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An increasing array of tools is being developed using artificial intelligence (AI) and machine learning (ML) for cancer imaging. The development of an optimal tool requires multidisciplinary engagement to ensure that the appropriate use case is met, as well as to undertake robust development and testing prior to its adoption into healthcare systems. This multidisciplinary review highlights key developments in the field. We discuss the challenges and opportunities of AI and ML in cancer imaging; considerations for the development of algorithms into tools that can be widely used and disseminated; and the development of the ecosystem needed to promote growth of AI and ML in cancer imaging. Koh, Papanikolaou et al. discuss the application of artificial intelligence in cancer imaging. The authors highlight opportunities for exploiting machine learning algorithms in this field, and outline barriers in their implementation and how these might be addressed.

This statement has been produced within the European Society of Radiology AI Working Group and identifies the key policies of the EU AI Act as they pertain to medical imaging. It offers specific recommendations to policymakers and the professional community for the effective implementation of the legislation, addressing potential gaps and uncertainties. Key areas include AI literacy, classification rules for high-risk AI systems, data governance, transparency, human oversight, quality management, deployer obligations, regulatory sandboxes, post-market monitoring, information sharing, and market surveillance. By proposing actionable solutions, the statement highlights ESR’s readiness in supporting appropriate application of the AI Act in the field, promoting clarity and the effective integration of AI technologies to ensure their impactful and safe use for the benefit of Europe’s patients. Critical relevance statement With the impending arrival of the EU AI Act, it is critical for stakeholders to provide timely input on its key areas. This statement offers expert feedback on the aspects of the EU AI Act that will affect medical imaging. Key Points The AI Act will significantly impact the field of medical imaging, shaping how AI technologies are used and regulated. The ESR is committed to develop guidelines and best practices, collaborating on the implementation process. This statement offers expert feedback on the aspects of the framework that will affect medical imaging. Graphical Abstract

Mobile medical imaging devices are invaluable for clinical diagnostic purposes both in and outside healthcare institutions. Among the various imaging modalities, only a few are readily portable. Magnetic resonance imaging (MRI), the gold standard for numerous healthcare conditions, does not traditionally belong to this group. Recently, low-field MRI technology companies have demonstrated the first decisive steps towards portability within medical facilities and vehicles. However, these scanners’ weight and dimensions are incompatible with more demanding use cases such as in remote and developing regions, sports facilities and events, medical and military camps, or home healthcare. Here we present in vivo images taken with a light, small footprint, low-field extremity MRI scanner outside the controlled environment provided by medical facilities. To demonstrate the true portability of the system and benchmark its performance in various relevant scenarios, we have acquired images of a volunteer’s knee in: (i) an MRI physics laboratory; (ii) an office room; (iii) outside a campus building, connected to a nearby power outlet; (iv) in open air, powered from a small fuel-based generator; and (v) at the volunteer’s home. All images have been acquired within clinically viable times, and signal-to-noise ratios and tissue contrast suffice for 2D and 3D reconstructions with diagnostic value. Furthermore, the volunteer carries a fixation metallic implant screwed to the femur, which leads to strong artifacts in standard clinical systems but appears sharp in our low-field acquisitions. Altogether, this work opens a path towards highly accessible MRI under circumstances previously unrealistic.

Purpose This study’s purpose was to investigate how an ideal anatomic femoral attachment affects the dynamic length change pattern of a virtual medial patellofemoral ligament (MPFL) from an extended to a highly flexed knee position; to determine the relative length and length change pattern of a surgically reconstructed MPFL; and to correlate femoral attachment positioning, length change pattern, and relative graft length with the clinical outcome. Methods Twenty-four knees with isolated nonanatomic MPFL reconstruction were analysed by three-dimensional computed tomography at 0°, 30°, 60°, 90°, and 120° of knee flexion. The lengths of the MPFL graft and a virtual anatomic MPFL were measured. The pattern of length change was considered isometric if the length distance changed <5 mm through the entire dynamic range of motion. Results Knee flexion significantly affected the path lengths between the femoral and patellar attachments. The length of the anatomic virtual MPFL decreased significantly from 60° to 120°. Its maximal length was 56.4 ± 6.8 mm at 30°. It was isometric between 0° and 60°. The length of the nonanatomic MPFL with a satisfactory clinical result decreased during flexion from 0° to 120°. Its maximal length was 51.6 ± 4.6 mm at 0° of knee flexion. The lengths measured at 0° and 30° were isometric and statistically greater than the lengths measured at higher flexion degrees. The failed nonanatomic MPFL reconstructions were isometric throughout the dynamic range, being significantly shorter (27.1 ± 13.3 %) than anatomic ligaments. Conclusion The femoral attachment point significantly influences the relative length and the dynamic length change of the grafts during knee flexion–extension and graft isometry. Moreover, it influences the long-term outcome of the MPFL reconstructive surgery. A nonanatomic femoral fixation point should not be considered the cause of persistent pain and instability after MPFL reconstruction in all cases. Level of evidence III.

Radiology faces structural, cultural, and systemic challenges that threaten the sustainability and quality of its research. This article critically examines the complex factors shaping radiological research engagement, emphasizing the need to redefine academic value systems within the specialty. Radiology training remains largely generalist, limiting disease-specific clinical insight, while rapid technological advances have shifted research toward engineering and computational fields, eroding radiology’s clinical ownership of imaging innovation. Multidisciplinary collaboration among radiologists, clinicians, physicists, and data scientists is essential to maintain clinically meaningful and translational research. Establishing disease-focused groups within professional societies will surely promote subspecialized expertise and guidance. Training and mentorship gaps further impede progress. Traditional curricula provide limited research exposure, while early subspecialization, structured mentorship, and integrated research training during residency are proposed to foster clinical excellence and scientific engagement. Increasing productivity demands, together with unprecedented digital workflow pressures, contribute to cognitive overload and burnout. These factors discourage participation in research. Institutional reforms ensuring protected research time, equitable recognition of academic work, and improved cognitive ergonomics are vital for innovation. Funding constraints and limited grant-writing skills reduce competitiveness, as imaging research often struggles against therapeutic fields. Developing collaborative research networks and scientific writing training can enhance funding success. Finally, quantity-driven academic metrics promote low-value publications. A shift toward value-based evaluation—prioritizing clinical relevance, methodological rigor, and collaboration—is therefore needed. Radiology must realign its academic structures to sustain high-quality research and reaffirm its dual role as a clinical cornerstone and scientific innovator. The Cancer Image Europe (EUCAIM) infrastructure facilitates collaboration among radiologists, clinicians, researchers, and innovators, representing a valuable opportunity for radiologists in training to engage in research. Critical relevance statement Radiology faces structural, cultural, and systemic challenges that threaten the sustainability and quality of its research. This article critically examines the complex factors shaping radiological research engagement, emphasizing the need to redefine academic value systems within the specialty. Key Points Radiology must overcome structural and cultural barriers to sustain impactful research. Multidisciplinary collaboration and disease-focused training are key to clinical innovation. Reforming evaluation systems and protecting research time are essential for progress. Graphical Abstract

Myotonic dystrophy type 1 (DM1) is a severe autosomal dominant neuromuscular disease in which the musculoskeletal system contributes substantially to overall mortality and morbidity. DM1 stems from a noncoding CTG trinucleotide repeat expansion in the DMPK gene. The human skeletal actin long repeat (HSA LR ) mouse model reproduces several aspects of the disease, but the muscle-wasting phenotype of this model has never been characterized in vivo. Herein, we used quantitative MRI to measure the fat and muscle volumes in the leg compartment (LC) of mice. These acquired data were processed to extract relevant parameters such as fat fraction and fat infiltration (fat LC/LC) in HSA LR and control (FBV) muscles. These results showed increased fat volume (fat LC) and fat infiltration within the muscle tissue of the leg compartment (muscle LC), in agreement with necropsies, in which fatty clumps were observed, and consistent with previous findings in DM1 patients. Model mice did not reproduce the characteristic impaired fat fraction, widespread fat replacement through the muscles, or reduced muscle volume reported in patients. Taken together, the observed abnormal replacement of skeletal muscle by fat in the HSA LR mice indicates that these mice partially reproduced the muscle phenotype observed in humans.