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Purpose To evaluate the cumulative radiobiological impact of daily megavoltage cone‐beam computed tomography (MV‐CBCT) imaging dose based on normal tissue complication probability (NTCP) and excess absolute risk (EAR) of secondary malignancies among radiotherapy patients treated for breast, pelvic, and head & neck cancers. This study investigated whether MV‐CBCT imaging dose warrants protocol personalization according to patient age, anatomical treatment site, and organ‐specific radiosensitivity. Methods This retrospective study included cohorts of breast (n = 30), pelvic (n = 17), and head & neck (n = 20) cancer patients undergoing radiotherapy with daily MV‐CBCT. Imaging dose distributions employing two common MV‐CBCT protocols (5 and 10 MU per fraction) were analyzed. NTCP values were estimated using logistic models, while EAR were calculated using Schneider's organ equivalent dose (OED)‐based model, integrating organ‐specific dose, patient age, and established tissue‐specific risk coefficients. Comparative statistical analyses were conducted using paired t‐tests, and results were further stratified by patient age (< 40, 40–60, > 60 years). Results In breast cancer patients, NTCP values increased significantly for lung tissue when comparing the 10 MU protocol to the 5 MU one (p < 0.001), while those for heart and breast tissues showed minimal and insignificant differences. EAR estimations revealed substantial risk increases among younger breast cancer patients (< 40 years), with some exceeding 15 cases per 10 000 person‐years under the 10 MU protocol. Conversely, pelvic and head & neck cohorts demonstrated consistently low NTCP and EAR values (< 1%), with no meaningful differences observed between the two imaging protocols. Across all cancer sites, younger age consistently correlated with higher secondary cancer risks. Conclusion Routine daily MV‐CBCT imaging at the 10 MU protocol possesses minimal additional risk in pelvic and head & neck radiotherapy. However, among breast cancer patients, particularly those under 40 years, the 10 MU protocol significantly elevates the theoretical secondary cancer risk estimates and lung NTCP. These findings support transitioning from conventional uniform imaging approach toward personalized MV‐CBCT protocols, tailored according to patient age, anatomical site, and organ radiosensitivity. A stratified imaging framework is proposed to optimize clinical outcomes, balancing treatment accuracy, and long‐term patient safety.

The World Federation of Pediatric Imaging (WFPI) MR Protocols Committee was formed in response to the critical need for standardized magnetic resonance imaging (MRI) protocols tailored specifically for pediatric populations. This initiative addresses the inherent challenges and variabilities in pediatric MRI practices due to the unique physiological and anatomical characteristics of children, which often result in extended scan times, increased costs, and greater need for sedation. The committee, comprising a diverse group of international radiologists, pediatric imaging societies, and major MRI vendors, collaboratively developed a comprehensive set of MRI protocols. These protocols are designed to enhance diagnostic accuracy, reduce sedation use, and streamline workflows, thereby minimizing healthcare disparities across global regions. Protocols cover a wide range of applications, including neuroradiology, abdominal imaging, and musculoskeletal conditions, with specific focus on practical implementation in both high-resource and resource-limited settings. After rigorous development and refinement through global feedback, these protocols have been made accessible through the WFPI website and will be directly integrated into MRI systems via vendor collaborations. These protocols provide a flexible, foundational approach that can be adapted to suit the needs of centers worldwide. This ensures that even basic protocols are accessible across different settings, allowing customization based on available resources and specific clinical demands.

Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence. Key Points • This report provides guidelines for MRI in endometriosis . • Minimal and optimal MRI acquisition protocols are provided . • Recommendations are proposed for patient preparation , best MRI sequences and reporting criteria .

Phase four of the Alzheimer's Disease Neuroimaging Initiative (ADNI4) magnetic resonance imaging (MRI) protocols aim to maintain longitudinal consistency across two decades of data acquisition, while adopting new technologies. Here we describe and justify the study's design and targeted biomarkers. The ADNI4 MRI protocol includes nine MRI sequences. Some sequences require the latest hardware and software system upgrades and are continuously rolled out as they become available at each site. The main sequence additions/changes in ADNI4 are: (1) compressed sensing (CS) T1‐weighting, (2) pseudo‐continuous arterial spin labeling (ASL) on all three vendors (GE, Siemens, Philips), (3) multiple‐post‐labeling‐delay ASL, (4) 1 mm3 isotropic 3D fluid‐attenuated inversion recovery, and (5) CS 3D T2‐weighted. ADNI4 aims to help the neuroimaging community extract valuable imaging biomarkers and provide a database to test the impact of advanced imaging strategies on diagnostic accuracy and disease sensitivity among individuals lying on the cognitively normal to impaired spectrum. Highlights A summary of MRI protocols for phase four of the Alzheimer's Disease Neuroimaging Initiative (ADNI 4). The design and justification for the ADNI 4 MRI protocols. Compressed sensing and multi‐band advances have been applied to improve scan time. ADNI4 protocols aim to streamline safety screening and therapy monitoring. The ADNI4 database will be a valuable test bed for academic research.

IntroductionThe application of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture has grown rapidly since its introduction in 2005. As the use of HR-pQCT for clinical research continues to grow, there is an urgent need to form a consensus on imaging and analysis methodologies so that studies can be appropriately compared. In addition, with the recent introduction of the second-generation HrpQCT, which differs from the first-generation HR-pQCT in scan region, resolution, and morphological measurement techniques, there is a need for guidelines on appropriate reporting of results and considerations as the field adopts newer systems.MethodsA joint working group between the International Osteoporosis Foundation, American Society of Bone and Mineral Research, and European Calcified Tissue Society convened in person and by teleconference over several years to produce the guidelines and recommendations presented in this document.ResultsAn overview and discussion is provided for (1) standardized protocol for imaging distal radius and tibia sites using HR-pQCT, with the importance of quality control and operator training discussed; (2) standardized terminology and recommendations on reporting results; (3) factors influencing accuracy and precision error, with considerations for longitudinal and multi-center study designs; and finally (4) comparison between scanner generations and other high-resolution CT systems.ConclusionThis article addresses the need for standardization of HR-pQCT imaging techniques and terminology, provides guidance on interpretation and reporting of results, and discusses unresolved issues in the field.

Purpose of Review Trauma constitutes a social and a clinical problem. The CT protocol to be adopted in polytrauma patients is still not standardized across institutions. A variety of protocols can be found in the available literature, which differ from each other in timing acquisition and number of phases. Recent Findings Even if multiple recent studies are investigating the role of split bolus technique, multiphasic protocol has been shown to be associated with early detection and adequate characterization of vascular injuries, so it should be still considered as the “best” CT protocol for the assessment of high-energy trauma patients. Summary The article provides a review on the currently available literature on the CT protocols adopted in polytraumatized patients.

Cardiovascular magnetic resonance (CMR) has taken on an increasingly important role in the diagnostic evaluation and pre-procedural planning for patients with congenital heart disease. This article provides guidelines for the performance of CMR in children and adults with congenital heart disease. The first portion addresses preparation for the examination and safety issues, the second describes the primary techniques used in an examination, and the third provides disease-specific protocols. Variations in practice are highlighted and expert consensus recommendations are provided. Indications and appropriate use criteria for CMR examination are not specifically addressed.

Purpose Positron emission tomography/computed tomography (PET/CT) imaging has been widely used in clinical practice. Long axial field-of-view (LAFOV) systems have enhanced clinical practice by leveraging their technological advantages and have emerged as the new state-of-the-art PET imaging modalities. A consensus was conducted to explore expert views in this emerging field to comprehensively elucidate the proposed workflow in LAFOV PET/CT examinations and highlight the potential challenges inherent in the workflow. Methods A multidisciplinary task group formed by 28 experts from six countries over the world discussed and approved the consensus based on the published guidelines, peer-reviewed articles of LAFOV PET/CT, and the collective experience from clinical practice. This consensus focuses on the workflow that allows for a broader range of imaging protocols of LAFOV PET/CT, catering to diverse patient needs and in line with precision medicine principles. Results This consensus describes the workflows and imaging protocols of LAFOV PET/CT for various imaging scenarios including routine static imaging, dynamic imaging, low-activity imaging, fast imaging, prolonged imaging, delayed imaging, and dual-tracer imaging. In addition, imaging reconstruction and reviewing specific to LAFOV PET/CT imaging, as well as the main challenges facing installation and application of LAFOV PET/CT scanner were also summarized. Conclusion This consensus summarized the various imaging workflow, imaging protocol, and challenges of LAFOV PET/CT imaging, aiming to enhance the clinical and research applications of these scanners.

This study evaluates the imaging quality and radiation dose of six flat-panel volume CT protocols with varying technical parameters, including examination time (“Artis Icono” angiography system (Siemens Healthcare AG, Erlangen, Germany): 14s DCT HEAD MICRO CARE (14s I), 14s DCT HEAD MICRO CARE 4 (14s II), 8s DCT HEAD 70kV CARE 1 (8s I), 8s DCT HEAD 70kV CARE 3 (8s II), 4s DCT HEAD CARE FB (4s I), 4s DCT HEAD CARE FB 2 (4s II)) for middle ear visualization in human skull specimens. A scoring system assessed the delineation of 28 anatomical structures, narrowed to eight for detailed evaluation. Protocols 14s I and 8s I achieved the highest image quality, exceeding the clinical threshold. 8s I protocol demonstrated an optimal balance between image quality and radiation safety, adhering to the ALADA principle (“as low as diagnostically acceptable”). While 14s I offered superior detail, it involved higher radiation exposure without substantial further image improvement, indicating a saturation effect. Shorter protocols, such as 4s I, offered radiation-sparing advantages but did not consistently meet clinical image quality standards. Protocol 8s I is recommended as the standard for middle ear imaging, with 4s I as a potential alternative for cases requiring minimized radiation exposure and reduced motion artifact susceptibility.

Purpose To compare the performance of imaging interpretation, intra- and inter-reader agreement between an abbreviated (aMRI) and full (fMRI) MRI protocol for diagnosis of pelvic endometriosis. Methods Seventy consecutive fMRI exams performed under suspicion of pelvic endometriosis were selected. Four radiologists (Rd) (1–10 years experience) independently evaluated presence/absence of endometriosis at 9 anatomic sites (AS). The readers evaluated aMRI (coronal T2 TSE volumetric images and axial T1 GRE fat-sat without contrast, extracted from fMRI) and fMRI protocols randomly, with at least 4 weeks interval between readings. The degree of confidence for diagnosis at each AS was evaluated with a 1–3 Likert Scale (1: low; 3: high). Intra- and inter-reader agreement between protocols were evaluated by kappa statistics and took reading experience into account. The gold standard for assessing the performance of imaging interpretation (sensitivity, specificity and accuracy) used a consensus reading of two other Rd (> 15 years experience). Results There was no significant difference in the accuracy of imaging interpretation between the abbreviated (0.83–0.86) and full (0.83–0.87) protocols ( p = 0.15). Intra-reader agreement between protocols ranged from substantial to almost perfect (0.74–0.96). A substantial inter-reader agreement was found for both protocols for readers with similar levels of experience (0.67–0.69) and in the global analysis (0.66 for both protocols). No difference was found in terms of degree of confidence between protocols, for all readers. Conclusion An abbreviated MRI protocol for pelvic endometriosis provided an accuracy of interpretation comparable to that of a complete protocol, with similar degrees of confidence and reproducibility, regardless the level of experience.