Clinical Risk Management in radiology. Part I: general background and types of error and their prevention.

The present contribution, presented as an Editorial, addresses the issue of patient safety in Radiology: this topic, of great current National and Regional interest, has stimulated a strong focus on accidents and mistakes in medicine, together with the diffusion of procedures for Risk Management in all health facilities. The possible sources of incidents in the radiological process are exposed, due to human errors and to system errors connected both to the organization and to the dissemination of Information Technology in the Radiological world. It also describes the most common methods and tools for risk analysis in health systems, together with some application examples presented in Part II.

The O3-Vet project: a veterinary electronic patient record based on the web technology and the ADT-IHE actor for veterinary hospitals.

A veterinary electronic patient record, compliant with the IT standards (HL7, DICOM and IHE), was developed at the School of Veterinary Medicine, University of Milan (Italy) in order to improve the veterinary hospital workflows, making the stored clinical data more homogenous and sharable, thereby increasing the integration with current and future software applications. The system was developed by open-source software in order to reduce the implementation and maintenance costs and to make the system sharable with other veterinary hospitals or research centers without additional costs. The system was tested from May to October 2006. Results show that the majority of the veterinarians involved in the test agreed on the advantages obtained by the use of application software concerning the availability of all the useful clinical data [71.4%], the quality of the diagnostic procedures [78.58%] and the efficiency [85.58%] of hospital activities.

Fractal analysis of lumbar vertebral cancellous bone architecture.

Osteoporosis is characterized by bone mineral density (BMD) decreasing and spongy bone rearrangement with consequent loss of elasticity and increased bone fragility. Quantitative computed tomography (QCT) quantifies bone mineral content but does not describe spongy architecture. Analysis of trabecular pattern may provide additional information to evaluate osteoporosis. The aim of this study was to determine whether the fractal analysis of the microradiography of lumbar vertebrae provides a reliable assessment of bone texture, which correlates with the BMD. The lumbar segment of the spine was removed from 22 cadavers with no history of back pain and examined with standard x-ray, traditional tomography, and quantitative computed tomography to measure BMD. The fractal dimension, which quantifies the image fractal complexity, was calculated on microradiographs of axial sections of the fourth lumbar vertebra to determine its characteristic spongy network. The relationship between the values of the BMD and those of the fractal dimension was evaluated by linear regression and a statistically significant correlation (R = 0.96) was found. These findings suggest that the application of fractal analysis to radiological analyses can provide valuable information on the trabecular pattern of vertebrae. Thus, fractal dimensions of trabecular bone structure should be considered as a supplement to BMD evaluation in the assessment of osteoporosis.

[Statistics of bone mineral density determined with a double-energy X-ray equipment]. / Statistica dei valori di densità minerale ossea determinati utilizzando una apparecchiatura a raggi X con doppia energia.

This study was aimed at analyzing the bone mineral density values measured in a non-selected sample of more than 2,500 Italian women from the Treviso province. The subjects were divided into nine 10-year age groups. The figures (%) in each age group are presumed to be constant over time, although arranged on a Gaussian curve because of high interperson variability. The tables with normal rates, made on the basis of the data obtained, represent the reference parameters to evaluate bone mineral content in all the women referred to our hospital for this particular reason. The tables mirror, with the highest possible accuracy, the typical figures of the female population in Treviso, inasmuch as those findings were obtained from a statistically homogeneous sample (that is, uniform in nature). On the other hand, slight differences were observed relative to the figures of population segments other than our study population. Since the risk of bone fractures is related to how quickly bone mass decreases over time, seriated measurements should be compared with the normal curve which is similar in women of every race. Thus, the tables indicate probable normality whenever the figure found for one woman falls within the normal age and race ranges the patient belongs to. If the patient belongs to a population with different lifestyle and environmental factors, the tables are but indicative; for more accurate evaluation, a late control should be made. On the contrary, if rates are markedly lower than normal, a control should be made much sooner. Moreover, the correlations between the bone density rates found in different bone segments indicate the very poor chance of predicting fracture risk at a different point from the examined one. This means that the body areas at greater risk must be studied separately. Finally, we stress the reason why it is impossible to obtain the very same information from bone mineral content measurements on the whole skeleton and how these data can be used.

[The physical aspects of traditional radiology and of computed radiology compared]. / Aspetti fisici della radiologia tradizionale e della radiologia computerizzata a confronto.

In the last decade a new radiographic technique has been establishing itself which makes the most of technological progress in the fields of laser optics, of materials and of computer science and integrates conventional techniques introducing the digital image also into radiographic diagnosis. The authors, who have gained a wide experience in both the theory and the applications of Computed Radiography (CR), carefully reviewed Italian literature and found no review article on technical theoretical principles, while many such papers are found in international literature. Therefore, they took the lead for a review paper on this subject. For easier reading, the paper was divided into three parts: the first one is the necessary introduction to the physical parameters to understand radiographic images, i.e., the signal-to-noise ratio, the modulation transfer function, the Wiener spectrum and the detective quantum efficiency. The second part deals with the physical features of the formation of conventional radiographic images: the latest notions about the conversion of X-ray energy into light photons by intensifying screen phosphors are here reported. Finally, radiographic image readability is related to the characteristics of the screen-film system. The third part of the paper deals with CR, in particular with the problems related to image acquisition through the screens called imaging plates, to the laser reading technique and to image reconstruction. Finally, the different physical phenomena leading to radiant image degradation are examined sequentially, bearing in mind that the diagnostic yield of CR images can be improved with image processing, to obtain images which can be compared to conventional ones.

[Bone mineral content measurement: reflections on the equipment]. / Misura della componente minerale dell'osso: riflessioni sulle apparecchiature.

Metabolic bone disorders are extremely interesting from an epidemiological, clinical and social point of view. In particular, some of them are important for they are typical of elderly people--i.e., the portion of population which is on the increase due to the lengthening of the average life. On the other hand, thanks to the current intervention techniques, the number of chronic nephropathics (in whom metabolic bone conditions may develop) has markedly increased. Therefore, sufficiently reliable methods are needed to allow the thorough evaluation of bone mineral components. Unfortunately, these methods are only of quantitative value because they are unable to discriminate the statuses of the two essential bone components--i.e., cortex and spongiosa--; we all know that bone mineral loss can currently be quantified only when amounting to < 20% of the total value, due to the addition of the mineral contents of the two components. In this paper the authors briefly report on the noninvasive techniques currently in use for the measurement of bone mineral components, especially relative to their physical bases, the knowledge of which is essential for a correct evaluation. The authors accurately reviewed the literature data relative to the various techniques and compared the results obtained by the different authors. Thus, no personal experience is reported, since this paper is aimed at being considered as a reference mark for the reader to be helped in the choice of the equipment suiting him most. However, as to preventing metabolic osteopathies, quantitative methods cannot yield absolute data, which addresses the current research to densitometry by means of the Compton method. The latter may finally lead to the development of operative equipment allowing not only the separate measurement of cortical and spongiose values, but also the qualitative evaluation of bone status--i.e., not limited to mineral loss but including also the determination of the protein, fat and water components.