Tomosynthesis performance compared to radiography and computed tomography for sacroiliac joint structural damage detection in patients with suspected axial spondyloarthritis.

Purpose: To compare tomosynthesis performance to radiography for the differentiation of sacroiliitis versus normal or degenerative changes in sacroiliac joints in patients with suspected axial spondyloarthritis (SpA). Materials and methods: Radiography, tomosynthesis and CT of sacroiliac joints (29 patients) were performed on the same day in consecutive patients with suspected SpA. The examinations were retrospectively read independently, blinded by two radiologists (one junior and one senior, and twice by one junior). Interobserver and intraobserver agreement was evaluated using the kappa coefficient. Effective doses for each imaging sensitivity, specificity and accuracy were assessed and compared with CT as gold standard. Results: CT detected 15/58 joints with sacroiliitis. The imaging sensitivity, specificity and accuracy were 60%, 84% and 44%, respectively, for radiography and 87%, 91% and 77% for tomosynthesis. The mean effective dose for tomosynthesis was significantly lower than that of CT (5-fold less) and significantly higher than that of radiography (8-fold more). Conclusion: Tomosynthesis is superior to radiography for sacroiliitis detection in patients with suspected SpA, with 5-fold less radiation exposure than CT.

Comparison of two versions of a deep learning image reconstruction algorithm on CT image quality and dose reduction: A phantom study.

PURPOSE: To compare the impact on CT image quality and dose reduction of two versions of a Deep Learning Image Reconstruction algorithm. MATERIAL AND METHODS: Acquisitions on the CT ACR 464 phantom were performed at five dose levels (CTDIvol : 10/7.5/5/2.5/1 mGy) using chest or abdomen pelvis protocol parameters. Raw data were reconstructed using the filtered-back projection (FBP), the enhanced level of AIDR 3D (AIDR 3De), and the three levels of AiCE (Mild, Standard, and Strong) for the two versions (AiCE V8 vs AiCE V10). The noise power spectrum (NPS) and task-based transfer function (TTF) for bone (high-contrast insert) and acrylic (low-contrast insert) inserts were computed. To quantify the changes of noise magnitude and texture, the square root of the area under the NPS curve and the average spatial frequency (fav ) of the NPS curve were measured. The detectability index (d') was computed to model the detectability of either a large mass in the liver or lung, or a small calcification or high contrast tissue boundaries. RESULTS: The noise magnitude was lower with both AiCE versions than with AIDR 3De. The noise magnitude was lower with AiCE V10 than with AiCE V8 (-4 ± 6% for Mild, -13 ± 3% for Standard, and -48 ± 0% for Strong levels). fav and TTF50% values for both inserts shifted towards higher frequencies with AiCE than with AIDR 3De. Compared to AiCE V08, fav shifted towards higher frequencies with AiCE V10 (45 ± 4%, 36 ± 3%, and 5 ± 4% for all levels, respectively). The TTF50% values shifted towards higher frequencies with AiCE V10 as compared with AiCE V8 for both inserts, except for the Strong level for the acrylic insert. Whatever the dose and AiCE levels, d' values were higher with AiCE V10 than with AiCE V8 for the small object/calcification and for the large object/lesion. CONCLUSION: As compared to AIDR 3De, lower noise magnitude and higher spatial resolution and detectability index were found with both versions of AiCE. As compared to AiCE V8, AiCE V10 reduced noise and improved spatial resolution and detectability without changing the noise texture in a simple geometric phantom, except for the Strong level. AiCE V10 seems to have a greater potential for dose reduction than AiCE V8.

Diagnostic reference levels during fluoroscopically guided interventions using mobile C-arms in operating rooms: A national multicentric survey.

PURPOSE: To establish diagnostic reference levels (DRLs) and achievable levels (ALs) for the most common fluoroscopically guided interventions (FGIs) performed in operating rooms using mobile C-arm equipment. METHODS: A national survey was performed in 57 centers in France. Anonymous data from 6817 patients undergoing FGIs were prospectively collected over a period of 7 months. DRLs (third quartile of the distribution) and ALs (median of the distribution) were determined for each type of intervention in terms of kerma area product (KAP) and fluoroscopy time (FT). RESULTS: DRLs and ALs were proposed for 31 procedure types related to seven surgical specialties: orthopedics (n = 9), urology (n = 3), vascular (n = 6), cardiology (n = 5), neurosurgery (n = 3), gastrointestinal (n = 3), and multi-specialty (n = 2). DRLs in terms of KAP ranged from 0.1 Gy·cm2 for hallux valgus to 78 Gy·cm2 for abdominal aortic aneurysm endovascular repair. A factor of 155 was obtained between the FTs for a herniated lumbar disk (0.2 min) and an abdominal aortic aneurysm endovascular repair (31 min). The highest variations were obtained within orthopedic procedures in terms of KAP (ratio 122) and within gastrointestinal procedures in terms of FT (ratio 9). Overall, the FGIs associated with the highest radiation exposure (KAP > 10 Gy·cm2) were found in the cardiology, vascular, and gastrointestinal specialties. CONCLUSIONS: DRLs and ALs are suggested for a wide range of FGIs performed in operating rooms using a mobile C-arm. We aim at providing a practical optimization tool for medical physicists and surgeons.

Selection of optimal cardiac phases for ECG-triggered coronary CT angiography in pediatrics.

PURPOSE: The use of coronary computed tomography angiography (CCTA) in children remains limited by patient's irradiation, and motion artefacts impairing image quality. Triggering the acquisition at the appropriate moment, and acquiring only necessary components of the cardiac cycle could overcome these limitations. Yet, optimal cardiac intervals to perform CCTA as a function of heart rate (HR) have not yet been addressed in pediatrics. METHODS: Fifty children with coronary artery anomalies underwent a CCTA on a wide-coverage single-beat CT scanner. Multiple phases from 25% to 85% of the R-R interval were acquired and reconstructed with 10% increments. Two radiologists independently assessed motion artifacts on each cardiac phase using a 4-point semi-quantitative scale. RESULTS: At patient level, the best phase for acquisition was found in diastole for patients with HR ≤ 75 bpm and in systole for patients with HR > 85 bpm. At coronary segments and structures level, median optimal phases were reported at 70%, 80%, 47%, 50%, and 54% of the R-R interval for patients with HR ≤ 60, 61-75, 86-100, 101-130, and >130 bpm respectively. For patients with HR between 76 and 85 bpm, no clear trend could be observed. Optimal acquisition durations represented 10% (2 phases), 20% (3 phases), 50% (multiphase), 20% (3 phases), and 10% (2 phases) of the R-R interval for patients with HR ≤ 60, 61-75, 76-100, 101-130, and >130 bpm, respectively. CONCLUSIONS: Optimal positioning and duration of CCTA acquisition intervals were investigated as a function of children's HR, to reduce motion artifacts and patient's irradiation.

UDP-GLYCOSYLTRANSFERASE 72E3 Plays a Role in Lignification of Secondary Cell Walls in Arabidopsis.

Lignin is present in plant secondary cell walls and is among the most abundant biological polymers on Earth. In this work we investigated the potential role of the UGT72E gene family in regulating lignification in Arabidopsis. Chemical determination of floral stem lignin contents in ugt72e1, ugt72e2, and ugt72e3 mutants revealed no significant differences compared to WT plants. In contrast, the use of a novel safranin O ratiometric imaging technique indicated a significant increase in the cell wall lignin content of both interfascicular fibers and xylem from young regions of ugt72e3 mutant floral stems. These results were globally confirmed in interfascicular fibers by Raman microspectroscopy. Subsequent investigation using a bioorthogonal triple labelling strategy suggested that the augmentation in lignification was associated with an increased capacity of mutant cell walls to incorporate H-, G-, and S-monolignol reporters. Expression analysis showed that this increase was associated with an up-regulation of LAC17 and PRX71, which play a key role in lignin polymerization. Altogether, these results suggest that UGT72E3 can influence the kinetics of lignin deposition by regulating monolignol flow to the cell wall as well as the potential of this compartment to incorporate monomers into the growing lignin polymer.

Correction to: National dose reference levels in computed tomography-guided interventional procedures-a proposal.

The original version of this article, published on 02 May 2020, unfortunately contained a mistake.

National dose reference levels in computed tomography-guided interventional procedures-a proposal.

OBJECTIVES: To establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive. METHODS: Seventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to 20 patients per procedure at each center. RLs were calculated as the 3rd quartiles of the distributions and target values for optimization process (TVOs) as the median. RLs and TVOs were compared with previously published studies. RESULTS: Results on 5001 procedures from 49 centers confirmed the great variability in patient dose for the same category of procedures. RLs were proposed for the DLPs and NHs in the seventeen categories. RLs in terms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal infiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH for biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 mGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of procedures. CONCLUSIONS: This study was the first nationwide multicentric survey to propose RLs for interventional procedures under CT guidance. Heterogeneity of practice in centers were found with different levels of patient doses for the same procedure. The proposed RLs will allow imaging departments to benchmark their practice with others and optimize their protocols. KEY POINTS: • National reference levels are proposed for 17 categories of interventional procedures under CT guidance. • Reference levels are useful for benchmarking practices and optimizing protocols. • Reference levels are proposed for dose length product and the number of helical acquisitions.

Radiation Exposure During Transarterial Chemoembolization: Angio-CT Versus Cone-Beam CT.

INTRODUCTION: Cone-beam computed tomography (CBCT) has been developed to improve reliability of many interventional radiology (IR) procedures performed with Angio system, such as transarterial chemoembolization (TACE). Angio-CT has emerged as a new imaging technology that combines a CT scanner with an Angio system in the same IR suite. The purpose of our study was to compare Angio system with CBCT capability and Angio-CT in terms of patient radiation exposure during TACE procedures. MATERIALS AND METHODS: Consecutive TACE procedures performed between January 2016 and September 2017 with the two imaging modalities (Artis Zeego defining the CBCT group and Infinix-i 4D-CT defining the Angio-CT group) were reviewed. TACE and patient's characteristics and patient radiation exposure parameters were collected. Dose-area products (DAP) and dose-length products (DLP) were converted into effective doses (ED) using conversion factors. Accuracy of tumor targeting and response was retrospectively assessed. RESULTS: A total of 114 TACE procedures in 96 patients were included with 57 procedures in each group. The total ED in the Angio-CT group was 2.5 times lower than that in the CBCT group (median 15.4 vs. 39.2 mSv, p < 0.001). Both 2D ED and 3D ED were lower in the Angio-CT group than in the CBCT group (5.1 vs. 20 mSv, p < 0.001, and 7.4 vs. 17.9 mSv, p < 0.001, respectively). There was no significant difference neither in terms of classes of tumor targeting (p = 0.509) nor in terms of classes of tumor response (p = 0.070) between both groups. CONCLUSION: Angio-CT provides significant decrease in patient effective dose during TACE procedures compared to Angio system with CBCT.

Submillisievert Multiphasic Coronary Computed Tomography Angiography for Pediatric Patients With Congenital Heart Diseases.

BACKGROUND: The use of coronary computed tomography (CT) angiography in children with coronary artery anomalies is increasing. However, it remains technically demanding and the need to adapt acquisition parameters to a patient's cardiac characteristics has not yet been addressed. The aim of the study was to prospectively assess the feasibility of personalized multiphasic coronary CT angiography for pediatric patients. METHODS: Fifty pediatric patients (mean age 6.1±4.9 years) with coronary artery anomalies underwent a coronary CT angiography on a wide detector single-source CT equipment. Fifteen different acquisition patterns were used to trigger the acquisition at the best theoretical moment within the cardiac cycle. The appropriate pattern was automatically selected based on the patient's heart rate and heart rate variability, derived from the patient's ECG. Two independent radiologists qualitatively evaluated images. RESULTS: All acquisitions fully answered the clinical question for a mean effective dose of 0.97±0.34 mSv. Image quality qualified as good or excellent in 94% of cases (47/50). No examination was considered as not assessable but 6% (3/50) were scored as adequate for diagnosis. For these 3 patients, motion artifacts were the main cause of average image quality. No significant visual differences were reported between the different coronary arteries (mean score of 3.6 on a 4-point scale). No correlation between image quality and cardiac parameters were reported ( r=-0.19 and r=0.00, respectively for heart rate and heart rate variability). CONCLUSIONS: Personalized multiphasic coronary CT angiography acquisitions could be performed with diagnostic quality for a dose equivalent of <4 months of natural background irradiation. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03194763.

Synthesis of O-1- O-6 Substituted Positional Isomers of d-Glucose-Thioether Ligands and Their Ruthenium Polypyridyl Conjugates.

A library of positional isomers of d-glucose ( O-1- O-6) as ligands and their 11 light-active ruthenium conjugates has been synthesized. A protecting group strategy without the necessity of using palladium on carbon for the modification for the 2- O and 4- O position allows for the incorporation of sulfur donor atoms as ligands for transition metal complexes.

Surgeon's and patient's radiation exposure during percutaneous thoraco-lumbar pedicle screw fixation: A prospective multicenter study of 100 cases.

HYPOTHESIS: Percutaneous pedicle screw fixations (PPSF) are increasingly used in spine surgery, minimizing morbidity through less muscle breakdown but at the cost of intraoperative fluoroscopic guidance that generates high radiation exposure. Few studies have been conducted to measure them accurately. MATERIAL AND METHODS: The objective of our study is to quantify, during a PPSF carried out in different experimented centers respecting current radiation protection recommendations, this irradiation at the level of the surgeon and the patient. We have prospectively included 100 FPVP procedures for which we have collected radiation doses from the main operator. For each procedure, the doses of whole-body radiation, lens and extremities were measured. RESULTS: Our results show a mean whole body, extremity and lens exposure dose per procedure reaching 1.7±2.8µSv, 204.7±260.9µSv and 30.5±25.9µSv, respectively. According to these values, the exposure of the surgeon's extremities and lens will exceed the annual limit allowed by the International Commission on Radiological Protection (ICRP) after 2440 and 4840 procedures respectively. CONCLUSION: Recent European guidelines will reduce the maximum annual exposure dose from 150 to 20mSv. The number of surgical procedures to not reach the eye threshold, according to our results, should not exceed 645 procedures per year. Pending the democratization of neuronavigation systems, the use of conventional fluoroscopy exposes the eyes in the first place. Therefore they must be protected by leaded glasses. LEVEL OF PROOF: IV, case series.

Spatial regulation of monolignol biosynthesis and laccase genes control developmental and stress-related lignin in flax.

BACKGROUND: Bast fibres are characterized by very thick secondary cell walls containing high amounts of cellulose and low lignin contents in contrast to the heavily lignified cell walls typically found in the xylem tissues. To improve the quality of the fiber-based products in the future, a thorough understanding of the main cell wall polymer biosynthetic pathways is required. In this study we have carried out a characterization of the genes involved in lignin biosynthesis in flax along with some of their regulation mechanisms. RESULTS: We have first identified the members of the phenylpropanoid gene families through a combination of in silico approaches. The more specific lignin genes were further characterized by high throughput transcriptomic approaches in different organs and physiological conditions and their cell/tissue expression was localized in the stems, roots and leaves. Laccases play an important role in the polymerization of monolignols. This multigenic family was determined and a miRNA was identified to play a role in the posttranscriptional regulation by cleaving the transcripts of some specific genes shown to be expressed in lignified tissues. In situ hybridization also showed that the miRNA precursor was expressed in the young xylem cells located near the vascular cambium. The results obtained in this work also allowed us to determine that most of the genes involved in lignin biosynthesis are included in a unique co-expression cluster and that MYB transcription factors are potentially good candidates for regulating these genes. CONCLUSIONS: Target engineering of cell walls to improve plant product quality requires good knowledge of the genes responsible for the production of the main polymers. For bast fiber plants such as flax, it is important to target the correct genes from the beginning since the difficulty to produce transgenic material does not make possible to test a large number of genes. Our work determined which of these genes could be potentially modified and showed that it was possible to target different regulatory pathways to modify lignification.

Genetic association of stomatal traits and yield in wheat grown in low rainfall environments.

BACKGROUND: In wheat, grain filling is closely related to flag leaf characteristics and function. Stomata are specialized leaf epidermal cells which regulate photosynthetic CO2 uptake and water loss by transpiration. Understanding the mechanisms controlling stomatal size, and their opening under drought, is critical to reduce plant water loss and maintain a high photosynthetic rate which ultimately leads to elevated yield. We applied a leaf imprinting method for rapid and non-destructive phenotyping to explore genetic variation and identify quantitative traits loci (QTL) for stomatal traits in wheat grown under greenhouse and field conditions. RESULTS: The genetics of stomatal traits on the adaxial surface of the flag leaf was investigated using 146 double haploid lines derived from a cross between two Australian lines of Triticum aestivum, RAC875 and Kukri. The drought tolerant line RAC875 showed numerous small stomata in contrast to Kukri. Significant differences between the lines were observed for stomatal densitity and size related traits. A negative correlation was found between stomatal size and density, reflecting a compensatory relationship between these traits to maintain total pore area per unit leaf surface area. QTL were identified for stomatal traits on chromosomes 1A, 1B, 2B, and 7A under field and controlled conditions. Most importantly some of these loci overlap with QTL on chromosome 7A that control kernel number per spike, normalized difference vegetation index, harvest index and yield in the same population. CONCLUSIONS: In this first study to decifer genetic relationships between wheat stomatal traits and yield in response to water deficit, no significant correlations were observed among yield and stomatal traits under field conditions. However we found some overlaps between QTL for stomatal traits and yield across environments. This suggested that stomatal traits could be an underlying mechanism increasing yield at specific loci and used as a proxy to track a target QTL in recombinant lines. This finding is a step-forward in understanding the function of these loci and identifying candidate genes to accelerate positional cloning of yield QTL in wheat under drought.

Glycosylation Is a Major Regulator of Phenylpropanoid Availability and Biological Activity in Plants.

The phenylpropanoid pathway in plants is responsible for the biosynthesis of a huge amount of secondary metabolites derived from phenylalanine and tyrosine. Both flavonoids and lignins are synthesized at the end of this very diverse metabolic pathway, as well as many intermediate molecules whose precise biological functions remain largely unknown. The diversity of these molecules can be further increased under the action of UDP-glycosyltransferases (UGTs) leading to the production of glycosylated hydroxycinnamates and related aldehydes, alcohols and esters. Glycosylation can change phenylpropanoid solubility, stability and toxic potential, as well as influencing compartmentalization and biological activity. (De)-glycosylation therefore represents an extremely important regulation point in phenylpropanoid homeostasis. In this article we review recent knowledge on the enzymes involved in regulating phenylpropanoid glycosylation status and availability in different subcellular compartments. We also examine the potential link between monolignol glycosylation and lignification by exploring co-expression of lignin biosynthesis genes and phenolic (de)glycosylation genes. Of the different biological roles linked with their particular chemical properties, phenylpropanoids are often correlated with the plant's stress management strategies that are also regulated by glycosylation. UGTs can for instance influence the resistance of plants during infection by microorganisms and be involved in the mechanisms related to environmental changes. The impact of flavonoid glycosylation on the color of flowers, leaves, seeds and fruits will also be discussed. Altogether this paper underlies the fact that glycosylation and deglycosylation are powerful mechanisms allowing plants to regulate phenylpropanoid localisation, availability and biological activity.

Surgeon's and Patient's Radiation Exposure Through Vertebral Body Cement Augmentation Procedures: A Prospective Multicentric Study of 49 Cases.

OBJECTIVE: Vertebral body cement augmentation as a treatment option for osteoporotic or traumatic fractures has become increasingly popular during the past decade. However, these surgical procedures require numerous fluoroscopic examinations, resulting in high radiation exposure for the patient and the surgical team. The aim of this study was to evaluate the level of radiation exposure of the spine surgeon and the patient during these percutaneous procedures. METHODS: Forty-nine patients admitted for single- or 2-level vertebral compression fracture were prospectively included and treated with vertebral body cement augmentation. For each procedure, radiation dose was measured on the surgeon's whole body, lens, and extremities as well as patient irradiation. Each surgeon wore 2 thermoluminescent dosimeters to measure lens and extremities radiation exposure and 1 electronic personal dosimeter. Patient clinical and surgical data, effective dose to patient, and surgeon were analyzed. RESULTS: Mean operative time was 31.5 ± 11.7 minutes. The average fluoroscopic time was 61.0 ± 27.1 seconds. The average whole-body radiation dose per procedure was 1.4 ± 2.1 µSv. The average equivalent dose to lens and extremities were 44 µSv and 59 µSv, respectively. CONCLUSIONS: Values of radiation doses for surgeon and patient were lower than those reported in the previous literature. The recommended annual dose limit is set to 500 mSv for extremities and 150 mSv for lens. According to our results, the exposure dose to the eye exceeds the annual limit after 3500 procedures. However, there is increasing concern among surgeons about radiation exposure, and there is still a need for solutions as preventive measures.

Assessment of the Radiation Exposure of Surgeons and Patients During a Lumbar Microdiskectomy and a Cervical Microdiskectomy: A French Prospective Multicenter Study.

OBJECTIVE: Cervical and lumbar disk herniations are the most frequently carried out procedures in spinal surgery. Often, a few snapshots during the procedure are necessary to validate the level or to position the implant. The objective of this study is to quantitatively estimate the radiation received by a spine surgeon and patient during a low-dose radiation procedure. METHODS: We conducted a prospective multicenter study in France from November 2014 to April 2015. Four spine centers were monitored for radiation received by surgeons during interventions for lumbar disk herniation and cervical disk herniation. RESULTS: A total of 134 patients were included. For lumbar disk herniation, the average exposure for the surgeon was 0.584 µSv on the chest, 5.291 µSv on the lens, and 9.295 µSv on the hands per procedure. For these procedures, the dose area product (DAP) was 94.2 ± 198.4 cGy·cm(2), and the fluoroscopic time was 10.2 ± 16.9 seconds. For a herniated cervical disk, the average exposure for the surgeon was 0.122 µSv on the chest, 3.106 µSv on the lens, and 7.143 µSv on the hands per procedure. For these procedures, the DAP was 35.7 ± 72.1 cGy·cm(2), and the fluoroscopic time was 19.7 ± 13.7 seconds. CONCLUSIONS: Exposure to x-rays for surgeons and patients during surgery for lumbar disk herniation is higher than during surgery for cervical herniation disk. Our results show that radiation exposure to the spine surgeon is still far below the annual dose limits.