Background Incorrect artificial intelligence (AI) suggestions can lead to automation bias; however, their impact on medical image interpretation is underresearched. Purpose To assess how incorrect AI suggestions influence the diagnostic accuracy, read times, and visual search behavior of readers interpreting screening mammograms. Materials and Methods In this retrospective multireader paired study conducted between September 2024 and February 2025, 10 National Health Service Breast Screening Programme mammography readers evaluated a test set of two-view mammography screening examinations. The test set included true-positive (TP), false-negative (FN), false-positive (FP), and true-negative (TN) AI suggestions, verified by 3 years of follow-up or histopathologic analysis. In round 1, readers interpreted cases without AI. In round 2, conducted 6 weeks later, a commercially available AI tool was used as decision support, displaying prompts with a region score of 10 or higher (scale, 0-100). Eye-tracking cameras recorded readers' fixations-maintained gaze-over specific image areas. Wilcoxon signed rank tests were used for paired comparisons between rounds, and Kruskal-Wallis tests compared cases with different AI outcomes. Results The test set (n = 60) included cases with 26 TP, 14 FN, 14 FP, and six TN AI suggestions. Median reader sensitivity was lower for cases with FN AI suggestions when reading cases with AI (39%) compared with unassisted reading (71%; P = .002). Reader specificity was higher for cases with FP AI suggestions (39% vs 21%; P = .004). A greater number of visible (TP and FP) AI prompts led to longer median read times, from 25 seconds (zero prompts) to 34 seconds (four or more prompts) (P = .001). Readers fixated less when reviewing cancer cases that AI failed to detect (FN suggestions) compared with unassisted reading (0.44 vs 0.47 fixations per second; P = .03). Shorter fixation durations were observed when readers interpreted cases with FP AI suggestions compared with unassisted reading (0.54 vs 0.56 second; P = .001). Conclusion Incorrect AI suggestions influenced both reader accuracy and visual search behaviors during mammography interpretation. The greatest negative impact was observed with FN AI suggestions; therefore, AI thresholds should be calibrated accordingly. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Clauser in this issue. See also the editorial by Abbasi and Giess in this issue.

Chronic liver disease is a substantial cause of mortality and morbidity worldwide, with metabolic dysfunction-associated steatotic liver disease affecting about one-third of the population. Shear-wave elastography (SWE) is a safe and noninvasive US method for quantifying liver fibrosis. It is a widely available, low-cost imaging test that has proven accurate and reliable for diagnosing advanced liver fibrosis, a key determinant of mortality risk among patients with chronic liver disease. Established society guidelines for SWE outline patient selection, preparation, image acquisition, examination reliability characterization, and reporting. However, inconsistencies between guidelines and the complexity of recommendations pose barriers to practical clinical implementation. To address this gap, established best practices for US SWE are reviewed and synthesized, actionable recommendations for streamlining clinical deployment are provided, and common pitfalls are highlighted.

Background To support crew health during spaceflight, in-flight imaging must extend beyond the capabilities of portable ultrasound (US). Digital radiography may provide improved diagnostic quality and enable equipment monitoring through nondestructive testing. Purpose To demonstrate the feasibility of a commercial-off-the-shelf (COTS) radiography system for on-orbit imaging applications. Materials and Methods In a prospective study, a portable, digital, COTS radiography system was evaluated during the 3.5-day Fram2 polar orbital flight. Anatomic and equipment radiographs were obtained preflight and in-flight by crew participants with 4 hours of training. Radiographs were evaluated by independent radiologists on overall image quality, spatial resolution, contrast resolution, and positioning (Likert scores of 1-5). Preflight radiographs were compared with in-flight radiographs using the Wilcoxon rank sum test. Hardware testing and crew surveys were conducted postflight; survey responses were thematically analyzed due to small sample size. Results Three crewmembers participated (mean age, 42.8 years ± 13.9 [SD]; two women). In-flight and preflight anatomic radiographs (seven each) demonstrated no evidence of differences in overall image quality (mean score, 4.86 ± 0.26 vs 5.0 ± 0, respectively; P > .99), spatial resolution (mean score, 4.86 ± 0.26 vs 5.00 ± 0; P = .46), or contrast resolution (mean score, 4.86 ± 0.26 vs 5.00 ± 0; P = .46). However, for central radiographs (chest, abdomen, pelvis; 12 of 14 images), image positioning was worse in-flight than preflight (mean score, 4.07 ± 0.72 vs 4.95 ± 0.13, respectively; P = .02). In-flight nondestructive testing enabled visualization of internal equipment components to the submillimeter scale. The radiography system functioned nominally postflight despite minor re-entry damage. Crew surveys rated equipment and protocols easy to use. Conclusion By acquiring the first human radiographs in space, this study demonstrated the feasibility of on-orbit radiography, expanded diagnostic capabilities for crew health and equipment evaluation, and identified operational standardization gaps and image-aligned challenges in microgravity. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Abbara and McMillan in this issue.

Background Understanding how symptomatic intracranial atherosclerotic disease (sICAD) evolves and identifying high-risk lesion characteristics could improve risk stratification. Purpose To delineate the evolution patterns of plaque morphologic features and focal hemodynamics in sICAD and identify morphologic features and hemodynamics associated with plaque progression and recurrence of stroke and/or transient ischemic attack (TIA). Materials and Methods In this prospective, longitudinal study, participants with high-grade (60%-99% stenosis) sICAD confirmed at three-dimensional rotational angiography (3DRA) between August 2007 and December 2021 received guideline-based medical treatment, with follow-up evaluations at 1, 3, 6, and 12 months and every 6 months afterward. All participants underwent follow-up 3DRA at 1 year or upon stroke recurrence if earlier. The sICAD plaque morphologic features and focal hemodynamics were assessed and compared at baseline and follow-up 3DRA and using 3DRA-based computational fluid dynamics models. The primary outcome was a composite of relevant ischemic stroke or hard TIA recurrence and/or plaque progression in 3DRA at 1 year. Results Among 97 participants (median age, 62 years [IQR, 56-68 years]; 68 male), the primary outcome occurred in 26 (27%): 17 (18%) with relevant ischemic stroke and/or TIA recurrence and nine (9%) with plaque progression. Focal pressure and wall shear stress measures also changed over 1 year. Greater plaque thickness (adjusted odds ratio, 10.49 [95% CI: 2.67, 41.20]), smaller upstream plaque shoulder angulation (adjusted odds ratio, 0.97 [95% CI: 0.95, 1.00]), and maximum stenosis located distally (adjusted odds ratio, 3.81 [95% CI: 1.19, 12.18]) at baseline were independently associated with primary outcome. Higher and lower wall shear stress measures across the upstream and downstream plaque segments, respectively, at baseline were also associated with primary outcome. Conclusion Plaque morphologic features and focal hemodynamics evolved over time in participants with sICAD under medical treatment; thicker plaque, smaller upstream shoulder angulation, and skewed distal load were associated with lesion progression and recurrence of stroke and/or TIA. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article.

Purpose To develop a photoacoustic microscopy (PAM) method for classifying colorectal liver metastasis (CRLM) microvascular networks as angiogenesis-type or vessel co-option-type at different metastatic stages and to evaluate their responses to bevacizumab. Materials and Methods Seventy-two BALB/c nude mice received intrasplenic injections of HCT116-luc or HT29-luc cells to establish CRLM models. PAM was used to visualize CRLM vascular architecture, and its diagnostic accuracy was validated through histopathologic analysis. Intergroup differences in PAM parameters were assessed with one-way analysis of variance or independent-samples t tests. Results PAM differentiated angiogenesis-type from vessel-co-option-type CRLMs according to distinct vascular architectures: Angiogenesis-type CRLMs exhibited lower vessel density (15.66% ± 4.38 vs 31.44% ± 6.95; P < .001) and vessel junction density (1.19 × 10[-3] n/px[2] ± 0.52 vs 3.12 × 10[-3] n/px[2] ± 1.11; P = .001) and higher vessel diameter (31.45 µm ± 4.59 vs 13.68 µm ± 1.61; P < .001) and lacunarity (0.294 arbitrary units [au] ± 0.095 vs 0.148 au ± 0.059; P = .003) than vessel co-option-type CRLMs. These differences persisted throughout the 8-week progression period. A 33.3% reduction in vessel density at 3 weeks following bevacizumab treatment was observed in angiogenesis-type CRLMs (untreated, 15.66% ± 4.38 vs treated at 3 weeks, 10.44% ± 4.91; P = .047), with no evidence of a difference in vessel co-option-type CRLMs (untreated, 31.44% ± 6.95 vs treated at 3 weeks, 28.82% ± 3.56; P = .56). Conclusion PAM quantified microvascular signatures differentiating CRLM blood supply patterns and identified vessel co-option-type metastases as resistant to bevacizumab. Keywords: Angiogenesis, Bevacizumab, Colorectal Cancer, Histopathologic Growth Pattern, Liver Metastases, Photoacoustic Imaging, Photoacoustic Microscopy, Vessel Co-Option Supplemental material is available for this article. © RSNA, 2026 See also editorial by Wang and Chen in this issue.

Purpose To identify a panel based on circulating proteins to predict clinical outcomes after local ablation across patients with primary and metastatic liver cancer to improve patient selection. Materials and Methods This exploratory post hoc analysis is derived from ESTIMATE, a prospective controlled trial (DRKS registration no. 00010587) evaluating progression-free survival and overall survival (OS) after local ablation of liver malignancies between 2017 and 2023. Baseline plasma samples from patients with hepatocellular carcinoma, intrahepatic cholangiocarcinoma, or metastatic breast or colorectal cancer treated with interstitial brachytherapy were profiled using an immunoassay panel. Group comparisons used t tests or Mann-Whitney U tests. Survival was assessed using Kaplan-Meier, log-rank, and Cox regression analyses. Multivariable Cox models were adjusted for tumor type, number of lesions, and treatment response. Model discrimination was assessed using time-dependent areas under the receiver operating characteristic curves (AUCs) for OS, with bootstrap resampling used to estimate optimism-corrected performance. Results In total, 103 patients (62 male; mean age, 67.5 years; range, 36-87 years) were included. Elevated chemokine (C-C motif) ligand 20, interleukin-15, and interleukin-8 levels were associated with poor clinical outcomes across various liver tumors and were therefore incorporated into an immune-inflammatory prognostic model (all P < .05). AUC analysis revealed the predictive accuracy of the model for OS at 6, 12, and 18 months (AUCs: 0.70, 0.72, and 0.74, respectively), and bootstrap optimism-corrected performance ranged from 0.61 to 0.68. Conclusion The findings revealed a cross-cancer panel of circulating proteins that reliably and effectively predicts treatment response and prognosis after local ablation of liver malignancies. Keywords: Prognosis & Prediction, Treatment Response Assessment, Ablation Techniques, Interventional Oncology, Molecular Imaging-Clinical Translation, Molecular Imaging-Cancer, Liquid Biopsy, Abdomen/GI, Decision Analysis, Evidence-based Medicine, Outcomes Analysis, Liver Cancer, Interstitial Brachytherapy, Cross-Cancer Biomarkers, Proximity Extension Assay German Clinical Trials Register no. DRKS 00010587 Supplemental material is available for this article. © RSNA, 2026.

Purpose To apply a vendor-neutral Agatston score (vnAS) for aortic valve calcification across multiple CT systems and to aortic stenosis severity classification. Materials and Methods Anthropomorphic phantoms with varying degrees of calcification were scanned using seven different CT systems and a reference electron-beam CT system to determine the vnAS. The vnAS was calculated using a regression model, whose performance was evaluated by both the coefficient of determination and analysis of variance. The vnAS was subsequently validated on a retrospective patient sample from eight international centers. Thresholds of severe aortic valve stenosis were defined as 1274 and 2065 AU for women and men, respectively. Results The Agatston scores from all CT systems were strongly correlated with that of the reference system (R[2] > 0.932). On the basis of their echocardiographic findings, 183 of 831 (22.0%) patients (mean age ± SD, 77 years ± 10; 351 of 831 [42.2%] women) had discordant echocardiographic aortic valve stenosis findings. Among women with discordant results, the vnAS was higher than the traditional aortic valve calcium score (median, 1693 AU [IQR, 908-2513 AU] vs 1181 AU [IQR, 726-1964 AU], respectively; P < .001). Similar findings were observed for men (median, 2658 AU [IQR, 1894-3822 AU] vs 2056 AU [IQR, 1408-3056 AU], respectively; P < .001). Using the vnAS, 8.5% of women and 17.8% of men with discordant echocardiographic findings were reclassified into the severe aortic stenosis group. Conclusion A previously developed calibration tool, the vnAS, was validated and reclassified patients with discordant echocardiographic findings into the severe aortic stenosis group. Keywords: CT, Echocardiography, Percutaneous, Cardiac, Valves, Calcifications/Calculi, Technology Assessment, Vendor-neutral Agatston Score, Aortic Stenosis, Aortic Valve Calcification, Phantoms Supplemental material is available for this article. © RSNA, 2026 See also commentary by Jaltotage and Leipsic in this issue.