Significant chronic airway abnormalities in never-smoking HIV-infected patients.

OBJECTIVES: The aim of the study was to describe chronic lung disease in HIV-infected never-smokers by looking at clinical, structural and functional abnormalities. METHODS: This comparative cross-sectional study included 159 HIV-infected never-smoking patients [mean (± standard deviation) age 54.6 ± 9.1 years; 13.2% female; 98.1% with undetectable viral load] and 75 nonmatched never-smoking controls [mean (± standard deviation) age 52.6 ± 6.9 years; 46.7% female]. We examined calcium scoring computer tomography (CT) scans or chest CT scans, all with a lung-dedicated algorithm reconstruction, to assess emphysema and airway disease (respiratory bronchiolitis and/or bronchial wall thickening), tested pulmonary function using spirometry, lung volumes and the diffusion lung capacity of carbon monoxide (DLCO), and assessed respiratory symptoms using the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT). RESULTS: Twenty-five (17.2%) of the HIV-infected patients versus two (2.7%) of the controls had a CAT score > 10. Only 5% of the HIV-infected patients showed FEV1% < 80%, and 25% had DLCO < 75% of the predicted value. Based on the CT scans, they had increased prevalences, compared with the controls, of airway disease (37% versus 7.9%, respectively) and emphysema (18% versus 4%, respectively), with more severe and more frequent centrilobular disease. After correction for age, sex and clinical factors, HIV infection was significantly associated with CAT > 10 [odds ratio (OR) 7.7], emphysema (OR 4), airway disease (OR 4.5) and DLCO < 75% of predicted (OR 4). CONCLUSIONS: Although comparisons were limited by the different enrolment methods used for HIV-infected patients and controls, the results suggest that never-smoking HIV-infected patients may present with chronic lung damage characterized by CT evidence of airway disease. A minority of them showed respiratory symptoms, without significant functional abnormalities.

Diagnostic accuracy of a velcro sound detector (VECTOR) for interstitial lung disease in rheumatoid arthritis patients: the InSPIRAtE validation study (INterStitial pneumonia in rheumatoid ArThritis with an electronic device).

BACKGROUND: Interstitial lung disease (ILD) is a severe systemic manifestation of rheumatoid arthritis (RA). High-resolution computed tomography (HRCT) represents the gold standard for the diagnosis of ILD, but its routine use for screening programs is not advisable because of both high cost and X-ray exposure. Velcro crackles at lung auscultation occur very early in the course of interstitial pneumonia, and their detection is an indication for HRCT. Recently, we developed an algorithm (VECTOR) to detect the presence of Velcro crackles in pulmonary sounds and showed good results in a small sample of RA patients. The aim of the present investigation was to validate the diagnostic accuracy of VECTOR in a larger population of RA patients, compared with that of the reference standard of HRCT, from a multicentre study. METHODS: To avoid X-ray exposure, we enrolled 137 consecutive RA patients who had recently undergone HRCT. Lung sounds of all patients were recorded in 4 pulmonary fields bilaterally with a commercial electronic stethoscope (ES); subsequently, all HRCT images were blindly evaluated by a radiologist, and audio data were analysed by means of VECTOR. RESULTS: Fifty-nine of 137 patients showed ILD (43.1%). VECTOR correctly classified 115/137 patients, showing a diagnostic accuracy of 83.9% and a sensitivity and specificity of 93.2 and 76.9%, respectively. CONCLUSIONS: VECTOR may represent the first validated tool for the screening of RA patients who are suspected for ILD and who should be directed to HRCT for the diagnosis. Moreover, early identification of RA-ILD could contribute to the design of prospective studies aimed at elucidating unclear aspects of the disease.

Non-surgical Management of Blunt Splenic Trauma: A Comparative Analysis of Non-operative Management and Splenic Artery Embolization-Experience from a European Trauma Center.

PURPOSE: The objective of our study was to retrospectively compare the outcomes of non-operative management (NOM) and splenic artery embolization (SAE) in the management of hemodynamically stable patients with splenic injuries. MATERIALS AND METHODS: In a 5-year period, 109 patients were recorded; 60/109 were treated with NOM and 49/109 with SAE. For each patient, the following parameters were assessed: Glasgow coma scale, injury severity score, American Association for the Surgery of Trauma splenic injury grade, transfusion requirements, hemoglobin level, presence of a splenic vascular lesion (SVL) and amount of hemoperitoneum (Bessoud scale). Different SAE techniques (proximal, distal, combined) with different materials were employed. Clinical success was defined as spleen conservation at 30 days; failure was defined as spleen re-bleeding within 30 days, requiring splenectomy. Student's t test or Chi-square analysis and the Kaplan-Mayer curve were used to analyse each group's results and compare them with those of the other group. RESULTS: In the SAE group, AAST splenic injury grade was higher and serum hemoglobin levels were lower. The SAE group had significantly more SVL and hemoperitoneum compared to the NOM group. The clinical success rate was not significantly different between groups (NOM = 95%, SAE = 87.8%; p = 0.16). Sixty-six percent of NOM failures were related to inadequate patient selection, while 67% of SAE failures were due to technical/procedural issues. CONCLUSION: Our study observed a high splenic salvage rate with the use of SAE as an adjunct to NOM, and suggests that it may be further improved with appropriate patient selection and an improved embolization technique.

Os acromiale: frequency and a review of 726 shoulder MRI.

Os acromiale consist in a lack of fusion between the different ossification spots of the acromial side of scapula from the age of 23-25 years. A relation between os acromiale and some shoulder pathology like impingement syndrome, cuff tear and subacromial bursitis has been described. The etiology is not already known. The aim of this study was to evaluate the frequency of os acromiale in our population, the link between os acromiale and sex, side and shoulder pathology. 1042 shoulder MRI were evaluated to find out os acromiale and the linked cuff pathology. In our population, the frequency of os acromiale was 3.44% without differences between sexes, with prevalence on the right shoulder. No differences in cuff and bursa pathology were present between affected and unaffected subjects. Os acromiale is an anomaly still underdiagnosed. It is important to be recognized because it allows to make an accurate pre-surgical plan. To make a correct diagnosis, axial MRI cut or TC is necessary.

Linking food web functioning and habitat diversity for an ecosystem based management: a Mediterranean lagoon case-study.

We propose a modelling approach relating the functioning of a transitional ecosystem with the spatial extension of its habitats. A test case is presented for the lagoon of Venice, discussing the results in the context of the application of current EU directives. The effects on food web functioning due to changes related to manageable and unmanageable drivers were investigated. The modelling procedure involved the use of steady-state food web models and network analysis, respectively applied to estimate the fluxes of energy associated with trophic interactions, and to compute indices of food web functioning. On the long term (hundred years) temporal scale, the model indicated that the expected loss of salt marshes will produce further changes at the system level, with a lagoon showing a decrease in the energy processing efficiency. On the short term scale, simulation results indicated that fishery management accompanied by seagrass restoration measures would produce a slight transition towards a more healthy system, with higher energy cycling, and maintaining a good balance between processing efficiency and resilience. Scenarios presented suggest that the effectiveness of short term management strategies can be better evaluated when contextualized in the long term trends of evolution of a system. We also remark the need for further studying the relationship between habitat diversity and indicators of food web functioning.

In vivo effect of two different pulsed electromagnetic field frequencies on osteoarthritis.

Osteoarthritis (OA) is a joint pathology characterized by fibrillation, reduced cartilage thickness and subchondral bone sclerosis. There is evidence that pulsed electromagnetic fields (PEMFs) counteract OA progression, but the effect of two different PEMF frequencies has not yet been shown. The aim of this study was to test the effectiveness of PEMFs at two different frequencies (37 and 75 Hz) in a late OA stage in 21-month-old Guinea pigs. After 3 months of 6 h/day PEMF stimulation, histological and histomorphometric analyses of the knees were performed. At both frequencies, PEMFs significantly reduced histological cartilage score, fibrillation index (FI), subchondral bone thickness (SBT) and trabecular number (Tb.N) and increased trabecular thickness (Tb.Th) and separation (Tb.Sp) in comparison to the not treated SHAM group. However, PEMFs at 75 Hz produced significantly more beneficial effects on the histological score and FI than 37 Hz PEMFs. At 75 Hz, PEMFs counteracted cartilage thinning as demonstrated by a significantly higher cartilage thickness values than either those of the SHAM or 37 Hz PEMF-treated groups. Although in severe OA both PEMF frequencies were able to limit its progression, 75 Hz PEMF stimulation achieved the better results.

Quantitative ethogram of male reproductive behavior in the South European toothcarp Aphanius fasciatus.

This work provides an ethogram of male reproductive behavior in the most widespread Mediterranean killifish, the South European toothcarp Aphanius fasciatus. The ethogram was obtained by video-recording the behavior of breeding groups under aquarium conditions. The behavioral analysis revealed the existence of seven behavioral states, with the expression of different forms of male-male competition: single and multiple courtship, single and multiple spawning, aggression, homosexual courtship, and post-mating cannibalism. These behaviors were organized into sequences that followed a first-order Markov chain. Single courtship was the most prevalent behavior, but more than one male, from two to five, could participate simultaneously in courtship and spawning. Results suggested that the breeding system is based on mate monopolization, with high levels of sperm competition and parasitic spawning. Results are discussed in light of the current literature on alternative mating tactics and male-male competition in teleost fishes.

Vulnerability of artisanal fisheries to climate change in the Venice Lagoon.

Within the context of global warming, the western coast of the northern Adriatic Sea can be regarded as an extremely vulnerable area. Owing to the local geographic features, this area has been described as the Venetian lacuna, where Mediterranean Sea climatic conditions are replaced by Atlantic Ocean ones, supporting the presence of glacial relicts, such as sprat Sprattus sprattus, flounder Platichthys flesus and brown shrimp Crangon crangon. Nektonic assemblage therefore represents a good candidate in terms of an early proxy for thermal regime alterations. It represents a dynamic component of the lagoon ecosystem, changing in space and time, actively moving through the entire system, and dynamically exchanging with the open sea. Here, the first signals of the change have been already detected, such as the presence of alien thermophilic species. Within this context, since the beginning of the century, sampling of the nektonic assemblage has been carried out, integrating them with landings data from the fish market. Vulnerabilities to thermal regime changes have been tested by (1) categorizing species according to the mean distribution area in terms of latitudinal range (over 45°, 30°-45° and below 30°), and (2) analysing both spatial and temporal variations within fishing grounds. Results indicated a high potential vulnerability of the artisanal fishery to climate change, as the commercial catch is entirely composed of species from cold (>45° N) and temperate (between 45° and 30° N) latitudes. At present no alien thermophilic species have been recorded within the lagoon, which is possibly a sign of good resilience of the assemblage. Finally, abundance of species from cold latitudes has decreased during the past decade. All of this has been discussed in the context of the mean annual temperature trend.

Sexual dimorphism of vertical bar patterning in the South European toothcarp Aphanius fasciatus.

Sexual dimorphism of vertical bar patterning along the ontogenetic gradient was investigated in the South European toothcarp Aphanius fasciatus through the analysis of field samples collected from four different Venice Lagoon sites. Results suggested that, after controlling for site effect, vertical bar number and density were more correlated with size in females than in males, yielding a higher number of less spaced bars in females than in males. Results are discussed with regard to the interplay between natural and sexual selection acting on vertical bar dimorphism, suggesting a role of disruptive colouration in females and a more pronounced role of sexual selection in males.

Mitochondrial DNA variability of the pipefish Syngnathus abaster.

This study provides data on the genetic structuring of the pipefish Syngnathus abaster in the western Mediterranean and Adriatic Seas. A total of 109 specimens were collected in brackish-water biotopes. The control region and three other regions of the mitochondrial genome were analysed. The most relevant result was the high genetic structuring found by Bayesian inference (BI), maximum likelihood (ML) and network analyses, which were consistent in showing three well-separated clusters of S. abaster populations. Furthermore, BI and ML did not support the monophyly of the taxon S. abaster. These results suggest the occurrence of a species complex in the study area, whose differentiation may have occurred since the Pleistocene. The results also show a very high genetic variability at the inter-population level, with no shared haplotypes among sites. Evolutionary forces due to the fragmented nature of the brackish-water habitats may account for the high genetic divergence found among the groups and populations. Finally, although dispersal by rafting over long distances may occasionally occur, this study suggests linear stepping-stone model of colonization to be most likely. The complexity of the results obtained suggests that further studies are needed to elucidate the phylogeny of S. abaster.

In vitro tenocyte metabolism in aging and oestrogen deficiency.

Little is known about tendons and tenocyte biological behaviour during aging and, especially, oestrogen deficiency. The aim of this study was to evaluate in vitro the proliferation and metabolism of tenocytes isolated from the Achilles tendons of ovariectomised (OVX), middle-aged (OLD) and young (YOUNG) rats. An in vitro model of micro-wound healing was also used to assess age and oestrogen deficiency differences in tendon healing. In standard culture condition, OLD and OVX tenocytes showed a significantly lower proliferation rate, collagen I, aggrecan and elastin than YOUNG ones. In OVX group, fibronectin and elastin significantly decreased in comparison to YOUNG and OLD groups, respectively, whereas vascular endothelial growth factor and metalloproteinases-13 increased than those of both YOUNG and OLD groups. In the micro-wound healing model, tenocytes from both OVX and OLD showed a significantly lower healing rate, proliferation rate, collagen I and nitrix oxide in comparison to YOUNG. OVX elastin value was significantly lower than YOUNG one and OVX healing rate and cell migration speed, proliferation rate and fibronectin results were lower, whereas collagen III and metalloproteinase-13 higher in comparison to both YOUNG and OLD groups. These results highlighted how aging and, more significantly, oestrogen deficiency negatively affect tendon metabolism and healing. Our work improves the body of knowledge on the effects of senescence and oestrogen deficiency on tenocyte behaviour and allows further studies to find solution for the prevention of tendon injuries in aging and menopause.

γ-Tocopherol inhibits human prostate cancer cell proliferation by up-regulation of transglutaminase 2 and down-regulation of cyclins.

To establish a system to study differentiation therapy drugs, we used the androgen-independent human prostate PC-3 tumor cell line as a target and α- and γ-tocopherol as inducers. Effects of α- and γ-tocopherol on the cell cycle, proliferation and differentiation, were examined. A more significant growth inhibition activity for γ- than for α-tocopherol was observed. Flow cytometry analysis of α- and γ-tocopherol-treated prostate carcinoma PC3 cells showed decreased progression into the S-phase. This effect, particularly evident for γ-tocopherol, was associated with an up-regulation and increased activity of transglutaminase 2 (TG2), a reduced DNA synthesis and a remarkable decreased levels of cyclin D1 and cyclin E. Activation of TG2 suggests that γ-tocopherol has an evident differentiative capacity on PC3 cells, leading to an increased expression of TG2, and reduced cyclin D1 and cyclin E levels, affecting cell cycle progression. It is feasible that up-regulation and activation of TG2, associated with a reduced proliferation, are parts of a large-scale reprogramming that can attenuate the malignant phenotype of PC3 cells in vitro. These data suggest further investigation on the potential use of this γ-form of vitamin E as a differentiative agent, in combination with the common cytotoxic treatments for prostate cancer therapy.

E-learning in radiology: an Italian multicentre experience.

OBJECTIVE: The aim of this study was to design, deliver and evaluate an e-learning teaching programme for post-graduate radiodiagnostics training that would involve various post-graduate schools throughout Italy. MATERIALS AND METHODS: All of the Directors of Italian post-graduate schools of radiodiagnostics were sent an e-mail on 27 September 2010 informing them of our willingness to set up an e-learning project for the academic year 2010-2011 in the form of single-subject teaching seminars. The proposed subjects were the semeiotics of the various organs and apparatuses in the context of "Urgent/Emergency Pathology". After having received registrations, a calendar of lessons was planned to be held between 10 November 2010 and 12 October 2011. The validity of the project was tested by means of a multiple-choice questionnaire covering the technical and didactic quality of the entire project, to be completed by the students. RESULTS: Fifty-one percent of the universities in Italy participated in the project: Trieste, Udine, Verona, Milan-Bicocca, Novara, Varese, Genoa, Sassari, Rome Campus, the Catholic University of Rome, Chieti, Foggia, Catania, Modena, Florence, Palermo, Bologna, Pavia, Parma and Ferrara. The lessons were attended by a total of 10,261 post-graduate medical students, for an average of 513.1 students per lesson. Seventy percent of the students judged the didactic content "excellent", 25% "good", and 5% "satisfactory"; none said it was unsatisfactory. In terms of visual quality (particularly the details of the radiological images proposed in the form of slides and/or video clips), 73% judged it "excellent", 20% "good", 6% "satisfactory", and 1% "poor". The audio quality was judged "excellent" by 71%, "good" by 22%, "satisfactory" by 6% and "poor" by 1%. In relation to judgement of audio and video quality, it has to be underlined that this was greatly affected by the hardware/software configuration and the band speed and technology of the Internet connection. CONCLUSIONS: Technological evolution is overcoming all barriers, and technology is also having a positive impact on the approach to teaching. Our multicentre teaching experience merits the following considerations: the quality of the teaching product was certified by the students' judgements of its didactic content and the quality of reception; the economic cost of the teaching had a minimal impact on the post-graduate schools (€ 18 per lesson). In terms of breaking down national barriers, it is to be hoped that the coordination and integration of diagnostic imaging e-learning projects, with the participation of post-graduate schools in different European countries, can be developed not only in a spirit of "cultural sharing" and the exchange of teaching experiences.

In vivo 3 T MR diffusion tensor imaging for detection of the fibre architecture of the human uterus: a feasibility and quantitative study.

OBJECTIVE: The aim of this study was to investigate the feasibility of depicting fibre architecture of human uteri in vivo using 3 T MR diffusion tensor imaging (MR-DTI) with a three-dimensional (3D) tractography approach. Quantitative results were provided. METHODS: In vivo 3 T MR-DTI was performed on 30 volunteers (9 Caesarean delivery). Main diffusion directions reflecting the fibre orientation were determined using sensitivity-encoding single-shot echo planar imaging with diffusion-sensitised gradients (b=600 mm(2) s(-1)) along 32 directions. A deterministic fibre-tracking algorithm was used to show in vivo fibre architecture, compared with ex vivo histological slides of cadaveric uteri. The number of fibres, the fibre density, the fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) were measured in 13 volunteers. RESULTS: Anisotropy was found in most regions of normal uteri and the preferential order of uterine fibres depicted, consisting of two representative fibre directions: circular and longitudinal, as in ex vivo studies. Two-thirds of uteri with a Caesarean scar did not have the same orientation of fibres in the anterior isthmus when compared with non-scarred myometrium. Quantitative data were obtained from 13 volunteers: Caesarean-scarred uteri (n=5) showed lower fibre number and density in the scarred anterior isthmus than the nulliparous uteri (n=8). No significant differences were found in FA (0.42 ± 0.02, 0.41 ± 0.02; p=0.25) and ADC (1.82 ± 0.18 × 10(-3) mm(2) s(-1), 1.93 ± 0.25 × 10(-3) mm(2) s(-1); p=0.20). CONCLUSION: Fibre architecture of the human uterus can be depicted in vivo using 3 T MR-DTI. Advances in knowledge 3 T MR-DTI can help to provide an in vivo insight of uterine anatomy non-invasively, especially in females with previous Caesarean surgery, in order to provide better management of subsequent deliveries.

Role of diffusion-weighted magnetic resonance imaging in prostate cancer evaluation.

PURPOSE: The authors analysed the role of diffusion-weighted imaging (DWI) as an additional tool in magnetic resonance (MR) evaluation of prostate cancer. MATERIALS AND METHODS: Forty-one patients with suspected prostate cancer underwent MR imaging (1.5 Tesla). A DWI sequence was added to the standard morphological protocol, with a maximum b value of 1,000 s/mm(2). Diffusion maps were obtained, and the apparent diffusion coefficient (ADC) was calculated by drawing a region of interest (ROI) over healthy tissue and areas suspicious for malignancy. Histology was considered the gold standard. RESULTS: The areas correctly classified by MR imaging (42/51) had a low signal intensity on T2-weighted imaging and low ADC value (0.99 ± 0.15 mm(2)/s; p<0.01) compared with the healthy peripheral zone (PZ) (1.73 ± 0.27 mm(2)/s; p<0.01). Nine areas classified as suspicious for malignancy on T2-weighted sequences showed high ADC (1.44 ± 0.06 mm(2)/s; p<0.01) and were confirmed to be disease free by subsequent histological examination. The accuracy of morphofunctional MR imaging was 81.6% compared with 73.7% of the morphological analysis alone. CONCLUSIONS: The addition of DWI to the standard protocol increases the overall diagnostic performance of MR imaging in detecting prostatic cancer. Thus, DWI can help the clinician determine the most appropriate management strategy for the patient.

Injectable calcium-phosphate-based composites for skeletal bone treatments.

Alpha-tricalcium-phosphate-based bone cements hydrolyze and set, producing calcium-deficient hydroxyapatite. They can result in an effective solution for bone defect reconstruction due to their biocompatibility, bioactivity and adaptation to shape and bone defect sizes, together with an excellent contact between bone and graft. Moreover, the integration of hydrogel phase based on poly(vinyl alcohol) (PVA) to H-cem-composed of α-tricalcium phosphate (98% wt) and hydroxyapatite (2% wt)-allows improving the mechanical and biological properties of the cement. The aim of this work was to evaluate the influence of the PVA on relevant properties for the final use of the injectable bone substitute, such as setting, hardening, injectability and in vivo behaviour. It was shown that by using PVA it is possible to modulate the setting and hardening properties: large increase in injectability time (1 h) in relation with the plain cement (few minutes) was achieved. Moreover, in vivo tests confirmed the ability of the composite to enhance bone healing in trabecular tissue. Histological results from critical size defects produced in rabbit distal femoral condyles showed after 12 weeks implantation a greater deposition of new tissue on bone-composite interfaces in comparison to bone-cement interfaces. The quality of bone growth was confirmed through histomorphometric and microhardness analysis. Bone formation in the composite implantation sites was significantly higher than in H-cem implants at both times of evaluation.

Osteopenic bone cell response to strontium-substituted hydroxyapatite.

Ionic substitution is a powerful tool to improve the biological performance of calcium phosphate based materials. In this work, we investigated the response of primary cultures of rat osteoblasts derived from osteopenic (O-OB) bone to strontium substituted hydroxyapatite (SrHA), and to hydroxyapatite (HA) as reference material, compared to normal (N-OB) bone cells. Strontium (Sr) and calcium (Ca) cumulative releases in physiological solution are in agreement with the greater solubility of SrHA than HA, whereas the differences between the two materials are levelled off in DMEM, which significantly reduced ion release. O-OB cells grown on SrHA exhibited higher proliferation and increased values of the differentiation parameters. In particular, Sr substitution increased the levels of proliferation, alkaline phosphatase, and collagen type I, and down-regulated the production of interleukin-6 of O-OB cells, demonstrating a promising future of SrHA in the treatment of bone lesions and defects in the presence of osteoporotic bone.

Role of magnetic resonance imaging in the detection of anastomotic biliary strictures after liver transplantation.

INTRODUCTION: Biliary complications after orthotopic liver transplantation (OLT) are the principal cause of morbidity and graft dysfunction, ranging in incidence from 5.8% to 30% of cases. Biliary strictures are the most frequent type of late complication. The aim of this study was to evaluate the role of magnetic resonance cholangiography (MRC) to detect biliary anastomotic strictures among patients undergone OLT with abnormal liver function tests. MATERIALS AND METHODS: One hundred twenty-one of 300 patients who underwent OLT were evaluated by MRC for clinically suspected anastomotic biliary strictures. In all patients, we performed various precholangiographic sequences including T1- and T2-weighted and MRC (radial SE 2D and SS-TSE 3D). Magnetic resonance imaging findings were subdivided as absence or presence of an anastomotic stricture. Diagnostic confirmation was obtained by endoscopic retrograde cholangiography (n=32), percutaneous transhepatic cholangiography (n=21) or surgical treatment (n=18). RESULTS: MRC detected 56 anastomotic biliary strictures, 53 of which were confirmed by other imaging modalities. MRC showed two false-negative cases and three false-positive cases. The sensitivity, specificity, positive and negative predictive values, and accuracy of MRC to detect biliary strictures were 96%, 96%, 95%, 97%, and 96%, respectively. CONCLUSION: MRC proved to be a reliable noninvasive technique to visualize the biliary anastomosis and depict biliary strictures after OLT. MRC should be used when a biliary anastomotic stricture is suspected in an OLT patient.

E-learning in radiology: Italian multicentre experience.

PURPOSE: The aim of our work was to design, implement and evaluate an e-learning programme in favour of trainee radiologists enrolled at the many specialty schools located throughout Italy, in the spirit of "sharing culture". MATERIALS AND METHODS: Once a common educational programme and time slot had been identified and planned, the programme was delivered via Internet-based video conferencing once a week for 2-h lectures. Each lecture was followed by interaction between the teaching staff and trainees at the individual sites. The universities involved were Trieste, Udine, Verona, Milano Bicocca, Novara, Varese, Genova, Sassari, Rome "Campus", Rome "Cattolica", Chieti, Foggia, Catania, Modena and Firenze. The University of Rome "Cattolica" participated in the project with two locations: Rome "Policlinico Gemelli" and Rome "Cattolica Campus of Campobasso". RESULTS: Eighteen lectures were conducted, for a total of 36 h. "Transient" connection interruption occurred 13 times for a total of 33 min over 2,160 min of lessons. Video quality and, in particular, details of radiological images shown in slides or moving pictures, were rated as very good by 71% of trainees, good by 24% and satisfactory by 4.5%; no one gave a rating of unsatisfactory. CONCLUSIONS: Based on our experience, whereas e-learning in radiology has become established and compulsory, there is the need for legislation that on the one hand protects online teaching activity and on the other allows study and continuing medical education (CME) credits to be recognised.