Digital twin technology, which creates virtual replicas of physical entities, has emerged as a transformative paradigm in healthcare engineering, enabling personalized medicine, surgical simulation, and real-time patient monitoring. This study presents a comprehensive scien-tometric analysis of 200 highly cited articles retrieved from Scopus using a targeted search string focused on digital twins, virtual patients, and patient avatars in healthcare. The analysis characterizes publication trends, citation impact, leading contributors, thematic clusters, and collaborative networks. Results indicate that research output has accelerated dramatically since 2019, with 2021–2024 representing the most productive period. The highest citation concentrations are found in studies applying digital twins to cardiology, oncology, surgical planning, and healthcare system optimization. The United States, China, Germany, and the United Kingdom dominate production, with strong interdisciplinary collaborations among en-gineering, computer science, and clinical departments. Co-occurrence analysis of author keywords reveals six major thematic clusters: cardiovascular digital twins, surgical simulation and virtual patients, personalized and precision medicine, enabling technologies (IoT, AI, blockchain), healthcare system digital twins, and ethical and regulatory considerations. This scientometric mapping provides researchers, clinicians, and policymakers with an evidence-based roadmap of a rapidly evolving field positioned at the intersection of engineering and medicine.

Total Quality Management (TQM), a comprehensive and strategic management philosophy based on continuous quality improvement, strong customer relations, and involvement of the entire organization, has moved from its industrial roots to become the primary support of modern healthcare deliveries. The present article offers a thorough review of the literature that synthesizes 30 years of scientific work from all over the world and provides a critical analysis of the application, effectiveness, and evolution of TQM in the complicated context of hospitals. The analysis starts with the historical and theoretical foundations of TQM in healthcare, connecting basic quality frameworks to modern practices. It then assesses with great care the large volume of evidence proving TQM's positive effect on the most important hospital performance indicators such as patient safety, satisfaction, clinical outcomes, operational efficiency, and economic viability. The discussion devotes a considerable part to the strong challenges and barriers to TQM being successfully implemented, bringing in studies from both developed and developing countries to point out the hurdles that are common and the ones that are particular to a given context. Moreover, the review goes into the interaction between TQM and other process improvement approaches like Lean and Six Sigma. Lastly, it outlines the future path of quality management in the healthcare sector by looking into the alliance of TQM with digital transformation, AI, telemedicine, and innovation management. The paper wraps up by asserting that TQM is still a 'must-have' strategic option for hospitals but that it needs strong and determined leadership, a broad-based quality culture, and an adaptive to change technology and methodology for its successful running.