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Objectives Escape rooms provide an interactive learning experience, combining clinical knowledge with problem-solving and teamwork. A radiology-themed escape room has been organized at the European Congress of Radiology in 2019 and 2023–2025, with over 900 people participating in total. The process of developing a radiology-themed escape room is discussed, and the results of a participant survey are presented. Materials and methods The development of a radiology-themed escape room was based on five steps. Initially, an overarching concept was chosen, then multiple puzzle ideas were brainstormed. These were linked together to form a story, and then fully developed with relevant images and materials. Finally, the room was tied together, and a fitting atmosphere was created. Participants in 2025 were asked to complete a survey with questions on their training status, the challenges that they found most difficult, and their thoughts on the activity as a learning tool and for improving teamwork. Results Three different concepts of radiology-themed escape rooms were developed for the congresses from 2019 to 2025. The overarching concepts were a polytrauma situation, a thrombectomy for fulminant pulmonary embolism, and a tumor board, respectively. Two hundred ninety people participated in 2025, and 149 completed the exit survey; 66.7% of participants were able to complete the room in time. Enjoyment, learning, and team building were all rated highly by participants. Conclusion A development process for designing a radiology-themed escape room is presented. A prior implementation shows an enjoyable and educational experience for radiologists and other medical professionals. Critical relevance Insights are given on the development of a radiology-themed escape room, providing a unique interactive learning opportunity for residents that incorporates image interpretation with teamwork and cognitive puzzles, resulting in an enjoyable educational experience. Key Points A step-by-step guide on developing a radiology-themed escape room is presented. Radiological escape rooms provide an enjoyable, educational, and team-building experience. Interactive learning experiences could play a larger role in modern radiology education. Graphical Abstract

PurposeThe field of radiology is currently underestimated by undergraduate medical students. The “Hands-on Radiology” summer school was established to improve radiology knowledge and interest among undergraduates. The purpose of this questionnaire survey was to analyze whether a radiological hands-on course is an effective tool to reach and motivate undergraduate students.Materials and methodsThe three-day course held in August 2022 included lectures, quizzes, and small group hands-on workshops focusing on practical work with simulators. All participants (n = 30) were asked to rate their knowledge and motivation to specialize in radiology at the beginning of the summer school (day 1) and the end (day 3). The questionnaires included multiple choice questions, 10-point scale questions and open comment questions. The second questionnaire (day 3) included additional questions regarding the program (topic choice, length, etc.).ResultsOut of 178 applicants, 30 students (16.8%) from 21 universities were selected to participate (50% female and 50% male students). All students completed both questionnaires. The overall rating was 9.47 on a 10-point scale. While the self-reported knowledge level increased from 6.47 (day 1) to 7.50 (day 3), almost all participants (96.7%, n = 29/30) mentioned an increased interest in the specialization of radiology after the event. Interestingly, most students (96.7%) preferred onsite teaching instead of online teaching and chose residents over board-certified radiologists as teachers.ConclusionIntensive three-day courses are valuable tools to strengthen interest in radiology and increase knowledge among medical students. Particularly, students who already have a tendency to specialize in radiology are further motivated.Key pointsThe three-day student program enhanced the visibility of radiology as a specialization.Interest in and knowledge of radiology was increased among participants.Participants’ motivation to consider specialization in radiology increased.Participants favored onsite teaching and teaching by residents instead of consultants.Networking is a major factor during such courses among participants.

Radiology plays a key role in the diagnosis and monitoring of hepatocellular carcinoma (HCC). Ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are used to identify HCC lesions. Multiparametric MRI provides detailed insights into the tumor biology through the analysis of morphology, perfusion and diffusion. In this way preoperative decisions can be optimized. The guidelines recommend using contrast-enhanced MRI or ultrasound for the diagnosis of HCC. The preferred method is MRI due to its superiority in the detection of small lesions The treatment response is evaluated using modified response evaluation criteria for solid tumors (RECIST) and the European Association for the Study of the Liver (EASL) criteria. The use of multiparametric MRI in conjunction with the liver imaging reporting and data system (LI-RADS) plays overall a central role in the precise diagnosis and monitoring of the treatment of HCC.

In addition to morphology and tissue perfusion, diffusion-weighted imaging (DWI) is the third pillar of multiparametric diagnostics in oncology. Due to the strong correlation between the apparent diffusion coefficient (ADC) and cell count in hepatocellular carcinoma (HCC), it can be used as a surrogate marker for tumor cell quantity. Therefore, ADC effectively reflects the effects of cytoreductive treatment, such as transarterial chemoembolization (TACE) and systemic chemotherapy and becomes an important clinical marker for treatment response. The DWI should remain an integral part of a magnetic resonance imaging (MRI) protocol in primary HCC diagnostics and treatment monitoring but is of secondary clinical importance compared to contrast-enhanced MRI perfusion sequences and the use of liver-specific contrast agents. For the future, standardization of DWI sequences for better comparability of various study protocols would be desirable.

Zusammenfassung Neben Morphologie und Gewebeperfusion ist die Diffusionsbildgebung („diffusion-weighted imaging“, DWI) die dritte Säule der multiparametrischen Diagnostik in der Onkologie. Aufgrund der starken Korrelation zwischen apparentem Diffusionskoeffizienten (ADC) und Zellzahl beim hepatozellulären Karzinom (HCC) kann dieser als Surrogatmarker für die Tumorzellmenge dienen. Daher spiegelt der ADC effektiv die Auswirkungen zytoreduzierender Behandlungen wie transarterielle Chemoembolisation und systemische Chemotherapie wider und wird zu einem wichtigen klinischen Marker des Therapieansprechens. Die DWI sollte in HCC-Primärdiagnostik und Therapieverlaufskontrolle ein fester Bestandteil eines MRT(Magnetresonanztomographie)-Protokolls bleiben, ist jedoch in der klinischen Bedeutung nachrangig gegenüber kontrastmittelgestützten MRT-Perfusionssequenzen und dem Einsatz leberspezifischer Kontrastmittel. Für die Zukunft wäre eine Standardisierung von DWI-Sequenzen zur besseren Vergleichbarkeit verschiedener Studienprotokolle wünschenswert.

Neben Morphologie und Gewebeperfusion ist die Diffusionsbildgebung („diffusion-weighted imaging“, DWI) die dritte Säule der multiparametrischen Diagnostik in der Onkologie. Aufgrund der starken Korrelation zwischen apparentem Diffusionskoeffizienten (ADC) und Zellzahl beim hepatozellulären Karzinom (HCC) kann dieser als Surrogatmarker für die Tumorzellmenge dienen. Daher spiegelt der ADC effektiv die Auswirkungen zytoreduzierender Behandlungen wie transarterielle Chemoembolisation und systemische Chemotherapie wider und wird zu einem wichtigen klinischen Marker des Therapieansprechens. Die DWI sollte in HCC-Primärdiagnostik und Therapieverlaufskontrolle ein fester Bestandteil eines MRT(Magnetresonanztomographie)-Protokolls bleiben, ist jedoch in der klinischen Bedeutung nachrangig gegenüber kontrastmittelgestützten MRT-Perfusionssequenzen und dem Einsatz leberspezifischer Kontrastmittel. Für die Zukunft wäre eine Standardisierung von DWI-Sequenzen zur besseren Vergleichbarkeit verschiedener Studienprotokolle wünschenswert.

Zusammenfassung Die Radiologie spielt eine Schlüsselrolle in der Diagnose und Überwachung von hepatozellulären Karzinomen (HCC). Dabei werden Ultraschall, Computertomographie (CT) und Magnetresonanztomographie (MRT) zur Identifizierung von HCC-Läsionen eingesetzt. Die multiparametrische MRT bietet detaillierte Einblicke in die Tumorbiologie durch die Analyse von Morphologie, Perfusion und Diffusion. Dadurch können präoperative Entscheidungen optimiert werden. Die Leitlinien empfehlen für die HCC-Diagnose eine kontrastverstärkte MRT oder Ultraschall. Die MRT wird aufgrund ihrer Überlegenheit bei der Detektion kleiner Läsionen bevorzugt. Das Therapieansprechen wird anhand modifizierter RECIST (Response Evaluation Criteria for Solid Tumors)- und EASL (European Association for the Study of the Liver)-Kriterien bewertet. Die multiparametrische MRT in Verbindung mit LI-RADS (Liver Imaging Reporting And Data System) spielt insgesamt eine zentrale Rolle bei der präzisen Diagnose und Überwachung der Therapie des HCC.

Die Radiologie spielt eine Schlüsselrolle in der Diagnose und Überwachung von hepatozellulären Karzinomen (HCC). Dabei werden Ultraschall, Computertomographie (CT) und Magnetresonanztomographie (MRT) zur Identifizierung von HCC-Läsionen eingesetzt. Die multiparametrische MRT bietet detaillierte Einblicke in die Tumorbiologie durch die Analyse von Morphologie, Perfusion und Diffusion. Dadurch können präoperative Entscheidungen optimiert werden. Die Leitlinien empfehlen für die HCC-Diagnose eine kontrastverstärkte MRT oder Ultraschall. Die MRT wird aufgrund ihrer Überlegenheit bei der Detektion kleiner Läsionen bevorzugt. Das Therapieansprechen wird anhand modifizierter RECIST (Response Evaluation Criteria for Solid Tumors)- und EASL (European Association for the Study of the Liver)-Kriterien bewertet. Die multiparametrische MRT in Verbindung mit LI-RADS (Liver Imaging Reporting And Data System) spielt insgesamt eine zentrale Rolle bei der präzisen Diagnose und Überwachung der Therapie des HCC.

Background: Overweight and obesity among adults are a growing global public health threat and an essential risk factor for various noncommunicable diseases. Although intermittent fasting is a generally new dietary approach to weight management that has been increasingly practiced worldwide, the effectiveness of 2 days per week dry fasting remains unclear. Objective: The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study aims to determine the cardiometabolic, anthropometric, dietary intake, and quality of life changes among civil servants with overweight and obesity, following combined intermittent fasting and healthy plate (IFHP) and healthy plate (HP) and explore the participants’ experiences. Methods: We designed a mixed methods quasi-experimental study to evaluate the effectiveness of the IFHP and HP methods among adults with overweight and obesity. A total of 177 participants were recruited for this study, of which 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) to the HP group. The intervention comprised 2 phases: supervised (12 weeks) and unsupervised (12 weeks). Data collection was conducted at baseline, after the supervised phase (week 12), and after the unsupervised phase (week 24). Serum and whole blood samples were collected from each participant for analysis. Data on sociodemographic factors, quality of life, physical activity, and dietary intake were also obtained using questionnaires during data collection. Results: Most of the participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). The expected outcomes of this study are changes in body weight, body composition, quality of life, physical activity, dietary intake, and cardiometabolic parameters such as fasting blood glucose, 2-hour postprandial blood glucose, hemoglobin A1c, fasting insulin, and lipid profile. Conclusions: The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study is a mixed methods study to evaluate the effectiveness of combined IFHP and HP interventions on cardiometabolic and anthropometric parameters and explore participants’ experiences throughout the study. Trial Registration: ClinicalTrials.gov NCT05034653; https://clinicaltrials.gov/ct2/show/NCT05034653 International Registered Report Identifier (IRRID): RR1-10.2196/33801

Adult obesity and overweight pose a substantial risk to global public health and are associated with various noncommunicable diseases. Although intermittent fasting (IF) is increasingly used as a relatively new dietary strategy for weight loss, the effectiveness of 2 days per week of dry fasting remains unknown. This study aims to evaluate the effectiveness of a combined dry IF and healthy plate (IFHP) and healthy plate (HP) intervention in improving anthropometric outcomes and body composition. This nonrandomized controlled trial involved 177 adults who were overweight and obese. Among them, 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) were allocated to the HP group. The overall study duration was 6 months (October 2020 to March 2021). The intervention was divided into 2 phases: supervised (3 months) and unsupervised (3 months). The data were collected at baseline, after the supervised phase (month 3), and after the unsupervised phase (month 6). Anthropometric (weight, height, waist circumference, and hip circumference) and body composition (body fat percentage, body fat mass, skeletal muscle mass, and visceral fat area) data were measured at all 3 data collection points. Sociodemographic data were obtained using a questionnaire at baseline. Most participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). After 3 months, there were significant reductions in weight (difference -1.68; P<.001), BMI (difference -0.62; P<.001), body fat percentage (difference -0.921; P<.001), body fat mass (difference -1.28; P<.001), and visceral fat area (difference -4.227; P=.008) in the IFHP group, whereas no significant changes were observed in the HP group. Compared to baseline, participants in the IFHP group showed a significant decrease in weight (difference -1.428; P=.003), BMI (difference -0.522; P=.005), body fat percentage (difference -1.591; P<.001), body fat mass (difference -1.501; P<.001), visceral fat area (difference -7.130; P<.001), waist circumference (difference -2.304; P=.001), and hip circumference (difference -1.908; P=.002) at month 6. During the unsupervised phase, waist (IFHP difference -3.206; P<.001, HP difference -2.675; P=.004) and hip (IFHP difference -2.443; P<.001; HP difference -2.896; P<.001) circumferences were significantly reduced in both groups (P<.01), whereas skeletal muscle mass (difference 0.208; P=.04) and visceral fat area (difference -2.903; P=.003) were significantly improved in the IFHP group only. No significant difference in the between-group comparison was detected throughout the intervention (all P>.05). A combined IFHP intervention was effective in improving anthropometric outcomes and body composition in adults with overweight and obesity. RR2-10.2196/33801.