18F-FDGPET/CT: diabetes and hyperglycaemia

BACKGROUND: Some patients who undergo 18F-FDG PET/CT for neoplastic or benign disease are also affected by diabetes or hyperglycaemia. We propose different preparation procedures in patients (pts) with hyperglycaemia (acute, temporary or chronic) or diabetes (type 1 or 2) at the time of the 18F-FDG injection, in order to improve the diagnostic scheduling of 18F-FDG PET/CT. MATERIAL AND METHODS: We evaluated a sample of 13,063 pts, examined in two different PET/CT centres, one with a stationary scanner (94.4%) and the other with a mobile device (5.6%). High blood sugar was present in 1,698 patients (13%) at the time of the 18F-FDG injection (hyperglycaemia was defined as fasting blood glucose > 11.1 mmol/l). We considered all 18F-FDG PET/CT tests performed over a period of 4 years (2006-2009). In the first 2 years (6,236 tests), scheduling was done directly by the administrative secretary. In the next two years, 6,827 pts underwent a preliminary visit to assess the test indications, medical history, and therapy as well as pre-test preparation. We evaluated different preparation protocols for hyperglycaemic or diabetic pts, especially those recommended in the guidelines of the European Association of Nuclear Medicine (EANM) and Society of Nuclear Medicine (SNM). RESULTS: In the four-year period, 713/13,063 patients (5.45%) were rescheduled; of these, 78.8% were rescheduled in the two years before the implementation of our preparation protocols and 21.2% in the next two years. Before the implementation of our preparation protocols, 562 patients (9%) presented occasional, acute or chronic hyperglycaemia (56.7%), or diabetes (43.3%), requiring postponement of the test to a later date. The test was not performed in 17 of 6,236 pts (0.27%) because of blood glucose levels above 11.1 mmol/l for several days, while in 16/6236 pts (0.26%) the 18F-FDG injection was performed despite high blood glucose levels, in view of the clinical urgency. After the implementation of the preparation protocols, 2.2% of pts were rescheduled because of occasional, acute or chronic hyperglycaemia (79%), or diabetes (21%); 0.1% of pts did not undergo the test because of chronic high blood glucose levels. Although the administration of insulin is recommended in the EANM and SNM guidelines, in our new preparation procedures experience it was not necessary, because we reduced the numbers of hyperglycaemic pts thanks to screening at the preliminary visit and a subsequent good preparation of the patient before scheduling. CONCLUSIONS: The application of our preparation protocols improves the on-time performance and diagnostic accuracy, and increases patients' compliance. Copyright © 2013 Via Medica

An Italian prospective multicenter study on colonoscopy practice and quality: What has changed in the last 10 years

Background: A relevant number of adenomas can be missed during colonoscopy. Aims: Assess the current status of colonoscopy procedures in Italian centers. Methods: A prospective observational study involving 17 hospitals (34 endoscopists) included consecutive patients undergoing standard colonoscopy. In the first phase, endoscopists performed consecutive colonoscopies. In the second phase, retraining via an online learning platform was planned, while in the third phase data were collected analogously to phase 1. Results: A total of 3,504 patients were enrolled. Overall, a BBPS score ≥6 was obtained in 95.6% of cases (94.8% and 96.9% in the pre- and post-training phases, respectively). 88.4% of colonoscopies had a withdrawal time ≥6 min (88.2% and 88.7% in the pre- and post-training phases). Median adenoma detection rate (ADR) was 39.1%, with no significant differences between the pre- and post-training phases (40.1% vs 36.9%; P = 0.83). In total, 81% of endoscopists had a ADR performance above the 25% threshold. Conclusion: High colonoscopy quality standards are achieved by the Italian hospitals involved. Quality improvement initiatives and repeated module-based colonoscopy-training have been promoted in Italy during the last decade, which appear to have had a significant impact on quality colonoscopy metrics together with the activation of colorectal cancer screening programs

Transport of swirling entropy waves through an axial turbine stator

The transport of entropy waves and their impact on the stage aerodynamics are still open questions. This paper shows the results of an experimental campaign that focuses on the swirling entropy waves advection through an axial turbine stator. The research aims at quantifying the aerodynamic impact of the swirling entropy waves on the first nozzle and characterizing their transport. The disturbance is generated by a novel entropy wave generator that ensures a wide set of different injection parameters. The device injects the disturbance axially, four different clocking positions are investigated. Measurements show a severe temperature attenuation of the swirling entropy wave at stator outlet. The high temperature location changes with the injection position as a result of the different interaction with the stator secondary flows. Depending on the injection position, the aerodynamic flow field is strongly perturbed by the injected swirl profile, instead the entropy wave effect is negligible