Application prospects of phased-array computed tomography in the diagnosis and treatment of digestive system diseases: A cross-sectional survey

Abstract

BACKGROUND

Phased-array computed tomography (PACT), as a revolutionary imaging technology, replaces mechanical rotation with electronic scanning to achieve the theoretical potential for micrometer-level spatial resolution and millisecond-level temporal resolution. Despite its significant technical advantages, systematic research remains lacking on its specific clinical application prospects for digestive system diseases, particularly from the perspective of clinicians.

AIM

To investigate digestive disease clinicians’ awareness, perceived potential, and prioritized applications for the nascent PACT technology in the context of digestive diseases within China.

METHODS

A nationwide, cross-sectional survey was conducted from August 2025 to December 2025. A structured questionnaire was distributed to 150 digestive disease clinicians, assessing demographics, baseline awareness of PACT, and potential ratings (1-5 Likert scale) for 16 pre-defined clinical scenarios. Perceived challenges and implementation strategies were also explored. Data analysis employed descriptive statistics, scenario ranking, subgroup analyses, and thematic analysis of open-ended responses with independent coding by two researchers.

RESULTS

Among 112 respondents (74.67% completion rate), 91.07% had minimal prior awareness of PACT. Upon understanding its technical advantages (micron-scale spatial and millisecond temporal resolution), 82.14% anticipated a significant or revolutionary impact on digestive disease management. The highest-rated applications were for interventional planning/efficacy assessment of hepatobiliary-pancreatic tumors (mean = 4.42) and early detection of sub-centimeter hepatocellular carcinoma (mean = 4.33). Subgroup analyses revealed significant differences in perceptions: (1) Physicians from tertiary grade A hospitals rated early pancreatic cancer detection higher than those from other centers (4.38 vs 4.15, P = 0.032); (2) Hepatologists assigned greater potential to non-invasive liver fibrosis assessment than non-hepatologists (4.12 vs 3.89, P = 0.041); and (3) Senior physicians valued PACT more for judging early gastrointestinal cancer invasion depth (4.32 vs 4.05, P = 0.028) and tumor ablation planning (4.58 vs 4.30, P = 0.034). Major perceived barriers to adoption included the need for extensive radiologist training (68.75%), lack of high-level evidence (66.96%), and high costs (62.5%). Most respondents (53.57%) advocated for integration with artificial intelligence to maximize value.

CONCLUSION

Chinese digestive disease clinicians demonstrate high perceived potential for PACT, particularly in oncology and interventional contexts, contingent upon overcoming key translational hurdles related to evidence generation, specialist training, and cost-effectiveness. Future development should prioritize high-quality clinical trials for top-rated applications and explore synergistic integration with artificial intelligence.

Key Words: Phased-array computed tomography; Digestive system diseases; Application prospects; Survey research; Clinical needs

Core Tip: This first national survey reveals that while Chinese digestive disease clinicians are largely unfamiliar with Phased-array computed tomography, they strongly endorse its potential to address critical gaps in digestive disease care, especially early cancer detection and precise intervention. The study identifies specific high-priority applications, quantifies significant differences in perception based on physician specialty and practice setting, and outlines key barriers – training, evidence, cost – that must be overcome for successful clinical translation. The findings provide a strategic, evidence-based roadmap for developers and clinical researchers to guide the future of this disruptive imaging technology.

INTRODUCTION

Digestive system diseases, spanning from functional disorders to lethal malignancies, represent a major global health burden with rising incidence and mortality rates, particularly in Asia[1,2]. This trend underscores an urgent, unmet need for advancements in early, precise diagnosis and minimally invasive therapeutic guidance. Medical imaging is a cornerstone in this endeavor, yet all current modalities present significant trade-offs. Endoscopy, while a gold standard for luminal evaluation, is invasive, operator-dependent, and limited to assessing the mucosal surface and immediate vicinity[3]. Conventional computed tomography (CT) provides rapid, wide-field anatomic imaging but is fundamentally constrained in spatial resolution, impairing the detection of early, sub-centimeter malignancies, and carries inherent ionizing radiation risks[4,5]. Magnetic resonance imaging (MRI) offers superior soft-tissue contrast but suffers from longer acquisition times, susceptibility to motion artifacts, and higher costs, limiting its utility for rapid or large-scale screening[6]. Ultrasound is portable and real-time but remains highly operator-dependent and diagnostically challenging in gas-filled viscera[7]. Collectively, these limitations highlight a clear clinical demand for an imaging paradigm that concurrently offers ultra-high spatial resolution, excellent temporal resolution for motion suppression, low radiation dose, and the potential for functional assessment.

Phased-array computed tomography (PACT) emerges as a potentially paradigm-shifting technology designed to address these very limitations[8]. It departs radically from the conventional rotating-gantry CT model. Instead, PACT utilizes a static, ring-shaped array of distributed X-ray sources and a corresponding full-ring detector assembly. Through precise electronic sequencing and timing, these sources are triggered in rapid succession, enabling “electronic scanning” that captures data from multiple angles without the need for rapid, continuous mechanical gantry rotation (Figure 1). This fundamental design shift theoretically eliminates the physical bottlenecks of gantry rotation, paving the way for simultaneous, orders-of-magnitude improvements in both spatial resolution (with the theoretical potential to reach the micron scale) and temporal resolution (in the millisecond range)[9,10]. Such capabilities could revolutionize the visualization of microscopic pathologic changes and virtually “freeze” physiologic motion, including peristalsis and cardiac pulsation.

Figure 1 Schematic diagram of the electronic control imaging system for phased-array computed tomography. The core technology of Phased-array computed tomography is based on the electronic rotation of a full-circle detector array and a distributed X-ray source array, drawing on the principles of phased-array technology. It employs X-ray electronic steering technology based on multi-source coordination, replacing the mechanical rotation of the X-ray tube and detector in spiral computed tomography with electronic control technology. Specifically, at different time points T1, T2, and T3, the X-ray tube, under electronic control, sequentially irradiates the human body, forming a static spiral continuous rotation scan. The spatial angular positions at which the X-ray tube sequentially irradiates change from R1→R2→R3→R4→R5.

The unique challenges of imaging the digestive system, such as motion artifacts from respiration and peristalsis and the difficulty of assessing gas-filled viscera, make PACT’s potential for high temporal and spatial resolution particularly attractive.

Despite compelling theoretical advantages, the pathway from technical innovation to routine clinical adoption is complex and must be guided by end-user perspectives. Currently, there is a critical lack of systematic data capturing how frontline clinicians, the ultimate end-users in gastroenterology and hepatology, perceive the value, prioritize potential applications, and anticipate the challenges of implementing PACT. This study aimed to fill this knowledge gap by conducting a comprehensive, national survey of Chinese digestive disease clinicians. Our objective was to map the landscape of clinician awareness, expectations, and concerns regarding PACT, thereby generating an evidence-based framework to inform its future development, validation, and integration into digestive disease management pathways.

MATERIALS AND METHODS

Ethical approval and informed consent

This study was conducted in accordance with the Declaration of Helsinki and electronic informed consent was obtained from all participants prior to survey commencement.

Study design and participant recruitment

We conducted a descriptive, cross-sectional survey between August 2025 and December 2025. The target population was practicing digestive disease clinicians across China. Inclusion criteria were: (1) Current clinical practice in gastroenterology/hepatology or gastrointestinal surgery; (2) Holding a valid medical license; and (3) Direct involvement in the diagnosis or management of digestive diseases. Physicians in training without independent practice privileges were excluded.

A hybrid sampling strategy combining purposive and snowball sampling was employed to ensure national breadth and access to the target specialist group. Invitations with a link to the anonymous online questionnaire (hosted on Wenjuanxing, www.wjx.cn) were distributed via academic society mailing lists and direct peer-to-peer link sharing on WeChat. A target sample size of 150 was set based on feasibility and the aim of achieving a representative geographic and institutional spread. Given this non-probability sampling approach, we report a completion rate rather than a response rate.

Questionnaire development and content validity

The survey instrument was developed through a multi-step process (Figure 2). First, a preliminary item pool was generated based on a review of PACT technical literature and interviews with two senior digestive disease clinicians and two abdominal radiologists. The draft questionnaire was then piloted with 3 clinicians not involved in the main study to assess clarity, comprehensiveness, and completion time. Feedback was used to refine terminology, simplify instructions, and finalize the scenario list, ensuring face and content validity. To ensure full transparency and reproducibility, the complete questionnaire, including the standardized description of PACT provided to respondents, has been included as Supplementary material.

Figure 2 Design approach of this study. PACT: Phased-array computed tomography.

The final questionnaire consisted of six sections: (1) Informed consent and study information; (2) Demographics and practice profile: Professional title, hospital grade (categorized per China’s hospital tier system: Grade III-A, III-B, II-A, other), department, primary subspecialty focus (multiple selections allowed), years of clinical experience, and weekly frequency of reviewing abdominal CT reports; (3) Baseline awareness and initial impression: A 4-point scale assessed familiarity with PACT prior to the survey. A subsequent item gauged the perceived overall impact on digestive disease management after a standardized, concise description of PACT’s core technical advantages was provided; (4) Application scenario assessment: Participants rated the perceived potential utility of PACT for 16 specific clinical scenarios across five domains (liver, pancreas, gastrointestinal, functional/dynamic, interventional/surgical) using a 5-point Likert scale (1 = very low potential, 5 = very high potential). These 16 items were treated as independent ratings and were not summed to form a composite score. The internal consistency of these 16 items was excellent (Cronbach’s alpha = 0.92); (5) Challenges and implementation considerations: Multiple-choice questions identified anticipated barriers to clinical adoption and preferences for complementary technologies [e.g., artificial intelligence (AI), three-dimensional visualization] to maximize PACT’s value; and (6) Open-ended feedback: An optional field for suggestions on future PACT-related clinical research priorities.

Statistical analysis

Data analysis was performed using SPSS Statistics (Version 20.0, IBM Corp., Armonk, NY, United States). Descriptive statistics summarized demographic variables and responses to single-choice/multiple-choice questions, presented as n (%). For the 16 application scenarios, mean scores and SD were calculated, and scenarios were ranked accordingly.

Pre-planned subgroup comparisons were conducted using independent samples t-tests or one-way analysis of variance. Groups were defined as: (1) Hospital tier: Tertiary grade A (III-A) vs non-tertiary grade A (all others); (2) Professional title: Senior (associate chief physician/chief physician) vs junior (resident/attending physician); (3) Subspecialty focus: Respondents who selected “liver diseases” were compared to all others for liver-specific scenarios; and (4) Similarly, those selecting “pancreatic diseases” were compared for pancreas-specific scenarios. To maintain group independence for these t-tests, respondents selecting multiple relevant subspecialties (e.g., both liver and pancreas) were excluded from the respective subspecialty comparisons. A two-tailed P value of < 0.05 was considered statistically significant.

For all subgroup comparisons, we report the test statistic (t value), degrees of freedom, and exact two-tailed P value. Effect sizes (Cohen’s d) and 95%CI for the mean differences are also reported to provide a measure of the magnitude of the observed differences. As these subgroup analyses were pre-planned but exploratory, no formal adjustment was made for multiple comparisons, and P values should be interpreted with appropriate caution. The use of parametric tests (t-tests, analysis of variance) for Likert-scale data is justified in this sample by the Central Limit Theorem, which ensures the sampling distribution of the mean is approximately normal. As a sensitivity analysis, non-parametric Mann-Whitney U tests were performed for the main subgroup comparisons and confirmed the pattern of significant findings.

For the open-ended question, a conventional thematic analysis was conducted. Two researchers independently reviewed all responses, generated initial codes, and iteratively discussed and refined them to identify overarching themes, which are reported qualitatively alongside representative anonymous direct quotes.

RESULTS

Respondent characteristics

A total of 150 survey links were distributed, with 112 completed responses received, yielding an effective completion rate of 74.7%, the geographical distribution is shown in Figure 3. The demographic and professional characteristics of the respondents are detailed in Table 1. The cohort was predominantly comprised of attending physicians (42.0%), practicing in tertiary hospitals (86.6% combined from grade III-A and III-B), within gastroenterology departments (66.1%). Gastrointestinal diseases were the most common subspecialty focus (73.2%), and the majority (57.1%) reported daily exposure to abdominal CT reports, confirming their relevance as key stakeholders in diagnostic imaging.

Figure 3 Geographic distribution of respondents in China. The sample size and proportion for each geographic region are as follows: (1) Northeast (1/112, 0.89%); (2) North China (94/112, 83.93%); (3) Northwest (5/112, 4.46%); (4) Southwest (1/112, 0.89%); (5) Central China (1/112, 0.89%); (6) East China (3/112, 2.68%); and (7) South China (7/112, 6.25%).

Table 1 Basic information of respondents.

Basic information	Content	Number	Percentage
Professional title	Resident	27	24.11
	Attending	47	41.96
	Associate chief	26	23.21
	Chief	12	10.71
Medical institution grade	Grade III class A	64	57.14
	Grade III class B	33	29.46
	Grade II class A	8	7.14
	Other	7	6.25
Department	Gastroenterology	74	66.07
	Gastrointestinal surgery	38	33.93
Primary subspecialty practice areas (multiple-choice)	Liver	41	36.61
	Biliary tract	29	25.89
	Pancreatic	31	27.68
	Gastrointestinal	82	73.21
	Interventional endoscopy	32	28.57
Experience	< 5 years	30	26.79
	5-10 years	37	33.04
	11-20 years	31	27.68
	> 20 years	14	12.50
Frequency of exposure to digestive system computed tomography	Almost daily	64	57.14
	3-4 times weekly	28	25.00
	1-2 times weekly	18	16.07
	Rarely	2	1.79

Awareness and overall perception of PACT

Baseline awareness of PACT was strikingly low: (1) 41.1% had never heard of it; and (2) 50.0% had only heard the name without understanding its principles. Only 8.9% reported being “somewhat familiar”. Given that 91.07% of respondents had minimal awareness, it is highly unlikely that any participants had direct, hands-on experience with a PACT system. Their subsequent ratings were therefore based on the technical information provided, not on clinical experience. However, after reading the standardized description of its technical capabilities, perceptions shifted dramatically. A majority (59.8%) believed PACT would have an “important” impact, and 22.3% anticipated a “revolutionary” impact on digestive disease. Merely 6.3% considered its impact likely to be “limited”.

Potential clinical applications: Ratings and rankings

All 16 proposed clinical scenarios received mean scores above the neutral midpoint of 3.0, indicating broad perceived potential. The highest-rated applications clustered in the domains of oncology and intervention (Table 2). The top three scenarios were: (1) Interventional therapy planning and efficacy assessment for hepatobiliary-pancreatic tumors (mean = 4.42, SD = 0.69); (2) Early detection and differentiation of sub-centimeter hepatocellular carcinoma in cirrhosis (mean = 4.33, SD = 0.71); and (3) Detection and staging of early pancreatic cancer (< 2 cm) (mean = 4.30, SD = 0.73). Applications related to functional or dynamic imaging, while still positively rated, received comparatively lower scores.

Table 2 Potential scores for phased-array computed tomography applications in digestive system diseases.

Category	Application scenarios	Mean	SD
Liver	Early detection and differentiation of micro-liver cancer (< 1 cm) in the context of cirrhosis	4.33	0.71
	Early identification of liver metastases	4.32	0.68
	Precise differentiation of benign lesions such as focal nodular hyperplasia and hemangiomas	4.19	0.74
	Non-invasive quantitative assessment of liver fibrosis and cirrhosis	3.98	0.88
Pancreatic	Detection and staging of early pancreatic cancer	4.30	0.73
	Accurate assessment of the risk of malignant transformation in pancreatic cysts	4.23	0.72
	Differential diagnosis between chronic pancreatitis and pancreatic cancer	4.21	0.71
	Detailed evaluation of necrosis extent and vascular complications in acute pancreatitis	4.20	0.73
Gastrointestinal	Localization and risk stratification of submucosal tumors in the gastrointestinal tract	4.24	0.69
	Assessment of infiltration depth for early gastrointestinal cancers	4.17	0.77
	Evaluation of activity, extent, and complications (e.g., fistulas) in inflammatory bowel disease	4.16	0.77
Function and dynamic imaging	Quantitative analysis of organ blood perfusion	4.09	0.72
	Dynamic assessment of gastrointestinal motility	3.91	0.82
Interventional and surgical planning	Localization of ablation scope and efficacy assessment for liver and pancreatic tumors	4.42	0.69
	Pre-procedural vascular access planning and post-procedural assessment	4.07	0.74
	Precise preoperative assessment of liver vasculature and volume	4.04	0.74

Subgroup analyses: Divergent perspectives

Subgroup analyses revealed statistically significant differences in how various clinician groups perceived the potential of PACT for specific tasks (Table 3).

Table 3 Results of subgroup analyses showing statistically significant differences.

Dimension	Scenarios	Subgroup-1 (n)	M1 ± SD	Subgroup-2 (n)	M2 ± SD	Mean difference (95%CI)	t (degrees of freedom = 110)	P value	Cohen’s d value
Hospital grade	Detection and staging of early pancreatic cancer	Grade III class A (n = 64)	4.38 ± 0.71	Non-grade III class A (n = 48)	4.15 ± 0.73	0.23 (0.02-0.44)	2.18	0.032	0.32
	Dynamic assessment of gastrointestinal motility	Grade III class A (n = 64)	3.73 ± 0.90	Non-grade III class A (n = 48)	4.17 ± 0.76	0.44 (0.15-0.73)	3.04	0.003	0.52
Sub-specialty	Non-invasive quantitative assessment	Liver disease (n = 41)	4.12 ± 0.81	Non-liver disease (n = 71)	3.89 ± 0.91	0.23 (0.01-0.45)	2.07	0.041	0.27
	Assessment of necrotic extent in acute pancreatitis	Pancreatic disease (n = 31)	4.55 ± 0.57	Non-pancreatic disease (n = 81)	4.19 ± 0.81	0.36 (0.08-0.64)	2.50	0.014	0.48
	Pre-procedural planning and postoperative evaluation	Liver disease (n = 41)	4.32 ± 0.80	Non-liver disease (n = 71)	4.05 ± 0.80	0.27 (-0.04 to 0.58)	1.72	0.046	0.34
Professional title	Early gastrointestinal cancer invasion depth	Seniority (n = 38)	4.32 ± 0.68	Junior (n = 74)	4.05 ± 0.83	0.27 (0.03-0.51)	2.23	0.028	0.35
	Tumor ablation and evaluating treatment efficacy	Seniority (n = 38)	4.58 ± 0.55	Junior (n = 74)	4.30 ± 0.79	0.28 (0.02-0.54)	2.15	0.034	0.39

M1: Mean score for subgroup-1; M2: Mean score for subgroup-2.

By hospital tier: Physicians from top-tier (grade III-A) hospitals assigned significantly higher importance to PACT for early pancreatic cancer detection and staging compared to those from other hospitals [4.38 vs 4.15; mean difference (95%CI): 0.23 (0.02-0.44); t (110) = 2.18, P = 0.032, Cohen’s d = 0.32]. Conversely, physicians from non-grade III-A institutions rated its potential for dynamic assessment of gastrointestinal motility significantly higher [3.73 vs 4.17; mean difference (95%CI): 0.44 (0.15-0.73); t (110) = 3.04, P = 0.003, Cohen’s d = 0.52].

By subspecialty focus: Hepatologists perceived significantly greater potential for non-invasive quantitative assessment of liver fibrosis/cirrhosis than non-hepatologists [4.12 vs 3.89; mean difference (95%CI): 0.23 (0.01-0.45); t (110) = 2.07, P = 0.041, Cohen’s d = 0.27]. Pancreatologists rated PACT’s utility for detailed assessment of necrosis and vascular complications in acute pancreatitis higher than non-pancreatologists [4.55 vs 4.19; mean difference (95%CI): 0.36 (0.08-0.64); t (110) = 2.50, P = 0.014, Cohen’s d = 0.48]. Similarly, hepatologists also assigned higher potential to pre-procedural vascular access planning and post-procedural assessment compared to non-hepatologists [4.32 vs 4.05; mean difference (95%CI): 0.27 (-0.04 to 0.58); t (110) = 1.72, P = 0.046, Cohen’s d = 0.34].

By professional seniority: Senior physicians (associate chief/chief) rated the utility of PACT for judging the invasion depth of early gastrointestinal cancers [4.32 vs 4.05; mean difference (95%CI): 0.27 (0.03-0.51); t (110) = 2.23, P = 0.028, Cohen’s d = 0.35] and for precise tumor ablation margin delineation and efficacy assessment [4.58 vs 4.30; mean difference (95%CI): 0.28 (0.02-0.54); t (110) = 2.15, P = 0.034, Cohen’s d = 0.39] significantly higher than their junior colleagues.

Anticipated challenges and future directions

When asked to identify the principal challenges to clinical adoption (multiple selections allowed), respondents most frequently cited: (1) Radiologists requiring completely new training and interpretation expertise (68.8%); (2) Insufficient high-level evidence for clinical effectiveness (67.0%); and (3) High equipment procurement and operational costs (62.5%). Other concerns included data management challenges and unclear positioning relative to MRI or endoscopic ultrasound.

Regarding maximizing value, over half of the respondents (53.6%) selected integration with AI-assisted diagnosis software as the most critical complementary technology. In a separate question, developing integrated diagnostic systems for complex diseases was seen as the most exciting additional application direction (39.3%).

Thematic analysis of open-ended responses

Analysis of 87 qualitative responses yielded several consistent themes. The most frequent recommendation (coded in 19 responses) was the imperative for “high-quality, multi-center clinical research” to validate diagnostic accuracy and clinical utility. Many emphasized the need for “head-to-head comparative studies against current gold standards”. Other themes included conducting “feasibility and cost-effectiveness analyses”, the importance of “standardizing scanning protocols and interpretation criteria”, and the desire to see PACT evaluated for “population screening of high-risk individuals for early gastrointestinal cancers”. Representative quotes included: (1) “We need prospective trials comparing PACT directly with MRI and EUS for pancreatic lesions”; and (2) “Cost-effectiveness studies are crucial before we can advocate for this in our hospital”.

DISCUSSION

This national survey provides a crucial, early benchmark of digestive disease clinicians’ perceptions on PACT, a disruptive imaging technology still in its translational infancy. The most salient finding is the profound dichotomy between extremely low baseline awareness and subsequently high levels of optimism regarding its potential impact. This pattern suggests that while dissemination of knowledge about technological innovations within the clinical community may be slow, the underlying appetite for solutions that address persistent diagnostic and therapeutic challenges, such as the detection of minute lesions or the guidance of precise interventions, is substantial. However, it is critical to distinguish this perceived potential, which may be influenced by information framing effects and expectation bias, from validated clinical performance. The ratings reflect an “informed opinion” based on the technology’s theoretical advantages, not on practical clinical experience. Our data effectively translate PACT’s abstract technical specifications into a concrete, clinician-prioritized roadmap for its development and validation.

The strong consensus on prioritizing oncology-related applications is both expected and instructive. The difficulties in early detection of pancreatic cancer and sub-centimeter hepatocellular carcinoma, as well as the limitations in precisely defining tumor margins for local therapies, represent some of the most intractable problems in modern digestive oncology[11,12]. Current modalities each have their own limitations: (1) CT has resolution thresholds; (2) MRI is susceptible to motion artifacts; and (3) EUS is invasive and operator-dependent. PACT’s theoretical ability to combine high resolution with rapid, motion-free imaging could directly address these specific pain points[13]. Therefore, the high ratings for these scenarios are not merely an expression of hope but a direct mapping of the technology’s hypothesized capabilities onto well-defined clinical pain points. This alignment should decisively guide the focus of initial prototype testing and pilot clinical studies.

It is important to acknowledge the significant gap between promising technical specifications and actual clinical implementation. The pathway from a benchtop prototype to a routine clinical tool involves rigorous validation, regulatory approval, workflow integration, and health economic assessment – a process that typically takes many years[14]. The enthusiasm captured in this survey represents the crucial first step in this journey: Establishing clinical demand.

The significant disparities revealed by our subgroup analyses offer a more nuanced and actionable understanding than an aggregate view alone. The finding that tertiary center specialists value PACT more for complex cancer staging likely reflects their referral-based practice patterns, where they routinely encounter diagnostically ambiguous, advanced, or post-treatment cases where superior imaging could directly alter management[15]. In contrast, the higher valuation of motility assessment by non-tertiary physicians may point to a different set of needs: The desire for a robust, accessible, and objective tool to evaluate common functional disorders in settings where dedicated motility labs are unavailable. This implies that PACT’s value proposition may need to be tailored differently for academic/referral centers vs broader community practice.

The subspecialty-specific differences further validate the survey’s sensitivity. Hepatologists’ heightened interest in non-invasive fibrosis quantification resonates deeply with the decades-long quest to replace liver biopsy, a procedure fraught with sampling error and patient risk[16]. Pancreatologists’ emphasis on detailed complication mapping in acute pancreatitis aligns with the critical need for precise anatomic delineation to guide invasive drainage procedures or surgical intervention in severe cases. These are not generic imaging needs but highly specialized demands that arise from deep immersion in the management of specific disease states. A “one-size-fits-all” marketing or development strategy for PACT would fail to engage these key opinion leaders effectively.

Similarly, the elevated scores from senior physicians for procedural planning applications (tumor ablation, endoscopic mucosal resection or endoscopic submucosal dissection depth assessment) carry particular weight. As the individuals ultimately responsible for high-risk therapeutic decisions and their outcomes, their heightened appreciation for precision imaging underscores a direct link between perceived technological capability and real-world clinical consequence[17,18]. Their endorsement is a critical precursor to adoption in interventional suites and operating rooms.

The barriers identified, the triumvirate of training, evidence, and cost, constitute the classic but formidable gauntlet for any new medical technology[19]. The paramount concern regarding radiologist re-training is especially astute. It acknowledges that a revolutionary scanner generates a fundamentally different type of image dataset, necessitating the development of new interpretive skills and diagnostic criteria. This challenge is both a human resource and an educational one. The demand for high-level evidence underscores a rational, evidence-based mindset; clinicians are signaling that compelling trial data, not just technical specifications, will be the currency of adoption. Future studies must therefore be prospectively designed, multi-center, and comparative in nature. While cost is a ubiquitous hurdle, its prominence indicates that demonstrating not just efficacy but also cost-effectiveness or the ability to improve outcomes in ways that reduce overall care costs will be essential for widespread reimbursement and uptake.

The clear clinician-driven vision for integration with AI is perhaps the most forward-looking insight[20,21]. It recognizes that the “big data” problem of ultra-high-resolution imaging could paradoxically overwhelm human interpreters. In a concrete workflow, AI algorithms could be developed for automated lesion detection (e.g., flagging suspicious sub-centimeter pancreatic lesions), precise segmentation of tumor boundaries for ablation planning, and extraction of quantitative imaging biomarkers (radiomics) that correlate with genomic and pathological data to build predictive models of treatment response or prognosis[22]. AI is seen not as a replacement but as an essential co-pilot, potentially mitigating the training burden and extracting consistent, quantitative data that could fuel the evidence-generation engine.

This study has several limitations that must be considered when interpreting its findings. First, as a survey, it measures perceptions and expectations, not objective clinical performance. The crucial distinction between perceived potential and validated clinical utility must be recognized. Second, the findings are susceptible to information framing effects; the positive description of PACT’s capabilities may have inflated enthusiasm and ratings. To mitigate this, the exact description used has been provided in the Supplementary material for transparency. Third, the non-probability sampling strategy (purposive and snowball sampling) and the predominance of physicians from tertiary hospitals (86.6%) likely introduced selection bias, potentially overrepresenting the views of more academically engaged clinicians and limiting the generalizability of our findings to the entire population of Chinese digestive disease clinicians, particularly those in community or rural settings. The true denominator of the target population is unknown, which is why we report a completion rate. Fourth, the subgroup analyses, while pre-planned, were exploratory in nature, and no formal adjustment was made for multiple comparisons. The reported P values should therefore be interpreted with appropriate caution, and the effect sizes provide a more robust measure of the differences. Fifth, there is a regional bias in the number of digestive disease clinicians surveyed in this study across different parts of China. We hope to reduce this bias in future studies to enhance the representativeness of the survey. Finally, the actual clinical performance, workflow integration, and final cost of mature PACT systems may differ from current theoretical conceptions as the technology evolves.

CONCLUSION

In summary, this first national survey reveals that Chinese digestive disease clinicians, once informed, are highly receptive to the perceived potential of PACT, particularly for addressing core challenges in digestive oncology and image-guided therapy. However, this receptivity is conditional upon a clear pathway to overcome significant translational barriers. The findings provide a strategic blueprint: (1) Direct initial clinical research toward the highest-ranked applications (early hepatobiliary-pancreatic cancer detection and interventional planning); (2) Design these studies as rigorous comparative trials to build the necessary evidence base; (3) Concurrently invest in developing AI-powered analytical tools and specialized training programs for radiologists; and (4) Conduct parallel health economic analyses. By proactively addressing these clinician-identified priorities and concerns, the journey of PACT from a revolutionary engineering concept to a validated, routine clinical tool can be significantly accelerated, with the ultimate goal of improving patient care in gastroenterology and hepatology.