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The application of chatbots and NLP in radiology is an emerging field, currently characterized by a growing body of research. An umbrella review has been proposed utilizing a standardized checklist and quality control procedure for including scientific papers. This review explores the early developments and potential future impact of these technologies in radiology. The current literature, comprising 15 systematic reviews, highlights potentialities, opportunities, areas needing improvements, and recommendations. This umbrella review offers a comprehensive overview of the current landscape of natural language processing (NLP) and natural language models (NLMs), including chatbots, in healthcare. These technologies show potential for improving clinical decision-making, patient engagement, and communication across various medical fields. However, significant challenges remain, particularly the lack of standardized protocols, which raises concerns about the reliability and consistency of these tools in different clinical contexts. Without uniform guidelines, variability in outcomes may hinder the broader adoption of NLP/NLM technologies by healthcare providers. Moreover, the limited research on how these technologies intersect with medical devices (MDs) is a notable gap in the literature. Future research must address these challenges to fully realize the potential of NLP/NLM applications in healthcare. Key future research directions include the development of standardized protocols to ensure the consistent and safe deployment of NLP/NLM tools, particularly in high-stake areas like radiology. Investigating the integration of these technologies with MD workflows will be crucial to enhance clinical decision-making and patient care. Ethical concerns, such as data privacy, informed consent, and algorithmic bias, must also be explored to ensure responsible use in clinical settings. Longitudinal studies are needed to evaluate the long-term impact of these technologies on patient outcomes, while interdisciplinary collaboration between healthcare professionals, data scientists, and ethicists is essential for driving innovation in an ethically sound manner. Addressing these areas will advance the application of NLP/NLM technologies and improve patient care in this emerging field.

( Background ) Over the years, there has been increasing interest in adopting a quality approach in radiology, leading to the strategic pursuit of specific and key performance indicators (KPIs). These indicators in radiology can have significant impacts ranging from radiation protection to integration into digital healthcare. ( Purpose ) This study aimed to conduct a narrative review on the integration of key performance indicators (KPIs) in radiology with specific key questions. ( Methods ) This review utilized a standardized checklist for narrative reviews, including the ANDJ Narrative Checklist, to ensure thoroughness and consistency. Searches were performed on PubMed, Scopus, and Google Scholar using a combination of keywords related to radiology and KPIs, with Boolean logic to refine results. From an initial yield of 211 studies, 127 were excluded due to a lack of focus on KPIs. The remaining 84 studies were assessed for clarity, design, and methodology, with 26 ultimately selected for detailed review. The evaluation process involved multiple assessors to minimize bias and ensure a rigorous analysis. ( Results and Discussion ) This overview highlights the following: KPIs are crucial for advancing radiology by supporting the evolution of imaging technologies (e.g., CT, MRI) and integrating emerging technologies like AI and AR/VR. They ensure high standards in diagnostic accuracy, image quality, and operational efficiency, enhancing diagnostic capabilities and streamlining workflows. KPIs are vital for radiological safety, measuring adherence to protocols that minimize radiation exposure and protect patients. The effective integration of KPIs into healthcare systems requires systematic development, validation, and standardization, supported by national and international initiatives. Addressing challenges like CAD-CAM technology and home-based radiology is essential. Developing specialized KPIs for new technologies will be key to continuous improvement in patient care and radiological practices. ( Conclusions ) In conclusion, KPIs are essential for advancing radiology, while future research should focus on improving data access and developing specialized KPIs to address emerging challenges. Future research should focus on expanding documentation sources, improving web search methods, and establishing direct connections with scientific associations.

The gut microbiota is a complex ecosystem of microorganisms residing in the human gastrointestinal tract, playing a crucial role in various biological processes and overall health maintenance. Dysbiosis, an imbalance in the composition and function of the gut microbiota, is linked to systemic autoimmune diseases (SAD). Short-chain fatty acids (SCFAs), especially butyrate, produced by the gut microbiota through the fermentation of dietary fibers, play a significant role in immunomodulation and maintaining intestinal homeostasis. Butyrate is essential for colonocyte energy, anti-inflammatory responses, and maintaining intestinal barrier integrity. Studies show reduced butyrate-producing bacteria in SAD patients, suggesting that increasing butyrate levels could have therapeutic benefits. Butyrate's anti-inflammatory effects and its potential therapeutic role have been studied in rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, systemic sclerosis, and Behçet's disease. Despite promising in vitro and animal model results, human studies are limited, and the optimal strategies for modulating dysbiosis in SADs remain elusive. This review explores the current evidence on the immunoregulatory role of butyrate and its potential therapeutic effects in SAD.

Objective: To retrospectively evaluate the incidence rate (IR) of elevated echocardiographic estimated systolic pulmonary artery pressure (sPAP), suspected for pulmonary hypertension (PH), in systemic sclerosis (SSc) patients after the introduction of a combination therapy with bosentan and sildenafil for treatment or prevention of digital ulcers., Methods: Patients attending the Scleroderma Unit of the Universital Hospital of Careggi from July 2010 to July 2023 were enrolled. Patients older than 18 years old with a history of digital ulcers, treated with bosentan and sildenafil in combination for at least 12 months, were included. Patients with a diagnosis of PH preceding the introduction of the therapy were excluded. Demographical data, disease duration, laboratoristic, and instrumental data (pulmonary function tests, echocardiographic estimation of sPAP, and ultrasonographic value of renal resistive index) were collected. The IR of echocardiographic signs suspected of pulmonary hypertension and their 95% confidence interval were calculated in events/1000 patients-years., Results: Thirty-five patients were enrolled; the mean disease duration was 12.82 years (SD 5.92). The mean duration of the combination treatment was 81.03 (SD 43.1.3) months, and the total at-risk time was 2674 months. Two patients (5.7%) presented echocardiographic signs of PH (sPAP 50 mmHg and 40 mmHg); the IR was calculated to be 9/1000 patients-years (95% CI 7.95-10.12). In one of the two patients, right heart catheterism (RHC) excluded PAH, while the other patient refused to undergo RHC, and PAH could not be confirmed/excluded. The stability of PFTs and echocardiographic sPAP was observed during the observation time., Conclusions: The results of this retrospective study suggest that combination therapy with endothelin receptor antagonists and phosphodiesterase-5 (PDE5) inhibitors could help in preventing PAH in SSc; prospective case-control studies on a larger population are needed to improve knowledge in this field., Competing Interests: The authors declare no conflicts of interest.

Lung involvement represents a fearful complication in rheumatoid arthritis (RA), potentially involving all compartments of the pulmonary system. Regarding interstitial lung disease (ILD), the HRCT represents the gold standard technique for its diagnosis; however, the examination is burdened by radiation exposure and high costs. In addition, although some risk factors for ILD are known, no algorithms exist to know which patients to submit to HRCT and when. In this context, lung ultrasound (LUS) showed promising results for at least 10 years, demonstrating correlation with high resolution computed tomography (HRCT) findings in other rheumatic diseases. Here, LUS may represent a screening test providing additional information to clinical examination and pulmonary function tests. The data deriving from LUS experience in other rheumatic diseases could steer the future towards the use of this technique also in RA patients, and in this review, we report the most relevant literature regarding LUS in RA-ILD.

In recent years, the landscape of diagnostic imaging has undergone a significant transformation with the emergence of home radiology, challenging the traditional paradigm. This shift, bringing diagnostic imaging directly to patients, has gained momentum and has been further accelerated by the global COVID-19 pandemic, highlighting the increasing importance and convenience of decentralized healthcare services. This study aims to offer a nuanced understanding of the attitudes and experiences influencing the integration of in-home radiography into contemporary healthcare practices. The research methodology involves a survey administered through Computer-Aided Web Interviewing (CAWI) tools, enabling real-time engagement with a diverse cohort of medical radiology technicians in the health domain. A second CAWI tool is submitted to experts to assess their feedback on the methodology. The survey explores key themes, including perceived advantages and challenges associated with domiciliary imaging, its impact on patient care, and the technological intricacies specific to conducting radiologic procedures outside the conventional clinical environment. Findings from a sample of 26 medical radiology technicians (drawn from a larger pool of 186 respondents) highlight a spectrum of opinions and constructive feedback. Enthusiasm is evident for the potential of domiciliary imaging to enhance patient convenience and provide a more patient-centric approach to healthcare. Simultaneously, this study suggests areas of intervention to improve the diffusion of home-based radiology. The methodology based on CAWI tools proves instrumental in the efficiency and depth of data collection, as evaluated by 16 experts from diverse professional backgrounds. The dynamic and responsive nature of this approach allows for a more allocated exploration of technicians' opinions, contributing to a comprehensive understanding of the evolving landscape of medical imaging services. Emphasis is placed on the need for national and international initiatives in the field, supported by scientific societies, to further explore the evolving landscape of teleradiology and the integration of artificial intelligence in radiology. This study encourages expansion involving other key figures in this practice, including, naturally, medical radiologists, general practitioners, medical physicists, and other stakeholders.

(Background) Domiciliary radiology, which originated in pioneering studies in 1958, has transformed healthcare, particularly during the COVID-19 pandemic, through advancements such as miniaturization and digitization. This evolution, driven by the synergy of advanced technologies and robust data networks, reshapes the intersection of domiciliary radiology and mobile technology in healthcare delivery. (Objective) The objective of this study is to overview the reviews in this field with reference to the last five years to face the state of development and integration of this practice in the health domain. (Methods) A review was conducted on PubMed and Scopus, applying a standard checklist and a qualification process. The outcome detected 21 studies. (Key Content and Findings) The exploration of mobile and domiciliary radiology unveils a compelling and optimistic perspective. Notable strides in this dynamic field include the integration of Artificial Intelligence (AI), revolutionary applications in telemedicine, and the educational potential of mobile devices. Post-COVID-19, telemedicine advances and the influential role of AI in pediatric radiology signify significant progress. Mobile mammography units emerge as a solution for underserved women, highlighting the crucial importance of early breast cancer detection. The investigation into domiciliary radiology, especially with mobile X-ray equipment, points toward a promising frontier, prompting in-depth research for comprehensive insights into its potential benefits for diverse populations. The study also identifies limitations and suggests future exploration in various domains of mobile and domiciliary radiology. A key recommendation stresses the strategic prioritization of multi-domain technology assessment initiatives, with scientific societies' endorsement, emphasizing regulatory considerations for responsible and ethical technology integration in healthcare practices. The broader landscape of technology assessment should aim to be innovative, ethical, and aligned with societal needs and regulatory standards. (Conclusions) The dynamic state of the field is evident, with active exploration of new frontiers. This overview also provides a roadmap, urging scholars, industry players, and regulators to collectively contribute to the further integration of this technology in the health domain.

Background and Objectives: In SSc, ILD is a major cause of morbidity and mortality. We aimed to investigate the performance of DLCO (diffusing capacity of lung carbon monoxide) and FVC (forced vital capacity) delta change (Δ) and baseline values in predicting the development of SSc-ILD., Methods: Longitudinal data of DLCO, FVC, and ILD on the HRCT of SSc patients from the EUSTAR database were evaluated at baseline (t 0 ) and after 12 (±4) (t 1 ) and 24 (±4) (t 2 ) months., Results: 474/17805 patients were eligible for the study (403 females); 46 (9.7%) developed ILD at t 2 . Positivity for anti-topoisomerase antibodies (117 patients) showed an association with ILD development at t 2 ( p = 0.0031). Neither the mean t 0 to t 1 change (Δ) of DLCO nor the mean t 0 to t 1 FVCΔ predicted the appearance of ILD at t 2 . Investigating the possible role of baseline DLCO and FVC values in predicting ILD appearance after 24 (±4) months, we observed a moderate predictive capability of t 0 DLCO < 80%, stronger than that of FVC < 80%., Conclusions: We suggest that an impaired baseline DLCO may be predictive of the appearance of ILD after 2 years of follow-up. This result advances the hypothesis that a reduction in gas exchange may be considered an early sign of lung involvement. However, further rigorous studies are warranted to understand the predictive role of DLCO evaluation in the course of SSc.

Background: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is one of the most relevant complications of SSc and the major cause of death. The pathogenesis of SSc-ILD involves a complex interplay of multiple cell types and different molecular pathways, with both inflammation and fibrosis as pathological hallmarks. To date, there are no treatments able to target both components of the disease. Janus kinase inhibitors (JAKinibs) represent an interesting therapeutic option because they exert both anti-inflammatory and anti-fibrotic properties., Methods: Here, we performed a narrative review concerning the potential role of JAKinibs in SSc-ILD to define the state of art and to evaluate the pathogenetic rationale behind this type of treatment., Results: Currently, few studies investigated SSc-ILD response to JAKinibs treatment. Data were analyzed from three clinical studies and four case reports and progression of SSc-ILD was not evident in 93.5% of patients treated with JAKinibs., Conclusions: Available evidence of efficacy of JAKinibs in SSc-ILD is sparse but promising. JAKinibs could be an interesting treatment in SSc-ILD because of their potential inhibition of the fibrotic processes combined with their anti-inflammatory action. Moreover, JAKinibs were also shown in some studies to have a potential effect on pulmonary arterial hypertension (PAH), another threatening complication in SSc. More data are necessary to define JAKinibs role in SSc-ILD treatment.

Background: Systemic sclerosis (SSc) is a rare connective tissue disease that can affect different organs and has extremely heterogenous presentations. This complexity makes it difficult to perform an early diagnosis and a subsequent subclassification of the disease. This hinders a personalized approach in clinical practice. In this context, machine learning (ML), a branch of artificial intelligence (AI), is able to recognize relationships in data and predict outcomes., Methods: Here, we performed a narrative review concerning the application of ML in SSc to define the state of art and evaluate its role in a precision medicine context., Results: Currently, ML has been used to stratify SSc patients and identify those at high risk of severe complications. Additionally, ML may be useful in the early detection of organ involvement. Furthermore, ML might have a role in target therapy approach and in predicting drug response., Conclusion: Available evidence about the utility of ML in SSc is sparse but promising. Future improvements in this field could result in a big step toward precision medicine. Further research is needed to define ML application in clinical practice.

Background: Chest computed tomography (CT) is the gold standard for the evaluation of systemic sclerosis-related interstitial lung disease (SSc-ILD). Lung ultrasound (LUS) is a radiation-free tool that identifies the B-lines as a main feature of ILD. We aimed to investigate the role of LUS in the evaluation of the extent of SSc-ILD. Methods: Adult SSc patients underwent pulmonary function tests (PFTs), LUS and CT. The CT images were qualitatively, semi-quantitatively (the Wells score on five levels and the categorical Goh et al. staging) and quantitatively (histogram-based densitometry) analysed for ILD. LUS quantified B-lines in 21 intercostal spaces on both the anterior and posterior chest wall. Results: Out of the 77 SSc patients eligible for the study, 35 presented with ILD on CT (21 limited, 14 extensive). Total B-lines significantly differentiated ILD vs. no ILD (median 24 vs. 8, p < 0.001). Posterior and total B-lines significantly differentiated limited from absent ILD, while anterior B-lines distinguished extensive from limited ILD. Total B-lines correlated with the Wells score (r = 0.446, p < 0.001) and MLA (r = −0.571, p < 0.001); similar results were confirmed when anterior and posterior B-lines were analysed separately. Conclusions: LUS is a useful tool to identify SSc-ILD and to correlate with different evaluations of ILD extent and severity.

In systemic sclerosis (SSc), the gastrointestinal tract (GIT) plays a central role in the patient's quality of life. The microbiome populates the GIT, where a relationship between the Lactobacillus and gastrointestinal motility has been suggested. In this study, the analysis of oral Lactobacillus species in SSc patients and healthy subjects using culture-independent molecular techniques, together with a review of the literature on microbiota and lactobacilli in SSc, has been carried out. Twenty-nine SSc female patients (mean age 62) and twenty-three female healthy subjects (HS, mean age 57.6) were enrolled and underwent tongue and gum swab sampling. Quantitative PCR was conducted in triplicate using Lactobacillus specific primers rpoB 1, rpoB 1o and rpoB 2 for the RNA-polymerase β subunit gene. Our data show significantly ( p = 0.0211) lower Lactobacillus spp rpoB sequences on the tongue of patients with SSc compared to HS. The mean value of the amount of Lactobacillus ssprpoB gene on the gumsofSSc patients was minor compared to HS. A significant difference between tongue and gums ( p = 0.0421) was found in HS but not in SSc patients. In conclusion, our results show a lower presence of Lactobacillus in the oral cavity of SSc patients. This strengthens the hypothesis that Lactobacillus may have both a protective and therapeutic role in SSc patients.