Ketamine with midazolam gave less pain and fewer desaturations than fentanyl in radiologist-led sedation

The edition in brief

In a single-centre randomised trial of 264 image-guided lung biopsies, bone biopsies and abscess drainages, radiologist-administered ketamine with midazolam reduced peak procedural pain by 1.4 points on a 0–10 scale compared with fentanyl with midazolam, and pain above 4 fell from 17% to 2.3%. Desaturation below 90% was less common (2.3% vs 9.8%), but hallucinations were more common (11.4% vs 3.8%); complications did not differ. A multicentre retrospective study of an AI model for femoral neck fracture on pelvic and hip radiographs reported 97.5% sensitivity and 98.8% specificity in external testing, and 94.7% sensitivity for radiograph-negative or indeterminate fractures against 86.2% for musculoskeletal radiologists; AI assistance raised reader sensitivity and cut reading time. An international registry analysis of 904,209 head CTs found size-adjusted dose varied more than two-fold between commonly used acquisition clusters, pointing to room for protocol optimisation. A systematic review of 16 studies found PSMA PET/CT sensitivity for pathologically confirmed pelvic nodes of only 55% and MRI 33%, so a negative scan does not exclude microscopic nodal disease. The pearl covers suspected hip fracture with a normal radiograph.