[The radiation dose problem in computed tomography. Actual data and strategies for a corrected use of ionizing radiation in computed tomography]. / Il problema della dose di radiazioni in tomografia compute- rizzata. dati attuali e strategie per un corretto utilizzo delle radiazioni ionizzanti in tomografia computerizzata.

New technologies in these years has taken to a spread and to a growth of the CT application with an increase of patients and population exposure. In clinical practice some technical devices can be used to reduce the exposure dose of multidetector CT that allows radiologist to answer the clinical question with less damage to the patient. The radiologist remains however the guarantor of the ionizing radiation exposition and he has to consider also the opportunity to use other methodics (MR, US) to answer some questions. The radiologist has the role to evaluate the clinical indication to the exam demanded from other doctor and has the responsibility for exam management and for progressive radiologic course, controls and follow-up.

[Imaging of simple and complicated acute cholecystitis]. / Imaging delle colecistiti acute semplici e complicate.

Acute Cholecystitis is a common disease and it needs to be treated in emergency. In case of complication, surgery is mandatory in 48-72 hours. Ultrasonography (US) is the first diagnostic step in that it allows to identify the signs of major complications, not always visible. Spiral CT identifies complications misdiagnosed at US and allows a correct classification. However, spiral CT is able to depict fluid collections or gas in the wall or in the lumen of the gallbladder or free air in the peritoneum, signs not always depicted by US and which also needs surgical treatment in emergency. If one or more signs of complications are present, CT is mandatory to identify complicated cholecystitis (phlegmonous or empyematous cholecystitis, abscesses, emphysematous, gangrenous, hemorragic or perforated cholecystitis) and to indicate its urgent surgery.

[CT and MR virtual colonscopy: indications, limits and comparison with conventional colonscopy]. / Colonscopia virtuale TC e RM: indicazioni, limiti e confronto con la colonscopia tradizionale.

Virtual endoscopy is a new method for studying the colon; it consists in acquisition of CT and MR images and to elaborate them with a workstation, to create endoluminal vision as like as traditional colonscopy, permitting the complete exploration of colonic lumen, also with stenotic tumors. The analysis of the differences between CT and MR colography shows like these two techniques present both advantages and disadvantages, such as the impossibility to perform MR in patients with pace-maker or in claustrophobic patients and the impossibility to perform CT with iodated agents in patients with renal failure or with a story of adverse reactions. The increased use of these techniques is due to the high sensitivity of last-generation CT and MR machine, to the increased spatial resolution, to specific softwares for digital cleaning of colon, to the introduction of high-end workstations and to the possibility of computed assisted diagnosis (CAD). So, it is desiderable that the increasing spread of multidetector CT devices and the future technical innovations, should have the effect to increase culture and experience in various diagnostic centers about CT-colography, making possible the spreading of virtual endoscopy as a screening tool.

[Imaging of median sternotomy complications]. / Imaging delle complicanze dopo sternotomia mediana.

Median sternotomy is the surgical technique of chosen for cardiac surgery. Although the complications after median sternotomy are not so frequent, these are associated to elevated mortality. The complications can interest the presternal compartment, the sternal compartment or the retrosternal compartment. Even if the clinical diagnosis of infection is not difficult for the clinician, it is nearly impossible to establish the depth of the infection. Multislice CT, thanks to the possibility to obtain thin layers and three-dimensional multiplanar reconstructions and Volume Rendering, turns out extremely useful for being able to demonstrate the extension and the depth of the infection. Of fundamental importance it is the elaboration of the images, executed on workstation, with which multiplanar reformatted and Volume Rendering images are obtained. The CT turns out useful moreover like guide for the execution of interventional procedures such as aspiration of material for bacteriological characterization or eventual positioning of a catheter for abscess drainage. The Magnetic Resonance, thanks to its high resolution of contrast and to its multiplanarity, finds one of its elective applications in the study of the flogistic and neoplastic processes of the soft tissues. A great limit of the MR is the possible generation of artifacts due to sternal suture.

[Imaging update in geriatric oncology]. / Attualità nell'imaging in oncologia geriatrica.

The cancer is a problem that plagues all the ages but the greater part of the malignant tumors hits the old persons. The more elevated incidence sites of primary tumor in geriatrical age are the prostate, the lung and the colon-rectum in the men and the breast, the colon-rectum, the lung and the stomach in the women. The imaging has made steps of giant in the last few decades, with the introduction of new equipment and methodical news so as to assure everybody early and accurated diagnosis. For the lung carcinoma great advantages have been bring to us with the introduction of CT-PET and the multislice CT, that has concurred the execution of virtual bronchoscopy. The virtual endoscopy has been applied with happening also in the screening of the carcinoma of colon-rectum, executed through CT or MR. New MR technologies have allowed perform spectroscopic studies in such organs as prostate and breast, bringing the biochemical diagnosis beyond that morphologic. The MR then turns out fundamental in the appraisal of the Patient with bone metastases thanks also to the new whole body examinations. Finally the recent technology has allowed the execution of multiorgan CT screening bringing in this way new possibilities but also new questions.

[Role of imaging in the evaluation and characterization of adrenal masses]. / Ruolo dell'imaging nella identificazione e caratterizzazione delle masse surrenaliche.

The primary role of imaging in identification as well as in characterization adrenal lesions has been demonstrated by several studies. The recent technologic progress has allowed to identify adrenal lesions even when they are very small, with a consequent conspicuous increase of the frequency of incidentalomas. Computed Tomography, Magnetic Resonance and Nuclear Medicine are routinely used to evaluate adrenal glands and their pathologic conditions. The aim of this article is to show how the imaging is employed to assess adrenal masses, with special regard to the contribution given by Computed Tomography (CT) and Magnetic Resonance (MR) imaging to the differential diagnosis between benignant and malignant lesions.

[Emergency Radiology layout]. / Risorse tecnologiche in radiologia d'emergenza.

The purpose of Radiologic Unit in Emergency is to reach diagnostic and therapeutic effectiveness in the best way and in less time possible. The Portable Ultrasound Device is an instrument necessary in Emergency Room and in ambulance/helicopter to evaluate the evidence of endoperitoneal bleeding. The CT is the radiologic methodic more fast that permits a complete evaluation of all body segments in traumatized patient in the famous "golden hour" after the trauma, therefore it would be placed in Emergency Area. The multislice CT brought to a reduction of morbidity and mortality, thanks to a quick acquisition, to a thin collimation, to a more spatial resolution and to an optimal vessel opacization, determining a saving of hospital global costs, therefore a reduction of percentage of not necessaries operations and permitting a more rapid diagnosis, obtaining a considerable reduction of waiting in Trauma Emergency Room with more rapid and aimed therapies and a consequent costs reduction. To satisfy a so wide question of radiologic exams necessaries devices are informatic systems completely connected between Radiology department and other departments. Main advantages of MR in Emergency are the use of non ionising radiations, the possibility to effect diffusion and perfusion studies and to evaluate spinal cord damage. Reduction of time of patient preparation and times of acquisition and elaboration of imagines by modern and performant devices is basic to make more rapid therapeutic decisions.

Ultrasonographic and spiral CT evaluation of simple and complicated acute cholecystitis: diagnostic protocol assessment based on personal experience and review of the literature.

PURPOSE: The aim of this study was to identify and classify the ultrasonographic and computed tomography (CT) signs of simple and complicated acute cholecystitis and to define the correct diagnostic protocol. MATERIALS AND METHODS: We retrospectively reviewed 35 patients (23 men and 12 women; mean age 66.6 years) presenting with acute cholecystitis who were assessed by emergency ultrasonography (US) (30/35 cases) and spiral CT (12/35 cases); all patients underwent emergency surgery. The US signs were analysed and classified as major criteria (wall thickening and stratification, distension, Murphy's sign), minor criteria (bile stones, sludge, and biliary tract dilatation), and complication signs (gas collections, aerobilia, fluid collection, difficult or missed identification of the gallbladder). Imaging results were compared with histological findings (gold standard), and accuracy, sensitivity, specificity, and positive and negative predictive values (PPVs and NPVs) were assessed for each modality. Concordance between the US and CT findings was also evaluated for cases undergoing both examinations; additional findings provided by one or the other modality were also assessed. RESULTS: US had an accuracy of 66.6%, a sensitivity of 37.5%, a specificity of 70%, a PPV of 100%, and an NPV of 58.3%. CT had 100% accuracy, sensitivity, and specificity. Concordance between US and CT was observed for diagnosis of complications, but CT provided additional findings in all cases. The majority of complicated cases undergoing US examination (68.7%) revealed more than two major criteria and one minor criterion or at least one sign of complication. CONCLUSIONS: If more than two major signs associated with one minor sign or at least one sign of complication are present at US, CT is mandatory to recognise and thoroughly evaluate the type of complication and indicate appropriate treatment.

Multidetector CT-generated virtual bronchoscopy: an illustrated review of the potential clinical indications.

Multidetector computed tomography-generated virtual bronchoscopy (VB) is a recent technical development that allows visualisation of the lumen and wall of the trachea and proximal part of the bronchial tree. A dynamic image is produced that resembles what is seen with fibreoptic bronchoscopy (FB). Although the technique has not yet reached daily clinical practice and it can never replace FB, performing VB can be useful in well-defined clinical situations. In this paper, the value and limitations of virtual bronchoscopy will be reviewed, to illustrate the potential role of virtual bronchoscopy in the evaluation of trachea and bronchial tree pathology.

[The radiologic report and its readability]. / Il referto radiologico e la sua leggibilità.

AIM: The aim of this study was to evaluate the readability of radiologic reports and to determine whether they can be improved by modifying then according to precisely defined rules. MATERIAL AND METHODS: Forty reports, 10 for each diagnostic procedure (conventional radiography, US, CT, MRI); were randomly selected from a corpus of 400. The reports were analysed quantitatively using a dedicated software and qualitatively taking into account the formal, syntactic and lexical aspects of linguistically correct language and specially defined rules. On the basis of the collected results the reports were modified and analysed. RESULTS: Once again the modifications resulted in increased legibility (as testified by readability indices) that was more evident in US and X-ray reports and less evident in CT and MR reports because of the quantity of technical terms. It hoped that a radiological lexicon and guidelines for report writing will be widely adapted, so that radiologic reports will be more readable and easy understand.