Evaluation of Turnaround Times of Diagnostic Biopsies: A Metric of Quality in Surgical Pathology.

Introduction. Timely and accurate diagnosis of diseases is crucial for effective patient care. Turnaround time (TAT) in surgical pathology, defined as the time between accessioning the sample and reporting results, is a key performance indicator reflecting quality and efficiency. This study explores factors affecting TAT for diagnostic biopsies in a tertiary oncology hospital. Methods. A 1-month pilot study was conducted, focusing on 695 in-house diagnostic biopsies. Biopsies were categorized as routine (requiring only hematoxylin and eosin (H&E) staining) or complex cases (requiring additional tests). TAT was defined as the time between sample accessioning and report availability in the electronic medical record, with delays defined as exceeding 3 days for routine cases and 4 days for complex cases. Survival analysis using Kaplan-Meier plots was utilized to analyze TAT. Results. The overall mean TAT was 3.7 ± 2 days, with routine cases at 3.1 ± 2 days and complex cases at 4.8 ± 2 days (P < 0.001). Survival analysis revealed prolonged TAT for complex cases. Organ-specific analysis highlighted variations in TAT, with brain biopsies presenting the highest complexity and longest TAT. Surprisingly, malignant cases demonstrated slightly shorter TATs compared to benign cases (P = 0.026). Delays were observed in 34% of all cases. Conclusions. Laboratory TAT is crucial and is frequently used as a performance benchmark. We analyzed the various causes of delayed TAT in our hospital's histopathology department, with an emphasis on variables in the analytical phase. The results of this study demonstrate that cases involving ancillary techniques had significantly longer TATs compared to routine H&E cases.

Harmonizing sound and light: X-ray imaging unveils acoustic signatures of stochastic inter-regime instabilities during laser melting.

Laser powder bed fusion (LPBF) is a metal additive manufacturing technique involving complex interplays between vapor, liquid, and solid phases. Despite LPBF's advantageous capabilities compared to conventional manufacturing methods, the underlying physical phenomena can result in inter-regime instabilities followed by transitions between conduction and keyhole melting regimes - leading to defects. We investigate these issues through operando synchrotron X-ray imaging synchronized with acoustic emission recording, during the remelting processes of LPBF-produced thin walls, monitoring regime changes occurring under constant laser processing parameters. The collected data show an increment in acoustic signal amplitude when switching from conduction to keyhole regime, which we correlate to changes in laser absorptivity. Moreover, a full correlation between X-ray imaging and the acoustic signals permits the design of a simple filtering algorithm to predict the melting regimes. As a result, conduction, stable keyhole, and unstable keyhole regimes are identified with a time resolution of 100 µs, even under rapid transitions, providing a straightforward method to accurately detect undesired processing regimes without the use of artificial intelligence.

Additive manufacturing of alloys with programmable microstructure and properties.

In metallurgy, mechanical deformation is essential to engineer the microstructure of metals and to tailor their mechanical properties. However, this practice is inapplicable to near-net-shape metal parts produced by additive manufacturing (AM), since it would irremediably compromise their carefully designed geometries. In this work, we show how to circumvent this limitation by controlling the dislocation density and thermal stability of a steel alloy produced by laser powder bed fusion (LPBF) technology. We show that by manipulating the alloy's solidification structure, we can 'program' recrystallization upon heat treatment without using mechanical deformation. When employed site-specifically, our strategy enables designing and creating complex microstructure architectures that combine recrystallized and non-recrystallized regions with different microstructural features and properties. We show how this heterogeneity may be conducive to materials with superior performance compared to those with monolithic microstructure. Our work inspires the design of high-performance metal parts with artificially engineered microstructures by AM.

Encapsulation of Electron Beam Melting Produced Alloy 718 to Reduce Surface Connected Defects by Hot Isostatic Pressing.

Defects in electron beam melting (EBM) manufactured Alloy 718 are inevitable to some extent, and are of concern as they can degrade mechanical properties of the material. Therefore, EBM-manufactured Alloy 718 is typically subjected to post-treatment to improve the properties of the as-built material. Although hot isostatic pressing (HIPing) is usually employed to close the defects, it is widely known that HIPing cannot close open-to-surface defects. Therefore, in this work, a hypothesis is formulated that if the surface of the EBM-manufactured specimen is suitably coated to encapsulate the EBM-manufactured specimen, then HIPing can be effective in healing such surface-connected defects. The EBM-manufactured Alloy 718 specimens were coated by high-velocity air fuel (HVAF) spraying using Alloy 718 powder prior to HIPing to evaluate the above approach. X-ray computed tomography (XCT) analysis of the defects in the same coated sample before and after HIPing showed that some of the defects connected to the EBM specimen surface were effectively encapsulated by the coating, as they were closed after HIPing. However, some of these surface-connected defects were retained. The reason for such remnant defects is attributed to the presence of interconnected pathways between the ambient and the original as-built surface of the EBM specimen, as the specimens were not coated on all sides. These pathways were also exaggerated by the high surface roughness of the EBM material and could have provided an additional path for argon infiltration, apart from the uncoated sides, thereby hindering complete densification of the specimen during HIPing.

Can Appropriate Thermal Post-Treatment Make Defect Content in as-Built Electron Beam Additively Manufactured Alloy 718 Irrelevant?

Electron beam melting (EBM) is gaining rapid popularity for production of complex customized parts. For strategic applications involving materials like superalloys (e.g., Alloy 718), post-treatments including hot isostatic pressing (HIPing) to eliminate defects, and solutionizing and aging to achieve the desired phase constitution are often practiced. The present study specifically explores the ability of the combination of the above post-treatments to render the as-built defect content in EBM Alloy 718 irrelevant. Results show that HIPing can reduce defect content from as high as 17% in as-built samples (intentionally generated employing increased processing speeds in this illustrative proof-of-concept study) to <0.3%, with the small amount of remnant defects being mainly associated with oxide inclusions. The subsequent solution and aging treatments are also found to yield virtually identical phase distribution and hardness values in samples with vastly varying as-built defect contents. This can have considerable implications in contributing to minimizing elaborate process optimization efforts as well as slightly enhancing production speeds to promote industrialization of EBM for applications that demand the above post-treatments.

Performance of Hybrid Powder-Suspension Axial Plasma Sprayed Al2O3-YSZ Coatings in Bovine Serum Solution.

Ceramic coatings on metallic implants are a promising alternative to conventional implants due to their ability to offer superior wear resistance. The present work investigates the sliding wear behavior under bovine serum solution and indentation crack growth resistance of four coatings, namely (1) conventional powder-derived alumina coating (Ap), (2) suspension-derived alumina coating (As), (3) composite Al2O3-20wt % Yittria stabilized Zirconia (YSZ) coating (AsYs) deposited using a mixed suspension, and (4) powder Al2O3-suspension YSZ hybrid composite coating ApYs developed by axial feeding plasma spraying, respectively. The indentation crack growth resistance of the hybrid coating was superior due to the inclusion of distributed fine YSZ particles along with coarser alumina splats. Enhanced wear resistance was observed for the powder derived Ap and the hybrid ApYs coatings, whereas the suspension sprayed As and AsYs coatings significantly deteriorated due to extensive pitting.