Publications

PURPOSE: To develop expert consensus recommendations for patient selection and procedural techniques in cryoneurolysis for chronic pain management using a Delphi process.

MATERIALS AND METHODS: A panel of 22 international interventionists participated in a two-round Delphi process. Participants rated 42 statements on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree). Consensus was predefined as ≥ 75% of ratings ≥ 7. Descriptive statistics (n, mean ± SD, % ≥ 7) were calculated.

RESULTS: High agreement supported cryoneurolysis for localized chronic pain refractory to conservative therapies (mean 8.55 ± 0.60; 100% ≥ 7) and cases with identifiable peripheral nerve targets (8.45 ± 0.74; 100% ≥ 7). Imaging guidance was deemed essential for nerve identification and probe placement (8.91 ± 0.29; 100% ≥ 7). The panel endorsed individualized freeze-thaw cycles to achieve Sunderland II injury (8.27 ± 0.83; 91% ≥ 7) and emphasized thorough patient education (9.0 ± 0.0; 100% ≥ 7). Experts recommended repeat cryoneurolysis within weeks if initial response was incomplete (8.64 ± 0.65; 100% ≥ 7) and alternative therapies after two unsuccessful sessions (8.36 ± 0.73; 95% ≥ 7). No consensus was reached on restricting treatment to a single anatomical region (5.82 ± 2.91; 50% ≥ 7) or routine prophylactic antibiotics (6.27 ± 2.57; 54% ≥ 7).

CONCLUSION: This Delphi study establishes expert-derived consensus standards for cryoneurolysis, highlighting careful patient selection, mandatory imaging guidance, and flexible freeze protocols while identifying areas requiring further research.

A general fabrication method for metal-organic framework (MOF) coatings through a vapor sublimation and deposition process is reported. The vapor-phase fabrication mechanism relies on the interplay between thermodynamic properties and the solid-vapor interface reaction. The processing parameters of ion concentration, vapor pressure, and system temperature enable control of the sublimation rate, and ion-linker nucleation and coordination reactions occur at the dynamic solid-vapor interface to form the proposed MOF coatings. The reaction rate is controllable and is proportional to the sublimation rate during the fabrication process. On the basis of the proposed fabrication mechanism, experiments are facilitated to obtain combinations of multiple metal cores and a variety of functionalized linkers for vapor deposition from solid solution sublimation. The fabrication process involves pore size control, crystalline orientation customization, and encapsulation of cargo to form composite coatings, and these processes are implemented during the same one coating fabrication process. The initiation and manipulation of the nucleation radius and thus the nucleation rate are easy to control and are related to the fabricated MOF coatings with tunable crystalline morphologies. Moreover, the MOF coating thickness is a time-dependent process that is proportional to the sublimation rate and deposition time. In the present study, the surface area of the fabricated MOF coatings was 1250 m2/g, the Young's modulus was 2.8 GPa, the surface roughness was 238.7 ± 17.3 nm, and thicknesses ranging from 200 nm to 5 μm were prepared. Maximized compatibility is also discussed through the exploitation of solid solutions that are free of organic solvents and a purely dry process, and the final MOF coatings are conformal with high fidelity regardless of the substrate material type and the complexity of the geometries in both 2D and 3D. The stability of the MOF coating is inspected by an adhesion test that reveals the highest adhesion standard in the ASTM D3359 classification. The cell culture on this coating verified high cell viability with promoted cell attachment, proliferation, and increased osteointegration activities.

In 2005, three emergent strategic themes for academic radiology were identified to help deal with growing issues in the clinical, research, and educational missions. However, over the past two decades, these emergent strategic themes have actually evolved at different speeds with different levels of adoption by academic radiology departments. By considering these strategic themes as analogs to innovations, we have been able to apply concepts from the study of the diffusion of innovations and demonstrate the relevant "S-curves" so as to analyze the evolution of these strategic themes and their likely future courses. We have found that the emergent strategic theme of "throughput" has been fully adopted among academic radiology departments throughout the 2005 to 2025 period and is in the mature phase-at least with respect to the conventional approach of utilizing human radiologists without AI assistance to perform the key tasks of interpreting and reporting imaging studies. On the other hand, the emergent strategic themes of "teams" and "self-directed learning" for the research and educational missions, respectively, have been adopted only by a subset of academic radiologists and radiology departments during this period, with particularly low rates of adoption in the 2005 to 2015 period. Future development of each of these emergent strategic themes will be significantly impacted by the parallel development, introduction, and evolution of AI within academic radiology in the years to come.

Multiple barriers have been identified to developing a learning health care systems (LHSs) including organizational culture, data systems and interoperability, funding and workforce limitations, and regulatory challenges. Artificial intelligence (AI) is being explored both inside and outside of health care, with varying degrees of scientific rigor in the testing of AI applications. LHSs and AI face similar implementation challenges, which presents an opportunity for synergy. By reviewing AI use cases from the lens of how it can be used to reduce previously identified barriers to progressing toward an LHS, opportunities for facilitating this journey can be identified. AI tools can impact both clinical and nonclinical business processes. The process of testing and implementing AI tools based on high-quality evidence or signal should prespecify thresholds and expectations of incremental effectiveness (marginal risk-benefit) improvement compared with current standards of care, as is standard in health services research, quality improvement, process improvement, and best practices of comparative health care research. Business process examples to improve workflow using AI tools may adhere to less rigorous evidentiary standards compared with tools guiding patient-centered clinical decision scenarios, such as with AI-based diagnostic applications. This review indicates that AI tools provide tremendous opportunities for radiology to improve health care systems, workflow processes, and patients' health outcomes.

PURPOSE: To evaluate the impact of capsular tension ring (CTR) implantation on refractive outcomes, intraocular lens (IOL) stability, and postoperative complications in high myopic patients undergoing cataract surgery.

DESIGN: Systematic review and meta-analysis.

METHODS: A systematic search of PubMed, EMBASE, Cochrane Library, and Google Scholar through March 2025 identified studies comparing cataract surgery with and without CTR implantation in high myopic eyes. The primary outcome was prediction refractive error (PE). Secondary outcomes included absolute refractive error (AE), postoperative corrected distance visual acuity (CDVA), IOL decentration, anterior chamber depth (ACD), posterior capsular opacification (PCO), and Nd:YAG capsulotomy rates. Random-effects meta-analysis, sensitivity analysis, and meta-regression were performed.

RESULTS: Nine studies (4 randomized controlled trials and 5 cohort studies; 846 eyes) were included. CTR implantation did not significantly affect PE (mean difference [MD], 0.00; 95% confidence interval [CI], -0.07 to 0.08; P = .93) or postoperative CDVA (MD, 0.00; 95% CI, -0.06 to 0.06; P = 1.00). However, CTR significantly reduced AE (MD, -0.12; 95% CI, -0.20 to -0.05; P = .001) and IOL decentration (MD, -0.04; 95% CI, -0.07 to -0.01; P = .004).No covariates significantly influenced PE in meta-regression.

CONCLUSIONS: CTR implantation appears to modestly improve refractive predictability and IOL stability in high myopic eyes without compromising postoperative visual acuity. However, given the limited evidence base and small effect sizes, these findings should be interpreted with caution. CTR implantation may be considered in selected myopic cases with suspected zonular weakness or large capsular bags where additional capsular stability is desired.

Extending our validated benchmarking work, GPT-5 showed no improvement in sociodemographic-linked decision variation compared with GPT-4o and seemed to be worse on several endpoints. We re-tested GPT-5 with a fixed pipeline: 500 physician-validated emergency vignettes, each replayed across 32 sociodemographic labels plus an unlabeled control, answering the same four questions (triage, further testing, treatment level, and need for mental-health assessment). This design holds clinical content constant to isolate the effect of the label. GPT-5 reproduced subgroup-linked variation, with higher assigned urgency and less advanced testing for several historically marginalized and intersectional groups. Notably, several LGBTQIA+ labels were flagged for mental-health screening in 100% of cases, versus  41-73% for comparable groups with GPT-4o. Additionally, in an adversarial re-run that inserted one fabricated medical detail into otherwise standard clinical cases, GPT-5 adopted or elaborated on the fabrication in 65% of runs (vs 53% for GPT-4o). A single mitigation prompt reduced this to 7.67%.

INTRODUCTION: Given the high prevalence of vertebral fractures following radiotherapy in patients with metastatic spine disease, torso muscle segmentation is necessary for biomechanical modeling of vertebral loading, permitting individualized evaluation of fracture risk.

METHODS: In this study, we developed and validated a deep-learning model for full volumetric segmentation of the thoracic and abdominal spinal musculature in cancer patients with metastatic spine disease from sparsely annotated clinical CT image data. We obtained CT data for 148 metastatic spine disease patients undergoing radiotherapy treatment, and an external set of randomly selected 30 subjects from the National Lung Screening Trial. We extracted 1924 axial CT images at the midpoint of each vertebral level (T4 to L4) and manually labeled the key extensor and flexor muscles (up to 8 muscles per side) at each level. We trained a 2D nnU-Net deep-learning (DL) model to segment each muscle and, using these sparse annotations, trained the model to segment each muscle's 3D volume per spine. Two experienced radiologists independently and blindly evaluated the anatomical fidelity of the segmentations using a Likert scale, for 1) manual- and 2) DL-segmentation, 3) random test samples from the muscle's 3D volume and 4) an external NLST CT data.

RESULTS: The DL method achieved comparable performance to manual segmentations with a mean Dice score above 0.769. Mann-Whitney test analysis showed that the radiologist ratings of DL-generated muscle segmentations were noninferior to the manual segmentation for each muscle.

DISCUSSION: Demonstrating excellent performance for rapid, high-anatomical fidelity 3D segmentation of the main flexor, extensor, and stabilizing thoracolumbar muscles, the DL model from clinical CT scans, this development holds significant potential for reducing the manual effort required to generate individualized musculoskeletal models in cancer patients.

Meningiomas are the most common primary intracranial neoplasms of all brain tumors. Although the majority are benign, a subset displays aggressive behavior characterized by recurrence, anaplastic transformation, or, rarely, extracranial metastasis. Lung parenchyma represents the most frequent site of spread, followed by mediastinal and pleural involvement. Despite recent advances in molecular characterization, predicting metastatic potential remains challenging. We report three cases of meningiomas with thoracic metastases illustrating distinct biological trajectories. Case 1 involved a 33-year-old woman with a germline BAP1 mutation and recurrent cerebellopontine angle meningioma (WHO grade 1). After multiple resections and radiotherapy, surveillance imaging revealed pulmonary and hilar lesions. Both EBUS-TBNA and percutaneous lung biopsy confirmed a metastatic meningioma (EMA+, SSTR2+, PR rare+, BAP1 loss). Case 2 describes a 45-year-old man with a de novo anaplastic meningioma (WHO grade 3) who later developed multiple bilateral pulmonary nodules confirmed via robotic-assisted bronchoscopy (EMA+, SSTR2+, CAM5.2-). Case 3 details a 79-year-old man with a recurrent spheno-orbital anaplastic meningioma who developed bilateral pulmonary metastases diagnosed by Ion robotic bronchoscopy and confirmed by neuropathology (SSTR2+, EMA focal+, PR+). Meningioma metastasis remains exceedingly rare, but risk increases with higher grade, recurrence, and molecular alterations such as BAP1 loss or NF2 inactivation. Latency varies from months in anaplastic cases to decades in low-grade tumors. Minimally invasive techniques, including EBUS-TBNA and robotic bronchoscopy, provide accurate and safe diagnostic confirmation, especially when thoracic disease is suspected. Thoracic metastases from meningioma demonstrate diverse clinical courses independent of histologic grade. Molecular profiling, particularly BAP1 and NF2 status, may refine risk assessment and justify risk-adapted surveillance incorporating chest imaging or PET/CT. Treatment is largely palliative, with local resection or radiotherapy offering control in selected cases. Continued integration of molecular diagnostics and modern bronchoscopic technologies may improve recognition and management of these rare metastatic events.

BACKGROUND: Trigeminal autonomic cephalalgias (TACs) are characterized by unilateral headache with cranial autonomic symptoms. Sudden subtype changes may suggest secondary causes.

CASE PRESENTATION: A 66-year-old woman presented with a rapid shift from paroxysmal hemicrania to SUNCT. Varicella zoster virus (VZV) reactivation was confirmed by CSF analysis and aqueous humor PCR. Ocular involvement included panuveitis and papillitis. Symptoms resolved after 14 days of intravenous acyclovir.

CONCLUSION: Rapid TACs subtype transformation should prompt evaluation for secondary causes. Early diagnosis of VZV can lead to favorable outcomes.