Medical radiological procedures: which information would be chosen for the report?

AIMS AND OBJECTIVES: The aim of this study was to properly define the information regarding patient exposure to Ionizing Radiations in the radiological report, according to the European Directive 2013/59/EURATOM (EU 2013/59 art.58(b)). For this purpose, we evaluated the results from other Member States EU 2013/59 transpositions and from Guidelines recommendation published by International Organizations involved in diagnostic radiology. A practical way for implementing art.58 is also traced. MATERIALS AND METHODS: Dosimetric quantities, such as exposure, absorbed dose and effective dose which may be included in radiological report, were first analyzed; then, in order to define international state of art of Member States EU 2013/59 transposition, a Web research using French, English, Spanish and German key words was performed. RESULTS: EU 2013/59 transposition for 5 Member States was reported. Especially regarding art.58, a European project reports that few European countries (11 of 28) have identified the dose metrics to be used in radiological report. Scientific organizations supporting clinical radiologists and medical physicists have published Guidelines reporting parameters useful to quantify the radiation output and to assess patient dose. CONCLUSIONS: Our research revealed that there is not a shared interpretation of patient exposure information to be included in radiological report. Nevertheless, according to scientific community, authors believe that the exposure is the most appropriate information that could be included in radiological report. Alternatively, but with more expensiveness, a risk index based on effective dose could be used. Moreover, the systematic exposure information recorded could be useful for dose estimates of population from medical exposure.

Volumetric breast density and risk of advanced cancers after a negative screening episode: a cohort study.

BACKGROUND: We evaluated the association between volumetric breast density (BD) and risk of advanced cancers after a negative screening episode. METHODS: A cohort of 16,752 women aged 49-54 years at their first screening mammography in the Florence screening programme was followed for breast cancer (BC) incidence until the second screening round. Volumetric BD was measured using fully automated software. The cumulative incidence of advanced cancer after a negative screening episode (including stage II or more severe cancer during the screening interval - on average 28 months - and at the subsequent round) was calculated separately for Volpara density grade (VDG) categories. RESULTS: BC incidence gradually increased with the increas in BD: 3.7‰, 5.1‰, 5.4‰ and 9.1‰ in the VDG categories 1-4, respectively (p trend < 0.001). The risk of advanced cancers after a negative screening episode was 1.0‰, 1.3‰, 1.1‰, and 4.2‰ (p trend = 0.003). The highest BD category, compared with the other three together, has double the invasive BC risk (RR = 2.0; 95% CI 1.5-2.8) and almost fourfold risk of advanced cancer (RR = 3.8; 95% CI 1.8-8.0). CONCLUSION: BD has a strong impact on the risk of advanced cancers after a negative screening episode, the best early surrogate of BC mortality. Therefore, our results suggest that screening effectiveness is quite different among BD categories.

Beyond the Boost: Measuring the Intrinsic Dipole of the Cosmic Microwave Background Using the Spectral Distortions of the Monopole and Quadrupole.

We present a general framework for the accurate spectral modeling of the low multipoles of the cosmic microwave background (CMB) as observed in a boosted frame. In particular, we demonstrate how spectral measurements of the low multipoles can be used to separate the motion-induced dipole of the CMB from a possible intrinsic dipole component. In a moving frame, the leakage of an intrinsic dipole moment into the CMB monopole and quadrupole induces spectral distortions with distinct frequency functions that, respectively, peak at 337 and 276 GHz. The leakage into the quadrupole moment also induces a geometrical distortion to the spatial morphology of this mode. The combination of these effects can be used to lift the degeneracy between the motion-induced dipole and any intrinsic dipole that the CMB might possess. Assuming the current peculiar velocity measurements, the leakage of an intrinsic dipole with an amplitude of ΔT=30 µK into the monopole and quadrupole moments will be detectable by a PIXIE-like experiment at ∼40 nK (2.5σ) and ∼130 nK (11σ) level at their respective peak frequencies.

Radiation protection in non-ionizing and ionizing body composition assessment procedures.

Body composition assessment (BCA) represents a valid instrument to evaluate nutritional status through the quantification of lean and fat tissue, in healthy subjects and sick patients. According to the clinical indication, body composition (BC) can be assessed by different modalities. To better analyze radiation risks for patients involved, BCA procedures can be divided into two main groups: the first based on the use of ionizing radiation (IR), involving dual energy X-ray absorptiometry (DXA) and computed tomography (CT), and others based on non-ionizing radiation (NIR) [magnetic resonance imaging (MRI)]. Ultrasound (US) techniques using mechanical waves represent a separate group. The purpose of our study was to analyze publications about IR and NIR effects in order to make physicians aware about the risks for patients undergoing medical procedures to assess BCA providing to guide them towards choosing the most suitable method. To this end we reported the biological effects of IR and NIR and their associated risks, with a special regard to the excess risk of death from radio-induced cancer. Furthermore, we reported and compared doses obtained from different IR techniques, giving practical indications on the optimization process. We also summarized current recommendations and limits for techniques employing NIR and US. The authors conclude that IR imaging procedures carry relatively small individual risks that are usually justified by the medical need of patients, especially when the optimization principle is applied. As regards NIR imaging procedures, a few studies have been conducted on interactions between electromagnetic fields involved in MR exam and biological tissue. To date, no clear link exists between MRI or associated magnetic and pulsed radio frequency (RF) fields and subsequent health risks, whereas acute effects such as tissue burns and phosphenes are well-known; as regards the DNA damage and the capability of NIR to break chemical bonds, they are not yet robustly demonstrated. MRI is thus considered to be very safe for BCA as well US procedures.

Can Dietary and Physical Activity Modifications Reduce Breast Density in Postmenopausal Women? The DAMA Study, a Randomized Intervention Trial in Italy.

BACKGROUND: Few randomized trials have been carried out to evaluate the effect of lifestyle modifications on mammographic breast density (MBD). The randomized 2 × 2 factorial Diet, physical Activity and MAmmography trial aimed to evaluate whether MBD can be reduced in postmenopausal women with high baseline MBD by a 24-month dietary and/or physical activity (PA) interventions. METHODS: We randomized healthy postmenopausal women, attending the Florence (Italy) mammographic screening program, ages 50 to 69 years, nonsmokers, with MBD > 50% and no recent hormone therapy, to (i) a dietary intervention focused on plant foods, with a low glycemic load, low in saturated fats and alcohol; (ii) a PA intervention combining daily moderate intensity activities and one weekly supervised session of more strenuous activity; (iii) both interventions; (iv) general recommendations. We evaluated changes in MBD based on Volpara estimates comparing baseline and follow-up digital mammograms by an intention-to-treat-analysis. RESULTS: MBD measures were available for 226 participants. An interaction emerged between treatments and thus we run analyses by arms. A decrease in volumetric percent density emerged for women in the dietary intervention (ratio 0.91; 95% CI, 0.86-0.97; P = 0.002) and in the PA intervention arm (0.93; 95% CI, 0.87-0.98; P = 0.01) in comparison with controls. No clear effect emerged in the double intervention arm. CONCLUSIONS: This intervention trial suggests that a 24-month dietary or PA intervention may reduce MBD in postmenopausal women. IMPACT: A modification of dietary habits or an increase in PA in postmenopausal women may reduce MBD. Further studies are needed to confirm these findings for planning breast cancer preventive strategies.

New cosmic microwave background constraint to primordial gravitational waves.

Primordial gravitational waves (GWs) with frequencies > or approximately equal to 10(-15) Hz contribute to the radiation density of the Universe at the time of decoupling of the cosmic microwave background (CMB). This affects the CMB and matter power spectra in a manner identical to massless neutrinos, unless the initial density perturbation for the GWs is nonadiabatic, as may occur if such GWs are produced during inflation or some post-inflation phase transition. In either case, current observations provide a constraint to the GW amplitude that competes with that from big-bang nucleosynthesis (BBN), although it extends to much lower frequencies (approximately 10(-15) Hz rather than the approximately 10(-10) Hz from BBN): at 95% confidence level, omega(gw)h(2)

Probing the largest scale structure in the universe with polarization map of galaxy clusters.

We introduce a new formalism to describe the polarization signal of galaxy clusters on the whole sky. We show that a sparsely sampled, half-sky map of the cluster polarization at z approximately 1 would allow us to better characterize the very large scale density fluctuations. While the horizon length is smaller in the past, two other competing effects significantly remove the contribution of the small scale fluctuations from the quadrupole polarization pattern at z approximately 1. For the standard LambdaCDM universe with vanishing tensor mode, the quadrupole moment of the temperature anisotropy at z = 0 is expected to have an approximately 32% contribution from fluctuations on scales below 6.3 h(-1) Gpc. This percentage would be reduced to approximately 2% level for the quadrupole moment of polarization pattern at z approximately 1. A cluster polarization would shed light on the potentially anomalous features of the largest scale fluctuations.

Decaying particles and the reionization history of the universe.

We investigate the possibility that the Universe is significantly reionized by the decay products of heavy particles. The ionization produced by decaying particles implies a high optical depth even if the maximum level of ionization ever produced is low (10(-2)). As a consequence, a high ionization fraction (x approximately equal to 0.5) at high redshifts (z approximately equal to 20) fails to fit the cosmic microwave background (CMB) spectra at l> or =30. Recent CMB data limit the primordial abundance of the decaying particles, favoring long decay times. Other significant sources of reionization are still needed at z approximately equal to 13. The decay process heats up the medium, bringing the expected y distortion to unobservable levels.