Image reject analysis is a critical quality assurance (QA) tool in diagnostic imaging, helping to minimise unnecessary radiation exposure and improve imaging efficiency. This study evaluates image rejection patterns in a computed radiography (CR) system at a major tertiary teaching hospital in Ghana, identifying key sources of errors and their implications for radiology practice. A retrospective review of radiographic images acquired between April and June 2023 was conducted. Images, including those flagged as rejects were retrieved from the CR system and analysed for rejection rates, trends by anatomical region, and key error sources. Of the 5889 images reviewed, 974 were rejected, resulting in an overall rejection rate of 16.5%. Rejection rates varied considerably across anatomical regions. High rejection rates were observed in skull/sinus (34.9%, n = 90/258), pelvic (29.9%, n = 88/294) and abdomen (26.9%, n = 84/312) examinations. Low rejects were recorded for ankle (1.8%, n = 2/110), humerus (2.4%, n = 2/82), forearm (6.7%, n = 6/90), elbow (9.7%, n = 6/62), and lower leg (7.5%, n = 16/214). Across all examinations, the three leading causes of image rejection were anatomical cut-off (40.5%, n = 394), positioning errors (27.5%, n = 268), and beam centering errors (18.5%, n = 180). Less frequent causes included exposure-related issues (6.6%, n = 64), patient movement (2.9%, n = 28), and artefacts or ghosting (4.1%, n = 40). This study reinforces the role of image reject analysis as a valuable QA measure in CR systems. The high rejection rates observed highlight the need for targeted interventions in positioning, workflow optimization, and radiographer training, particularly in resource-constrained settings to enhance diagnostic quality and patient safety.

Video consultations enable guideline-based and continuous medical care under the structurally challenging conditions of correctional facilities. This article presents the model of team-based telemedicine using concrete fields of application such as tele-general medicine, telepsychiatry, tele-substitution therapy, and teledermatology. Special attention is given to technical requirements, quality assurance measures, and the challenges and opportunities in correctional healthcare delivery. The approaches described are based on the experiences of the "Videoclinic" in more than 120 correctional institutions. In addition, the results of an initial empirical analysis of telemedicine routine care data (January 2023 to March 2025) and asatisfaction survey of medical and nursing staff (March 12 to 9 April 2024) are presented, which provide insights into the realities of healthcare delivery, the disease spectrum of inmates, and indications regarding the effectiveness and acceptance of telemedicine care in correctional settings.

US is an important diagnostic tool in evaluation of the pancreas, as it is noninvasive, does not require irradiation, and offers real-time imaging capability and broad accessibility. Despite the utility of pancreatic US, it often has limited effectiveness due to the complex anatomy of the pancreas and peripancreatic structures, which inevitably leads to diagnostic errors. The authors summarize the lessons learned from quality assurance rounds at a high-volume tertiary care center. The errors are systematically categorized as perceptual, interpretive, information transfer, and process errors. Each error type is discussed with detailed case studies from clinical practice to underscore common pitfalls and their impact on patient management. Perceptual errors occur when the operators overlook subtle pathologic signs due to the complex anatomy. Interpretive errors arise from misjudgments regarding the clinical significance of visible abnormalities, while information transfer errors stem from inadequate communication of patient history or suboptimal review of previous imaging findings. Process errors reflect systemic issues related to US protocol and scanning techniques. The authors advocate having a thorough understanding of the US appearances of normal and variant pancreatic anatomy and emphasize the importance of correlating US findings with findings of complementary imaging modalities to improve diagnostic accuracy. They also highlight the need to use high-resolution US transducers, embrace new technologies, and adopt meticulous scanning techniques as valuable practical strategies to mitigate diagnostic errors. By providing a detailed analysis of cases, this review demonstrates how structured quality assurance measures and continuous education can significantly reduce diagnostic errors. These efforts are crucial in ensuring accurate diagnoses and optimizing patient outcomes. ©RSNA, 2025 Supplemental material is available for this article.

Results of RCTs are criticised because the quality assurance (QA) of surgical interventions is not considered. This is particularly true in cancer trials, because higher standards of surgery may confer more favourable outcomes. Although methods for surgical QA exist, it is unclear how to operationalise and report them in the context of pragmatic cancer trials. We describe the development and application of QA processes to an RCT comparing laparoscopically assisted (LAO) and open oesophagectomy (OO) in patients with localised oesophageal cancer. Three QA measures were developed in Phase 1 and tested for feasibility in Phase 2: (i) centre/surgeon entry criteria, (ii) agreement of key components of LAO/OO, and (iii)monitoring adherence to intervention protocols using CRFs and intra-operative photographs. All centres met entry criteria and 30/31 Phase 2 surgeons submitted two videos. Although photos were received for 88.8% of procedures, only 44(14.9%) were complete. Adherence to key intervention components (abdominal/thoracic nodal clearance, hiatal dissection) was consistently reported as better in CRFs than that observed in the intra-operative photographs. Embedding QA measures into pragmatic surgical cancer RCTs is feasible, and provides important data about the quality of interventions. Methods to streamline data collection and analyses are needed prior to widespread use.

The review article provides a comprehensive examination of the multifaceted factors influencing HIV laboratory testing. It underscores the critical importance of rigorous quality assurance measures, including the calibration and maintenance of laboratory instruments, the use of control samples, and thorough documentation to ensure accuracy and reliability in test results. The paper highlights the necessity of continuous education and certification for laboratory staff to maintain proficiency in the latest testing methods and protocols. It also explores the impact of sociocultural dynamics, such as stigma and discrimination, on HIV testing and treatment behaviors, advocating for culturally sensitive strategies to enhance testing uptake and adherence. Economic evaluations of HIV screening programs are emphasized as crucial for optimizing resource allocation, with assessments focusing on cost-effectiveness and the broader impact on public health. The paper calls for international collaboration, with organizations like WHO and UNAIDS playing pivotal roles in supporting global testing and prevention efforts. By integrating these elements, the review aims to identify best practices and areas for improvement, ultimately enhancing the quality of HIV laboratory testing and supporting better health outcomes for individuals and communities affected by HIV.

As generative artificial intelligence (GenAI) technologies, such as large language models, become deeply integrated into academic research, questions surrounding their ethical and responsible use have become central to higher education policy. This study provides a thorough analysis of guidelines and regulations governing GenAI in higher education research, mapping and comparing policy responses across four key domains: governmental authorities, higher education institutions (HEIs), academic publishers, and publication manuals. Using an inductive qualitative approach, we systematically analyzed a purposive sample of 74 policy documents from around the world, encompassing diverse institutional and regulatory perspectives. The analysis began by quantifying the frequency of major policy themes, revealing both convergence and divergence in institutional approaches to GenAI. For governmental policies, 10 recurring themes were identified, focusing on ethical use, AI quality assurance, regulatory compliance, and the need for transparency and accountability. HEI policies highlighted 14 themes, emphasizing disclosure requirements, safeguarding academic integrity, addressing concerns about AI misuse, and promoting AI literacy and training among researchers and students. Publishers’ guidelines featured 10 themes, including clear positions on AI authorship, accountability of human authors, and requirements for disclosure and transparency in scholarly communication. Publication manuals identified 11 key themes, reflecting evolving citation practices, mandatory acknowledgment of AI tool use, and the integration of new standards for referencing AI-generated content. Five core domains emerged as central to effective policy: transparency and disclosure, authorship and accountability, quality assurance and safety measures, data security and privacy, and AI literacy and training. Across all document types, transparency and disclosure were consistently emphasized as foundational to ethical research conduct, while approaches to authorship, quality assurance, and data security exhibited variation in specificity and enforcement. The analysis revealed a widespread consensus that AI cannot be listed as an author, yet the mechanisms for ensuring human accountability and for documenting AI’s contribution varied across domains. Quality assurance protocols and privacy safeguards were present but differed in their rigor and implementation, often reflecting regional or institutional priorities. Notably, the need for robust AI literacy and training was frequently cited as essential for mitigating risks associated with GenAI misuse and for fostering responsible academic practice. The comparative synthesis underscores the importance of multi-stakeholder collaboration in developing comprehensive, adaptable policies that address the dynamic challenges posed by GenAI. While there are significant areas of thematic overlap, such as a shared commitment to transparency and ethical standards, notable gaps persist—particularly in guidance around equity, inclusivity, and the practical enforcement of AI-related policies. The study concludes that harmonizing regulatory frameworks and fostering AI literacy will be essential to safeguard academic integrity and support innovation in research practice. These findings offer actionable insights for policymakers, university leaders, publishers, and academic communities seeking to responsibly integrate GenAI into higher education research.

We sought to investigate the frequency of diagnostic changes in hematopathology cases referred to the University of Michigan during a 3-year period and explore which parameters contribute to diagnostic change. Pathology reports from hematology patients who came to the University of Michigan for a second opinion from 2017 to 2019 were reviewed. Diagnostic discrepancies were classified into major or minor. Specimen type, hematopathology board certification and practice time of the outside pathologists, referring practice type, and whether the second review was done at the referring institution were recorded too. Agreement in diagnosis by the above-listed specimen characteristics was analyzed. A total of 2786 cases were reviewed (2016 bone marrow and 770 tissue specimens). Disagreements in diagnosis were found in 263 cases (9.4% of total cases), and 163 (5.9%) were major disagreements. Among the major disagreements, 119 (73%) were in bone marrow specimens and 44 (27%) in tissue specimens. Among bone marrows, the most common revisions were myeloid neoplasm reclassifications (35.3%), whereas lymphoma subtype revisions comprised 70.4% of all changes in tissues. Univariate analysis showed that major disagreement rates were significantly higher in cases signed out by pathologists without hematopathology certification, those practicing for more than 10 years, and in cases from nonacademic institutions. When analyzing bone marrows and tissues separately, these differences remained significant only for bone marrows. Second review of pathology material serves as an important quality assurance and patient safety measure. Lack of hematopathology training of the referring pathologists may contribute to the rate of diagnostic discrepancy.

Graduate education plays a crucial role in shaping a nation’s academic and research landscape, particularly in producing highly skilled professionals and scholars. In the Philippines, the Commission on Higher Education (CHED) has issued CMO No. 15 series of 2019 which prescribes the policies, standards, and guidelines for graduate programs in the Philippines. This policy study examined the status of Bicol University’s graduate education in response to this new framework, focusing on program alignment, institutional challenges, and opportunities for development. Using a qualitative-descriptive approach, the study assessed the extent to which Bicol University’s graduate programs comply with CHED’s updated policies and standards. Key areas of analysis included curriculum structure, faculty qualifications, research productivity, accreditation status, among others. Findings indicate that while Bicol University has made significant progress in aligning its graduate education with CHED’s mandates, challenges persist. These include inadequate faculty complement, limited faculty research engagement, limited publication, and the need for more strategic industry and international partnerships. Additionally, compliance with new accreditation and quality assurance measures requires further institutional support and policy refinements. Based on these findings, the study provides strategic recommendations for improving the implementation of CHED’s New Graduate Education Framework at Bicol University. Key recommendations include strengthening faculty complement, enhancing faculty research and publication support, increasing institutional funding for graduate research, fostering collaborative programs with industry and global institutions, and continuously refining policies to ensure sustainable program development. By addressing these areas, Bicol University can enhance the quality and competitiveness of its graduate programs, ultimately contributing to national higher education goals and international academic standards. This study contributes to the ongoing discourse on policy implementation in graduate education, particularly in bridging regulatory frameworks with institutional realities. It underscores the importance of proactive institutional strategies in navigating policy transitions while ensuring that graduate education remains responsive to both national and global academic demands.

Ongoing surveillance of analytical platforms in preimplantation genetic testing: phase 4.

Quality assurance in machine Learning: Do we hit the mark for total joint arthroplasty models? A systematic review.

Neutron activation in interrupted neutron beams.

Abstract Introduction/Objective Interinstitutional pathology consultations serve as an essential quality assurance measure. This study benchmarks diagnostic discrepancies and clinical impact over 40 years at our institution. Methods/Case Report A retrospective review was conducted on 1,038 surgical pathology consultation cases referred to our department in 2023 (n = 447) and 2024 (n = 591), initiated post-final diagnosis by outside institutions. Diagnostic discrepancies and clinical impact were analyzed. Data were compared to literature-reported discrepancy rates and historical departmental data from 1984–2024. Results Discrepancies were identified in 1.6% of cases in both 2023 and 2024, well below the 6.3% rate in the literature. In 2023, 3 out of 6 cases (0.7%) were amended, none with clinical impact. In 2024, 4 out of 7 cases (0.7%) were amended, with 1 (0.002%) potentially impacting clinical management. The diagnoses of remaining 7 cases were not altered after internal reviews during the 2 years. The 40-year cumulative departmental discrepancy rate was 2.2%, major discrepancy 0.9%, and clinical impact 0.03%, all significantly below national benchmark rates. Conclusion Our data confirm high diagnostic accuracy and low clinical impact of discrepancies in interinstitutional consultations. These results validate the effectiveness of internal diagnostic processes and highlight the value of peer review in maintaining quality standards in surgical pathology.

Female genital schistosomiasis is a condition with a complex diagnosis and severe consequences such as infertility. In the absence of a reliable biomarker, in endemic settings the World Health Organization recommends colposcopy as a diagnostic tool for the detection of female genital schistosomiasis lesions. Nevertheless, it is seldom performed in low-resource contexts due to a lack of expertise or insufficient infrastructure. This study aims to assess Female Genital Schistosomiasis colposcopy at the primary level of care, evaluating its diagnostic accuracy in reference to gynaecologist diagnosis in a highly endemic context. This is a secondary analysis of a cross-sectional study conducted in the Boeny region of Madagascar, which collected colposcopy images and Female Genital Schistosomiasis decision at the primary health care level with re-evaluation by gynaecologists. Statistical analysis using R included descriptive statistics, measures of diagnostic accuracy with 95% confidence intervals and binary Poisson regression with robust standard errors, while reporting followed the STARD statement. Among 495 included participants, a high sensitivity [96.4% (95% CI 93.7-98.0)] and relatively low specificity [28.7% (95% CI 21.8-36.5)], with a fair agreement [κ 0.30 (95% CI 0.22-0.39)], was observed for midwife-led colposcopy. Practice of midwives (3.5 months) was associated with reduced concordance [APR 0.88 (95% CI 0.79-0.98)] and specificity [APR 0.27 (95% CI 0.15-0.49)]. The environment of one health care centre negatively influenced concordance and specificity of midwife-led colposcopy. Midwives can detect female genital schistosomiasis with high sensitivity but limited specificity when compared to expert gynaecologists, revealing variation in performance between environments as well as the influence of practice and workload. This study suggests that implementing midwife-led colposcopy at primary care level for female genital schistosomiasis screening is feasible but requires appropriate quality assurance measures.

HIV diagnostic testing in most African countries follows national algorithms that typically use two tests, with or without a tie-breaker. We assessed the accuracy of these algorithms using data from population-based surveys in 14 sub-Saharan African countries, where all HIV-positive results were further confirmed with the Geenius HIV-1/2 supplemental assay. Our findings show that inter-test concordance and positive predictive values (PPVs) varied by HIV prevalence, with higher PPVs observed in higher-prevalence settings. Overall, the PPV of HIV diagnosis was close to 99%, indicating that two-test algorithms can provide highly accurate results when testing is performed with strict adherence to quality standards and tester competency. These results underscore the importance of quality assurance (QA) and suggest that countries with lower HIV prevalence may benefit from adopting a three-test algorithm. However, such changes should be accompanied by careful attention to logistics, procurement, training, record keeping, and other QA measures.

Universal Health Coverage (UHC) remains a critical goal in sub-Saharan Africa, where healthcare systems face significant challenges. State-Church Partnership has emerged as an innovative strategy to address gaps in healthcare delivery, leveraging the extensive networks of Faith-Based Organizations to provide essential services, particularly in remote areas. A scoping review followed Arksey and O'Malley's framework and the PRISMA-ScR guidelines. We systematically searched peer-reviewed databases, including PubMed, Web of Science, Scopus, and CINAHL, for relevant studies published from inception until December 2024. Data were extracted and thematically analyzed using NVivo 11 to identify key themes related to state-church partnership models, their impact on UHC, implementation challenges, and emerging best practices. The review included eight studies covering various state-church partnership models in sub-Saharan Africa (SSA). Findings highlight that FBOs contribute between 30% and 70% of healthcare services in some regions, improving access, affordability, and equity. They play a critical role in maternal and child health, HIV/AIDS prevention, and health workforce training. However, challenges such as funding constraints, service quality variability, and limited policy integration hinder their effectiveness. Emerging best practices include enhanced government collaboration, community engagement, and capacity-building initiatives. In conclusion, State-Church Partnerships are vital in strengthening healthcare systems and achieving UHC in SSA. To maximize their impact, formalized policy frameworks, sustainable financing mechanisms, and quality assurance measures are essential. Strengthening state-FBO collaboration can bridge healthcare gaps and ensure equitable healthcare access.

Silicon carbide (SiC) detectors have been widely demonstrated to be suitable alternative detectors for dosimetry in FLASH radiotherapy, showing radiation hardness and dose-rate independence at the FLASH radiotherapy instantaneous dose rates (IDRs). However, the practical use of such devices in the preclinical/clinical environment still requires the development of special handy housing enabling the quality assurance (QA) measurements under the reference dosimetric conditions. A 10μm thick, 4.5 mm2area SiC detector produced by the STLab company was recently embedded at the INFN-Catania Division inside a plastic waterproof 15 mm diameter cylindrical housing. This encapsulated version of SiC (eSiC) allows the measurement of the dose in reference conditions and of the dose profiles in liquid/solid water phantoms for assuring high accuracy dosimetry QA procedures. Dosimetric characterizations were performed with both electron and proton beams at conventional and ultra-high dose rates (UHDR). A first experiment was carried out at the Centro Pisano for Flash Radiotherapy using UHDR 9 MeV electron beams to confirm the linearity of the charge response as a function of the dose per pulse after the encapsulation procedure. A linearity from 1.8 Gy/pulse up to about 12 Gy/pulse, corresponding to an IDR of 3 MGy s-1, was found. The percentage depth dose (PDD) distribution in water of 9 MeV electron beams was also measured and compared with the PDD measured with a Freiburg Physikalisch-Technische Werkstätten Dr. Pychlau GmbH (PTW) flash diamond detector, used as reference dosimeter. The eSiC detector was also tested with proton beams accelerated by the IBA Proteus 235 cyclotron at the Trento Proton Therapy facility. A response independence on the total delivered dose (1-30 Gy) and average dose rate (50-530 Gy s-1) was found using the UHDR 228 MeV proton beam available along the experimental beamline. The depth dose distribution measured with the eSiC within a liquid water phantom was successfully compared with the one simultaneously measured by the IBA PPC05 reference chamber, using 180 MeV clinical proton beams. The excellent results demonstrated that this first realized eSiC prototype can be used to accurately perform reference and relative dosimetry with UHDR electron and proton beams, contributing to support the clinical translation of FLASH radiotherapy.

Diabetic ketoacidosis (DKA) is a life-threatening hyperglycemic emergency with high morbidity and mortality in diabetes. This study explored determinants of diabetic ketoacidosis among adult diabetic patients in Ambo Town, Ethiopia. An unmatched case–control study was conducted from February 1 to March 30, 2024, involving 78 DKA cases and 230 controls (patients with diabetes mellitus and without DKA). Data were collected through structured questionnaires and chart reviews. Quality assurance measures included pretesting, data collector training, and supervision. Data were analyzed using SPSS version 25, with binary logistic regression identifying significant determinants, considering p < 0.05 as significant. The mean age of participants was 45.87 years (± 17.12 SD). Statistically significant determinants of DKA included being a type 1 diabetic [AOR 3.5; 95% CI 1.54–7.96], presence of comorbidities [AOR 4.82; 95% CI 2.03–11.42], irregular attendance at diabetic clinic appointments [AOR 6.14; 95% CI 2.25–14.7], discontinuation of prescribed medications [AOR 3.07; 95% CI 1.34–7.04], lack of health insurance [AOR 5.00; 95% CI 2.22–11.26] and other diabetes-related complications [AOR 4.25; 95% CI 1.59–11.3]. Therefore, Interventions should target follow-up care, medication adherence, insurance access, and comorbidity management to reduce risk and improve outcomes.

Though numerous quality assurance (QA) measures are in place for the practice of gynecologic cytopathology, many of them are not clearly defined and may be variably used by laboratories worldwide. To assess current practice patterns regarding the implementation of selected gynecologic cytology QA metrics to help develop guidance for laboratories. A supplemental questionnaire was mailed to laboratories participating in the 2022 College of American Pathologists (CAP) Gynecologic Cytopathology (PAP Education) Program requesting data regarding their QA measures in gynecologic cytology. A total of 562 laboratories responded to the supplemental questionnaire; responses from 511 laboratories were analyzed further. Of 492 laboratories, most considered Papanicolaou (Pap) tests from patients with untreated abnormal cytology in the previous year (386; 78.5%) or with an abnormal gynecologic biopsy finding (concurrent or within the past year) (331; 67.3%) as high-risk for negative rescreening. Many laboratories (436 of 511; 85.3%) required pathologist review of Pap tests for indications other than reactive/abnormal cells (eg, endometrial cells in women 45 years of age and older). For assessing cytologists' performance, 88.5% (399 of 451) of respondents recorded the discrepancy rate between cytologist's and pathologist's interpretations. For monitoring pathologists' performance, most laboratories (243 of 389; 62.5%) evaluated cases with significant cytologic-histologic discrepancy. The CAP survey provided a detailed assessment of current QA practices regarding gynecologic cytology, which can aid laboratories in making decisions related to enhancement of QA in their setting. As the guidelines and tools for cervical cancer screening evolve, QA metrics will need to be accordingly refined.

Abstract This systematic review aimed at providing a comprehensive overview of conversations and voices of scholars on access, equity and quality in higher education (HE) in Africa. The systematic review employed a thematic analysis approach to synthesise findings from 38 selected sources. The review revealed that although some significant strides have been made to improve access, equity and quality of higher education in Africa, there are some challenges persisting with infrastructure, regional and spatial disparities, and privatisation. The review also revealed weak enforcement of quality assurance measures. Strategies for addressing these challenges include expanding public sector HE, deregulating the educational sector, promoting open and distance learning, implementing preferential admission policies and enhancing financial aid. This research provides valuable insights for policy makers, educators and stakeholders, fostering a collaborative approach to address challenges and promote holistic development in African higher education. Context and implicationsRationale for this studyThis review was done to identify the perspectives of African scholars on access, equity and quality in Africa's HE institutions.Why the new findings matterThe findings highlight patterns of focus on issues of access, equity and quality, and reveal gaps that need to be addressed to foster inclusivity and quality of HE in Africa.Implications for practitioners and policy makersFor practitioners, it offers broader insights into the need to adopt contextually centred and culturally relevant pedagogies to address the needs of diverse learners. For policy makers, it provides constructive insights on strategies to improve access and foster inclusive quality higher education. This study provides a status review or update to the African Union (AU) and Africa's ministers of education in relation to Agenda 2063 and the Continental Education Strategy for Africa (CESA) 2016–2025. With this information, the AU and ministers of education, and all stakeholders can collectively work to address the challenges of meeting the concrete steps and milestones set in these frameworks.

Diffusion-weighted imaging (DWI) offers critical insights into tissue microstructure through the assessment of water molecule random displacements and plays a central role in the assessment of neoplastic and non-neoplastic diseases. To successfully implement and use DWI in clinical practice, guidelines for acquisition, interpretation of image contrast and of artefacts should be followed, taking the disease process and body part into account. We recommend covering a b-value range of 0-1000 s/mm2 in the brain (along at least six directions for white matter), and 50-800 s/mm2 in the body. Available acquisition acceleration options should be used to reduce repetition time (TR), echo time (TE), and echo-planar imaging (EPI) distortions, while considering the penalty in signal-to-noise ratio (SNR) and image sharpness. DW images and the apparent diffusion coefficient (ADC) map should be read jointly for the clinical interpretation. Areas of slower diffusion are hyperintense on DW images and hypointense on the ADC map, and vice versa. Magnetic susceptibility distortions and signal drop-outs or pile-ups are particularly pronounced at air-tissue or metal-tissue interfaces and may obscure areas of interest or hinder the co-localisation with structural scans. By following these guidelines and recommendations, radiologists and imaging professionals can enhance diagnostic accuracy, reduce variability, and maximise the clinical value of DWI across diverse applications. KEY POINTS: This article provides an overview of DWI principles, clinical applications, potential pitfalls, and emerging advances, alongside expert recommendations for optimal implementation. We provide key considerations tailored to specific applications (neuro and whole-body imaging), including protocol optimisation, adherence to established guidelines, and quality assurance measures to minimise artefacts and ensure reproducibility. By following the guidelines and recommendations summarised in this work, radiologists and imaging professionals can enhance diagnostic accuracy, reduce variability, and maximise the clinical value of DWI across diverse applications.