This Week in Radiology — Jul 18, 2026

Welcome to This Week in Radiology. This week we are covering ten notable papers spanning three broad themes: advances in neuroimaging workflows, optimizing thoracic imaging and lung cancer care, and strategies for radiation reduction and clinical operations. Let's dive in.

We begin in the brain, where imaging plays a critical role in acute decision-making. In the American Journal of Neuroradiology, an expert panel from the American Society of Functional Neuroradiology published a state-of-practice paper evaluating the role of arterial spin labeling MR perfusion in acute ischemic stroke, particularly in the context of expanding endovascular therapy criteria [1]. As MR perfusion becomes more integrated into patient selection guidelines, arterial spin labeling offers a valuable, contrast-free alternative for identifying salvageable tissue and assessing collateral status, which is especially useful for patients with renal insufficiency or contrast allergies. However, the panel notes that arterial spin labeling is not yet validated in prospective endovascular therapy selection trials, and it requires standardized acquisition protocols and automated postprocessing before routine integration into time-sensitive workflows. Meanwhile, for bedside triage when conventional MRI is unavailable, another systematic review and meta-analysis in the American Journal of Neuroradiology evaluated portable low- and ultra-low-field MRI for acute ischemic stroke detection [3]. Looking at nine studies comprising over four hundred patients, researchers found a pooled sensitivity of seventy-three percent and a pooled specificity of seventy-nine percent. Crucially, this means portable MRI missed approximately one in four confirmed infarcts, with missed lesions typically being small or sub-centimetric. Clinicians should therefore view portable MRI as a bedside adjunct rather than a stand-alone rule-out test. Moving to CT workflows, an assessment of an FDA-approved automated alignment, co-registration, and subtraction tool called NeuroAlign CT was published in the American Journal of Neuroradiology [5]. In a study of two hundred and one head CTs with intracranial hemorrhage, three neuroradiologists evaluated serial changes with and without the software. While overall diagnostic accuracy did not significantly differ, utilizing the automated tool reduced average reading times from ninety-eight seconds down to seventy-one seconds, significantly increased reader confidence, and improved the diagnostic accuracy for identifying worsening hemorrhage from eighty percent to nearly ninety-three percent. Finally, in the domain of advanced neurovascular imaging, a retrospective case series in the American Journal of Neuroradiology demonstrated the high utility of photon counting detector CT angiography for detecting spinal arteriovenous fistulas, a notoriously difficult-to-localize cause of myelopathy [6]. Across eight patients, photon counting CT angiography successfully localized the fistula in every single case, with the lesions being best visualized on zero-point-two millimeter low-energy threshold reconstructions.

Our second theme focuses on thoracic imaging, where researchers are refining how we screen, diagnose, and monitor pulmonary diseases. A retrospective cohort study in the Journal of the American College of Radiology evaluated lung cancer screening eligibility under the 2021 United States Preventive Services Task Force criteria among patients already diagnosed with lung cancer [10]. Out of over eighteen hundred patients diagnosed with primary lung cancer in a Southern California health system, only thirteen percent actually met the screening eligibility criteria prior to their diagnosis. Furthermore, certain demographic groups were significantly less likely to meet eligibility criteria; women had less than a third of the odds of being eligible compared to men, and Asian patients had roughly a third of the odds of being eligible compared to White patients. Compounding this issue, among the small subset of patients who were eligible for screening, fewer than ten percent had actually received a low-dose CT scan in the two years preceding their diagnosis. Once lung cancer is diagnosed and treated, surveillance imaging becomes paramount. A review in Radiographics details the complex patterns of lung cancer recurrence after definitive therapy, highlighting how the mode of spread dictates whether a recurrence manifests locally, regionally, or distantly [2]. The authors emphasize that post-treatment changes from surgery and radiation therapy can severely complicate CT interpretation, urging radiologists to familiarize themselves with recurrence patterns, such as lymphangitic carcinomatosis or aerogenous metastases, to ensure timely and accurate detection. For patients with non-malignant diffuse lung disease, a systematic review and meta-analysis in the Journal of Magnetic Resonance Imaging investigated the diagnostic performance of pulmonary MRI as a radiation-free alternative to CT for detecting interstitial lung disease [4]. Analyzing nine quantitative studies, the authors found that pulmonary MRI achieved a pooled sensitivity of ninety-one percent and a pooled specificity of eighty-six percent. When the analysis was restricted to protocols utilizing optimized, thin-slice ultrashort echo-time or zero-time echo sequences, the sensitivity rose to ninety-three percent and the specificity reached ninety-two percent, suggesting that pulmonary MRI is a highly viable, radiation-free alternative for longitudinal monitoring.

Our third theme addresses radiation optimization and clinical operations, emphasizing how we can improve patient safety and care delivery. In European Radiology, a prospective study evaluated the biological effects of internal fluorine-eighteen FDG administration and external CT radiation during PET/CT scans by measuring chromosomal aberrations in peripheral blood lymphocytes [8]. Comparing a reduced-dose CT protocol center with a standard-dose CT protocol center, researchers found that internal FDG administration had no detectable impact on chromosomal aberrations. However, standard-dose CT scans led to a statistically significant increase in chromosomal aberrations, whereas the reduced-dose CT protocol did not, providing strong biological justification for the routine use of reduced-dose CT protocols in PET/CT imaging. In pediatric imaging, the drive to eliminate radiation is even more critical. Another prospective study in European Radiology investigated the feasibility of using a fast field echo MRI sequence resembling CT, known as FRACTURE, for evaluating pediatric skull base bone lesions in forty patients [9]. The FRACTURE sequence provided CT-comparable bony delineation, significantly sharper bony edges, and vastly superior soft-tissue visualization compared to traditional CT. Surgeons and radiologists demonstrated near-perfect diagnostic and treatment-planning agreement when using the FRACTURE sequence, establishing it as a highly reliable, radiation-free alternative for pediatric preoperative planning. Finally, looking at clinical operations, a qualitative positive deviance study published in the Journal of the American College of Radiology investigated strategies associated with high inferior vena cava filter retrieval rates across United States hospitals [7]. Despite widespread guidelines recommending retrieval within three months of implantation, aggregate retrieval rates remain low. High-performing hospitals achieved retrieval rates between forty and seventy-four percent by implementing key operational strategies: establishing an empowered non-physician champion, using protocolized surveillance, utilizing presumptive rather than open-ended communication with clinicians regarding retrieval eligibility, and reserving formal clinic evaluations for medically complex patients. Interestingly, electronic medical record dashboards alone did not differentiate high-performing from intermediate-performing hospitals, showing that operational execution, rather than software tracking alone, drives clinical success.

If you only have time for one paper this week, make it the retrospective cohort study on lung cancer screening eligibility published in the Journal of the American College of Radiology [10]. This paper is a critical wake-up call for our specialty, demonstrating that our current national screening criteria miss the vast majority of patients who ultimately develop lung cancer, particularly women and racial minorities, while also highlighting a profound failure in utilizing screening even among those who qualify.

Here are the key takeaways from this week in Radiology. First, current United States lung cancer screening criteria fail to capture nearly eighty-seven percent of patients who go on to develop lung cancer, with women and Asian patients being disproportionately excluded, highlighting an urgent need to re-evaluate eligibility guidelines. Second, while portable low-field MRI is a valuable bedside adjunct for stroke triage, it misses approximately one in four confirmed infarcts, meaning it cannot be used to safely rule out an acute ischemic stroke. Third, incorporating automated head CT co-registration and subtraction software like NeuroAlign CT significantly reduces neuroradiologist reading times and improves accuracy for detecting worsening intracranial hemorrhage from eighty percent to nearly ninety-three percent. Fourth, standard-dose CT during PET/CT scans significantly increases chromosomal aberrations in lymphocytes while reduced-dose CT does not, emphasizing the biological importance of protocol optimization. Fifth, successful inferior vena cava filter retrieval programs depend on an empowered non-physician champion and protocolized, presumptive communication, rather than relying solely on passive electronic medical record dashboards.

That's your roundup for This Week in Radiology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.