Superb microvascular imaging (SMI) and elastosonography in thyroid nodule: diagnostic value in a real-time cohort.

PURPOSE: In clinical practice, thyroid nodules are classified according to TI-RADS by B-mode and color-flow Doppler study. The aim of the study is to evaluate the possible added value of Superb microvascular imaging (SMI) and elastosonography in the stratification of malignancy risk of thyroid nodules. METHODS: All patients with thyroid nodules who were candidates for needle aspiration were enrolled. Experienced operators performed a standard examination with TI-RADS calculation, followed by SMI and elastosonography on the nodules. The needle aspiration outcome was used as the gold standard. Statistical analysis calculated the ROC curves of the techniques applied individually and serially. RESULTS: In this prospective study, we analysed 260 nodules, found in 251 patients (mean age 58.6 yo ± 14). 11.2% were TI-RADS 1, 18.9% TI-RADS 2, 41.1% TI-RADS 3, 28.1% TI-RADS 4, and 0.8% TI-RADS 5. The SMI technique showed an AUC of 0.57 (95% CI 0.49; 0.66) while elastosonography had an AUC of 0.58 (95% CI 0.49; 0.67) when used individually. SMI together with elastosonography had AUC of 0.62 (95% CI 0.52; 0.71). TI-RADS had AUC of 0.67 (95% CI 0.59; 0.75). SMI and elastosonography applied together with TI-RADS had AUC of 0.69 (95% CI 0.61; 0.77). CONCLUSION: In the real-world cohort of patients, the SMI technique and elastosonography slightly increase the AUC of TI-RADS. Taken individually, SMI and elastosonography do not have a very strong AUC.

COVLIAS 3.0: cloud-based quantized hybrid UNet3+ deep learning for COVID-19 lesion detection in lung computed tomography.

Background and novelty: When RT-PCR is ineffective in early diagnosis and understanding of COVID-19 severity, Computed Tomography (CT) scans are needed for COVID diagnosis, especially in patients having high ground-glass opacities, consolidations, and crazy paving. Radiologists find the manual method for lesion detection in CT very challenging and tedious. Previously solo deep learning (SDL) was tried but they had low to moderate-level performance. This study presents two new cloud-based quantized deep learning UNet3+ hybrid (HDL) models, which incorporated full-scale skip connections to enhance and improve the detections. Methodology: Annotations from expert radiologists were used to train one SDL (UNet3+), and two HDL models, namely, VGG-UNet3+ and ResNet-UNet3+. For accuracy, 5-fold cross-validation protocols, training on 3,500 CT scans, and testing on unseen 500 CT scans were adopted in the cloud framework. Two kinds of loss functions were used: Dice Similarity (DS) and binary cross-entropy (BCE). Performance was evaluated using (i) Area error, (ii) DS, (iii) Jaccard Index, (iii) Bland-Altman, and (iv) Correlation plots. Results: Among the two HDL models, ResNet-UNet3+ was superior to UNet3+ by 17 and 10% for Dice and BCE loss. The models were further compressed using quantization showing a percentage size reduction of 66.76, 36.64, and 46.23%, respectively, for UNet3+, VGG-UNet3+, and ResNet-UNet3+. Its stability and reliability were proved by statistical tests such as the Mann-Whitney, Paired t-Test, Wilcoxon test, and Friedman test all of which had a p < 0.001. Conclusion: Full-scale skip connections of UNet3+ with VGG and ResNet in HDL framework proved the hypothesis showing powerful results improving the detection accuracy of COVID-19.

Evaluating the impact of delayed-phase imaging in Contrast-Enhanced Mammography on breast cancer staging: A comparative study of abbreviated versus complete protocol.

PURPOSE: Contrast-enhanced mammography (CEM) is an innovative imaging tool for breast cancer detection, involving intravenous injection of a contrast medium and the assessment of lesion enhancement in two phases: early and delayed. The aim of the study was to analyze the topographic concordance of lesions detected in the early- versus delayed phase acquisitions. MATERIALS AND METHODS: Approved by the Ethics Committee (No. 118/20), this prospective study included 100 women with histopathological confirmed breast neoplasia (B6) at the Radiodiagnostics Department of the Maggiore della Carità Hospital of Novara, Italy from May 1, 2021, to October 17, 2022. Participants underwent CEM examinations using a complete protocol, encompassing both early- and delayed image acquisitions. Three experienced radiologists blindly analyzed the CEM images for contrast enhancement to determine the topographic concordance of the identified lesions. Two readers assessed the complete study (protocol A), while one reader assessed the protocol without the delayed phase (protocol B). The average glandular dose (AGD) of the entire procedure was also evaluated. RESULTS: The analysis demonstrated high concordance among the three readers in the topographical identification of lesions within individual quadrants of both breasts, with a Cohen's κ > 0.75, except for the lower inner quadrant of the right breast and the retro-areolar region of the left breast. The mean whole AGD was 29.2 mGy. The mean AGD due to CEM amounted to 73% of the whole AGD (21.2 mGy). The AGD attributable to the delayed phase of CEM contributed to 36% of the whole AGD (10.5 mGy). CONCLUSIONS: As we found no significant discrepancy between the readings of the two protocols, we conclude that delayed-phase image acquisition in CEM does not provide essential diagnostic benefits for effective disease management. Instead, it contributes to unnecessary radiation exposure.

Comparison of frailty indexes as predictors of clinical outcomes after major thoracic surgery.

Background: Despite greater appreciation for the importance of frailty in surgical patients, due to improved understanding that frailty is often linked to poor outcomes, the optimal method of assessment remains unknown. In this study, we sought to evaluate the prevalence of frailty in patients considered for elective thoracic surgery and to test the ability of several frailty measurements to predict postoperative outcomes. Methods: Patients included were candidates for major elective thoracic surgery. Preoperative assessment of frailty included the Fried frailty phenotype, the Edmonton Frail Scale (EFS), the modified frailty index (mFI), the Clinical Frailty Scale (CFS), and additional components of frailty. Outcome data include days with chest drain, length of hospital stay, and postoperative adverse events. Results: According to the Fried frailty phenotype, 53% of 94 patients included were prefrail or frail. A significant association between frailty and postoperative complications was found (odds ratio 7.65; P=0.001). No association between CFS, mFI, EFS, and complications was observed. The Frailty Phenotype seemed the most accurate in predicting postoperative complications, with an area under the curve (AUC) of 0.77. Twenty-seven percent of patients meet the criteria for depression according to the Geriatric Depression Scale and they showed a higher risk of postoperative complications (OR 2.47; P=0.03). A lower psoas muscle index was associated with a higher risk of complications (OR 3.40; P=0.04). Conclusions: According to our results, the Fried frailty phenotype seems the most accurate tool to test frailty in patients undergoing thoracic resections. Surgeons should be aware that, although these aspects are not routinely tested, they are potential targets to improve clinical outcomes. Studies on additional interventions specifically targeting frail people in the setting of elective thoracic surgery are required.

Effective and organ doses in patient undergoing interventional neuroradiology procedures: A multicentre study.

PURPOSE: Radiation doses to adult patients submitted to cerebral angiography and intracranial aneurysms treatments were assessed by using DICOM Radiation Dose Structured Reports (RDSR) and Monte Carlo simulations. Conversion factors to estimate effective and organ doses from Kerma-Area Product (PKA) values were determined. METHODS: 77 cerebral procedures performed with five angiographic equipment installed in three Italian centres were analyzed. Local settings and acquisition protocols were considered. The geometrical, technical and dosimetric data of 16,244 irradiation events (13305 fluoroscopy, 2811 digital subtraction angiography, 128 cone-beam CT) were extracted from RDSRs by local dose monitoring systems and were input in MonteCarlo PCXMC software to calculate effective and organ doses. Finally, conversion factors to determine effective and organ doses from PKA were determined. Differences between centres were assessed through statistical analysis and accuracy of dose calculation method based on conversion factors was assessed through Bland-Altman analysis. RESULTS: Large variations in PKA (14-561 Gycm2) and effective dose (1.2-73.5 mSv) were observed due to different degrees of complexity in the procedures and angiographic system technology. The most exposed organs were brain, salivary glands, oral mucosa, thyroid and skeleton. The study highlights the importance of recent technology in reducing patient exposure (about fourfold, even more in DSA). No statistically significant difference was observed in conversion factors between centres, except for some organs. A conversion factor of 0.09 ± 0.02 mSv/Gycm2 was obtained for effective dose. CONCLUSIONS: Organ and effective doses were assessed for neuro-interventional procedures. Conversion factors for calculating effective and organ doses from PKA were provided.

Deep Learning in Breast Cancer Imaging: State of the Art and Recent Advancements in Early 2024.

The rapid advancement of artificial intelligence (AI) has significantly impacted various aspects of healthcare, particularly in the medical imaging field. This review focuses on recent developments in the application of deep learning (DL) techniques to breast cancer imaging. DL models, a subset of AI algorithms inspired by human brain architecture, have demonstrated remarkable success in analyzing complex medical images, enhancing diagnostic precision, and streamlining workflows. DL models have been applied to breast cancer diagnosis via mammography, ultrasonography, and magnetic resonance imaging. Furthermore, DL-based radiomic approaches may play a role in breast cancer risk assessment, prognosis prediction, and therapeutic response monitoring. Nevertheless, several challenges have limited the widespread adoption of AI techniques in clinical practice, emphasizing the importance of rigorous validation, interpretability, and technical considerations when implementing DL solutions. By examining fundamental concepts in DL techniques applied to medical imaging and synthesizing the latest advancements and trends, this narrative review aims to provide valuable and up-to-date insights for radiologists seeking to harness the power of AI in breast cancer care.

Locoregional staging of breast cancer: contrast-enhanced mammography versus breast magnetic resonance imaging.

PURPOSE: Breast cancer diagnosis often involves assessing the locoregional spread of the disease through MRI, as multicentricity, multifocality and/or bilaterality are increasingly common. Contrast-enhanced mammography (CEM) is emerging as a potential alternative method. This study compares the performance of CEM and MRI in preoperative staging of women with confirmed breast carcinoma. Patients were also asked to fill in a satisfaction questionnaire to rate their comfort level with each investigation. METHODS: From May 1st, 2021 to May 1st, 2022, we enrolled 70 women with confirmed breast carcinoma who were candidates for surgery. For pre-operative locoregional staging, all patients underwent CEM and MRI examination, which two radiologists evaluated blindly. We further investigated all suspicious locations for disease spread, identified by both CEM and MRI, with a second-look ultrasound (US) and eventual histological examination. RESULTS: In our study cohort, MRI and CEM identified 114 and 102 areas of focal contrast enhancement, respectively. A true discrepancy between MRI and CEM occurred in 9 out of 70 patients examined. MRI reported 8 additional lesions that proved to be false positives on second-look US in 6 patients, while it identified 4 lesions that were not detected by CEM and were pathological (true positives) in 3 patients. CONCLUSIONS: CEM showed results comparable to MRI in the staging of breast cancer in our study population, with a high rate of patient acceptability.

Optimisation of protection in the medical exposure of recurrent adult patients due to computed tomography procedures: development of recurrent exposures reference levels.

OBJECTIVES: To assess the incidence (1 year) and the cumulative incidence (3 years) of the condition of patients accruing cumulative effective doses (CED) of ≥ 100 mSv and their variability among different hospitals. To establish and validate a reference level for the CED in patients with recurrent exposures (RERL) and provide a RERL value. METHODS: Data of CT exposure was collected in 9 similar hospitals. The database included 294,222 patient*years who underwent 442,278 CT exams in 3 years. The incidence proportion of patients with CED ≥ 100 mSv in a given year (I100;1) and the 3-year cumulative incidence of patients with CED ≥ 100 mSv over 3 consecutive years (I100;3) were calculated and compared among different institutions. RESULTS: I100;1 ranged from a minimum of 0.1% to a maximum of 5.1%. The percentage of recurrent patients was quite uniform among centres ranging from 23 to 38%. The I100;3 ranged from a minimum of 1.1 to 11.4%. There was a strong positive correlation between the third quartile values of yearly CED and yearly incidence (r = 0.90; R2 = 0.81; p < 0.0001). RERL value in our study was found at 34.0 mSv. CONCLUSION: The management of patients with recurrent exposures is highly variable among hospitals leading to a 50-fold variation in I100;1 and to a tenfold variation in I100;3. RERL could be established and used by taking as a RERL quantity the CED and as a RERL value the 75th percentile of the third quartiles of the distribution of the yearly CED obtained by surveying different hospitals. CLINICAL RELEVANCE STATEMENT: This is the first ever multicentre study that quantifies recurrent exposures in terms of incidence and cumulative incidence of patients with CED ≥ 100 mSv. RERL establishment and use could benefit the optimisation of radioprotection of patients with recurrent exposures. KEY POINTS: This is the first multicentre study estimating yearly incidence and 3-year cumulative incidence of patients with cumulative effective doses ≥ 100 mSv. In this study, a 50-fold inter centre variation between the maximum (5.1%) and the minimum value (0.1%) of yearly incidence of patients with cumulative effective doses ≥ 100 mSv was reported. The range of the 3-year cumulative incidence extended from 1.1 to 11.4% (a tenfold variation) The third quartile of the yearly cumulative effective doses in a centre showed a strong positive correlation with the yearly incidence of patients with cumulative effective doses ≥ 100 mSv, with a potential of being used to set reference levels for recurrent exposures.

Capecitabine-Induced Ileitis during Neoadjuvant Pelvic Radio-Chemotherapy for Locally Advanced Rectal Cancer: A Case Report with Literature Review.

We report on a clinical case of capecitabine-induced acute ileitis in a patient treated with pre-operative concurrent chemoradiation with capecitabine for locally advanced rectal cancer and provide a comprehensive literature review. This a rare, but life-threatening, clinical situation, that clinicians should be aware of. Severe persistent diarrhea is the most frequent clinical feature and computed tomography is a valid tool for diagnosis. Conservative management includes capecitabine withdrawal, antidiarrheal therapy and endovenous hydration, together with dietary modifications and broad-spectrum antibiotics. Pelvic irradiation represents an adjunctive risk factor, which may increase the likelihood of occurrence of terminal ileitis. Early recognition and prompt intervention are crucial for successful clinical management.

Early patello-femoral condropathy assessment through quantitative analyses via T2 mapping magnetic resonance after anterior cruciate ligament reconstruction.

BACKGROUND: Patellar femoral chondropathy (FPC) is a common problem in patients undergoing anterior cruciate ligament reconstruction (ACL-R) surgery, which, if left untreated, predisposes to arthrosis. Magnetic resonance imaging (MRI) is the non-invasive gold standard for morphological evaluation of cartilage, while in recent years advanced MRI techniques (such as T2 mapping) have been developed to detect early cartilage biochemical changes. This study evaluates the different onset of early PFC between B-TP-B and HT through T2 mapping. Secondly, it aims to assess the presence of any concordance between self-reported questionnaires and qualitative MRI. MATERIALS AND METHODS: 19 patients enrolled were divided into two groups based on the type of intervention: B-PT-B and HT. After a median time of 54 months from surgery, patients were subjected to conventional MRI, T2 mapping, and clinical-functional evaluation through three self-reported questionnaires: Knee Injury and Osteoarthritis index (KOOS); Tegner Lysholm Knee Scoring Scale; International Knee Documentation Committee (IKDC). RESULTS: There is not statistically significant difference in the comparison between the two MRI techniques and the two reconstructive techniques. KOOS and Tegner Lysholm scales showed significant agreement with MRI results on the grading of chondropathy. CONCLUSIONS: There are no differences between B-TP-B and HT techniques in the early development of PFC detectable through non-invasive methods. Due to the large reduction in the frequency of physical activity following ACL-R and the finding of mild PFC (grade I and II) in a substantial proportion of patients, after a relatively short period from ACL-R, all patients should undergo conservative treatment.

Exploring the potential of contrast agents in breast cancer echography: current state and future directions.

Breast cancer stands as the most frequent malignancy and leading cause of death among women. Early and accurate detection of this pathology represents a crucial factor in enhancing both incidence and mortality rates. Ultrasound (US) examination has been extensively adopted in clinical practice due to its non-invasiveness, affordability, ease of implementation, and wide accessibility, thus representing a valuable first-line diagnostic tool for the study of the mammary gland. In this scenario, recent developments in nanomedicine are paving the way for new interpretations and applications of US diagnostics, which are becoming increasingly personalized based on the molecular phenotype of each tumor, allowing for more precise and accurate evaluations. This review highlights the current state-of-the-art of US diagnosis of breast cancer, as well as the recent advancements related to the application of US contrast agents to the field of molecular diagnostics, still under preclinical study.

Vascular Complications following Vacuum-Assisted Breast Biopsy (VABB): A Case Report and Review of the Literature.

INTRODUCTION: Vacuum-assisted breast biopsy (VABB) has been evaluated as a minimally invasive, safe, and accurate procedure with low complication risks; the most frequent one is the mild/moderate hematoma, which occurs with a low-frequency rate, and the majority of patients who experienced it can be treated successfully with only manual compression and dressing. Although cases of uncontrollable catastrophic bleeding are exceedingly rare, local breast vessel involvement is a concrete risk, even in patients with no bleeding propensity. CASE PRESENTATION: In this article, we aimed to describe a 60 years-old woman who, following VABB, experienced a massive hematoma without external bleeding and was successfully treated with embolization. The woman was called back for a cluster of suspicious microcalcifications identified in the left breast's upper-outer quadrant; however, following histopathological analysis, the few samples collected were negative. She had a silent past medical history, 100% performance status, and no active pharmacotherapy. Approximately 15-30 min after VABB, the patient complained of weakness, pain, and lipothymia. A physical examination revealed a massive hematoma without external bleeding. Clinical data reported PaO 65/40 mmHg and blood chemistry Hb < 10 g/dL. The emergency team was alerted to stabilize the patient, and after that, the breast hemorrhage was controlled by endovascular embolization. Despite this being a rare occurrence, it is important to draw up and follow an appropriate protocol to ensure proper patient management and early treatment. DISCUSSION: This case illustrates the prompt and accurate management of a rare complication following VABB. Due to the very high number of patients undergoing this particular procedure, we aim to point out the concrete risk of vascular injury; other similar cases are described to support our thesis and provide different clinical manifestations of this rare occurrence.

Mammary nodules as incidental findings on chest computed tomography: a retrospective analysis on their frequency and predictive value.

PURPOSE: To evaluate the frequency of mammary nodules as incidental findings on chest CT scans and to determine a correlation between semiological features and mammographic and histopathological outcomes. METHODS: A total of 42,864 chest CT scans performed on patients with breast-unrelated working diagnoses by the Radiology Department at AOU Maggiore della Carità, between 1st January 2016 and 30th April 2022, were analysed. Sixty-eight patients (3 males and 65 females) with mammary nodule CT detection were selected and subjected to mammography, mammary ultrasound and, eventually, biopsy. RESULTS: Thirty-five of the 68 patients received a histopathological confirmation of malignancy. According to Pearson's Chi-square test, the CT features most likely associated with BI-RADS 5 following mammography were post-contrast enhancement (p = 0.001), margin irregularity (p = 0.0001), nipple retraction (p = 0.001), skin thickening (p = 0.024), and the presence of structurally atypical lymph nodes suspicious for metastatic involvement (p = 0.0001). The CT features predictive of a biopsy positive for malignancy were post-contrast enhancement (p = 0.0001), margin irregularity (p = 0.0001), and the presence of suspicious lymph nodes (p = 0.011). Finally, 63.4% of patients with a working diagnosis related to cancer were diagnosed with breast cancer. CONCLUSION: Chest CT incidental findings of mammary nodules had a 0.21% incidence rate. The accurate description of some CT scan features, such as post-contrast enhancement, margin irregularity, nipple retraction, skin thickening and the presence of structurally atypical lymph nodes, may help to establish a radiological suspicion of malignancy, especially if these characteristics are supported by a working diagnosis of cancer.

Cumulative radiation exposure from radiological imaging in patients with Hodgkin and diffuse large b-cell lymphoma not submitted to radiotherapy.

OBJECTIVE: To assess the cumulated exposure to radiation due to imaging in Hodgkin (HL) and diffuse large B-cell (DLBCL) lymphoma patients who were not submitted to radiotherapy. METHODS: The study population included 51 and 83 adult patients with HL and DLBCL, with a follow-up duration >1 year. The cumulated exposure was expressed using patient-specific data as cumulated effective dose (CED). RESULTS: Fifty-one HL patients (median age 47 years) were followed for a median of 3.5 years. The median total CED per subject was 104 mSv. CT and PET/CT examinations accounted for 75 and 25% of the total CED, respectively. 26 patients (49%) had a total CED ≥ 100 mSv and the maximum CED was 302 mSv. Eighty-three DLBCL patients (median age 66 years) were followed for a median of 3.7 years. The median total CED per subject over the study period was 134 mSv. CT and PET/CT for 86% and 13% of the total CED, respectively. 56 patients (67%) had a total CED ≥100 mSv. The maximum CED was 557 mSv. CONCLUSION: Our study demonstrated the large number of imaging procedures performed for patients with lymphoma. Overall, 61% of the patients accrued a CED ≥ 100 mSv. Imaging policies were only in a partial agreement with current international guidelines. ADVANCES IN KNOWLEDGE: The cumulated exposure radiation exposure may be of concern in HL patients and the contribution of CT procedures to the total CED is significant. The standardisation of clinical guidelines for managing patients with lymphoma is warranted.

Ensemble Deep Learning Derived from Transfer Learning for Classification of COVID-19 Patients on Hybrid Deep-Learning-Based Lung Segmentation: A Data Augmentation and Balancing Framework.

BACKGROUND AND MOTIVATION: Lung computed tomography (CT) techniques are high-resolution and are well adopted in the intensive care unit (ICU) for COVID-19 disease control classification. Most artificial intelligence (AI) systems do not undergo generalization and are typically overfitted. Such trained AI systems are not practical for clinical settings and therefore do not give accurate results when executed on unseen data sets. We hypothesize that ensemble deep learning (EDL) is superior to deep transfer learning (TL) in both non-augmented and augmented frameworks. METHODOLOGY: The system consists of a cascade of quality control, ResNet-UNet-based hybrid deep learning for lung segmentation, and seven models using TL-based classification followed by five types of EDL's. To prove our hypothesis, five different kinds of data combinations (DC) were designed using a combination of two multicenter cohorts-Croatia (80 COVID) and Italy (72 COVID and 30 controls)-leading to 12,000 CT slices. As part of generalization, the system was tested on unseen data and statistically tested for reliability/stability. RESULTS: Using the K5 (80:20) cross-validation protocol on the balanced and augmented dataset, the five DC datasets improved TL mean accuracy by 3.32%, 6.56%, 12.96%, 47.1%, and 2.78%, respectively. The five EDL systems showed improvements in accuracy of 2.12%, 5.78%, 6.72%, 32.05%, and 2.40%, thus validating our hypothesis. All statistical tests proved positive for reliability and stability. CONCLUSION: EDL showed superior performance to TL systems for both (a) unbalanced and unaugmented and (b) balanced and augmented datasets for both (i) seen and (ii) unseen paradigms, validating both our hypotheses.

Innovation in Acute Ischemic Stroke Patients over 80 y/o-A Retrospective Monocentric Study on Mechanical Thrombectomy of Consecutive Patients: Is Age an Adequate Selection Criterion?

BACKGROUND: Although it is clear that stroke is a time-dependent and age-associated disease, we still need more evidence regarding the efficacy and outcomes in elderly patients who were excluded from the first trials of mechanical thrombectomy. The aim of this study is to highlight patient characteristics, the timing of medical attention and therapy, successful recanalization, and functional outcomes in patients over 80 y/o who underwent mechanical thrombectomy at the Ospedale Maggiore della Carità di Novara (Hub) since endovascular stroke treatment was first started here. METHODS: all 122 consecutive patients over 80 y/o at admission who underwent mechanical thrombectomy between 2017 and 2022 at our Hub center were retrospectively included in our database. A good functional outcome in these elderly patients was considered as the 90 days modified Rankin Scale (mRS) ≤ 3 and/or a decrease in functional status as ∆mRS ≤ 1 in order to interpret the results for patients with intact intellect and basal mRS > 3. Successful recanalization as a score of TICI ≥ 2b (Thrombolysis in Cerebral Infarction) was analyzed as a secondary outcome. RESULTS: Good functional outcome (mRS ≤ 3 and/or ∆mRS ≤ 1) was observed in 45.90% (56/122). The rate of successful recanalization (TICI ≥ 2b) was 65.57% (80/122). CONCLUSION: Our data confirm that a good outcome in the elderly age group has a correlation with age; being younger, with a milder NIHSS (National Institutes of Health Stroke Scale) at the onset and with a lower pre-morbid mRS is statistically associated with a better outcome. However, age should not be a criterion to exclude older patients from mechanical thrombectomy. Decision-making should take into consideration the pre-morbid mRS and the severity of the stroke on the NIHSS scale, especially in the age group over 85 y/o.

The Non-Invasive Diagnosis of Chronic Coronary Syndrome: A Focus on Stress Computed Tomography Perfusion and Stress Cardiac Magnetic Resonance.

Coronary artery disease is still a major cause of death and morbidity worldwide. In the setting of chronic coronary disease, demonstration of inducible ischemia is mandatory to address treatment. Consequently, scientific and technological efforts were made in response to the request for non-invasive diagnostic tools with better sensitivity and specificity. To date, clinicians have at their disposal a wide range of stress-imaging techniques. Among others, stress cardiac magnetic resonance (S-CMR) and computed tomography perfusion (CTP) techniques both demonstrated their diagnostic efficacy and prognostic value in clinical trials when compared to other non-invasive ischemia-assessing techniques and invasive fractional flow reserve measurement techniques. Standardized protocols for both S-CMR and CTP usually imply the administration of vasodilator agents to induce hyperemia and contrast agents to depict perfusion defects. However, both methods have their own limitations, meaning that optimizing their performance still requires a patient-tailored approach. This review focuses on the characteristics, drawbacks, and future perspectives of these two techniques.

Evaluation of operator eye exposure and eye protective devices in interventional radiology: Results on clinical staff and phantom.

PURPOSE: To assess occupational eye lens dose based on clinical monitoring of interventional radiologists and to assess personal protective eyewear (PPE) efficacy through measurements with anthropomorphic phantom. METHODS: Two positions of the operator with respect to X-ray beam were simulated with phantom. Dose reduction factor (DRF) of four PPE was assessed, as well as correlation between eye lens and whole-body doses. Brain dose was also assessed. Five radiologists were monitored for one-year clinical procedures. All subjects were equipped with whole-body dosimeter placed over lead apron at the chest level and eye lens dosimeter placed over the left side of the PPE. Kerma-Area Product (KAP) of procedures performed during the monitoring period was recorded. The correlation of eye lens dose with whole-body dose and KAP was assessed. RESULTS: DRF was 4.3/2.4 for wraparound glasses, 4.8/1.9 for fitover glasses, 9.1/6.8 for full-face visor in radial/femoral geometries. DRF of half-face visor depended on how it is worn (range 1.0-4.9). Statistically significant correlation between dose value over the PPE and chest dose was observed, while there was no correlation between eye lens dose and chest dose. The results on clinical staff showed statistically significant correlation between dose values over the PPE and KAP. CONCLUSIONS: All PPE showed significant DRF in all configurations, provided they were worn correctly. Single DRF value is not applicable to all clinical situations. KAP is a valuable tool for determining appropriate radiation protection measures.