For interventional radiologists working in the thoracic field, 2025 has been marked by mixed emotions: the familiar excitement of innovation-an intrinsic hallmark of interventional radiology-alongside emerging questions that challenge established practices and compel critical reflection.Among the many publications released over the past year, two studies stand out. Although they address different topics, together they prompt reflection on the future direction of thoracic interventional radiology and, specifically, on its most widespread and foundational procedure: lung biopsy.

To compare endovascular strategies for femoropopliteal lesions extending to the distal popliteal artery (PA). We retrospectively analyzed 275 femoropopliteal lesions extending to the distal PA (P2/P3) treated with drug-coated balloons (DCBs) and/or stents between July 2011 and October 2021. Outcomes were compared among three treatment strategies: full-cover stent (n = 90), full-cover DCB (n = 128), and hybrid therapy (n = 57) defined as stent implantation within P1 combined with DCB treatment in P2/P3. The primary outcomes were restenosis and major adverse limb events (MALE). Adjusted analyses using inverse probability of treatment weighing (IPTW) were performed to account for background differences. Predictors of restenosis were evaluated using Cox proportional hazards models. The 24-month restenosis rate was lowest with hybrid therapy compared to full-cover stent and full-cover DCB (26.7% vs. 62.1% vs. 60.7%, P = 0.010), whereas the 24-month MALE rate was highest with full-cover stent (29.1% vs.13.6% vs. 12.2%, P = 0.002) with the consistent findings after IPTW. Multivariate analysis identified full-cover DCB, full-cover stent, (hazard ratio [HR]: 1.95 and 2.42, P = 0.039 and 0.009 compared with hybrid therapy) and involving distal popliteal chronic total occlusion (HR: 1.70, P = 0.049) were independent predictors of restenosis, whereas hypertension (HR: 0.63, P = 0.025) was associated with reduced risk. Notably, restenosis after hybrid therapy was predominantly occlusive. Hybrid therapy for femoropopliteal lesions extending to the distal PA was associated with lower restenosis rate without increasing MALE risk. However, occlusive restenosis may complicate repeat intervention and warrants careful surveillance. Findings should be interpreted in light of treatment-selection bias and device heterogeneity.

To evaluate the feasibility of developing an artificial intelligence application for real-time specimen adequacy assessment during ultrasound-guided fine needle aspiration of the thyroid gland using small, locally derived datasets and open-source AI tools. 1,244 photomicrographic images of thyroid needle aspiration slides were used to develop training and testing datasets for a YOLOv5 convolutional neural network model. In silico performance was tested for standard metrics. The model was deployed in an application featuring a live, augmented reality microscopy display. Hands-on testing was performed using a set of 50 blinded patient specimens tested in duplicate (N=100) by human observers with no prior formal training in pathology. On an independent static image test set, the CNN achieved an AUROC of 0.954 (95% CI, 0.922-0.986) using images acquired with a dedicated microscope camera, with sensitivity 0.969, specificity 0.933, and accuracy 95.5%. Using images acquired with a smartphone camera, performance improved to an AUROC of 0.983 (95% CI, 0.965-1.000), with sensitivity 0.980, specificity 1.000, and accuracy 98.8%. In a simulated clinical workflow, human users assisted by the augmented reality AI tool demonstrated 96% concordance with the reference standard FNA adequacy assessment. An augmented reality microscopy tool based on a small-model CNN showed feasibility for performing real-time assessment of thyroid FNA specimen adequacy. Such a tool can enable telecytologic support of FNA assessment in radiologic facilities without an on-site pathologist.

The study aims to evaluate the potential of the free open-source general purpose image processing software 3D Slicer for minimal ablative margin (MAM) evaluation. 3D Slicer was retrospectively applied to assess MAM of ablated liver tumors with pre and post intraprocedural CT. Three operators with different years of experience were involved: two of them assessed the MAMs using 3D Slicers software with the segmentation andregistration tools and Model-to-Model extension, and categorized MAM in three categories (≤ 0mm, > 0- < 5mm, ≥ 5mm), while the third operator performed a visual assessment of the same MAMs. Concordance among the three operators (K Cohen) and image processing time for MAMs evaluation was evaluated. Among 60 ablated tumors between April 2023 and January 2024, 24 tumors from 20 patients (median age 64.8 ± 9.7 years, 80% male) were included in the analysis. Insufficient accuracy registration was the main cause of exclusion. Substantial agreement was found between operators using 3D Slicer across all three categories (≤ 0mm, > 0- < 5mm, ≥ 5mm), with K Cohen between 0.65 and 0.74. Instead, slight or no agreement between software's and visual assessment results was found (K Cohen between - 0.30 and 0.11). Mean time to calculate MAM was respectively of 25' and 16″ for operator 2 and 49' and 26″ for operator 3. Strong inter-reader agreement using 3D-Slicer is encouraging, but its workflow and time demands limit clinical use, highlighting the need for task-specific software.

To evaluate a fully robotic, teleoperated system for performing various endovascular interventions in a preclinical porcine model. The SENTANTE™ Endovascular Robotic System was assessed in six healthy porcine subjects using standard endovascular devices. Outcomes were assessed via procedural monitoring and gross pathological analysis. Haptic feedback performance was qualitatively assessed by the operators using a four-point scale (1 = very good, 2 = fair, 3 = poor, 4 = inadequate). A total of 18 endovascular interventional procedures were successfully completed, including renal artery stenting (3), embolization of the superior right renal artery branch (3), percutaneous transluminal angioplasty (PTA) of the superior mesenteric artery (3), left vertebral artery stenting (3), contralateral iliac artery PTA (3), and ipsilateral iliac artery stenting (3). All procedures (100%) were completed without manual conversion, including pre and post-procedural angiography, resulting in near-zero operator radiation exposure. The system was compatible with standard guidewires (0.014″, 0.018″, and 0.035″), catheters (2.7-8 Fr), and pushable coils (0.018″ and 0.035″). Post-procedural angiography demonstrated no signs of vessel injury. Minimal vessel trauma was observed in 3 of 16 target vessels during gross necropsy. Haptic feedback was rated as very good in three test models and as fair in the remaining three. In a preclinical model, the SENTANTE™ system demonstrated the feasibility of performing endovascular interventions via teleoperation, including angiography, stenting, coil embolization, and PTA. Its compatibility with standard devices, haptic feedback, and elimination of operator radiation exposure support progression to clinical feasibility trials.

This study evaluated the short-term efficacy and safety of prostatic artery embolization (PAE) using ethylene vinyl alcohol copolymer (EVOH) for symptomatic benign prostatic hyperplasia (BPH) and investigated the impact of EVOH penetration on clinical success. This retrospective, single-center study analyzed 73 men who underwent EVOH-based PAE. The primary endpoint was 3-month clinical success, defined as an International Prostate Symptom Score (IPSS) < 18 with a ≥ 25% decrease and an IPSS-related QoL score ≤ 3 with ≥ 1-point decrease. Complications were graded according to the Clavien-Dindo and CIRSE classification systems. Final cone-beam CT (CBCT) was performed to identify non-target embolizations (NTEs) and to grade EVOH penetration into each hemiprostate using a 0-3 scale. The Prostatic EVOH Penetration Score (PEPS) categorized whole-prostatic embolization as high (3|3, 3|2), medium (3|1, 2|2), and low (others). The secondary objective was to assess the correlation between PEPS groups and clinical success. Three-month clinical success was 88% (64/73), with a median IPSS decrease of - 12 points (Q1, Q3: - 17, - 7; P < 0.001) and a median QoL decrease of - 3 points (Q1, Q3: - 4, - 2; P < 0.001). No major complications occurred; 12/73 (16%) patients experienced minor complications. Eight NTEs were identified in 7/73 (10%) patients, all asymptomatic. Clinical success occurred in all patients with high PEPS (n = 57), in 7/11 (64%) patients with medium PEPS, and in none with low PEPS (n = 5) (P < 0.001). EVOH-based PAE is safe and effective at 3months for BPH-related symptoms. PEPS may help better define technical success as a predictor of short-term clinical outcomes.

Describe the incidence and severity of gastrointestinal tract-related adverse events (GIAE) following radiation segmentectomy (RS) for hepatocellular carcinoma (HCC) in the left hepatic lobe. A single-center retrospective analysis of patients with solitary, treatment-naïve, HCC in the left hepatic lobe who underwent Yttrium-90-containing glass microsphere RS from 6/2017-9/2023 was performed. Clinical, endoscopic apparent, and surgical GIAE up to last available follow-up were graded per the Common Terminology Criteria for Adverse Events. Tumor-to-GI tract distance and treatment parameters were evaluated for associations with GIAE. Forty-six patients with a median tumor size of 2.4cm (IQR 2.1, 3.6) and median follow-up of 931days (IQR 527, 1412) met inclusion criteria. Median treatment dose was 533Gy (IQR 456, 853). Grade 1 GIAE were documented on 14 (30%) patients, including nausea/emesis (n = 12) and gastritis/duodenitis (n = 2). Grade 2 GIAE were documented in 2 (4%) patients with either multifocal gastric and duodenal ulcers or gastric erosions per endoscopy performed at a median of 53days post-RS without histologic evidence of Yttrium-90 microspheres or radiation injury. In the 18 patients who underwent subsequent liver transplantation or hepatectomy, increased surgical dissection time was documented in 6 (33%) patients secondary to presumed radiation-related adhesions. Two surgical cases (11%) had grade 4 AE, which included intraoperative hemorrhage and duodenal avulsion. No significant association was found between GIAE and tumor-to-GI tract distance, dosimetry, or treatment parameters. The incidence of severe GIAE following RS for HCC in the left hepatic lobe was low. Surgical adhesions after RS were common, but most did not increase surgical morbidity.