medsci-skills 4.1.0

package/skills/ma-scout/SKILL.md

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+---
+name: ma-scout
+description: Meta-analysis topic discovery and feasibility assessment. Professor-first (profile → gap) or Topic-first (question → gap → co-author). Pre-protocol phase from idea to ranked topic list.
+triggers: ma-scout, MA 주제 찾기, professor MA, 메타분석 주제, MA gap, topic-first MA, 트렌드 MA, meta-analysis topic, 교수님 분석, 연구 분석
+tools: Read, Write, Edit, Bash, Grep, Glob
+model: opus
+---
+
+# MA Scout Skill
+
+You are helping a medical researcher discover meta-analysis topics.
+Two modes are available depending on the starting point.
+
+This skill handles the **pre-protocol phase** — from idea to ranked topic list.
+For actual MA execution (PROSPERO, screening, analysis), hand off to `/meta-analysis`.
+
+## Mode Selection
+
+Determine the mode from user input:
+
+| Signal | Mode |
+|--------|------|
+| Professor name or profile URL provided | **A: Professor-first** |
+| Clinical question, keyword, trend, or "find me a topic" | **B: Topic-first** |
+| Both supplied (e.g., "this topic with this professor") | **A** (topic as filter) |
+
+If ambiguous, ask the user whether to search by professor (supervisor-first) or by
+topic (question-first).
+
+## Communication Rules
+
+- Communicate with the user in their preferred language (typically Korean).
+- Research questions, PICO/PIRD, and README content in English.
+- Medical terminology always in English.
+
+---
+
+## Inputs
+
+### Mode A: Professor-first
+- Professor name (native-language + English)
+- Profile URL (ScholarWorks, SKKU Faculty, Google Scholar, ORCID)
+- PubMed author link (preferably with cauthor_id for disambiguation)
+- Known specialty (e.g., "thoracic imaging", "abdominal imaging")
+- Affiliation history (e.g., "Hospital A → Hospital B → retired")
+- Minimum required: **name + at least one profile URL or PubMed link**
+
+### Mode B: Topic-first
+- Clinical question or keyword (e.g., "AI for lung-nodule malignancy prediction", "dual-energy CT body composition")
+- Radiology subspecialty scope (e.g., thoracic, abdominal, neuro)
+- MA type preference (DTA, prognostic, intervention — optional)
+- Desired role: solo first author / co-first / supervisor-matched
+- Minimum required: **clinical question or keyword**
+
+---
+
+## Workflow
+
+> **Mode A (Professor-first):** Phase 0 → 1 → 2 → 3 → 4 → 5
+> **Mode B (Topic-first):** T-Phase 0 → T-1 → T-2 → T-3 → T-4 → T-5
+> Phase 2 (MA Gap Analysis) and Phase 4 (README template) are shared between both modes.
+
+---
+
+# ═══════════════════════════════════════════
+# MODE A: PROFESSOR-FIRST WORKFLOW
+# ═══════════════════════════════════════════
+
+### Phase 0: Disambiguation & Context Confirmation
+
+**Goal:** Resolve author identity before any search, and confirm user's relationship context.
+
+**CRITICAL — Do this BEFORE any PubMed search:**
+
+1. **Resolve full English name first:**
+   - If cauthor_id is provided → fetch that specific PMID page to get full name + affiliation
+   - NEVER start with initials-only search (e.g., "Ha HK") — common Korean initials cause massive contamination
+   - First search must be `"[Full Name]"[Author]` (e.g., `"Ha Hyun Kwon"[Author]`)
+
+2. **Confirm affiliation chain with user:**
+   - Ask the user whether `{detected affiliation}` matches the professor's history,
+     and request the user's relationship to the professor so topic proposals can be
+     tuned accordingly.
+   - This prevents wrong-institution assumptions
+   - Skip only if user already provided explicit affiliation history
+
+3. **Profile URL fallback chain** (Scopus requires auth, so plan alternatives):
+   - 1st: PubMed full name search (always works)
+   - 2nd: Google Scholar profile (WebSearch `"[Full Name]" radiology scholar`)
+   - 3rd: ResearchGate profile (WebSearch `"[Full Name]" researchgate radiology`)
+   - 4th: ScholarWorks / SKKU / university faculty page (if URL provided)
+   - Last: Scopus/ScienceDirect (often fails due to auth — do NOT rely on it)
+
+---
+
+### Phase 1: Profile Exploration (E-utilities API)
+
+**Goal:** Identify the professor's 5-6 distinct research pillars using PubMed E-utilities API.
+
+**CRITICAL — Use E-utilities API, NOT WebFetch for PubMed:**
+- Scripts: `~/.claude/skills/search-lit/references/pubmed_eutils.sh` + `parse_pubmed.py`
+- Rate limit: 350ms between calls (100ms with NCBI_API_KEY)
+- These are faster, more reliable, and return structured data (JSON/XML)
+
+**Step 1 — Total publication count + PMID list:**
+```bash
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+  '"[Full Name]"[Author]' 200 \
+  | python3 ~/.claude/skills/search-lit/references/parse_pubmed.py esearch
+```
+
+**Step 2 — Fetch metadata for MeSH-based clustering (parallel):**
+```bash
+# Get PMIDs from Step 1, then fetch summaries
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh fetch_json \
+  "PMID1,PMID2,..." \
+  | python3 ~/.claude/skills/search-lit/references/parse_pubmed.py esummary
+```
+
+**Step 3 — Topic-specific counts (launch 4-5 searches in parallel via Bash):**
+```bash
+# Run these in parallel Bash calls
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+  '"[Full Name]"[Author] AND "keyword1"' 5
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+  '"[Full Name]"[Author] AND "keyword2"' 5
+# ... repeat for each suspected pillar keyword
+```
+
+**Step 4 — MeSH term extraction for automatic pillar clustering:**
+```bash
+# Fetch full XML for top-cited papers to extract MeSH headings
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh fetch \
+  "PMID1,PMID2,...,PMID20" \
+  | python3 -c "
+import sys, xml.etree.ElementTree as ET
+from collections import Counter
+root = ET.fromstring(sys.stdin.read())
+mesh_counts = Counter()
+for article in root.findall('.//PubmedArticle'):
+    for mh in article.findall('.//MeshHeading/DescriptorName'):
+        mesh_counts[mh.text] += 1
+for term, count in mesh_counts.most_common(30):
+    print(f'{count:3d}  {term}')
+"
+```
+→ Top MeSH terms reveal natural research pillars (e.g., "Colonography, Computed Tomographic" = CTC pillar).
+
+**Step 5 — Google Scholar profile (parallel with PubMed calls):**
+- WebSearch: `"[Full Name]" radiology scholar google` for h-index, citation data
+
+**Output: Pillar Summary Table**
+
+| Pillar | Domain | Representative keywords | MeSH terms | Est. # papers |
+|--------|--------|-------------------------|-----------|---------------|
+| 1 | ... | ... | ... | ~N+ |
+
+---
+
+### Phase 2: MA Gap Analysis (Multi-Source)
+
+**Goal:** For each pillar, determine if a viable MA topic exists using PubMed + Consensus + Scholar Gateway + bioRxiv.
+
+For each pillar (run in parallel using meta-analyst agents):
+
+#### 2a. PubMed E-utilities — Existing MAs + Primary studies
+
+```bash
+# Existing MAs (structured count)
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+  '[pillar keywords] AND ("meta-analysis"[pt] OR "systematic review"[pt])' 50
+
+# Primary studies with extractable outcomes
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+  '[pillar keywords] AND ("sensitivity" OR "specificity" OR "accuracy" OR "prognosis" OR "outcome")' 50
+```
+
+#### 2b. Consensus MCP — Semantic MA gap detection
+
+Use `mcp__claude_ai_Consensus__search` to find existing SRs/MAs that PubMed keyword search might miss:
+```
+query: "systematic review OR meta-analysis [pillar topic] [imaging modality]"
+```
+Consensus returns citation-ranked results — check if any highly-cited MA already covers the proposed scope.
+**Limit:** max 3 Consensus calls per Phase 2 batch (rate limit).
+
+#### 2c. Scholar Gateway — Semantic similarity search
+
+Use `mcp__claude_ai_Scholar_Gateway__semanticSearch` for:
+- Finding MAs with different terminology (e.g., "pooled analysis" instead of "meta-analysis")
+- Detecting scope-overlapping MAs that use different keywords
+- Identifying methodological review papers that partially cover the topic
+
+#### 2d. bioRxiv/medRxiv — In-press competition detection
+
+Use `mcp__claude_ai_bioRxiv__search_preprints` to catch:
+- MAs posted as preprints but not yet indexed in PubMed
+- Ongoing SR/MA protocols shared as preprints
+- Very recent primary studies that could change feasibility
+
+```
+query: "[pillar keywords] meta-analysis OR systematic review"
+server: "medrxiv"  (for clinical topics)
+```
+
+#### 2e. Assessment matrix
+
+| Factor | Criteria |
+|--------|----------|
+| MA gap | 0 existing = best, 1-3 = check scope overlap, >5 = saturated |
+| Primary k | ≥8 for DTA, ≥6 for prognostic (minimum), ≥15 ideal |
+| Recency | Last MA >5 years old = update opportunity |
+| Competition | Check 2024-2026 for very recent MAs that block entry |
+
+#### 2f. PROSPERO competition check (MANDATORY)
+
+- Search PROSPERO via WebSearch: `site:crd.york.ac.uk/prospero [topic keywords]`
+- Also try WebFetch: `https://www.crd.york.ac.uk/prospero/#searchadvanced`
+- Look for registered-but-unpublished protocols that could block entry
+- If PROSPERO match found → flag as 🚫 competition risk in ranking
+
+#### 2g. Realistic k estimation
+
+- Raw PubMed hit count is NOT the real k — most studies lack 2x2 data or HR
+- Apply conservative discount: **k_realistic ≈ raw_count × 0.15–0.30** for DTA topics
+- Flag if k_realistic < 8 (DTA) or < 6 (prognostic) as ⚠️ feasibility risk
+- Report both raw and realistic estimates, e.g., `estimated k: ~130 (raw) → ~20–40 (extractable DTA data)`
+
+#### 2h. Niche subtopic discovery (if pillar appears saturated)
+
+- AI/radiomics angle on a classical topic
+- Specific modality comparison (e.g., CEUS vs MRI)
+- Treatment response (vs diagnosis which is often saturated)
+- Specific subpopulation or disease subtype
+- Use Consensus to check if the niche angle has already been covered
+
+---
+
+### Phase 3: Topic Ranking
+
+**Goal:** Rank all viable topics by composite score.
+
+Score each candidate on 5 criteria (★1-5):
+
+| Criteria | Weight | Description |
+|----------|--------|-------------|
+| **Professor fit** | Highest | Core area of the professor's career, publication count, distinctive contribution |
+| **MA gap** | High | No prior MA > ≥5 yr since last MA > recent MA exists |
+| **Feasibility (k)** | High | Number of includable studies and extractability of 2×2 or HR data |
+| **Clinical impact** | Medium | Whether the topic directly informs clinical decision-making |
+| **Execution ease** | Medium | Completable from literature alone; difficulty of managing heterogeneity |
+
+**Output: Ranked Topic Table**
+
+| Rank | Topic | Professor's Pillar | Prior MA | Estimated k (raw→realistic) | PROSPERO competition | Verdict |
+|------|-------|--------------------|----------|-----------------------------|----------------------|---------|
+| 1 | ... | ... | 0 | ~98 → 15–30 | None | ✅ Best fit |
+
+---
+
+### Phase 4: Folder & README Scaffolding
+
+**Goal:** Create project folders and README for each viable topic.
+
+1. **Folder location:** `{working_dir}/ma-scout/{initials}_{professor_name}/`
+2. **Naming convention:** `{NN}_{topic_slug}/` (within professor folder)
+   - Professor folder: `{initials}_{name}` (e.g., `KDK_Kim`, `LKS_Lee`)
+   - NN: sequential number within professor (01, 02, ...)
+   - topic_slug: English, underscore-separated
+   - Check existing folders with `ls` before creating
+
+3. **README.md template (PROSPERO-ready):**
+   Load the bilingual template block from
+   `${CLAUDE_SKILL_DIR}/references/project_readme_template.md` and copy it into
+   `{topic_folder}/README.md`. The reference covers both supervised (Mode A) and
+   solo-mode (Mode B, no supervisor) variants and contains the PICO/PIRD frame,
+   preliminary search, target journal table, and backward-planned timeline.
+
+---
+
+### Phase 5: Output Summary
+
+**Goal:** Persist findings for the user.
+
+1. Save the ranked topic table and README files to the working directory.
+2. Summarize: total topics scanned, viable topics found, recommended next steps.
+3. Suggest the user save results to their project management system (e.g., `/manage-project`).
+
+---
+
+## Niche Topic Discovery Heuristics
+
+When all major pillars are saturated (>5 prior MAs), try these angles:
+
+1. **"First MA" rule:** Professor's most unique/niche subtopic where MA = 0
+2. **AI/radiomics overlay:** Classical imaging topic + AI approach = new MA angle
+3. **Treatment response:** Diagnosis MAs saturated → treatment monitoring MA often open
+4. **Modality comparison:** Head-to-head (e.g., CEUS vs MRI) often underserved
+5. **Guideline gap:** Professor authored guidelines → MA supporting/updating those guidelines
+6. **Geographic/population niche:** Regional population-specific MA (e.g., parasitic diseases, TB)
+7. **Temporal update:** Last MA >5 years old + significant new primary studies since
+
+---
+
+## Quality Gates
+
+Before finalizing a topic as viable:
+
+- [ ] **Author identity confirmed** — full name resolved via E-utilities efetch, no initials-only contamination
+- [ ] **Affiliation confirmed** with user (or from reliable source)
+- [ ] Confirmed MA = 0 or last MA >5 years (via PubMed E-utilities, not assumption)
+- [ ] **Cross-validated via Consensus/Scholar Gateway** — no hidden MAs with different terminology
+- [ ] **bioRxiv/medRxiv checked** — no preprint MA in progress
+- [ ] Confirmed k_realistic ≥ 8 (DTA) or ≥ 6 (prognostic) after discount
+- [ ] **PROSPERO searched** — no registered competing protocol found
+- [ ] No 2024-2026 competing MA in press (check PubMed + preprints)
+- [ ] Professor's publication record demonstrates clear authority in this area
+- [ ] Research question is specific enough for PROSPERO registration
+- [ ] **README contains:** complete PICO/PIRD, PubMed search strategy, Embase draft, target journal with IF, timeline
+
+---
+
+## Handoff
+
+After MA Scout completes:
+- To **`/meta-analysis`**: When a topic is approved and ready for PROSPERO protocol (README has PICO + search strategy ready)
+- To **`manage-project`**: When project folder needs full scaffolding
+- To **`search-lit`**: When deeper preliminary search is needed before committing
+- To **`/analyze-stats`**: When feasibility requires power/sample-size calculation for the estimated k
+
+---
+
+## Parallel Execution Strategy
+
+For efficiency, launch multiple agents and API calls in parallel:
+
+**Phase 0 (Identity):**
+1. E-utilities esearch: `"[Full Name]"[Author]` → total count + PMIDs (FIRST)
+2. E-utilities efetch: top 20 PMIDs → MeSH terms → automatic pillar clustering
+
+**Phase 1 (Profile — all parallel):**
+3. Bash × 4-5: E-utilities esearch with topic-specific filters (parallel Bash calls)
+4. WebSearch: Google Scholar profile
+5. WebFetch: any provided profile URLs (skip Scopus)
+
+**Phase 2 (MA Gap — multi-source parallel):**
+6. Up to 4 meta-analyst agents in parallel, each covering 1-2 pillars
+7. Each agent runs ALL of:
+   - E-utilities esearch: existing MA count + primary study count
+   - Consensus MCP: semantic MA search (max 3 calls total across all agents)
+   - Scholar Gateway: scope-overlap check
+   - bioRxiv/medRxiv: preprint MA detection
+   - PROSPERO: competition check (WebSearch)
+8. Each agent reports: raw k, realistic k (15-30% discount), all sources checked
+
+**Phase 3 (Ranking):** Sequential, uses Phase 2 outputs.
+
+**Phase 4 (Scaffolding):** Sequential, creates folders + PROSPERO-ready READMEs.
+
+Total (Mode A): 5-8 parallel agents per professor, ~8-12 minutes per professor.
+
+### Mode B Parallel Strategy
+
+**T-Phase 0:** Sequential (user interaction for scope clarification).
+
+**T-Phase 1 (Landscape — all angles in parallel):**
+1. Per angle: Bash (PubMed MA count) + Bash (primary k) + Consensus + bioRxiv + PROSPERO
+2. 3-5 angles × 5 sources = 15-25 parallel calls
+
+**T-Phase 2 (Deep-dive):** Same as Mode A Phase 2, only for viable angles (typically 1-2).
+
+**T-Phase 4 (Co-author — if needed):**
+3. Bash: PubMed author frequency search
+4. WebSearch: Google Scholar profiles for top candidates
+
+Total (Mode B): ~5-8 minutes per topic scan (faster than Mode A — no profile exploration).
+
+### Known Pitfalls (from 3 professor analyses)
+- Common Korean/Asian initials (e.g., "Lee KS", "Kim DK") return 300+ papers with massive contamination. Always use full name first.
+- Scopus/ScienceDirect → 403 or redirect to login. Never rely on Scopus as primary data source.
+- Raw PubMed counts overestimate by 3-7x. ~130 hits often means 20-40 with extractable DTA data.
+- Professor may have moved institutions. Don't assume affiliation without verification.
+- **Consensus rate limit:** Max 3 batch calls. If rate-limited, wait 30s and retry once.
+- **E-utilities rate limit:** 350ms between calls (100ms with NCBI_API_KEY). Scripts handle this automatically.
+- **bioRxiv MCP:** Use `server: "medrxiv"` for clinical topics, `server: "biorxiv"` for preclinical.
+
+---
+
+# ═══════════════════════════════════════════
+# MODE B: TOPIC-FIRST WORKFLOW
+# ═══════════════════════════════════════════
+
+### T-Phase 0: Topic Clarification & Scope
+
+**Goal:** Refine the user's clinical question into a searchable, PROSPERO-registrable scope.
+
+1. **Parse the input** — extract:
+   - Disease/condition (e.g., "lung nodule", "hepatocellular carcinoma")
+   - Imaging modality or intervention (e.g., "dual-energy CT", "AI CAD")
+   - Outcome type: DTA (Se/Sp), prognostic (HR/OR), intervention (RR/MD), dosimetry
+   - Population specifics (e.g., "screening setting", "cirrhotic patients")
+
+2. **Expand to neighboring angles** — propose 3-5 variations:
+   ```
+   user input: "AI for lung nodule malignancy prediction"
+   → variant 1: AI vs radiologist for lung nodule malignancy prediction (DTA)
+   → variant 2: Radiomics for lung nodule malignancy (DTA)
+   → variant 3: Deep learning for incidental pulmonary nodule management (prognostic)
+   → variant 4: AI-assisted Lung-RADS upgrade accuracy (DTA)
+   → variant 5: Low-dose CT AI for lung cancer screening (DTA)
+   ```
+
+3. **User selects 1-3 angles** to investigate further.
+
+---
+
+### T-Phase 1: Landscape Scan (Multi-Source)
+
+**Goal:** For each selected angle, rapidly assess the MA landscape.
+
+**Run all angles in parallel. For each angle:**
+
+#### 1a. PubMed — Existing MA count
+```bash
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+  '[topic keywords] AND ("meta-analysis"[pt] OR "systematic review"[pt])' 50
+```
+
+#### 1b. PubMed — Primary study pool
+```bash
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+  '[topic keywords] AND ("sensitivity" OR "specificity" OR "hazard" OR "outcome")' 100
+```
+
+#### 1c. Consensus MCP — Semantic MA discovery
+```
+query: "systematic review [topic] [modality]"
+```
+Check for MAs using different terminology.
+
+#### 1d. bioRxiv/medRxiv — Preprint competition
+```
+query: "[topic] meta-analysis"
+server: "medrxiv"
+```
+
+#### 1e. PROSPERO — Registered protocols
+WebSearch: `site:crd.york.ac.uk/prospero [topic keywords]`
+
+**Output: Landscape Summary Table**
+
+| Variant | Existing MAs | Primary k (raw) | k (realistic) | PROSPERO | Preprint MA | Verdict |
+|---------|--------------|-----------------|---------------|----------|-------------|---------|
+| 1 | 3 | 120 | 18-36 | 1 | 0 | ⚠️ Competitive |
+| 2 | 0 | 85 | 13-25 | 0 | 0 | ✅ Optimal |
+
+---
+
+### T-Phase 2: Feasibility Deep-Dive
+
+**Goal:** For viable angles (MA ≤ 2, no PROSPERO conflict), run full gap analysis.
+
+This phase uses the **same Phase 2 (MA Gap Analysis)** as Mode A — steps 2a through 2h.
+The only difference: no "Professor fit" to evaluate, so focus on:
+- **Gap certainty** — are existing MAs truly non-overlapping with proposed scope?
+- **k quality** — are primary studies heterogeneous enough to warrant MA, or too uniform?
+- **User's domain fit** — does this align with user's radiology AI / imaging expertise?
+
+---
+
+### T-Phase 3: Topic Ranking (Topic-first weights)
+
+**Goal:** Rank viable topics with weights adjusted for topic-first approach.
+
+| Criteria | Weight | Description |
+|----------|--------|-------------|
+| **MA gap** | Highest | No existing MA > update opportunity > saturated |
+| **Feasibility (k)** | Highest | k_realistic ≥ 8 (DTA) or ≥ 6 (prognostic) |
+| **User domain fit** | High | Does it match the user's area of expertise? |
+| **Clinical impact** | Medium | Potential to change guidelines; directly tied to clinical decisions |
+| **Co-author availability** | Medium | Access to a domain expert (existing relationship or easy to reach) |
+| **Execution ease** | Medium | Can be done solo vs requires expert interpretation |
+
+**Output: Ranked Topic Table**
+
+| Rank | Topic | Existing MAs | Est. k | PROSPERO | Co-author needed | Overall |
+|------|-------|--------------|--------|----------|------------------|---------|
+| 1 | ... | 0 | 25 | None | Optional | ✅ Optimal |
+
+---
+
+### T-Phase 4: Co-Author Matching (Optional)
+
+**Goal:** If the user wants a senior co-author, find candidates.
+
+**Strategy 1 — Existing network (memory-based):**
+- Check memory files for professors with overlapping expertise
+- Cross-reference existing professor folders in the working directory
+- Best match = professor whose pillar naturally covers this topic
+
+**Strategy 2 — PubMed reverse search:**
+```bash
+# Find prolific authors in this specific topic
+bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+  '[topic keywords] AND ("{user_country}"[Affiliation])' 100
+```
+Then:
+- E-utilities efetch → extract author frequency from results
+- Top 5 most-published authors in this niche = potential co-authors
+- Cross-check Google Scholar for h-index and recent activity
+
+**Strategy 3 — Self-led (no senior co-author):**
+- Viable when: user has 2+ published MAs, topic is methodologically straightforward
+- Still need 2nd reviewer (junior colleague or peer) — flag this in README
+- Corresponding author = user
+
+**Output:** Co-author recommendation table or a "solo-viable" judgment.
+
+---
+
+### T-Phase 5: Folder & README Scaffolding (Topic-first)
+
+**Goal:** Create project folder and PROSPERO-ready README.
+
+1. **Folder location:** `{working_dir}/ma-scout/TOPIC/`
+   - Topic-first projects use `TOPIC/` prefix (not professor initials)
+   - Naming: `{NN}_{Topic_Abbreviation}/` (e.g., `01_AI_Lung_Nodule_DTA/`)
+   - If co-author matched later, can be moved under professor folder
+
+2. **README.md template:** Same PROSPERO-ready template as Mode A Phase 4 (see
+   `references/project_readme_template.md`), with these changes:
+   - `Supervisor:` → `Lead: {user_name}` or `Lead: {user_name} + {co-author}`
+   - Drop the supervisor-area row; use `Domain: {subspecialty}` instead.
+   - Rename `Professor's Authority` → `Team Expertise` (user's credentials + co-author if any)
+   - Timeline: drop the supervisor-proposal step → start directly at PROSPERO registration.
+
+   **Timeline template (self-led):**
+   | Step | Expected timing | Precondition |
+   |------|-----------------|--------------|
+   | PROSPERO registration | {YYYY-MM} | topic confirmed |
+   | Search complete | +1 week | PROSPERO registration |
+   | Screening complete | +2 weeks | 2nd reviewer secured |
+   | Data extraction | +3 weeks | screening consensus |
+   | Analysis + draft | +5 weeks | data lock |
+   | Co-author review | +7 weeks | draft complete |
+   | Submission | +8 weeks | final approval |
+
+3. **Summary:** Same as Mode A Phase 5 — save ranked results and recommend next steps.
+
+---
+
+### Topic Discovery Heuristics (Mode B specific)
+
+When the user asks for topic suggestions without a specific idea:
+
+1. **Trend scan** — Search recent high-IF radiology journals for "gap in the literature" + "meta-analysis needed":
+   ```bash
+   bash ~/.claude/skills/search-lit/references/pubmed_eutils.sh search \
+     '"no meta-analysis" AND "radiology"[Journal] AND 2024:2026[dp]' 30
+   ```
+
+2. **Guideline update gaps** — New guidelines (ACR, ESR, RSNA) often cite lack of MA evidence:
+   - Consensus search: `"practice guideline" AND "insufficient evidence" AND [radiology subspecialty]`
+
+3. **AI + classical imaging** — Overlay AI/DL/radiomics on well-studied classical topics:
+   - Many classical DTA topics have 10+ MAs, but AI angle has 0-1
+
+4. **Korean/Asian population** — Population-specific MA for diseases with geographic variation:
+   - TB, NTM, parasitic diseases, gastric cancer, liver fluke, HBV-related HCC
+
+5. **Technology adoption** — New modalities with growing evidence but no synthesis:
+   - Photon-counting CT, abbreviated MRI, contrast-enhanced mammography, AI CAD
+
+6. **Cross-subspecialty** — Topics spanning two subspecialties often fall through MA cracks:
+   - Cardiac + thoracic (coronary CT + lung screening), neuro + MSK (spine imaging)
+
+---
+
+### Quality Gates (Mode B specific)
+
+Before finalizing a topic-first MA as viable:
+
+- [ ] Clinical question refined to PICO/PIRD (not just a keyword)
+- [ ] MA gap confirmed via PubMed + Consensus + Scholar Gateway + bioRxiv (all 4 sources)
+- [ ] k_realistic ≥ 8 (DTA) or ≥ 6 (prognostic) after 15-30% discount
+- [ ] PROSPERO searched — no competing registered protocol
+- [ ] No 2024-2026 competing MA in press or preprint
+- [ ] User's domain expertise sufficient for clinical interpretation (or co-author identified)
+- [ ] 2nd reviewer identified or plan to recruit
+- [ ] README contains: complete PICO/PIRD, PubMed + Embase search strategy, target journal with IF, timeline
+- [ ] If self-led: user has ≥ 2 published MAs (otherwise, recommend co-author)
+
+---
+
+## Phase 6: Pre-Proposal Pipeline (Post-Scout)
+
+After MA Scout identifies viable topics, run the **pre-proposal pipeline** to prepare
+a "ready-to-propose" package before contacting the professor.
+
+### Pipeline Steps
+
+1. **Search Execution** — E-utilities with broadened synonyms (retmax=200)
+   - Primary search: `[topic] AND [outcome keywords]`
+   - Existing MA search: `[topic] AND ("meta-analysis"[pt] OR "systematic review"[pt])`
+
+2. **Metadata Collection** — `fetch_json` → `esummary` (batch 40-50 PMIDs)
+
+3. **Title-Based Triage** — Classify as INCLUDE / MAYBE / EXCLUDE
+   - CRITICAL: Check for existing MAs within results (initial scout may miss them)
+   - Separate bronchoscopic vs percutaneous (30% contamination in CBCT topics)
+   - Flag professor's own papers (authority evidence)
+   - Flag retracted papers
+
+4. **PRISMA Flow Draft** — Identification → Screening → Eligibility → Included (estimated)
+
+5. **Gap Re-assessment** — Update MA count, re-position if needed:
+   - MA=0 → "first MA" | MA=1 (>5yr) → "update MA" | MA≥3 (recent) → skip/niche
+
+6. **Output Files**:
+   - `candidates.md` — full triage table + PRISMA flow + gap finding
+   - `README.md` — updated Preliminary Search section with actual numbers
+
+### Parallel Execution
+- Launch up to 4 agents per wave (each topic independent)
+- Each agent: search → fetch → triage → write files → ~5-10 min
+- 21 topics completed in ~1 hour with 16 parallel agents
+
+### Professor Contact Package
+The pre-proposal gives the professor:
+- Candidate count + gap evidence (e.g., "MA = 0, 35 studies to include")
+- Clear role description (e.g., "independent screening review + discussion only")
+- Urgency of PROSPERO pre-registration to secure the topic
+
+## Anti-Hallucination
+
+- **Never fabricate publication counts, h-index, or pillar classifications.** All numbers must come from PubMed E-utilities API output.
+- **Never fabricate existing MA counts.** Always verify via PubMed search + PROSPERO check before claiming "MA = 0".
+- **Never invent professor expertise or affiliation.** Confirm with user before proceeding.
+- **k_realistic must use the 15-30% discount.** Raw PubMed counts overestimate by 3-7x. Always report both raw and realistic estimates.
+- If PubMed returns 0 or Consensus/Scholar Gateway is unavailable, state the limitation rather than guessing.