The petrous portion of the temporal bone is a complex pyramidal-shaped structure of the central skull base, which contains osseous, air cell, vascular, and neural structures in close proximity, making imaging interpretation challenging. A broad spectrum of lesions may involve this region, including inflammatory, neoplastic (benign or malignant), vascular, and osseous lesions. In the pediatric population, ongoing skull base maturation and normal anatomical variability further complicate imaging assessment and may mimic pathology. Cross-sectional imaging plays a central role, with CT providing detailed assessment of osseous structures and MRI offering superior soft tissue characterization. Familiarity with the normal developmental anatomy, common anatomical variants, imaging pitfalls, and characteristic imaging features of pediatric bone lesions is essential for accurate diagnosis and appropriate patient management. This review provides a structured overview of pediatric petrous apex lesions, emphasizing imaging protocols, normal developmental variants, and key imaging features across inflammatory, neoplastic, vascular, and miscellaneous entities.

Over the past four decades, the management of thyroid nodules and selected thyroid malignancies has progressively shifted from surgery-centered approaches toward image-guided minimally invasive treatments (MITT). What began in 1985 with ultrasound-guided percutaneous ethanol injection evolved into a range of energy-based techniques, including laser ablation (LA), radiofrequency ablation (RFA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU).This historical review aimed to reconstruct the major milestones in the development of image-guided thyroid ablation. A systematic PubMed literature search and predefined selection criteria were used to identify seminal studies, first clinical applications, major technological innovations, comparative studies, guideline-defining publications, and landmark long-term follow-up studies. Overall, 43 milestone papers were included for qualitative historical analysis. The evolution of thyroid ablation can be divided into five phases: conceptual origins (1985-1999), birth of the thermal procedures' era (2000-2006), methodological standardization (2007-2012), oncologic consolidation and comparative evidence (2013-2018), and final codification by means of international guideline endorsement and long-term validation (2019-2025). Recent 10-year follow-up studies have confirmed the durable efficacy of MITT for benign nodule management and their sustained oncologic control in low-risk papillary thyroid microcarcinoma. Image-guided thyroid ablation has transitioned from experimental innovation to an evidence-based, guideline-supported therapeutic domain, representing a paradigm shift toward precision medicine, organ preservation, and minimally invasive endocrine oncology.

While conventional radiography (CR) and computed tomography (CT) remain diagnostic staples in emergency settings, ultrasound (US) is a critical tool offering a rapid, dynamic, and noninvasive alternative for acute musculoskeletal (MSK) pathologies assessment. Prompt identification of conditions such as unstable fractures, soft tissue or muscular hematomas, joint effusions, and tendon ruptures is essential to prevent or mitigate long-term patient morbidity. This review summarizes the role of US in the emergency department, providing a practical overview of targeted scanning techniques and key sonographic signs. Additionally, common diagnostic pitfalls and effective escalation pathways are discussed to streamline clinical decision-making and optimize timely patient management.

Healthcare accounts for 4.4-4.5% of global greenhouse gas emissions, with computed tomography (CT) representing one of the most resource-intensive and energy-demanding diagnostic modalities. Sustainability should be integrated as a core component of quality in CT practice, achieving the perfect balance between diagnostic excellence and environmental responsibility. Several key intervention areas can be identified. CT scanners consume substantial amounts of energy, with 44-72% used during nonproductive idle periods. Potential mitigation strategies include protocol optimization, automated power-down systems, and infrastructure improvements. The current "store-everything" approach to CT datasets generates a considerable carbon footprint; adopting "digital temperance" by retaining only clinically relevant images can reduce storage-related emissions. Although workstations consume less energy than scanners, their cumulative impact can be reduced through automated policies and optimized hardware lifecycle management. Iodinated contrast media persist in aquatic ecosystems and may generate toxic by-products. Sustainable strategies include personalized weight-based dosing, multi-energy CT to reduce contrast volume, and recovery or recycling programs. Single-use consumables and the environmental costs of artificial intelligence were also addressed. A 17-item action list was developed to translate the evidence-informed recommendations into practical actions for sustainable CT practice. The transition toward environmentally responsible CT practice is an ethical and professional necessity that can no longer be delayed. This position paper identifies the key challenges and proposes practical, evidence-informed strategies to transform resource-consuming CT practices into actionable and sustainable workflows, while maintaining clinical effectiveness.