radiology-clinical-domain

Clinical domain research router

Use this skill to translate an organ or disease interest into an answerable clinical-imaging research question, or to test whether an existing study respects the clinical pathway that gives its endpoint meaning. It is an independent entry point and a cross-cutting source of clinical context for imaging, radiomics, AI and imaging-mechanism research.

Core stance

• Begin with the clinical decision and intended use, not with an available feature table or model.
• Keep screening, diagnosis, differential diagnosis, staging, response, recurrence, prognosis and treatment-effect questions separate. They imply different populations, time zeroes, reference standards, exclusions and claim ceilings.
• Define the estimand before selecting images or labels. Preserve patient, lesion, vessel, organ, examination and time-point hierarchy; none is automatically a new independent patient.
• Treat acquisition, reconstruction, contrast phase, scanner/site, treatment and calendar time as possible causes of an apparent signal, not merely covariates to add later.
• Mark changing staging, reporting, eligibility, diagnostic and treatment rules LIVE_VERIFICATION_REQUIRED. A remembered version or a high-impact paper is not a current rule.
• Separate AUTHOR_REPORTED, SOURCE_VERIFIED, LOCAL_EXPERT_CONFIRMED and NOT_ASSESSABLE. Never invent a local workflow, guideline version, outcome, treatment rule or specialist consensus.
• Research support is not individual patient care. Do not recommend diagnosis or treatment for a person; route clinical decisions to qualified responsible clinicians.

Choose the mode

Mode	Use when	Required emphasis
plan	turning an interest, cohort or biomarker into a study	decision point, PICO/estimand, time zero, endpoint, reference standard, acquisition window, confounders, validation and feasibility
audit	reviewing a protocol, Methods, cohort, labels, figures or manuscript	pathway fit, spectrum/verification/incorporation bias, protocol drift, treatment/time leakage, evidence anchors, reviewer red flags and repairs
mentor	a learner wants direction or alternatives	nearest answerable question, assumptions, competing designs, resource tiers, failure modes and decision-bearing questions
interpret	real results are supplied	clinical meaning, transportability, heterogeneity, competing explanations, decision consequence and surviving claim ceiling
writing-handoff	the science is frozen and needs manuscript placement	exact clinical facts for title/abstract/Methods/Results/Discussion, live-source status, limitations and forbidden overclaims

Declare one or more active domains: thoracic-lung-oncology, neuro-oncology, liver-hepatobiliary, breast, prostate-pelvic, cardiovascular, acute-emergency, musculoskeletal, pediatric, nuclear-medicine-theranostics, or local-extension-needed.

Use the live-standard receipt whenever a changing clinical or reporting rule affects eligibility, acquisition, category, stage, response, endpoint or a claim.

Required workflow

1. Read the clinical domain routing contract.
2. Read only the smallest active-domain playbook:
   • for thoracic-lung-oncology, neuro-oncology, liver-hepatobiliary, breast, prostate-pelvic or cardiovascular, read only that section in the starter playbooks;
   • for acute-emergency, read the acute/emergency playbook;
   • for musculoskeletal, read the MSK playbook;
   • for pediatric, read the pediatric playbook;
   • for nuclear-medicine-theranostics, read the nuclear medicine/theranostics playbook.
3. Build a compact clinical research passport:
   • disease and clinical setting;
   • decision point and intended use;
   • target population, exclusions and recruitment pathway;
   • index image/measurement, comparator and time zero;
   • outcome or target condition, horizon and estimand;
   • independent unit and repeated-measure hierarchy;
   • reference standard, verification window and adjudication;
   • treatment, intervention, surveillance and acquisition timeline;
   • relevant jurisdiction, institution and standard version;
   • representativeness across clinically material subgroups, access to the required imaging/ referral pathway, uncertain/failure-result harms, workflow burden and affected stakeholders.
4. Mark missing fields AUTHOR_INPUT_NEEDED; do not fill them with plausible defaults.
5. Run the live-standard gate for every rule that may change. Instantiate the versioned receipt and record issuing authority, normative identifier, full document title, version/edition/effective date, applicability, canonical URL, access date, retrieved artifact path and physical SHA-256, exact section/page/table locator, supported statement and supersedes/superseded_by relation. SOURCE_VERIFIED requires the retrieved artifact and locator, not merely a current landing page. If live access or the normative document fails, preserve LIVE_VERIFICATION_REQUIRED and do not state the rule as current.
6. Work in order: decision -> PICO/estimand -> cohort pathway -> image protocol -> reference standard -> treatment/time -> analysis unit -> mechanism alternatives -> validation -> claim ceiling.
7. Return the smallest complete artifact for the selected mode. If a reusable local record helps, use the clinical expert profile.
8. For any real or proposed use of human participants, identifiable images/records, linked clinical data or human tissue, hand the activity/data map to radiology-ethics: human-subjects. Preserve consent/waiver, privacy, secondary-use, tissue and sharing facts as AUTHOR_INPUT_NEEDED until verified; a clinically sound design is not ethical approval.

Scientific red lines

• Do not mix a screening cohort with symptomatic, surveillance or treatment-response patients without separate estimands and validation.
• Do not use downstream pathology, treatment, follow-up or future examinations in a model claimed to operate earlier in the pathway.
• Pathology is not a single infallible label: record sampling route, target, timing, tissue adequacy, spatial mismatch and whether image findings influenced verification.
• Excluding indeterminate, unverified, poor-quality or hard-to-biopsy cases can change the target population. Report the flow and consequence rather than calling the remainder “clean”.
• An imaging phenotype may reflect disease biology, treatment, comorbidity, acquisition or annotation. Name at least one plausible alternative biological and one technical explanation.
• Prediction or association is not mechanism; prognostic association is not treatment benefit; treatment-group outcome prediction is not a predictive biomarker without a valid comparator and interaction estimand.
• A standardized reporting category is not automatically a ground-truth disease label, continuous biological quantity or treatment prescription.
• Internal performance, reader agreement, multi-site transportability, clinical utility, biological concordance and causal validation are distinct rungs; do not rename one as another.

Output contract

Return, in order:

1. Route and evidence state — mode, active domain, task, supplied materials, live-source status and live-standard receipt IDs/digests.
2. Clinical research passport — decision point, PICO/estimand, time zero/horizon, unit and pathway.
3. Protocol and reference-standard map — acquisition/reconstruction, artifacts, label source, verification window and adjudication.
4. Treatment and time-line map — interventions, disease evolution, imaging windows and leakage or confounding risks.
5. Equity, access and consequence map — subgroup representation, missing pathway populations, equipment/expertise access, failure/uncertainty harms, workflow burden and stakeholder effects.
6. Mechanism alternatives and validation ladder — biological, clinical and technical explanations, discriminating evidence and achievable validation tier.
7. Constructive findings or mentor decisions — exact criterion, evidence anchor, severity, minimum repair, stronger option/cost, closure evidence and learner question.
8. Claim ceiling and writing handoff — allowed wording, prohibited upgrade, section placement, live citations, normative ID/version/locator, retrieved-artifact SHA-256, superseded relation and residual limitations.
9. Next action — the single decision-bearing next step plus AUTHOR_INPUT_NEEDED and LIVE_VERIFICATION_REQUIRED fields.

Handoffs and non-ownership

• Imaging series/phase/sequence qualification, acquisition/reconstruction, quantitative transforms, artifacts, dose, phantom/test-retest and protocol drift route to radiology-acquisition-qc; annotation, radiomics and model execution remain with their corresponding owners. Provide the clinical passport, endpoint, unit and timing contract.
• Imaging-to-molecular or pathology mechanism interpretation requires the mechanism module; provide disease context, treatment timeline, tissue-image mapping and claim ceiling.
• Parameter provenance, sensitivity, benchmark fairness and method fit require the method-evaluation module after the clinical estimand is fixed.
• Estimation, uncertainty, clustered inference, survival analysis and multiplicity require the statistics module with the true unit and estimand preserved.
• Human participants, identifiable images/records, linked clinical variables, human tissue, consent/waiver, privacy, secondary use and sharing governance require radiology-ethics: human-subjects. Provide population, recruitment, data/tissue flows, linkage/identifiability, sites/jurisdictions and proposed use; this module cannot infer IRB status or approval scope from a published cohort or manuscript sentence.
• Reader studies, threshold-to-action mapping, prospective workflow evaluation, implementation burden and clinical-utility evidence require radiology-translation. Provide the disease/ pathway, intended-use, reference-standard, treatment-time, subgroup/access and claim-ceiling lock; translation owns the reader/prospective/deployment study design.
• Full-manuscript review, prose drafting, response letters and submission-file audits remain separate tasks. This skill supplies immutable clinical facts and unresolved live-standard flags.
• Local expert entries are case-based evidence. They can inform questions and feasibility but cannot silently become universal clinical rules.

Boundary

The six starter routes and four focused playbooks are research-design aids, not clinical-practice guidelines. The pediatric pack may be composed with one organ/pathway pack, but its developmental, body-size, dose, sedation and family-dependence constraints remain explicit. For a different disease, create local-extension-needed from the same passport and live-standard protocol before giving disease-specific advice. No output from this skill substitutes for multidisciplinary review, prospective validation, ethics review or individual patient care.