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PROspectiVe imaging research DEsign and coNducT (PROVIDENT): Considerations for clinical trials and studies using imaging (Part II) 前瞻性影像学研究的设计和实施（PROVIDENT）：临床试验和影像学研究的考虑（第二部分）。
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-01-21 DOI: 10.1016/j.radi.2026.103329
K. Biscombe , N. Porta , P.G. Conaghan , S.J. Doran , A. Ribeiro , S. Mallett , T.E. Nichols , E.M.A. Hensor

Objectives

Imaging is used in a wide range of contexts in clinical research projects, but adds complexity to the design, conduct and analysis. This paper is the second of two in which we use a consensus approach to combine multidisciplinary perspectives on the challenges in conducting prospective clinical trials and other research studies involving imaging. Here we consider challenges in image interpretation and quantification, quality assurance and quality control (QA/QC); scanner imaging acquisition, data flow and storage, health economics (HE) decision modelling, costings for running a trial; and commercialisation.

Key findings

Availability of scanners and staff can impact deliverability. Pre-specification of key procedures, roles and responsibilities via appropriate documentation is important; ensuring compatibility across different sites and machines is challenging and requires advance input from multiple stakeholders. Testing critical procedures, including the flow of images and derived data between participating sites and/or external legal entities, can avoid delays. Effective QA/QC is conducted at regular intervals; relevant staff should be involved at the planning stage. Identifying appropriately qualified readers and arranging for image hosting takes time; this should be done prior to image acquisition. Testing image interpretation burden informs feasibility and costings. Cost estimates for research involving imaging and HE modelling of imaging interventions can be complex due to the interplay between local and national policies, and the extent to which the research imaging is integrated with standard care.

Conclusion

These considerations derived from a multidisciplinary team will be useful for funding applications, protocol design, trial implementation, conduct and commercialisation and uptake of new imaging techniques.

Implications for practice

Many prospective imaging studies could be improved by the upfront awareness of potential challenges and understanding of real-world examples these considerations provide.
目的：影像学在临床研究项目中广泛应用，但增加了设计、实施和分析的复杂性。本文是两篇论文中的第二篇，其中我们使用共识方法将多学科观点结合在进行前瞻性临床试验和其他涉及成像的研究中的挑战。在这里，我们考虑图像解释和量化，质量保证和质量控制（QA/QC）的挑战；扫描仪成像采集，数据流和存储，卫生经济学（HE）决策建模，运行试验的成本；和商业化。主要发现：扫描仪和员工的可用性会影响可交付性。通过适当的文件预先说明关键程序、角色和职责是很重要的；确保不同站点和机器之间的兼容性是具有挑战性的，需要多个利益相关者的预先输入。测试关键程序，包括参与站点和/或外部法律实体之间的图像和派生数据流，可以避免延误。有效的QA/QC定期进行；在规划阶段应让有关工作人员参与。确定合适的合格读者并安排图像托管需要时间；这应该在图像采集之前完成。测试图像判读负担可告知可行性和成本。由于地方和国家政策之间的相互作用，以及研究成像与标准护理相结合的程度，涉及成像和成像干预的HE建模的研究成本估计可能很复杂。结论：来自多学科团队的这些考虑将有助于资助应用、方案设计、试验实施、实施和商业化以及新成像技术的采用。对实践的启示：许多前瞻性成像研究可以通过预先意识到潜在的挑战和理解这些考虑提供的现实世界的例子来改进。
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引用次数: 0
Advancing practice radiography education in the UK: An analysis of themes from higher education programmes 推进实践放射学教育在英国：从高等教育课程的主题分析。
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-02-04 DOI: 10.1016/j.radi.2026.103344
J. Harcus , K. Hizzett , M. Clarkson , B. Snaith

Introduction

The development of radiographers to the enhanced, advanced and consultant levels relies on appropriate post-registration education to develop capabilities across four pillars of practice. In an evolving landscape, higher education institutions (HEIs) need to ensure provision is viable, meets demand, and aligns with professional frameworks. This study aimed to scope the current UK post-registration radiography provision to support advancing practice and explore future directions and challenges in delivery.

Methods

The multi-method qualitative study comprised two stages. Content analysis was undertaken of online information pertaining to programmes. Semi-structured online interviews were undertaken with HEI representatives from programme teams. Content and frequency analysis of education provision and thematic analysis of interviews using Braun and Clark’s methodology was undertaken.

Results

49 post-registration radiography programmes, at 25 HEIs, were identified during content analysis. Ultrasound, projectional radiograph reporting, and breast imaging were well provided for, yet options in radiotherapy, nuclear medicine, and DXA were limited, especially outside of England. 16 (64 %) of HEIs were represented at interview and four key themes were identified; sustainability and viability of provision, fragmentation of provision, ambiguity of levels of practice and accreditation, and addressing the four pillars of practice.

Conclusion

HEIs have identified significant challenges to viability of provision, placing programmes at significant risk. Saturation of some areas of practice, uncertain funding streams, and low student numbers were perceived to present a challenge to the sustainability of UK post-registration radiography education. The provision, and how it meets the requirements of the advancing practice workforce, presents a very mixed picture.

Implications for practice

Without a sustainable and collaborative approach to post-registration radiography education, support for the future advancing practice workforce is under threat, particularly in some discipline areas.
导读：将放射技师发展到高级、高级和顾问水平依赖于适当的注册后教育，以发展跨越四个实践支柱的能力。在不断变化的环境中，高等教育机构（HEIs）需要确保提供的服务是可行的，满足需求，并与专业框架保持一致。本研究的目的是扩大目前英国注册后放射照相规定的范围，以支持先进的实践，并探索未来的方向和挑战。方法：多方法定性研究分为两个阶段。对有关方案的网上资料进行了内容分析。与来自各项目团队的高等教育代表进行了半结构化的在线访谈。使用布劳恩和克拉克的方法对教育提供的内容和频率进行了分析，并对访谈进行了专题分析。结果：在内容分析中确定了25所高等学校的49个注册后放射学课程。超声、投影x线片报告和乳房成像得到了很好的提供，但放疗、核医学和DXA的选择有限，特别是在英国以外。16（64%）的高等教育机构在采访中得到了代表，并确定了四个关键主题；提供的可持续性和可行性，提供的碎片化，实践和认证水平的模糊性，以及解决实践的四大支柱。结论：高等教育机构已经确定了提供可行性的重大挑战，将课程置于重大风险之中。一些实践领域的饱和、不确定的资金流和低学生人数被认为对英国注册后放射学教育的可持续性提出了挑战。这一规定，以及它如何满足不断进步的执业人员的要求，呈现出一幅非常复杂的画面。对实践的影响：如果注册后放射学教育没有可持续和协作的方法，对未来先进实践劳动力的支持将受到威胁，特别是在一些学科领域。
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引用次数: 0
More than a comment: Radiographers' perspectives on image interpretation and image quality 不止一个评论：放射技师对图像解释和图像质量的看法。
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-02-05 DOI: 10.1016/j.radi.2026.103343
A. Tonks , J. Hewis , Y. Jimenez , F. Gray , E. Ekpo

Introduction

Radiographic quality is the degree to which technical requirements are met that result in clear and accurate reproduction of structures, to enable confident assessment and correct diagnosis. Radiographic image quality therefore comprises technical adequacy and diagnostic utility. It has been suggested that radiographer participation in the image interpretation process may improve their understanding of how these two elements are linked and therefore improve delivery of X-ray quality; however, this has not been directly examined. Therefore, the aim of this study was to investigate radiographers' perspectives on X-ray image quality following the implementation of radiographer commenting.

Methods

Radiographers who worked at hospitals that had implemented a Radiographer Comment and Alert model were invited to participate in one of four online focus groups recorded by Zoom in May–June 2024. The 13 participants, six females and seven males, had between two and 18 years of clinical experience across a range of modalities. Qualitative data was analysed using Braun & Clarke’s Reflexive Thematic Analysis to generate themes and subthemes relevant to the study aim.

Results

Six main themes were identified. The overarching finding was that image interpretation improved understanding and delivery of X-ray quality. The remaining five themes recognised mechanisms contributing to this; increased thought and reflection, enhanced performance expectations radiographers sought to meet, deeper knowledge-building and learning practices, improved technical decision making, and increased collaboration.

Conclusion

Introduction of formal image interpretation practices can be used as a tool to improve radiographers' understanding and production of high-quality X-rays, which provide clinical and economic healthcare benefits.

Implications for practice

Radiographer commenting is within scope for all registered practitioners and can therefore be easily and widely utilised to benefit image quality in the clinical setting.
x线摄影质量是指满足技术要求的程度，从而能够清晰准确地再现结构，从而实现自信的评估和正确的诊断。因此，放射图像质量包括技术充分性和诊断效用。有人建议，放射技师参与图像解释过程可以提高他们对这两个要素如何联系的理解，从而提高x射线的质量；然而，这一点尚未得到直接检验。因此，本研究的目的是探讨在实施放射技师评论后，放射技师对x射线图像质量的看法。方法：邀请在实施放射技师评论和警报模型的医院工作的放射技师参加Zoom于2024年5 - 6月记录的四个在线焦点小组之一。13名参与者，6名女性和7名男性，在一系列模式中有2到18年的临床经验。使用Braun & Clarke的反身性主位分析来分析定性数据，以生成与研究目标相关的主位和副主位。结果：确定了六个主要主题。最重要的发现是图像解释提高了对x射线质量的理解和传递。其余五个主题确认了对此作出贡献的机制；增加了思考和反思，提高了放射技师寻求满足的绩效期望，加深了知识建设和学习实践，改进了技术决策，加强了协作。结论：引入正式的图像解释实践可以作为提高放射技师对高质量x射线的理解和生产的工具，提供临床和经济医疗效益。对实践的影响：放射技师评论在所有注册从业人员的范围内，因此可以很容易和广泛地利用，以提高临床环境中的图像质量。
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引用次数: 0
Exploring augmented reality for hand hygiene training in radiography students: A pilot study 探索增强现实技术在放射学学生手部卫生培训中的应用：一项试点研究
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-01-29 DOI: 10.1016/j.radi.2026.103335
K. Amadita, D. Abu Awwad, F. Gray, A. Repole, D. Nocum, Y.A. Jimenez

Introduction

Augmented reality (AR) offers opportunities for hand hygiene training and assessment in health profession students, providing guided and repetitive experiential learning. This pilot study aimed to explore radiography students' perceptions of the usability and satisfaction of an AR system (ARS) for hand hygiene education and its effect on students’ knowledge, confidence, and practice.

Methods

Radiography students completed ARS-based hand hygiene training and assessment before clinical placement. Data was collected at three timepoints: Pre-intervention (Survey 1); Postintervention (Survey 2); and Post-placement (Survey 3). Surveys explored knowledge, confidence and perceptions of the ARS. Software-acquired data was automatically recorded. Following an opt-out recruitment approach, 73 students participated in this study.

Results

Self-reported confidence in hand hygiene practice improved after the AR intervention and remained stable post-placement. Hand hygiene knowledge was high before and after AR intervention, with no change post-placement. Training and assessment averaged five and 3 min respectively. Most students (58.6 %) passed the assessment on their first attempt. Common compliance errors were recorded across five out of six hand hygiene actions. Students found the ARS to be interactive and enjoyable. Negative feedback focused on the ARS’ detection of hand movements by a small proportion of students.

Conclusion

AR-based hand hygiene training is a feasible and engaging for radiography students, enhancing confidence and supporting skills acquisition through interactive, time-efficient practice. Identified limitations suggest improvements to introduction to the ARS-based training and the physical environment where intervention is conducted.

Implications for practice

Integrating AR into pre-clinical education can provide consistent, scalable, and immersive training that reinforces importance of hand hygiene. The time efficiency of AR supports inclusion in busy curricula, while its interactive nature may increase student engagement.
增强现实（AR）为卫生专业学生提供了手部卫生培训和评估的机会，提供了指导和重复的体验式学习。本初步研究旨在探讨放射学学生对AR手卫生教育系统（ARS）的可用性和满意度的看法，及其对学生的知识、信心和实践的影响。方法放射学学生在临床实习前完成以ars为基础的手卫生培训和评估。在三个时间点收集数据：干预前（调查1）；干预后（调查2）；和就业后（调查3）。调查探讨了对ARS的认识、信心和看法。软件采集的数据自动记录。采用选择退出的招募方式，73名学生参加了这项研究。结果AR干预后，自报手卫生习惯的信心有所提高，放置后保持稳定。AR干预前后手卫生知识水平较高，干预后无变化。培训和评估平均分别为5分钟和3分钟。大多数学生（58.6%）第一次就通过了评估。在六项手部卫生行动中，有五项记录了常见的合规错误。学生们发现ARS是互动和愉快的。负面的反馈集中在一小部分学生的手部运动检测上。结论基于ar的手卫生培训对放射学学生来说是一种可行的、有吸引力的培训方式，通过互动、高效的实践增强了学生的信心，并支持了技能的习得。确定的局限性建议改进基于急性呼吸道感染的培训的介绍和进行干预的物理环境。将AR整合到临床前教育中可以提供一致的、可扩展的、沉浸式的培训，从而加强手卫生的重要性。AR的时间效率支持在繁忙的课程中纳入，而其互动性可能会增加学生的参与度。
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引用次数: 0
Fracture detection using a low-dose computed tomography paediatric bone fracture phantom: A multi-reader study of radiographers 使用低剂量计算机断层扫描检测小儿骨折假象：对放射技师的多读卡器研究
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-01-24 DOI: 10.1016/j.radi.2026.103333
E. Doyle , J.F. Dipnall , M.R. Dimmock , K.L. Lee , M.E. Suleiman , O.J. Arthurs , J. McInerney , A.C. Offiah , R.R. van Rijn , R.B. Bassed

Introduction

Low-dose computed tomography (CT) has been proposed as an alternative approach to investigate suspected physical abuse (SPA). This is an important consideration for children under 1 year of age due to the inconvenience of initial and follow-up imaging in addition to CT of the head. Results from a pilot study using a bone fracture paediatric phantom suggested that fracture detection was inconsistent using low-dose CT. The aim of this study was to evaluate whether those findings were consistent for a larger cohort of observers.

Methods

Nine CT datasets were reviewed by 18 radiographers who marked the fractures using specialist image viewing software. Fractures detected were compared to the known fractures in the commercial paediatric bone fracture phantom. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), with bootstrapped 95 % confidence interval (CI), were calculated.

Results

None of the observers detected all seven fractures, with a maximum of five identified by four observers. Bootstrapping predicted that the most commonly detected fractures were of the skull with a sensitivity of 88 %, specificity of 67 %, 95 % CI for PPV ranging from 96 to 99 % and NPV of 15–44 % and the tibia and fibula with a sensitivity of 70 %, specificity of 83 %, 95 % CI for PPV ranging from 93 to 99 % and NPV of 16–45 %.

Conclusion

Radiographers had overall sensitivity of 60 % for fracture detection on this phantom, unaffected by radiation dose, but with large variability between observers. Therefore, more research is required to identify the factors that may have influenced this, such as experience, fracture or phantom-based effect.

Implications for practice

There is currently no evidence to support a change in current clinical practice which is the radiographic skeletal survey series to investigate SPA in children.
低剂量计算机断层扫描（CT）已被提议作为一种替代方法来调查疑似身体虐待（SPA）。对于1岁以下的儿童来说，这是一个重要的考虑因素，因为除了头部CT外，初始和后续成像都不方便。一项使用骨折儿童假体的初步研究结果表明，使用低剂量CT检测骨折是不一致的。本研究的目的是评估这些发现在更大的观察人群中是否一致。方法对18名使用专业图像查看软件标记骨折的放射科医师的CT数据进行分析。将检测到的骨折与商用儿科骨折假体中已知的骨折进行比较。计算敏感性、特异性、阳性预测值和阴性预测值（PPV、NPV），自举95%置信区间（CI）。结果没有一名观察员发现了全部7处骨折，最多4名观察员发现了5处骨折。Bootstrapping预测，最常检测到的骨折是颅骨，灵敏度为88%，特异性为67%，95% CI对PPV的灵敏度为96%至99%，NPV为15 - 44%；胫骨和腓骨的灵敏度为70%，特异性为83%，95% CI对PPV的灵敏度为93%至99%，NPV为16 - 45%。结论放射技师对该假体骨折检测的总体灵敏度为60%，不受辐射剂量的影响，但观察者之间的差异很大。因此，需要更多的研究来确定可能影响这一现象的因素，如经验、骨折或基于幻觉的效应。对实践的启示目前没有证据支持改变目前的临床实践，即影像学骨骼调查系列来调查儿童SPA。
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引用次数: 0
Group equivariant pyramid network for respiratory motion correction on PET image 基于群等变金字塔网络的PET图像呼吸运动校正
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-01-30 DOI: 10.1016/j.radi.2026.103336
Z. Wu , H. Zhou , J. Ning , F. Wang , B. She , J. He , X. Xiong

Introduction

Respiratory-induced artefacts cause blurring in PET images, impairing lesion identification and diagnosis. Existing correction methods exhibit limited feature learning capabilities, making it challenging to effectively eliminate artefacts.

Methods

The authors developed an SE(3)-equivariant convolution for 3D PET medical images. A Group Equivariant Dual-Pyramid Network (GEPN) was constructed, integrating channel-spatial attention-enhanced convolutional neural networks (CNNs) and SE(3) group-equivariant convolutional neural networks (G-CNNs) within its pyramid encoder for efficient organ feature extraction. The decoder proposed a novel Lie group-based motion decomposition strategy: multi-head neighbourhood attention captured inter-organ displacement, while an SE(3)-equivariant head resolved rotational/translational components, jointly mitigating respiratory motion artefacts.

Result

Experimental validation across diverse PET lung datasets demonstrates the superiority of GEPN. The method achieves Dice coefficients of 97.81 % for geometric phantom data, 92.07 % for lung phantom data, and 81.01 % for clinical data. Compared to baseline models, GEPN improves the Dice coefficient by 5.17 %. Furthermore, it exhibits significantly better artefact correction performance than existing methods in terms of lesion clarity and motion pattern alignment.

Conclusion

The GEPN framework successfully addresses respiratory artefact challenges through its innovative integration of group-equivariant architectures and attention mechanisms. Experimental results validate its effectiveness in enhancing PET image quality, outperforming existing approaches in both quantitative and perceptual metrics, thereby offering a robust solution to improve diagnostic reliability in clinical practice.

Implications for practice

The GEPN framework provides clinicians with significantly sharper PET images with reduced motion blur, enabling a more precise delineation of tumour boundaries and extent. This enhanced accuracy in defining lesion morphology directly supports improved radiotherapy planning, surgical targeting, and treatment response assessment.
呼吸引起的伪影导致PET图像模糊，损害病变的识别和诊断。现有的校正方法表现出有限的特征学习能力，使其难以有效地消除伪影。方法对三维PET医学图像进行SE(3)等变卷积。构建了一种群等变双金字塔网络（GEPN），将通道-空间注意增强卷积神经网络（cnn）和SE(3)群等变卷积神经网络（g - cnn）集成在其金字塔编码器中，实现了高效的器官特征提取。该解码器提出了一种新颖的基于李群的运动分解策略：多头邻域注意力捕获器官间位移，而SE(3)等变头部分解旋转/平移分量，共同减轻呼吸运动伪像。结果不同PET肺数据集的实验验证证明了GEPN的优越性。该方法对几何幻像数据的Dice系数为97.81%，对肺幻像数据的Dice系数为92.07%，对临床幻像数据的Dice系数为81.01%。与基线模型相比，GEPN将Dice系数提高了5.17%。此外，在病变清晰度和运动模式对齐方面，它比现有方法具有明显更好的伪影校正性能。GEPN框架通过创新地整合群等变结构和注意机制，成功地解决了呼吸伪像的挑战。实验结果验证了该方法在提高PET图像质量方面的有效性，在定量和感知指标上都优于现有方法，从而为提高临床实践中的诊断可靠性提供了一个强大的解决方案。GEPN框架为临床医生提供了更清晰的PET图像，减少了运动模糊，能够更精确地描绘肿瘤的边界和范围。这提高了病灶形态定义的准确性，直接支持改进放疗计划、手术靶向和治疗反应评估。
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引用次数: 0
Identification of selection criteria for DIBH in patients with left breast cancer using 3D-CRT and VMAT: An analysis with dosimetric parameters and NTCP models 使用3D-CRT和VMAT确定左乳腺癌患者DIBH的选择标准：剂量学参数和NTCP模型的分析
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-01-15 DOI: 10.1016/j.radi.2025.103324
H. Ayouni , S. Zarraa , B. Daoud , S. Saidi , S. Frikha , S. Yahyaoui , L. Ben Salem , C. Nasr

Introduction

Deep-inspiration breath-hold (DIBH) is a well-established technique for sparing organs-at-risk in breast cancer (BC) radiotherapy. Nonetheless, consensus on who benefits most remains elusive. This study aimed to establish dependable thresholds for anatomical parameters to identify these patients during three-dimensional conformal radiotherapy (3D-CRT) and volumetric modulated arc therapy (VMAT), and to confirm selection using multivariate logistic regression (MLR).

Methods

Forty-eight left BC patients were included in group A, subdivided into 20 undergoing breast-conserving surgery (group B) and 28 undergoing radical mastectomy (group C). Free-breathing 3D-CRT plans were replanned using DIBH, each plan generated using VMAT. Ratios of heart volume in field (%HVIF) and left lung volume (%LLV) between free-breathing/DIBH defined eligibility thresholds. Spearman correlation assessed relationships between %LLV/%HVIF and dosimetric parameters or normal tissue complication probabilities (NTCPs). MLR confirmed selection, and models' performance was evaluated using area under curve (AUC).

Results

Thresholds were 1.7 for %LLV and one for %HVIF. In 3D-CRT, %LLV significantly correlated with cardiac/left anterior descending artery (LAD) doses and LAD NTCP (groups A/C), while only mean heart dose (ΔMHD) and cardiac ΔV25 demonstrated significance (group B). In VMAT, %LLV significantly correlated with ΔMHD, heart maximum dose (ΔDmax), LAD mean dose (ΔDmean), and LAD ΔNTCP, independent of group. For %HVIF, significant correlations were found with heart %V25/%V40 (groups A/B) and LAD %Dmean (group A) in 3D-CRT but not in VMAT or group C. Thresholds of %LLV predicted DIBH with AUCs of 0.85/0.90/0.94 (3D-CRT) and 0.77/0.91/0.89 (VMAT). A similar trend was observed for %HVIF: 0.88/0.93/0.95 (3D-CRT) vs. 0.70/0.90/0.81 (VMAT).

Conclusion

%LLV is a useful tool for selecting DIBH across techniques, while %HVIF is more applicable to 3D-CRT.

Implications for practice

This streamlined approach supports more personalized clinical decision-making.
深度吸气屏气（DIBH）是一种成熟的技术，用于在乳腺癌（BC）放疗中保留高危器官。尽管如此，关于谁受益最大的问题仍难以达成共识。本研究旨在建立可靠的解剖学参数阈值，以识别这些患者在三维适形放疗（3D-CRT）和体积调制电弧治疗（VMAT）中，并使用多变量逻辑回归（MLR）确定选择。方法48例左乳腺癌患者分为保乳手术组20例（B组）和根治性乳房切除术组28例（C组）。使用DIBH重新规划自由呼吸3D-CRT计划，每个计划使用VMAT生成。自由呼吸/DIBH之间的现场心脏容积（%HVIF）和左肺容积（%LLV）的比值定义了资格阈值。Spearman相关性评估了%LLV/%HVIF与剂量学参数或正常组织并发症概率（NTCPs）之间的关系。MLR确认了选择，并用曲线下面积（AUC）评价了模型的性能。结果%LLV的阈值为1.7，%HVIF的阈值为1。在3D-CRT中，%LLV与心脏/左前降支（LAD）剂量和LAD NTCP （A/C组）显著相关，而只有心脏平均剂量（ΔMHD）和心脏ΔV25 （B组）具有显著性。VMAT中，%LLV与ΔMHD、心脏最大剂量（ΔDmax）、LAD平均剂量（ΔDmean）、LAD ΔNTCP相关，与组无关。在3D-CRT中，%HVIF与心脏%V25/%V40 （A/B组）和LAD %Dmean （A组）存在显著相关性，但在VMAT组和c组中没有。%LLV的阈值预测DIBH的auc分别为0.85/0.90/0.94 （3D-CRT）和0.77/0.91/0.89 （VMAT）。%HVIF也有类似的趋势：0.88/0.93/0.95 (3D-CRT) vs. 0.70/0.90/0.81 （VMAT）。结论%LLV是跨技术选择DIBH的有效工具，而%HVIF更适用于3D-CRT。这种简化的方法支持更个性化的临床决策。
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引用次数: 0
Malpractice in the machine age: Legal and ethical responses to machine learning in medical imaging 机器时代的医疗事故：医学成像中机器学习的法律和伦理反应。
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-02-06 DOI: 10.1016/j.radi.2026.103339
M.T. Chau , K.M. Spuur , S. White , A. Pyper , M. Crossman

Objectives

Artificial intelligence (AI) and machine learning (ML) are increasingly integrated into diagnostic imaging. This review examines how AI adoption affects malpractice risk, the legal standard of care, liability distribution, and informed consent. It also evaluates regulatory developments and ethical concerns, including explicability, autonomy, and professional accountability.

Key findings

AI-supported image interpretation can improve diagnostic accuracy and efficiency. Its integration is reshaping expectations of reasonable clinical practice, with the potential for negligence claims both when clinicians fail to use validated systems and when they rely on insufficiently tested tools. Liability is uncertain because diagnostic responsibility is distributed across clinicians, healthcare organisations, and developers. Existing negligence frameworks assume human reasoning and struggle to accommodate opaque algorithmic decision-making, limiting courts' ability to assess whether AI-assisted diagnoses meet accepted standards. “Black box” models heighten automation bias, hinder legal scrutiny of error, and complicate professional accountability. Informed consent case law suggests AI involvement should be disclosed when it introduces material differences in risk or outcome, although this remains inconsistently applied. Ethical challenges include threats to patient trust, potential clinician deskilling, and reduced transparency in clinical communication. Regulatory initiatives such as the European Union’s General Data Protection Regulation and AI Act move toward clearer governance through requirements for data quality, human oversight, and post-market monitoring, yet explicit malpractice guidance remains under-developed globally.

Conclusion

Traditional legal and ethical frameworks insufficiently address accountability for AI-driven diagnostic errors. Clarifying responsibility, decision authority, and validation requirements is essential to safeguard patient safety and clinician protection.

Implications for practice

Clinical protocols should specify approved use cases, oversight expectations, documentation of AI involvement, and management of clinician-algorithm disagreement. Training should support critical review of outputs to mitigate automation bias.
目的：人工智能（AI）和机器学习（ML）越来越多地集成到诊断成像中。本综述探讨了人工智能的采用如何影响医疗事故风险、法律护理标准、责任分配和知情同意。它还评估监管发展和道德问题，包括可解释性、自主性和专业问责制。主要发现：人工智能支持的图像解译可以提高诊断的准确性和效率。它的整合正在重塑对合理临床实践的期望，当临床医生未能使用经过验证的系统时，以及当他们依赖未经充分测试的工具时，都有可能出现疏忽索赔。责任是不确定的，因为诊断责任分布在临床医生、医疗机构和开发人员之间。现有的过失框架假设人类推理，并努力适应不透明的算法决策，限制了法院评估人工智能辅助诊断是否符合公认标准的能力。“黑匣子”模型加剧了自动化的偏见，阻碍了对错误的法律审查，并使专业问责复杂化。知情同意判例法建议，当人工智能的参与在风险或结果方面带来重大差异时，应予以披露，尽管这一点在适用上仍不一致。伦理挑战包括对患者信任的威胁，潜在的临床医生技能丧失，以及临床沟通透明度降低。欧盟的《通用数据保护条例》和《人工智能法案》等监管举措通过对数据质量、人力监督和上市后监测的要求，朝着更清晰的治理方向发展，但全球范围内明确的不当行为指导仍不完善。结论：传统的法律和伦理框架不足以解决人工智能驱动的诊断错误的问责问题。明确责任、决策权和验证要求对于保障患者安全和临床医生保护至关重要。对实践的影响：临床协议应该指定批准的用例、监督期望、人工智能参与的文档以及临床医生与算法分歧的管理。培训应支持对产出的批判性审查，以减轻自动化偏见。
{"title":"Malpractice in the machine age: Legal and ethical responses to machine learning in medical imaging","authors":"M.T. Chau ,&nbsp;K.M. Spuur ,&nbsp;S. White ,&nbsp;A. Pyper ,&nbsp;M. Crossman","doi":"10.1016/j.radi.2026.103339","DOIUrl":"10.1016/j.radi.2026.103339","url":null,"abstract":"<div><h3>Objectives</h3><div>Artificial intelligence (AI) and machine learning (ML) are increasingly integrated into diagnostic imaging. This review examines how AI adoption affects malpractice risk, the legal standard of care, liability distribution, and informed consent. It also evaluates regulatory developments and ethical concerns, including explicability, autonomy, and professional accountability.</div></div><div><h3>Key findings</h3><div>AI-supported image interpretation can improve diagnostic accuracy and efficiency. Its integration is reshaping expectations of reasonable clinical practice, with the potential for negligence claims both when clinicians fail to use validated systems and when they rely on insufficiently tested tools. Liability is uncertain because diagnostic responsibility is distributed across clinicians, healthcare organisations, and developers. Existing negligence frameworks assume human reasoning and struggle to accommodate opaque algorithmic decision-making, limiting courts' ability to assess whether AI-assisted diagnoses meet accepted standards. “Black box” models heighten automation bias, hinder legal scrutiny of error, and complicate professional accountability. Informed consent case law suggests AI involvement should be disclosed when it introduces material differences in risk or outcome, although this remains inconsistently applied. Ethical challenges include threats to patient trust, potential clinician deskilling, and reduced transparency in clinical communication. Regulatory initiatives such as the European Union’s General Data Protection Regulation and AI Act move toward clearer governance through requirements for data quality, human oversight, and post-market monitoring, yet explicit malpractice guidance remains under-developed globally.</div></div><div><h3>Conclusion</h3><div>Traditional legal and ethical frameworks insufficiently address accountability for AI-driven diagnostic errors. Clarifying responsibility, decision authority, and validation requirements is essential to safeguard patient safety and clinician protection.</div></div><div><h3>Implications for practice</h3><div>Clinical protocols should specify approved use cases, oversight expectations, documentation of AI involvement, and management of clinician-algorithm disagreement. Training should support critical review of outputs to mitigate automation bias.</div></div>","PeriodicalId":47416,"journal":{"name":"Radiography","volume":"32 3","pages":"Article 103339"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating radiography students’ perceptions of a standardised medical imaging request form following first clinical placement 评估放射学学生在第一次临床实习后对标准化医学成像申请表的认知。
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-02-09 DOI: 10.1016/j.radi.2026.103352
D.J. Nocum, D. Abu Awwad, W. Reed

Introduction

A standardised Medical Imaging Suite (MIS) request form was developed as an educational tool to simulate real-world clinical documentation and improve radiography students’ ability to interpret and communicate medical imaging requests. This form was integrated into the radiography curriculum to support learning outcomes related to clinical reasoning, documentation, and communication. This study evaluates student perceptions of the MIS request form and its influence on their preparedness following their first clinical placement.

Methods

A closed-ended survey was administered to second-year undergraduate (n = 73) and first-year postgraduate (n = 75) diagnostic radiography students at an Australian tertiary institution. The survey captured demographic data; perceived preparedness; communication confidence; usability of the MIS form; and its impact on critical thinking. Quantitative data were analysed descriptively. Optional open-ended questions allowed participants to expand on their responses, and the frequency of each issue was counted and reported as descriptive statistics.

Results

Of 148 eligible students, 137 completed the survey (92.6 % response rate; 48 % undergraduate, 52 % postgraduate). Most respondents were female (78.1 %) and aged 18–25 (84.7 %). Over 75 % agreed that the standardised MIS request form improved their understanding of clinical requests, confidence in interpreting information, and overall preparedness for placement. The redesigned MIS request form was rated clearer and more complete by 84.7 % of students, with 94.5 % recommending its continued use in X-ray practical classes.

Conclusion

Embedding a standardised imaging request form into the radiography curriculum appears to enhance student's clinical preparedness. The form supports the development of critical thinking, documentation accuracy, and interprofessional communication.

Implications for practice

Continued evaluation and refinement of the MIS request form will help maintain strong alignment between university teaching and clinical expectations.
简介：一个标准化的医学成像套件（MIS）请求表单被开发作为一个教育工具来模拟现实世界的临床文件，提高放射学学生解释和沟通医学成像请求的能力。该表格被整合到放射学课程中，以支持与临床推理、文献和交流相关的学习成果。本研究评估学生对管理信息系统申请表的看法及其对他们第一次临床实习后准备工作的影响。方法：对澳大利亚一所高等教育机构的放射诊断学本科二年级学生（73名）和研究生一年级学生（75名）进行封闭式调查。该调查收集了人口统计数据；感知到的准备;沟通的信心;管理信息系统表格的可用性；以及它对批判性思维的影响。定量数据进行描述性分析。可选的开放式问题允许参与者扩展他们的回答，每个问题的频率被计算并作为描述性统计报告。结果：148名符合条件的学生中，有137人完成了调查，回复率为92.6%，其中48%为本科生，52%为研究生。受访者以女性（78.1%）和18-25岁（84.7%）居多。超过75%的人认为标准化的管理信息系统申请表提高了他们对临床请求的理解，对解释信息的信心，以及对安置的全面准备。84.7%的学生认为重新设计的管理信息系统申请表更清晰、更完整，94.5%的学生建议在x射线实践课程中继续使用。结论：在放射学课程中嵌入标准化的成像申请表似乎可以增强学生的临床准备。这种形式支持批判性思维、文档准确性和跨专业沟通的发展。对实践的启示：对MIS申请表的持续评估和改进将有助于保持大学教学与临床期望之间的高度一致。
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引用次数: 0
Policies, processes, and principles of informed consent in radiotherapy for gynaecological cancers: A UK national survey 妇科癌症放射治疗的政策、程序和知情同意原则：英国全国调查。
IF 2.8 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Radiography
Pub Date : 2026-04-01 Epub Date: 2026-02-11 DOI: 10.1016/j.radi.2026.103351
D. Allen , H. Stewart , D. Hutton , V. Kulikov , C. Powlesland , H. Pritchard , L. Wareing , E. Holmes , L. Ashmore

Introduction

Informed consent is a legal requirement under The Health and Social Care Act 2008 and a vital part of patient-centred care. Despite national frameworks and guidance, there is significant variability in informed consent implementation across settings. This national service evaluation aimed to assess policies, processes, and principles guiding informed consent for gynaecological radiotherapy across United Kingdom (UK) NHS departments.

Methods

A survey exploring processes and training, principles, and values was sent to 58 NHS radiotherapy departments. Data were obtained from 38 departments (66 % response rate), representing all UK nations. Ethical approval was obtained.

Results

Variation was observed in staff training, use of best-practice guidelines, and content of consent documentation. While 71 % of departments used Royal College of Radiologists (RCR) consent forms, fewer identified professional guidance indicating a potential gap in guideline familiarity. Documentation varied in the number and detail of side-effects described but alignment was observed in core ethical principles. Respondents highlighted structural challenges, notably time and staffing constraints, which limited processes and patient support.

Conclusion

This is the first study to provide a national overview of informed consent policies and practices in NHS radiotherapy departments for gynaecological cancers. It identifies inconsistencies in training, documentation, and guideline awareness, but highlights shared professional values. Findings support the need for national guidance, standardised consent materials, and targeted staff education to ensure equitable and fully informed patient decision-making.

Implications for practice

Informed consent should be treated as an ongoing, patient-centred process that extends beyond the clinician–patient interaction. All staff should be familiar with policies and procedures to support patients’ understanding of treatment and long-term impacts. Standardised materials must be tailored to individual needs to facilitate meaningful, patient-centred discussions.
导言：知情同意是《2008年卫生和社会保健法》的一项法律要求，也是以病人为中心的护理的重要组成部分。尽管有国家框架和指导，但在不同情况下，知情同意的实施存在很大差异。这项国家服务评估旨在评估政策、流程和原则，指导英国（UK） NHS部门对妇科放疗的知情同意。方法：对58个NHS放疗科室进行流程、培训、原则和价值观调查。数据来自38个部门（66%的回复率），代表了所有英国国家。获得伦理批准。结果：在员工培训、最佳实践指南的使用和同意文件的内容方面存在差异。虽然71%的院系使用了皇家放射学院（RCR）的同意书，但较少的院系确定了专业指导，这表明在指南熟悉度方面存在潜在差距。文件中所描述的副作用的数量和细节各不相同，但核心伦理原则一致。受访者强调了结构性挑战，特别是时间和人员配备方面的限制，限制了流程和患者支持。结论：这是第一个研究提供了知情同意政策和实践的国家概述在NHS妇科癌症放疗部门。它确定了培训、文档和指南意识方面的不一致，但强调了共享的专业价值。调查结果支持需要国家指导、标准化的同意材料和有针对性的工作人员教育，以确保公平和充分知情的患者决策。对实践的启示：知情同意应被视为一个持续的，以患者为中心的过程，超出了临床与患者的互动。所有工作人员都应熟悉政策和程序，以支持患者了解治疗和长期影响。标准化的材料必须根据个人需求量身定制，以促进有意义的、以患者为中心的讨论。
{"title":"Policies, processes, and principles of informed consent in radiotherapy for gynaecological cancers: A UK national survey","authors":"D. Allen ,&nbsp;H. Stewart ,&nbsp;D. Hutton ,&nbsp;V. Kulikov ,&nbsp;C. Powlesland ,&nbsp;H. Pritchard ,&nbsp;L. Wareing ,&nbsp;E. Holmes ,&nbsp;L. Ashmore","doi":"10.1016/j.radi.2026.103351","DOIUrl":"10.1016/j.radi.2026.103351","url":null,"abstract":"<div><h3>Introduction</h3><div>Informed consent is a legal requirement under The Health and Social Care Act 2008 and a vital part of patient-centred care. Despite national frameworks and guidance, there is significant variability in informed consent implementation across settings. This national service evaluation aimed to assess policies, processes, and principles guiding informed consent for gynaecological radiotherapy across United Kingdom (UK) NHS departments.</div></div><div><h3>Methods</h3><div>A survey exploring processes and training, principles, and values was sent to 58 NHS radiotherapy departments. Data were obtained from 38 departments (66 % response rate), representing all UK nations. Ethical approval was obtained.</div></div><div><h3>Results</h3><div>Variation was observed in staff training, use of best-practice guidelines, and content of consent documentation. While 71 % of departments used Royal College of Radiologists (RCR) consent forms, fewer identified professional guidance indicating a potential gap in guideline familiarity. Documentation varied in the number and detail of side-effects described but alignment was observed in core ethical principles. Respondents highlighted structural challenges, notably time and staffing constraints, which limited processes and patient support.</div></div><div><h3>Conclusion</h3><div>This is the first study to provide a national overview of informed consent policies and practices in NHS radiotherapy departments for gynaecological cancers. It identifies inconsistencies in training, documentation, and guideline awareness, but highlights shared professional values. Findings support the need for national guidance, standardised consent materials, and targeted staff education to ensure equitable and fully informed patient decision-making.</div></div><div><h3>Implications for practice</h3><div>Informed consent should be treated as an ongoing, patient-centred process that extends beyond the clinician–patient interaction. All staff should be familiar with policies and procedures to support patients’ understanding of treatment and long-term impacts. Standardised materials must be tailored to individual needs to facilitate meaningful, patient-centred discussions.</div></div>","PeriodicalId":47416,"journal":{"name":"Radiography","volume":"32 3","pages":"Article 103351"},"PeriodicalIF":2.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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