Pulmonary embolism (PE) remains a leading cause of sudden cardiovascular death, with 30-day mortality ranging from ∼2% in low-risk cohorts to >25% in haemodynamically unstable cases. This narrative review synthesises the contemporary (2026) evidence base for interventional PE management in a UK context. We review the epidemiology of PE and the role of clinical scoring systems, and emerging imaging-biomarker approaches. The current UK treatment framework, based on international guidelines and the integration of the pulmonary embolism response team (PERT), is outlined. Evidence from recent randomised studies of ultrasound-assisted catheter-directed thrombolysis (ULTIMA, SEATTLE II, and OPTALYSE) and large-bore mechanical thrombectomy (FLARE, EXTRACT-PE, and PEERLESS) is critically appraised, with ongoing trials (HI-PEITHO, STRIKE-PE, and STORM-PE) and UK-specific data highlighted. Particular attention is given to procedural decision-making aimed at rapid right ventricular unloading, minimising bleeding risk, and optimising cost-effectiveness within the National Health Service. Structured follow-up is emphasised to enable early identification of chronic thromboembolic pulmonary hypertension (CTEPH) and post-PE syndrome, both underdiagnosed yet clinically significant sequelae. In 2026, the management of high-risk and select intermediate-high-risk PE is shifting towards catheter-based reperfusion delivered by radiologists embedded in multidisciplinary teams. Understanding the evolving evidence landscape, adhering to structured pathways, and performing systematic follow-up allow the effective translation of recent advances into meaningful reductions in mortality and improvements in patients' long-term quality of life. Simultaneously, there remains a need for robust UK-specific outcome and cost-effectiveness data to guide commissioning and ensure equitable access.

Proton beam therapy (PBT) is increasingly used in paediatric neuro-oncology due to its favourable dose distribution and potential to reduce treatment toxicity. As its clinical use expands, neuroradiologists play a central role in recognising therapy-related changes and supporting long-term surveillance. This review outlines key neuroradiological considerations across the PBT pathway. MRI is fundamental to planning, but its integration requires modified workflows, specialised immobilisation equipment, and tailored sequence design to balance geometric accuracy, signal-to-noise constraints, and patient tolerability. Ongoing sequence optimisation-including the use of high-resolution isotropic volumes and advanced reconstructions-aims to improve delineation of target structures and organs at risk. During treatment, anatomical changes such as tumour or cyst evolution may alter proton range, necessitating interval imaging and, in selected cases, adaptive replanning. Post-treatment assessment presents further challenges, as PBT may produce distinct radiological appearances compared with photon therapy. These include patterns of pseudoprogression, variations in white matter and microvascular injury, and a spectrum of vascular complications. Accurate interpretation is essential to distinguish treatment effects from recurrence and to guide further management. Advances in MRI-only workflow development, synthetic CT generation, ultra-high-field imaging, and computational modelling offer opportunities to further improve treatment precision and refine the characterisation of post-treatment effects. As PBT becomes more widely delivered, this review will aid neuroradiologists at referring centres who will increasingly encounter its distinct post-treatment appearances, highlighting the importance of familiarity with these patterns in routine practice and aiding standardisation of post-treatment imaging protocols.

Gynaecological malignancies are increasing in incidence in the UK, primarily driven by a rise in cases of endometrial cancer. The most common in order of prevalence thereafter are ovarian, cervical, vulval and vaginal cancers. Imaging is fundamental to their diagnosis, staging, response assessment and surveillance; and has significant implications in management by guiding local, regional or systemic treatment strategies. Advanced nuclear medicine imaging modalities, in particular [[18]F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT), have an evolving role in combining anatomical and functional data, resulting in superior sensitivity and specificity for detection of sites of disease compared to conventional techniques. Sentinel node lymphoscintigraphy using [[99m]Tc]-labelled nanocolloids is also integral to management pathways in selected cases, notably in patients with cervical and vulval cancer, to detect microscopic nodal disease and potentially avoid more extensive procedures which carry morbidity. This article provides a contemporary, evidence-based, overview of nuclear medicine imaging practice in gynaecological malignancy, separated by primary tumour location. It makes reference to current international guidelines and highlights key studies evidencing their utility, in addition to describing strengths and limitations compared to alternative modalities. Future advances on the horizon are also discussed, including novel radiopharmaceuticals and technological developments.

Papillary muscle fibrosis (PMF) is being increasingly recognised as a cause of ventricular arrhythmias; therefore, its identification is clinically relevant. PMF has been described in multiple cardiac conditions such as ischaemic cardiomyopathy, mitral valve prolapse and non-ischaemic cardiomyopathies such as hypertrophic cardiomyopathy (HCM), cardiac amyloidosis and cardiac sarcoidosis. Although cardiac magnetic resonance (CMR) imaging is a central tool in its diagnosis, PMF can be overlooked if the papillary muscles are not carefully assessed, especially in cases where the abnormal papillary muscle and the blood pool have the same signal intensity on the late gadolinium enhancement (LGE) phase. In an illustrative fashion, the present review aims to describe the normal anatomy of the papillary muscles, a range of conditions which can cause papillary muscle fibrosis and useful tips for its identification.