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Implantation of stainless-steel stents for disease of the superficial femoral artery has been associated with high rates of late clinical failure, and balloon angioplasty is therefore the preferred procedure. In this randomized trial, the use of nitinol stents was associated with lower rates of restenosis and better treadmill exercise performance at 6 months and 12 months than was the use of balloon angioplasty. The use of nitinol stents was associated with lower rates of restenosis and better treadmill exercise performance at 6 months and 12 months than was the use of balloon angioplasty. The use of percutaneous transluminal angioplasty to revascularize the superficial femoral artery can result in initial technical success rates of more than 95 percent, with a low risk of complications. 1 However, late clinical failure remains an important concern. Restenosis occurs in 40 to 60 percent of treated segments after one year. 1 – 3 The use of angioplasty to treat extensive disease of the superficial femoral artery has particularly poor results: at one year, the rates of restenosis exceed 70 percent for lesions longer than 100 mm. 4 Endovascular stenting avoids the problems of early elastic recoil, residual stenosis, and flow-limiting dissection after . . .

BackgroundDiagnosis of cardiac amyloidosis (CA) requires advanced imaging techniques. Typical surface ECG patterns have been described, but their diagnostic abilities are limited.ObjectiveThe aim was to perform a thorough electrophysiological characterisation of patients with CA and derive an easy-to-use tool for diagnosis.MethodsWe applied electrocardiographic imaging (ECGI) to acquire electroanatomical maps in patients with CA and controls. A machine learning approach was then used to decipher the complex data sets obtained and generate a surface ECG-based diagnostic tool.FindingsAreas of low voltage were localised in the basal inferior regions of both ventricles and the remaining right ventricular segments in CA. The earliest epicardial breakthrough of myocardial activation was visualised on the right ventricle. Potential maps revealed an accelerated and diffuse propagation pattern. We correlated the results from ECGI with 12-lead ECG recordings. Ventricular activation correlated best with R-peak timing in leads V1–V3. Epicardial voltage showed a strong positive correlation with R-peak amplitude in the inferior leads II, III and aVF. Respective surface ECG leads showed two characteristic patterns. Ten blinded cardiologists were asked to identify patients with CA by analysing 12-lead ECGs before and after training on the defined ECG patterns. Training led to significant improvements in the detection rate of CA, with an area under the curve of 0.69 before and 0.97 after training.InterpretationUsing a machine learning approach, an ECG-based tool was developed from detailed electroanatomical mapping of patients with CA. The ECG algorithm is simple and has proven helpful to suspect CA without the aid of advanced imaging modalities.

This article outlines the radiology-related staffing and education/training guidelines and recommendations developed by the European Commission-funded EU-REST (European Union Radiation, Education, Staffing & Training) project. The radiologist consortium partners propose the use of hour of machine/system/activity as the basic unit to calculate radiologist staffing needs. Education and training recommendations for radiologists include establishing 5 years as the standard duration of specialty training in radiology and establishing the ESR European Training Curriculum for Radiology as the European-wide standard. General recommendations for all professional groups include the maintenance of a central registry for each professional group and for relevant equipment, by each EU Member State, mandated CPD including techniques and knowledge relevant to each professional group, adoption vs adaptation of the project’s recommendations. Critical relevance statement The radiology-related staffing and education/training guidelines and recommendations developed by the EU-REST project propose a novel approach to calculate radiologist staffing numbers and provide recommendations regarding radiology education and training as well as general recommendations for all professional groups covered by the project. Key Points The pros and cons of taking population, workload, equipment or bed availability numbers as parameters to calculate radiology workforce are described. The reasons why these parameters are not suitable to calculate radiologist staffing needs are explained. The proposed use of hour of machine/system/activity as the basic unit to calculate radiologist staffing needs allows for establishing an adaptable and scalable guideline. Education and training recommendations for radiologists and non-profession-specific recommendations are summarised.

This second article of a series of three publications summarises the radiologist situation regarding staffing as well as education and training as analysed by The European Union Radiation, Education, Staffing & Training (EU-REST) study. Despite certain limitations posed by the dependence on survey responses, the results demonstrate that, for both workforce and education/training, considerable heterogeneity exists between Member States, which will impact healthcare delivery and the level of knowledge, skills, and competencies available. The number of radiologists per million inhabitants varies from 51 to 270. 16 out of 27 Member States have Radiologist numbers below the EU average of 127, and 45% of Radiologists in Europe are over 51 years old (in 2022). Clear guidance and metrics about workforce availability for the professions involved in the use of ionising radiation are needed to secure and improve the quality of healthcare delivery in Europe. Although the main scope of the EU-REST study was education, training and workforce availability, an attempt was made to characterise the numbers of pieces of medical imaging and radiotherapy equipment. Critical relevance statement Clear guidance and metrics on radiologist staffing and education/training are needed to address workforce shortages and harmonise education and training standards across the EU-27. Key Points The article describes the radiologist situation regarding staffing and radiation protection education in the EU Member States. Radiologist staffing and training vary considerably across the EU-27. The fact that more than half of the EU Member States have radiologist numbers below the EU average, and the large proportion of radiologists over 51 years of age, show that clear guidance and metrics are needed to ensure future quality of radiological care.

Objectives To assess the status of radiology subspecialisation recognition across Europe, targeting European Society of Radiology (ESR) National Societies. Methods A questionnaire was distributed to members of the ESR National Societies Committee regarding the recognition of radiology subspecialties in their respective countries. Results Responses were received from 37 out of 47 countries (78%). Radiology subspecialties are recognised in 25 countries, whereas in 12 countries, they are not. Among 12 countries without recognised subspecialisations, 9 expressed a desire for future recognition. There are large variations between countries regarding the number of officially recognised subspecialities, ranging from 0 to 12. Conclusion Based on responses from ESR National Societies Committee members, radiology subspecialties are recognised in 25 countries, while 12 countries do not have formal recognition. The majority of countries without recognised subspecialisations express interest in having them acknowledged in the future. Critical relevance statement This follow-up survey among ESR National Societies presents the recognition status of radiology subspecialisations in Europe. Among the 37 responding countries, there are significant variations in the number of officially recognised subspecialties, ranging from 0 to 12. Key Points Among the 37 ESR National Societies responding countries, between 0 and 12 out of 13 radiology subspecialties are recognised. No country recognises all subspecialties. The majority of countries without recognised subspecialisations would like them to be acknowledged.

Objectives This study evaluates the perceived impact of European School of Radiology (ESOR) training programs on radiologists’ professional development. Methods A cross-sectional survey targeted alumni who participated in ESOR fellowships from 2011 to 2023. The survey included questions on demographics, professional background, ESOR program details, and career impact. Data were collected via a web-based questionnaire and analyzed using descriptive statistics and thematic analysis. Results A total of 916 alumni were invited to the survey, with a response rate of 21% (190 participants). The median age was 31 years (range 29–33), and 54% were female. Most worked in public healthcare (62%) and were involved in academic activities (24%). Fellowship types included the visiting scholarship program (44%), Bracco fellowship (32%), and exchange program for fellowships (25%). The majority (59%) reported the fellowship helped them reach their current position, and 35% noted it upgraded their CV. Significant application of learned skills was reported by 69%. Ongoing cooperation with former tutors was maintained by 54%. Financial support was crucial, with 41% stating they could not have completed the training without it, 33% considering it very important, and 13% important. Participants rated the impact on clinical skills with a median score of 9/10. Other areas of impact included research skills (median 7/10), subspecialization (median 9/10), exposure to diverse practices (median 9/10), networking (median 10/10), and personal and professional growth (median 10/10). Conclusion ESOR training programs significantly enhance radiologists’ professional development through comprehensive support, high-quality training, and substantial financial aid, ensuring participants are well-equipped for career advancement. Critical relevance statement This study evaluates the perceived impact of ESOR training programs on radiologists’ professional development, highlighting significant enhancements in clinical skills, career advancement, and the critical role of financial support in facilitating access to high-quality education. Key Points The ESOR offers various programs addressing both foundational and advanced training in radiology. Fifty-nine percent of participants reported that ESOR fellowships helped them achieve their current positions. Participants experienced a median improvement score of 9 out of 10 in clinical skills. Fifty-four percent of participants maintained ongoing cooperation with former tutors post-fellowship. ESOR financial support was perceived as crucial by many participants, ensuring access to high-quality education. Graphical Abstract

BackgroundParameters of body composition have prognostic potential in patients with oncologic diseases. The aim of the present study was to analyse the prognostic potential of radiomics-based parameters of the skeletal musculature and adipose tissues in patients with advanced hepatocellular carcinoma (HCC).MethodsRadiomics features were extracted from a cohort of 297 HCC patients as post hoc sub-study of the SORAMIC randomized controlled trial. Patients were treated with selective internal radiation therapy (SIRT) in combination with sorafenib or with sorafenib alone yielding two groups: (1) sorafenib monotherapy (n = 147) and (2) sorafenib and SIRT (n = 150). The main outcome was 1-year survival. Segmentation of muscle tissue and adipose tissue was used to retrieve 881 features. Correlation analysis and feature cleansing yielded 292 features for each patient group and each tissue type. We combined 9 feature selection methods with 10 feature set compositions to build 90 feature sets. We used 11 classifiers to build 990 models. We subdivided the patient groups into a train and validation cohort and a test cohort, that is, one third of the patient groups.ResultsWe used the train and validation set to identify the best feature selection and classification model and applied it to the test set for each patient group. Classification yields for patients who underwent sorafenib monotherapy an accuracy of 75.51% and area under the curve (AUC) of 0.7576 (95% confidence interval [CI]: 0.6376–0.8776). For patients who underwent treatment with SIRT and sorafenib, results are accuracy = 78.00% and AUC = 0.8032 (95% CI: 0.6930–0.9134).ConclusionsParameters of radiomics-based analysis of the skeletal musculature and adipose tissue predict 1-year survival in patients with advanced HCC. The prognostic value of radiomics-based parameters was higher in patients who were treated with SIRT and sorafenib.

Purpose To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR). Methods A pattern matching algorithm was used to develop a risk model for symptomatic SCI using a prospective 63-patient single-center cohort to test the positive predictive value (PPV) of prolonged intraoperative hypotension and/or simultaneous closure of at least 2 of 4 the vascular territories supplying the spinal cord (left subclavian, intercostal, lumbar, and hypogastric arteries). This risk model was then applied to data extracted from the multicenter European Registry on Endovascular Aortic Repair Complications (EuREC). Between 2002 and 2010, the 19 centers participating in EuREC reported 38 (1.7%) cases of symptomatic spinal cord ischemia among the 2235 patients in the database. Results In the single-center cohort, direct correlations were seen between the occurrence of symptomatic SCI and both prolonged intraoperative hypotension (PPV 1.00, 95% CI 0.22 to 1.00, p=0.04) and simultaneous closure of at least 2 independent spinal cord vascular territories (PPV 0.67, 95% CI 0.24 to 0.91, p=0.005). Previous closure of a single vascular territory was not associated with an increased risk of symptomatic spinal cord ischemia (PPV 0.07, 95% CI 0.01 to 0.16, p=0.56). The combination of prolonged hypotension and simultaneous closure of at least 2 territories exhibited the strongest association (PPV 0.75, 95% CI 0.38 to 0.75, p<0.0001). Applying the model to the entire EuREC cohort found an almost perfect agreement between the predicted and observed risk factors (kappa 0.77, 95% CI 0.65 to 0.90). Conclusion Extensive coverage of intercostal arteries alone by a thoracic stent-graft is not associated with symptomatic SCI; however, simultaneous closure of at least 2 vascular territories supplying the spinal cord is highly relevant, especially in combination with prolonged intraoperative hypotension. As such, these results further emphasize the need to preserve the left subclavian artery during TEVAR.