Simon Ching-Shun Kao

Background: Artificial intelligence (AI) is increasingly incorporated into medical education. Widely available, general-purpose generative AI applications are increasingly capable of producing high-fidelity synthetic medical images, which may have potential educational uses. Objective: To assess the ability of widely available, general-purpose generative AI applications to produce synthetic pediatric neuroradiology images of teaching quality. Materials and methods: Ten significant diagnostic errors in pediatric neuroradiologic emergencies were identified and divided into 22 individual clinical scenarios. Two widely available, general-purpose generative AI applications, GPT-5 (OpenAI, San Francisco, CA) and Gemini 3 Pro with the Nano Banana Pro image-generation engine (Google, Mountain View, CA), were prompted to generate five separate images for each scenario, yielding a total of 220 images. Eight fellowship-trained pediatric radiologists independently assessed each image for teaching quality. Ratings were recorded and analyzed. Differences between applications were evaluated using Fisher’s exact test. Results: Overall, 8.6% of generated images (19/220) were deemed suitable for teaching by more than half of the pediatric radiologists. GPT-5 produced a higher proportion of acceptable images meeting this >50% criterion compared to Gemini 3 Pro (12.7% [14/110] vs. 4.5% [5/110]; P =0.031). Conclusion: At present, widely available, general-purpose generative AI applications should not be used to produce synthetic radiological images for educational purposes. Inaccuracies and inconsistencies limit reliability and may actively impair learning.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported. ARST1321 was a phase II study designed to compare the near complete pathologic response rate after preoperative chemoradiation with/without pazopanib in children and adults with intermediate-/high-risk chemotherapy-sensitive body wall/extremity non-Rhabdomyosarcoma Soft Tissue Sarcoma (ClinicalTrials.gov identifier: NCT02180867 ). Enrollment was stopped early following a predetermined interim analysis that found the rate of near complete pathologic response to be significantly greater with the addition of pazopanib. As a planned secondary aim of the study, the outcome data for this cohort were analyzed. Eight-five eligible patients were randomly assigned to receive (regimen A) or not receive (regimen B) pazopanib in combination with ifosfamide and doxorubicin + preoperative radiotherapy followed by primary resection at week 13 and then further chemotherapy at week 25. As of December 31, 2021, at a median survivor follow-up of 3.3 years (range, 0.1-5.8 years), the 3-year event-free survival for all patients in the intent-to-treat analysis was 52.5% (95% CI, 34.8 to 70.2) for regimen A and 50.6% (95% CI, 32 to 69.2) for regimen B ( P = .8677, log-rank test); the 3-year overall survival was 75.7% (95% CI, 59.7 to 91.7) for regimen A and 65.4% (95% CI, 48.1 to 82.7) for regimen B ( P = .1919, log-rank test). Although the rate of near complete pathologic response was significantly greater with the addition of pazopanib, outcomes were not statistically significantly different between the two regimens.

The most common pediatric extragonadal pelvic cancers include germ cell tumors, sacrococcygeal teratomas, and rhabdomyosarcomas (arising from the urinary bladder, prostate, paratesticular tissues, vagina, uterus, and perineum). This paper describes the radiological and nuclear medicine features of these entities and provides consensus‐based recommendations for the assessment at diagnosis, during, and after treatment.

This Editorial Comment discusses the following AJR article: Interobserver Agreement for CT and MRI Findings of Chronic Pancreatitis in Children: A Multicenter Ancillary Study Under the INSPPIRE Consortium.