The study was conducted by an international team of researchers based in the United States, Hungary, Switzerland, Gibraltar, Germany, and Canada. Led in part by Damla Aksen, then affiliated with training programs in neuroimaging and substance abuse research, the collaboration included investigators with long-standing expertise in behavioral addictions, trauma, and impulse-control disorders. The team set out to answer a question that has lingered in the trauma literature for decades: if sexual abuse is associated with elevated substance use, why do some survivors develop frequent use patterns while others do not? Their answer centers on the moderating role of impulsivity, the tendency to act quickly and without adequate forethought.

Impulsivity is not a single, unitary construct. Researchers typically decompose it into several facets, including negative urgency, the tendency to act rashly when experiencing distress; positive urgency, rash action in the context of intense positive emotion; lack of premeditation, or difficulty thinking through consequences before acting; lack of perseverance, the inability to stay focused on taxing tasks; and sensation seeking, the appetite for novel and intense experiences. In the context of trauma research, negative urgency has attracted particular attention because it links emotional dysregulation, a common consequence of abuse, directly to behavior. Survivors who experience intense negative affect and who also tend to act rashly under that affect may be especially likely to use substances as a rapid, if maladaptive, means of relief.

The theoretical framework underlying the study draws on established models of trauma and addiction. Sexual abuse is consistently associated in prior research with post-traumatic stress symptoms, depression, anxiety, and difficulties in emotion regulation. Self-medication theories propose that some survivors use alcohol, drugs, or nicotine to blunt these symptoms, and epidemiological work has repeatedly linked abuse histories to elevated rates of substance use disorders. At the same time, neurobiological research shows that early-life adversity can alter stress-response systems and prefrontal circuits that support inhibitory control, potentially creating both greater craving and weaker behavioral brakes. Impulsivity sits at the intersection of these processes, which is why the researchers hypothesized that it would strengthen the association between abuse history and how frequently people use substances.

To test this hypothesis at scale, the team analyzed data from 64,472 participants recruited through an international survey. The large sample allowed the investigators to examine whether the pattern held across countries, gender identities, and sexual orientations, dimensions that smaller studies often cannot adequately power. Participants reported whether they had experienced sexual abuse, completed validated measures of impulsivity, and indicated how frequently they used drugs, alcohol, and tobacco. By modeling impulsivity as a moderator rather than a simple covariate, the researchers could ask whether the strength of the abuse-substance use association itself changed as a function of impulsivity, a statistically distinct question from whether impulsivity independently predicts use.

The results supported the moderation hypothesis. Among participants with a history of sexual abuse, higher impulsivity was associated with more frequent use of drugs, alcohol, and tobacco. In practical terms, two survivors with comparable abuse histories and demographic profiles would be expected to differ in substance use frequency according to their impulsivity levels, with the more impulsive individual reporting more frequent use across the substances examined. The authors report that these patterns were examined across countries, gender identities, and sexual orientations, reflecting the study’s explicit aim of testing generalizability in a way that few prior investigations of this question have attempted. The consistency of the moderation pattern across such a large and diverse sample strengthens the case that impulsivity is a genuinely transdiagnostic risk amplifier rather than an artifact of any single population.

The findings carry several implications for clinical practice. Screening for impulsivity among trauma survivors could help clinicians identify individuals at heightened risk of frequent substance use before patterns become entrenched. Brief behavioral interventions that target impulsive responding, such as those emphasizing distress tolerance, delay discounting, and emotion regulation skills, are already used in treatments for borderline personality disorder and substance use disorders, and the new results suggest they may be particularly valuable for survivors of sexual abuse. Because the study measured use frequency rather than formal diagnoses, the results speak most directly to patterns of consumption, but frequent use is itself a well-established precursor to dependence, making early identification of high-frequency users a meaningful prevention goal.

The study also contributes to a broader scientific conversation about why trauma-related health disparities persist. Public health approaches to substance use often focus on availability, pricing, and policy, while individually oriented approaches focus on motivation and dependence. The current findings highlight a psychological trait that operates between trauma exposure and behavior, suggesting that interventions aimed at strengthening inhibitory control could reduce the downstream burden of substance-related harm among survivors. This framing aligns with a growing emphasis in psychiatric research on transdiagnostic mechanisms, constructs such as impulsivity, emotion dysregulation, and stress sensitivity that cut across diagnostic categories and may explain why a single risk factor, in this case sexual abuse, manifests as different outcomes in different people.

As with any survey-based study, the design has limitations that the authors and commentators must weigh. The data are cross-sectional, meaning they capture a snapshot rather than tracking participants over time, so the findings demonstrate associations rather than definitive causal sequences. Retrospective reports of sexual abuse and self-reported substance use are subject to recall and disclosure biases, and survey samples, however large, may not perfectly represent national populations. The authors also note funding and disclosure details in their conflict of interest statement, with several team members reporting consulting relationships, research support, or editorial roles with entities related to gambling, mental health publishing, and pharmaceutical or gaming organizations; the funders, according to the disclosure, had no role in study design, data collection, analysis, or manuscript preparation. These disclosures are standard practice and allow readers to evaluate the work in context.

Nevertheless, the scale and diversity of the sample make this one of the most comprehensive examinations to date of how impulsivity conditions the relationship between sexual abuse and substance use frequency. The convergence of evidence across countries, gender identities, and sexual orientations suggests that the underlying psychological mechanism is broadly shared, even as the absolute levels of substance use may vary across groups. For researchers, the study provides a template for large-scale moderation analyses that treat individual differences as central rather than incidental. For clinicians and prevention specialists, it offers a concrete, measurable risk marker that can be assessed quickly and addressed with existing evidence-based techniques. And for survivors and the people who support them, the findings underscore that the path from trauma to substance use is not uniform: understanding and treating the impulsive tendencies that can amplify risk may be as important as addressing the trauma itself.

Subject of Research: The moderating role of impulsivity in the association between sexual abuse and substance use frequency

Article Title: Among people with a history of sexual abuse, being impulsive is associated with more frequent use of drugs, alcohol and tobacco, per international survey study of 64,472 participants

Article References: Among people with a history of sexual abuse, being impulsive is associated with more frequent use of drugs, alcohol and tobacco, per international survey study of 64,472 participants. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: sexual abuse, impulsivity, substance use, alcohol, tobacco, drugs, trauma, PLOS One, international survey, moderation analysis, emotion regulation, public health

The survey, conducted jointly by the Society for Pediatric Radiology and the European Society of Paediatric Radiology, was distributed to members of both societies between August and September 2025. It asked radiologists whether their institutions had adopted ultrasound as the first imaging test for suspected midgut volvulus, how long they had been using it, who performed the examinations, what their protocols looked like, and what obstacles stood in the way of wider adoption. A total of 227 responses representing 179 hospitals across 38 countries were analyzed, with results stratified by geographic region to expose patterns that a single-country study would have missed.

The headline finding is a stark transatlantic divide. In Europe, 78.2 percent of responding hospitals reported using ultrasound as their first-line test for suspected volvulus. In other regions of the world, adoption stood at 61.1 percent. North America lagged dramatically behind, with only 28.9 percent of hospitals making sound waves the initial diagnostic probe. That means a newborn with the same life-threatening presentation may be sent first to an ultrasound suite in Munich or London but to a fluoroscopy suite in many US and Canadian centers, purely as a function of geography and institutional tradition rather than any difference in the underlying disease.

The reasons behind the gap are as revealing as the numbers themselves. When the researchers asked what barriers impeded adoption, European respondents most frequently pointed to acceptance among radiologists themselves, a professional culture question about whether ultrasound can reliably replace the long-entrenched upper gastrointestinal series. In North America, by contrast, the dominant barrier was sonographer training and competence. The distinction matters because it points to different solutions: persuading physicians to change their diagnostic habits is a different organizational challenge from building the technologist workforce capable of performing technically demanding pediatric bowel ultrasound at any hour of the day or night.

The technical demands of the examination help explain that workforce problem. Ultrasound for malrotation and volvulus hinges on mapping the vascular anatomy of the midgut, primarily by identifying the relative positions of the superior mesenteric vein and artery and by tracing the bowel loops to determine whether the duodenum courses in its expected retroperitoneal pattern. In volvulus, the sonographer may see the classic whirlpool sign, with the mesentery and vessels spiraling around a central axis, or a distended, fluid-filled proximal duodenum that tapers abruptly. Obtaining these views reliably in a squirming, crying infant, often in the middle of the night, requires hands-on training that cannot be transmitted through a written protocol alone.

Perhaps the most sobering discovery in the survey is what is missing even where ultrasound has been adopted. Across all regions, most institutions reported having no formal clinical pathway governing when and how first-line ultrasound should be used, no standardized reporting template to ensure that radiologists communicate their findings consistently, and no routine administration of oral or nasogastric fluid to distend the stomach and duodenum during the examination. Each of these omissions carries consequences. Without a clinical pathway, triage decisions fall to individual clinicians under pressure; without standardized reports, surgeons may receive ambiguous guidance on whether the bowel is at risk; without fluid instillation, some examinations may be nondiagnostic and default back to fluoroscopy anyway.

The survey did identify one intervention that respondents believed could overcome these fragmentation problems: the publication of formal, evidence-based guidelines. This was the most commonly cited factor that would facilitate broader adoption, ahead of technological improvements or institutional policies. The finding echoes a broader literature on implementation science, which has repeatedly shown that the translation of best evidence into routine practice stalls without authoritative, consensus-based guidance to legitimize change and standardize technique. Radiology is no exception, and pediatric bowel ultrasound, with its steep learning curve and operator-dependent accuracy, may be an especially strong candidate for guideline-driven standardization.

The scientific groundwork for a guideline already exists. A 2022 expert panel narrative review in the American Journal of Roentgenology laid out the techniques and interpretive framework for ultrasound in malrotation and volvulus, and a 2021 systematic review and meta-analysis in Archives of Disease in Childhood synthesized diagnostic accuracy data across studies. Individual centers have published encouraging institutional experiences, including a UK tertiary hospital series in Clinical Radiology reporting on ultrasound as the first-line investigation for midgut malrotation, and work examining the significance of nondiasonic examinations when ultrasound cannot answer the clinical question. Economic analyses have even suggested that ultrasound-first pathways can reduce cost and examination time compared with fluoroscopy, removing one traditional objection to the switch.

The practical stakes of this transition are considerable. A child with suspected volvulus typically undergoes imaging in an urgent, often out-of-hours setting, and the choice of first test determines how quickly a surgeon can be mobilized. Ultrasound offers advantages that matter enormously in pediatrics: it involves no ionizing radiation in a population that is more radiosensitive than adults, it requires no contrast ingestion in a vomiting child, it can be performed at the bedside in unstable patients, and it can be repeated without cumulative dose concerns. Fluoroscopy, for its part, offers a dynamic view of contrast passing through the duodenum that some radiologists still consider indispensable for excluding malrotation, even when ultrasound has already addressed the immediate question of whether volvulus is present.

What this survey ultimately documents is the moment of transition itself, captured before the dust settles. The authors’ conclusion is measured: the use of ultrasound as first-line imaging for suspected midgut volvulus varies widely across regions, the barriers reflect local staffing and training models, and formal published guidelines are frequently identified as a potential facilitator of broader implementation. In other words, the science has largely outrun the systems built to deliver it. Whether a child with bilious vomiting gets a radiation-free ultrasound first or a fluoroscopic contrast study still depends heavily on which side of an ocean they happen to be born on, and closing that gap will require not just more evidence but the deliberate work of training sonographers, persuading radiologists, and writing the guidelines that turn individual expertise into dependable, worldwide practice.

Subject of Research: International adoption of ultrasound as first-line imaging for suspected midgut volvulus in children

Article Title: International practice patterns in the use of ultrasound as first-line imaging for suspected midgut volvulus in children: a joint society for pediatric radiology–European society of paediatric radiology survey

Article References: Tutman, J., Perucca, G., Chan, S., El-Ali, A., Kljucevsek, D., Limantoro, I., Riccabona, M., Petit, P., Nguyen, H. N., & Samet, J. (2026). International practice patterns in the use of ultrasound as first-line imaging for suspected midgut volvulus in children: a joint society for pediatric radiology–European society of paediatric radiology survey. Pediatric Radiology. https://doi.org/10.1007/s00247-026-06792-y

Image Credits: AI Generated

DOI: 10.1007/s00247-026-06792-y

Keywords: midgut volvulus, pediatric radiology, ultrasound, malrotation, upper gastrointestinal series, international survey, clinical guidelines, sonographer training, bilious vomiting, medical imaging, Society for Pediatric Radiology, European Society of Paediatric Radiology

The study, led by Camilla Genovese of the Department of Infectious Diseases at Ospedale Luigi Sacco in Milan, together with Jean-François Timsit and Michael Thy of Bichat-Claude Bernard University Hospital and INSERM research units in Paris, set out to map how intensivists and nuclear medicine physicians around the world actually use 2-deoxy-2-[18F] fluoro-D-glucose PET/CT, or [18F]-FDG-PET/CT, in critically ill patients. The researchers distributed an electronic questionnaire worldwide through two of the most influential societies in the field: the European Society of Intensive Care Medicine, known as ESICM, and the European Association of Nuclear Medicine, known as EANM. The instrument collected demographic information, hospital characteristics, the availability and physical location of nuclear medicine services, the clinical indications for which PET/CT is requested in intensive care, the frequency of use, details of workflow organisation, and the obstacles that clinicians perceive when considering the test.

Forty-one respondents from 16 countries completed the survey. Although the sample is modest, its composition is telling. Most participants, 63 percent, worked in university hospitals, and the respondents divided almost neatly into two professional worlds: 71 percent specialised in intensive care medicine while 29 percent specialised in nuclear imaging. That split mirrors the very fault line the study set out to explore. PET/CT in the critically ill sits at the intersection of two specialties, and the survey suggests that neither has yet built the shared routines that would make the examination routine. A nuclear medicine department was available in 78 percent of the centres that responded, which sounds reassuring until one examines the geography: only 60 percent of those departments were co-located with the intensive care unit. In a patient whose blood pressure is maintained by infusions of vasopressors and whose oxygenation depends on a mechanical ventilator, distance is not a trivial detail. Every metre of corridor is a corridor of risk.

The raw numbers on utilisation are striking. Among centres that do use the technique, 43 percent performed only one to five scans per year, and a quarter of respondents performed just one or two scans per month. In an environment where diagnostic uncertainty is a daily companion, those figures suggest that a technology capable of resolving that uncertainty is being left largely on the shelf. The survey also asked what the scans were actually being used for. Infection topped the list, serving as the primary diagnostic indication in 74 percent of cases, followed by suspected malignancy at 57 percent and fever of unknown origin at 49 percent. The pattern makes physiological sense. Critically ill patients frequently harbour deep-seated infections, ventilator-associated pneumonia, catheter-related bloodstream infection, intra-abdominal sepsis, that conventional imaging fails to localise. Because activated immune cells and many tumour cells consume glucose avidly, the fluorinated glucose analogue accumulates precisely where the disease hides, and the paired CT supplies the anatomical coordinates clinicians need to intervene.

How, then, does the examination actually proceed in practice? The survey provides a snapshot of workflow that is as revealing as it is fragmented. Radiotracer administration took place mainly within the nuclear medicine department, in 77 percent of sites, meaning that the unstable patient had to be physically transported for the injection even before the imaging itself. Protocols for the dietary preparation that PET/CT demands, typically fasting to suppress endogenous insulin and ensure that glucose competition does not blunt tracer uptake, existed in only half of the participating centres. The absence of such standardisation matters at a technical level. Blood glucose levels that are too high reduce FDG uptake in target tissues and can degrade diagnostic sensitivity, which in a septic patient on parenteral nutrition is a genuine challenge. That only 50 percent of sites had formal preparation protocols suggests that much of the current practice is improvised rather than codified, and that image quality, and therefore diagnostic yield, may vary considerably from one centre to another.

When the researchers asked respondents directly what stood in the way, a coherent picture of systemic friction emerged. The barriers most commonly reported included the lack of standardised protocols, the prolonged duration of the procedure, limited imaging slots, ambiguous clinical indications, insufficient staff expertise and the logistical difficulties of transporting unstable intensive care patients. Each barrier deserves unpacking. A PET/CT examination is not a five-minute chest radiograph; it involves tracer production or delivery, injection, a waiting period of roughly an hour for uptake, and then acquisition on a scanner that is often shared with oncology services whose demand for slots is enormous. Staff expertise is a second constraint: positioning, monitoring and safely transporting a ventilated, sedated patient require a coordinated team of intensivists, nurses, radiographers and nuclear medicine physicians, and many centres simply lack experience in this choreography. Ambiguous indications compound the problem. Because no formal guidelines exist to direct the use of [18F]-FDG-PET/CT in the intensive care unit, clinicians have no authoritative framework telling them when the scan will genuinely change management and when it will merely delay it.

That absence of guidance is perhaps the survey’s most consequential finding. The authors emphasise that routine use of the technique in intensive care remains sporadic and that there are, at present, no formal guidelines governing its application. Medicine has repeatedly shown that imaging technologies with real diagnostic power underperform when their indications are left to individual judgement. The result is a vicious circle: because guidelines are lacking, use is rare; because use is rare, centres never develop the protocols, training and logistics that would make scans safe and efficient; and because the infrastructure never matures, the evidence base needed to write guidelines remains thin. The survey’s data, collected from both sides of the specialty divide, provide the empirical foundation needed to break that circle.

The study’s authors are explicit about the trajectory they hope the findings will set. The data, they write, highlight an unmet need for consensus guidelines and streamlined workflows to optimise the diagnostic value of [18F]-FDG-PET/CT in critical-care patients, and the results will inform forthcoming joint recommendations to be issued by ESICM and EANM. Such recommendations, grounded in the real-world practice patterns the survey documented, could specify which patients are most likely to benefit, how dietary preparation and glucose control should be managed, how transport of ventilated patients should be organised and staffed, and how scanner time might be reserved for intensive care indications. The stated aim is ultimately clinical rather than technical: to enhance patient outcomes through evidence-based imaging protocols. In intensive care, where every day of undiagnosed infection carries a measurable mortality cost, a scan that localises the source of sepsis and redirects therapy is not a luxury but a potential lifeline.

The survey is not without limitations, and the authors are careful about what it can and cannot claim. It is a self-reported questionnaire study with 41 respondents, and it captures practice rather than outcome: no one can yet say from these data whether PET/CT in the intensive care unit improves survival, shortens ventilation or reduces antibiotic exposure. The study involved no direct interaction with human subjects and relied entirely on secondary data, an ethical design that facilitated its broad international reach. What it delivers instead is a baseline, a map of where the world currently stands. It reveals a technology of proven diagnostic sensitivity for the very conditions that complicate critical illness, used only a handful of times a year in most centres, hampered by distance, duration, cost, protocol gaps and uncertainty about when it helps. Closing that gap between capability and practice is now a defined task, and the joint guidelines that ESICM and EANM are preparing will be the first serious attempt to define it. If they succeed, the hidden infections and tumours that PET/CT can illuminate may finally be found, not in the rarest of cases, but wherever a critically ill patient needs them found.

Subject of Research: Use of FDG PET/CT imaging in critically ill intensive care patients

Article Title: Practices and barriers in PET/CT use for critically ill patients: an international survey

Article References: Genovese, C., Timsit, J.-F., & Thy, M. (2026). Practices and barriers in PET/CT use for critically ill patients: an international survey. European Journal of Nuclear Medicine and Molecular Imaging. https://doi.org/10.1007/s00259-026-08172-y

Image Credits: AI Generated

DOI: 10.1007/s00259-026-08172-y

Keywords: PET/CT, FDG PET, intensive care, critical care imaging, nuclear medicine, occult infection, fever of unknown origin, international survey, ESICM, EANM, diagnostic imaging, clinical guidelines