Purpose: This multicentric retrospective study aimed to evaluate the diagnostic outcomes, adherence to guideline-based recommendations, and sustainability implications of 280 initial chest CT scans performed without contrast. The scans were conducted at the Radiology Unit of the Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan and the Radiology Department of Treviglio-Caravaggio Hospital-ASST Bergamo Ovest. The study focused on optimizing patient selection and radiological recommendations to align with evidence-based guidelines. Materials and methods: This retrospective study included 280 patients (mean age 61.68 years; 51.07% women, 48.93% men) who underwent their first chest CT scan without contrast. Diagnostic outcomes were analyzed across different clinical queries. Incidental findings and radiologists’ recommendations were assessed for alignment with Fleischner Society and ACR guidelines. Deviations were categorized as unnecessary imaging suggestions or missed indications. Radiation exposure was quantified using the dose-length product (DLP). Results: Diagnostic outcomes were positive in 54.64% of cases. Incidental findings occurred in 34.64% of cases, with guideline adherence at 81.43%. Deviations included unnecessary imaging in 14.29% and missed follow-up indications in 4.28% of cases. The median DLP was 237.5 mGy·cm (IQR 171.8–320.1). Conclusion: This study highlights significant opportunities to refine patient selection and radiological recommendations through adherence to Fleischner Society and ACR guidelines. By integrating evidence-based practices into routine workflows, the findings advocate for reduced unnecessary imaging, enhanced diagnostic pathways, and sustainable healthcare practices in chest CT imaging.

Radiomics has produced tens of thousands of publications yet almost no handcrafted radiomic signatures in routine clinical use, and the reasons are increasingly understood to be problems of reproducibility and clinical translation rather than of algorithms. This critical narrative review argues that the field systematically generates paper-grade evidence—findings sufficient to publish—far faster than decision-grade evidence—findings sufficient to change clinical practice. Drawing on meta-scientific research, we describe seven fragility mechanisms (publication bias, analytical flexibility, underpowering, HARKing [hypothesizing after the results are known], citation distortion, cognitive bias, and misaligned incentives) and show why radiomics is structurally exposed to all of them simultaneously: high-dimensional feature spaces, acquisition-dependent measurement instability, segmentation variability, retrospective single-centre data, small samples, and leakage-prone validation. We then summarise empirical evidence on the radiomics literature, which remains pervaded by suboptimal methodological quality, near-absent negative results, limited external validation, sparse calibration and clinical-utility assessment, low data and code sharing, and a measurable retraction signal. We interpret these patterns as the output of a self-reinforcing system rather than isolated errors, and argue that better algorithms alone cannot resolve them. Finally, we argue that closing this gap requires not better models but evidentiary discipline: the consistent, enforceable application of standards the field already has, and the calibration of published claims to the strength of the underlying evidence.

Background/Objectives: the aim of this study was to evaluate the safety and efficacy of percutaneous transhepatic lithotripsy using the SpyGlassDSTM cholangioscopy system for the treatment of difficult stones. Methods: Retrospectively, all patients treated with percutaneous transhepatic lithotripsy using SpyGlassDSTM cholangioscopy system were analyzed. As primary outcome measures, the following data were assessed: the presence of a previous history of the hepatobiliary disease, location of stones, reasons for the choice of the procedure, previous balloon bilioplasty, type of pre-procedural imaging, procedural time, technical success, clinical success, and post-procedural complications (according to CIRSE classification). Clinical success was considered “primary” when achieved with a single treatment, and “secondary” if more than one treatment was required in the duration of follow-up. Results: 10 patients (6 males and 4 females, mean age = 64 years, SD = 22), all with cholangitis due to gallstones, underwent 11 PTL procedures using SpyGlassDSTM. Technical and clinical successes were achieved in all patients (100%). Primary success was observed in 4/10 (40%) patients, while the remaining 6/10 (60%) patients undergoing re-treatment, and all showed secondary success (100%). No periprocedural complications were observed. In 10/11 procedures (90%), no relevant adverse events were recorded within the first thirty days of follow-up. In 1/11 case (9%), mild complications (grade I according to CIRSE classification) were registered in the following days after the procedure (<30 days). Conclusions: in conclusion, the treatment of percutaneous transhepatic lithotripsy using SpyGlassDSTM cholangioscopy of difficult stones has been demonstrated as efficient and safe treatment.

Radiomics has produced tens of thousands of publications yet almost no tools in routine clinical use, and the reasons are increasingly understood to be problems of reproducibility and clinical translation rather than of algorithms. This critical narrative review argues that the field systematically generates paper-grade evidence—findings sufficient to publish—far faster than decision-grade evidence—findings sufficient to change clinical practice. Drawing on meta-scientific research, we describe seven fragility mechanisms (publication bias, analytical flexibility, underpowering, HARKing [hypothesizing after the results are known], citation distortion, cognitive bias, and misaligned incentives) and show why radiomics is structurally exposed to all of them simultaneously: high-dimensional feature spaces, acquisition-dependent measurement instability, segmentation variability, retrospective single-centre data, small samples, and leakage-prone validation. We then summarise empirical evidence on the radiomics literature, which remains pervaded by suboptimal methodological quality, near-absent negative results, limited external validation, sparse calibration and clinical-utility assessment, low data and code sharing, and a measurable retraction signal. We interpret these patterns as the output of a self-reinforcing system rather than isolated errors, and argue that better algorithms alone cannot resolve them. Finally, we argue that closing this gap requires not better models but evidentiary discipline: the consistent, enforceable application of standards the field already has, and the calibration of published claims to the strength of the underlying evidence.

Objectives: To evaluate whether baseline splenic ^18F-FDG PET uptake and CT-derived spleen volume predict early progression (≤ 36 months) and progression-free survival (PFS) in diffuse large B cell lymphoma (DLBCL), and whether they interact. Materials and methods: Retrospective cohort of adults with newly diagnosed DLBCL undergoing baseline ^18F-FDG PET/CT and CT. Splenic PET positivity was defined visually (uptake exceeding hepatic background); spleen volume was measured semi-automatically. Early progression/relapse was analysed as a 36-month milestone endpoint and PFS as time-to-event. Multivariable logistic and Cox models included IPI, sex, treatment, splenic PET, spleen volume, and a PET × volume interaction. A prespecified PFS sensitivity analysis re-included event-free patients censored before 36 months. Results: 124 patients were included (68 men; median age 68 years [IQR 57–77]); 45/124 (36.3%) were PET-positive; median spleen volume was 3.13 dL (IQR 1.92–5.79). IPI predicted ≤ 36-month progression (OR 1.52; p = 0.021) and PFS (HR 1.44; p = 0.004). Splenic PET positivity predicted ≤ 36-month progression (OR 2.83; p = 0.048) but not PFS ( p = 0.103). The PET × volume interaction was significant (OR 0.70; p = 0.021; HR 0.81; p = 0.033). In PET-negative patients, larger spleen volume predicted higher risk (OR 1.42; p = 0.027; HR 1.22; p = 0.042), whereas volume was neutral in PET-positive cases. In the PFS sensitivity analysis ( N = 145), the interaction attenuated (HR 0.83; p = 0.057) and the PET-negative volume effect was borderline (HR 1.21; p = 0.053). Conclusion: Splenic PET positivity is a dominant risk marker in DLBCL in this cohort. CT-derived spleen volume may add conditional prognostic information in PET-negative patients, but the incremental value of the PET × volume interaction is modest and requires external validation.

Diagnostic imaging is central to contemporary healthcare, but increasing demand has intensified concerns regarding inappropriate and low-value examinations. Imaging appropriateness should be understood as a multidimensional quality framework rather than a simple reduction in examination volume. This narrative review synthesizes evidence on clinical outcomes, radiation protection, healthcare costs, organizational efficiency, equity, incidental findings, and environmental sustainability. A structured PubMed search was complemented by targeted database and institutional searches and selective citation tracking. Low-value imaging may disrupt diagnostic pathways through diagnostic uncertainty, unnecessary follow-up, avoidable radiation exposure, additional costs, waiting-list pressure, and environmental burden. Mitigation strategies include referral guidelines, clinical decision support, radiologist-led vetting, standardized incidental findings management, and audit and feedback. Their effects vary by setting and outcome: improved referral scores do not necessarily reduce utilization or improve patient outcomes. Environmental estimates depend on imaging modalities, electricity supply, and assessment boundaries, while proposed artificial intelligence applications require prospective validation. We translate this evidence into an operational pathway linking examination justification, modality and protocol selection, reporting, follow-up, and service evaluation. Imaging appropriateness therefore requires reducing low-value examinations while preserving diagnostic safety and timely, equitable access to clinically beneficial imaging.