analysis, with a median radiological follow-up of 10 months. Of these, 7 lesions were treated with perioperative RT and 17 with palliative RT. Systemic treatments during imaging follow-up were administered in 19/24 lesions. Among 17 lesions treated with palliative intent without surgery, four local failures occurred- all at EQD2 (α/β = 5) <40 Gy- and the estimated 1-year local control rate was 61.9%.Among these 17 lesions, mean tumour volume decreased from 301.5 cm³ (range: 0.9-2251) to 108.3 cm³ (range: 0.1-754) as best response after RT. Seven patients (58.3%) died from their disease, with a median overall survival of 46 months after diagnosis. PEComas appear to be radiosensitive, with substantial tumour volume reduction after RT and a dose-response signal favouring higher EQD2 dose. Nonetheless, overall survival was poor, reflecting the aggressive nature of this disease. This is the largest RT series in PEComa to date and suggests radiosensitivity in this disease.
To identify predictors of relapse in oligometastatic prostate cancer patients treated with Stereotactic Ablative Radiotherapy (SABR). This retrospective study included 57 patients with metachronous oligometastatic prostate cancer treated with SABR between January 2018 and December 2023. SABR was delivered with a median dose of 30 Gy (range 24-36 Gy) in 3-5 fractions. The primary endpoint was disease-free survival, while secondary endpoints included local relapse rates. Kaplan-Meier survival estimation and Cox proportional hazards regression analyses were used to identify prognostic factors. With a median follow-up of 34.5 months, the 1-year and 2-year DFS rates were 64.5% and 24.3%, respectively. Local control was achieved in 87% of patients. Multivariate analysis revealed post-SABR PSA reduction as the only significant predictor of relapse (HR = 0.235, 95% CI: 0.085-0.644, p = 0.005), indicating a 76.5% lower risk of recurrence in patients demonstrating substantial PSA declines after treatment. Traditional prognostic markers, including Gleason score, initial PSA levels, prior hormone therapy, and metastatic site did not significantly correlate with relapse risk. Post-SABR PSA kinetics are a more reliable predictor of relapse than conventional risk stratification factors in oligometastatic prostate cancer patients. In this single-centre cohort of metachronous oligometastatic prostate cancer treated with SABR (including both nodal and osseous metastases), early post-SABR PSA reduction was independently associated with relapse risk. These findings provide additional quantitative support for PSA dynamics as a pragmatic biomarker that may help stratify follow-up intensity and identify patients at higher likelihood of occult systemic disease, warranting prospective validation.
To evaluate the impact of ultra-high-resolution photon-counting detector CT (UHR PCD-CT) combined with ultra-low dose scanning protocol on the detection rate, image quality, diameter, and volumetric measurement accuracy of pulmonary nodules of varying sizes and types. A thoracic phantom with 15 pulmonary nodule models was scanned on UHR PCD-CT at five dose levels. Quantitative analysis was performed on the detection rate, long-axis/short-axis diameters, noise value (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the nodules at each dose level. Pulmonary nodule AI diagnostic software was used to measure nodule volume and calculate the absolute percentage error in volume (APEvolume). Similarly, the absolute percentage error in diameter measurement (APEdiameter) was calculated. Subjective image quality was assessed using a 5-point scale, with images from the 1.00 mGy dose group as the reference. Dose reduction significantly lowered the detection rates of pulmonary nodules while increasing both APEdiameter and APEvolume. Solid nodules (SNs) exhibited better detectability compared to ground-glass nodules (GGNs), with nodules ≥6 mm showing superior performance over smaller lesions. Subjectively, performance at 0.50 mGy was clear but slightly worse than that at standard-dose (1.00 mGy) (all P < 0.05). Even under ultra-low dose conditions (0.03-0.50 mGy), UHR PCD-CT combined with AI-assisted diagnostic software can still maintain the detection of pulmonary nodules and provide diagnostic-quality images. UHR PCD-CT is capable of yielding diagnostic image quality even at significantly reduced radiation doses, allowing for the confident assessment of specific nodule types and larger nodules.
We compare the contrast-to-noise ratio (CNR) of tumours on 4D-CT and DCE-CT and explore how DCE-CT can be used to enhance tumour delineation for radiotherapy targeting. A total of 18 intrahepatic lesions from 15 patients were included in this study. 8 patients with primary hepatocellular carcinoma, and 7 metastatic patients with a total of 10 tumours, underwent DCE-CT and respiration tracked 4D-CT. Both 4D-CT and DCE-CT were acquired at 120 kVp, but with 600 and 1920 mAs, respectively. CNRs were calculated for each lesion for each image set and compared using paired t-test. DCE-CT image sets had CNRs which were higher than those of 4D-CT image sets. The improvement in CNR was significant for lesions that were metastatic rather than primary, for lesions that were smaller than the mean size (5.7 cm), and for lesions which had undergone prior treatment rather than those which had not. Target volume delineation in liver radiotherapy is challenging due to the inherent low tumour CNR. DCE-CT significantly improves CNR in liver metastases compared to 4D-CT, the current standard for radiation treatment planning. Considerations for DCE-CT include patients with metastatic lesions, additional iodinated contrast and CT dose. DCE-CT combined with 4D-CT can offer advantages in delineating small, previously-treated metastatic tumours for radiotherapy.
Thermal ablation techniques, such as radiofrequency ablation (RFA) and microwave ablation (MWA), are used to treat hepatic malignancies. The 'oven effect,' where background cirrhotic tissue insulates and enhances heating, is well-documented in RFA but not in MWA. This study aims to explore whether the oven effect occurs in MWA. A retrospective comparative study included all patients undergoing MWA for hepatic malignancies between 2014 and 2017. Patients were divided into two groups based on liver lesion characteristics: H group (hepatocellular carcinoma, likely cirrhotic liver) and M group (metastases, likely non-cirrhotic liver). Ablation volumes were calculated using CT scans performed 6 weeks post-ablation. Multivariate linear regression analysis was performed to assess the significance of differences in ablation volume. 94 patients (57 in H group, 37 in M group) were included. Groups were demographically matched, and ablation parameters (intensity and duration) were comparable. The mean ablation volume in the M group was 2.3cm³ smaller than in the H group, but this difference was not statistically significant (95% confidence interval -7.8, 3.3; p = 0.42). This study found no evidence of the oven effect phenomenon in MWA. This may result from MWA's ability to achieve higher temperatures and larger ablation zones, reducing the impact of local tissue characteristics. This study provides preliminary evidence that MWA produces consistent ablation volumes regardless of liver background, suggesting it is a reliable method for both cirrhotic and non-cirrhotic livers, advancing patient-specific treatment planning. However prospective validation is required before integration into clinical guidelines.
This work presents the design, development, and initial proof of concept testing of a dosimetry device intended for FLASH radiotherapy. The system incorporates organic scintillating fibers coupled to a silicon photomultiplier (SiPM) and an FPGA-based readout, with fiber geometry optimized to minimize perturbations to a clinical proton beam, as confirmed through measurements at the Huntsman Cancer Institute (HCI). Tests using a portable X ray unit demonstrated a strong correlation between integrated charge and delivered dose (up to ∼35 mrem s-1) and showed that the detector can respond on nanosecond timescales, enabling the potential for rapid safety interlock triggering with minimal latency. Preliminary proton irradiations at HCI further indicated that the device can resolve individual beam pulses, a capability valuable for both FLASH research and conventional radiotherapy. These results highlight the need for continued refinement of the experimental setup, readout electronics, and detector performance to fully realize real time, in situ dose and pulse monitoring.
This systematic review describes the spectrum, distribution, and etiologies of non‑target [68Ga]Ga‑DOTANOC‑avid lesions proven by histopathology or follow‑up to be unrelated to normal biodistribution or the primary SSTR‑expressing disease. PubMed, Web of Science, and Scopus databases were utilized to conduct a systematic search and were updated until May 31, 2025. Three authors independently screened the titles and abstracts of the retrieved articles and selected the articles on the basis of the inclusion and exclusion criteria. Seventy-six eligible studies encompassing 542 patients reported 799 non-target [68Ga]Ga-DOTANOC-avid findings. Nononcologic causes accounted for the majority (59.6%), with malignant oncologic and benign tumorous etiologies accounting for 30.2% and 10.3%, respectively. The abdomen was the most common anatomical site (38%), followed by the thorax (21.6%), head/neck (18.1%), and musculoskeletal system (13.1%), whereas pelvic involvement was least common (9%). Abdominal non-target [68Ga]Ga-DOTANOC-avid findings represent a major interpretive challenge in [68Ga]Ga-DOTANOC PET/CT, as these findings often overlap with NET-predominant regions. Recognition of these patterns can increase diagnostic accuracy and support broader clinical integration of [68Ga]Ga-DOTANOC beyond its conventional utility.
This study provides a review of recent publications on different quality control (QC) techniques for radiotherapy linear accelerators (linacs). QC in radiotherapy is essential to ensure patient safety, deliver optimal quality treatments, monitor equipment performance over time and to satisfy statutory or recommended testing. Whilst conventional QC methods are still widely used and valuable, there have been advances in QC methods and approaches which aim to improve efficiency and keep pace with the rapidly advancing complexity of clinical equipment and treatment delivery methods. Existing reviews of QC concepts mainly focus on single QC techniques. There are limited reviews that explore and compare the variety of techniques to QC, which is the aim of this report. QC techniques were separated into seven domains: conventional QC, automated & manufacturer integrated QC, risk, statistical, artificial intelligence (AI), end-to-end & patient-specific QC (PSQC), external dosimetry audits & clinical trial credentialing audits. An overview of each technique with example studies from literature is presented.
To provide a structured and critical overview of the technical foundations, diagnostic performance, and clinical applicability of Zero Echo Time/Black-Bone MRI (ZTE/BB) and Dual-Energy CT Virtual Non-Calcium imaging (DECT-VNCa) in skeletal oncology, with the aim of clarifying their respective roles and potential complementarity within contemporary imaging workflows. A structured narrative review of peer-reviewed literature published between 2010 and 2025 was conducted, focusing on technical principles, methodological quality, lesion-level diagnostic performance, and clinical applications of ZTE/BB MRI and DECT-VNCa in oncologic bone disease. Evidence was synthesised according to anatomical region and diagnostic task, including staging, assessment of cortical integrity, marrow infiltration, and treatment response. ZTE/BB MRI demonstrates high-fidelity depiction of cortical bone, utility in PET/MR attenuation correction, and growing relevance in radiotherapy planning and skeletal tumour assessment. DECT-VNCa enables sensitive and reproducible evaluation of bone marrow involvement, improving detection of CT-occult disease and providing quantitative biomarkers correlated with cellularity and therapy-related changes. Direct head-to-head comparisons remain limited, and variability in acquisition protocols and quantitative thresholds persists across platforms. ZTE/BB MRI and DECT-VNCa should be considered complementary rather than competing techniques in skeletal oncology imaging. ZTE/BB MRI is particularly suited for radiation-free assessment of cortical integrity and structurally relevant disease, whereas DECT-VNCa offers rapid, quantitative characterisation of marrow involvement. An integrated, task-oriented use of these modalities may improve diagnostic coherence across different anatomical sites and phases of the oncologic pathway. Further prospective and standardised studies are required to harmonise protocols and define their optimal clinical integration.
Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Positron emission tomography (PET) enables non-invasive imaging of cardiovascular biology at the molecular level, providing insights into pathological processes that precede structural changes detectable by conventional imaging. While conventional PET has been used to investigate isolated cardiac pathologies, its short axial field-of-view (SAFOV) limits the exploration of multi-organ axes influencing cardiovascular disease. The advent of total-body PET systems represents a major advancement in molecular imaging, providing enhanced sensitivities with associated reductions in radiotracer dosing and acquisition times. Furthermore, long axial field-of-view (LAFOV) scanners enable simultaneous assessment of disease activity across the whole cardiovascular and multi-organ systems, facilitating the assessment of organ interactions and network analyses. The aim of this review is to explore the current uses of PET in the imaging of cardiovascular disease and to postulate how integration of total-body PET systems may enhance mechanistic understanding of these pathologies and provide new insights into their treatment.
Treatment options for metastatic hormone-sensitive prostate cancer (mHSPC) have expanded, with evidence supporting prostate radiotherapy in low-volume disease. However, evidence for consolidative radiotherapy to residual sites in patients rendered oligometastatic after systemic therapy is lacking. Advanced imaging with WB-MRI and PSMA PET/CT enables more accurate assessment of tumour burden and response. This feasibility study assessed response to initial systemic treatment with an ARPI or docetaxel in 29 patients with polymetastatic (>5 metastases) HSPC. PSA and WB-MRI response using MET-RADS-P criteria were recorded. 20/29 (69.0.%) of patients were down-risked to oligometastatic disease (≤5 sites) after a median of 5.5 (IQR 5-5.8) months, identified on WB-MRI. Median PSA was 0.2 ng/ml (IQR 0.1-0.7) in down-risked patients versus 1.5 ng/ml (IQR 1.1-84) in those not down-risked. Residual intraprostatic disease was seen in 55% (11/20) of down-risked patients. Most patients were down-risked on WB-MRI, supporting the existence of an induced oligometastatic state and providing rationale for the STAR TRAP randomised trial (ISRCTN16448082), which will assess the role of consolidative radiotherapy in this setting. WB-MRI correlates with PSA response and shows potential as an imaging biomarker in mHSPC in this small feasibility study.
Ischemic stroke is a major cause of disability and mortality worldwide, with an expected increased demand for imaging. Which approaches the limits of the current diagnostic MRI capacity. Short protocol MRI (sMRI) offers a potential solution by reducing scan times while maintaining diagnostic utility. The aim of this study is to evaluate the effectiveness, scan time reduction and diagnostic utility of SMRI in patients admitted with suspected ischemic stroke. This retrospective cohort study included 400 sMRI scans performed between April 2023 and June 2024 in a non-academic teaching hospital. Patients with haemorrhagic stroke or a history of multiple sclerosis were excluded. Outcomes were scanning time needed, time between admission, compared with a cohort 2022-2023 without short protocol, and MRI and need for additional imaging. Utilization of a SMRI scan resulted in 62% less total scan time and 47.8% more scan capacity and a median reduction of 26 hours in waiting time during admission. Ischemia was confirmed in 26.8% of cases. Only 2% required additional imaging, with clinically relevant findings in 2 cases (0.5%). Short protocol MRI significantly reduces scan and waiting time without compromising diagnostic quality in patients admitted with suspected ischemic stroke. SMRI is a feasible and time efficient imaging strategy for patients admitted with suspected stroke and may contribute to maintaining diagnostic MRI capacity.