Gleamer BoneView^© is a commercially available AI algorithm for fracture detection in radiographs. We aim to test if the algorithm can assist in better sensitivity and specificity for fracture detection by residents with prospective integration into clinical workflow. Radiographs with inquiry for fracture initially reviewed by two residents were randomly assigned and included. A preliminary diagnosis of a possible fracture was made. Thereafter, the AI decision on presence and location of possible fractures was shown and changes to diagnosis could be made. Final diagnosis of fracture was made by a board-certified radiologist with over eight years of experience, or if available, cross-sectional imaging. Sensitivity and specificity of the human report, AI diagnosis, and assisted report were calculated in comparison to the final expert diagnosis. 1163 exams in 735 patients were included, with a total of 367 fractures (31.56%). Pure human sensitivity was 84.74%, and AI sensitivity was 86.92%. Thirty-five changes were made after showing AI results, 33 of which resulted in the correct diagnosis, resulting in 25 additionally found fractures. This resulted in a sensitivity of 91.28% for the assisted report. Specificity was 97.11, 84.67, and 97.36%, respectively. AI assistance showed an increase in sensitivity for both residents, without a loss of specificity.

Purpose: Subtle spinal compression fractures can easily be missed. AI may help in interpreting these images. We propose to test the performance of an FDA-approved algorithm for fracture detection in radiographs on a per vertebra basis, assessing performance based on grade of compression, presence of foreign material, severity of degenerative changes, and acuity of the fracture. Methods: Thoracic and lumbar spine radiographs with inquiries for fracture were retrospectively collected and analyzed by the AI. The presence or absence of fracture was defined by the written report or cross-sectional imaging where available. Fractures were classified semi-quantitatively by the Genant classification, by acuity, by the presence of foreign material, and overall degree of degenerative change of the spine. The results of the AI were compared to the gold standard. Results: A total of 512 exams were included, depicting 4114 vertebra with 495 fractures. Overall sensitivity was 63.2% for the lumbar spine, significantly higher than the thoracic spine with 50.6%. Specificity was 96.7 and 98.3% respectively. Sensitivity increased with fracture grade, without a significant difference between grade 2 and 3 compression fractures (lumbar spine: grade 1, 52.5%; grade 2, 72.3%; grade 3, 75.8%; thoracic spine: grade 1, 42.4%; grade 2, 60.0%; grade 3, 60.0%). The presence of foreign material and a high degree of degenerative changes reduced sensitivity. Conclusion: Overall performance of the AI on a per vertebra basis was degraded in clinically relevant scenarios such as for low-grade compression fractures.

Background: Computed tomography is a standard imaging procedure for the detection of liver lesions, such as metastases, which can often be small and poorly contrasted, and therefore hard to detect. Advances in image reconstruction have shown promise in reducing image noise and improving low-contrast detectability. Purpose: To examine a novel, specialized, model-based iterative reconstruction (MBIR) technique for improved low-contrast liver lesion detection. Material and Methods: Patient images with reported poorly contrasted focal liver lesions were retrospectively reconstructed with the low-contrast attenuating algorithm (FIRST-LCD) from primary raw data. Liver-to-lesion contrast, signal-to-noise, and contrast-to-noise ratios for background and liver noise for each lesion were compared for all three FIRST-LCD presets with the established hybrid iterative reconstruction method (AIDR-3D). An additional visual conspicuity score was given by two experienced radiologists for each lesion. Results: A total of 82 lesions in 57 examinations were included in the analysis. All three FIRST-LCD algorithms provided statistically significant increases in liver-to-lesion contrast, with FIRST_MILD showing the largest increase (40.47 HU in AIDR-3D; 45.84 HU in FIRST_MILD; P < 0.001). Substantial improvement was shown in contrast-to-noise metrics. Visual analysis of the lesions shows decreased lesion visibility with all FIRST methods in comparison to AIDR-3D, with FIRST_STR showing the closest results ( P < 0.001). Conclusion: Objective image metrics show promise for MBIR methods in improving the detectability of low-contrast liver lesions; however, subjective image quality may be perceived as inferior. Further improvements are necessary to enhance image quality and lesion detection.

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

Background: Differentiation of bowel wall changes between ischemia and other causes in CT imaging can prove challenging, particularly in colon wall. Therefore, measurement of relative colon wall attenuation and contrast uptake were evaluated for aiding in diagnosis of colon ischemia. Methods: CTs with inquiry for bowel ischemia were retrospectively identified. Cases involving colon ischemia or colon wall changes of other etiologies were included. Three regions of interest (ROIs) were placed in representative areas of colon wall with and without evident changes, in arterial and venous phase images, respectively. Means of the ROIs were used to calculate the relative bowel enhancement between affected and unaffected wall in each contrast phase, as well as the contrast uptake of the wall between phases. Relative enhancement and contrast uptake were compared between patients with and without ischemia. A subset of cases was reanalyzed for intra- and inter-reader comparison. Results: 31 patients with and 56 patients without ischemia were included. Relative enhancement of affected to unaffected colon wall was -51.2% in arterial phase and -44.6% in venous phase images for patients with ischemia. Relative enhancement was significantly higher in patients without ischemia at -0.5% in both phases ( p < 0.001). There was no significant difference in contrast uptake of affected bowel (40.6% vs. 39.8% respectively, p = 0.67). ROC curves revealed a maximum Youden-Index at a cut-off of -37.4% (AUC: 0.818) in arterial phase to differentiate between groups. Intra-reader comparison showed a good, and inter-reader a moderate, correlation in a subset. Conclusions: Objective measurement of relative colon wall attenuation between affected and unaffected areas can be an additional imaging feature to aid in identifying ischemic colon.