Basic knowledge and new advances in panoramic radiography imaging techniques: A narrative review on what dentists and radiologists should know

Objectives: A panoramic radiograph (PAN) is the most frequently diagnostic imaging technique carried out in dentistry and oral surgery. The correct performance of image acquisition is crucial to obtain adequate image quality. The aim of the present study is to (i) review the principles of PAN image acquisition and (ii) describe positioning errors and artefacts that may affect PAN image quality. Methods: Articles regarding PAN acquisition principles, patient’s positioning errors, artefacts, and image quality were retrieved from the literature. Results: Head orientation is of the utmost importance in guaranteeing correct image acquisition. Symmetry, occlusal plane inclination, mandibular condyles localization, cervical spine position, aspect of upper teeth root apexes, exposure parameters, and metal and motion artefacts are factors that greatly affect the image quality of a successful PAN. Conclusions: Several factors are the basis for PAN performance; therefore, a systematic approach that takes into account correct patient positioning and preparation is strongly suggested to improve overall examination quality

Hydronephrosis and pyonephrosis

Urinary tract infections (UTIs) are a frequent clinical problem in infants and children, and they may develop into serious complications with long-term sequelae. Their prevalence varies according to age and sex: males are more interested in the neonatal period and in the first year of age, while females are more involved after that time. The clinical outcome and the severity of UTIs depend on many risk factors including urinary tract malformations and dysfunctions, virulence and properties of the pathogen, host response to the infection, and promptness of diagnosis and management

Ultra-High Frequency Ultrasound (Uhfus) Applications in Sjogren Syndrome: Narrative Review and Current Concepts

Primary Sjogren’s syndrome (SS) is a systemic autoimmune chronic inflammatory disease with predominant involvement of the exocrine glands, particularly the salivary glands (SGs). The role of salivary glands ultrasound (SGUS) in the work-up of patients with primary Sjogren syndrome (SS) is progressively increasing due to its useful support in diagnosis and follow-up as a widely available, repeatable, noninvasive and safe technique. Although SGUS is not yet included in the dominant primary SS classification, several studies supported its inclusion in the American College of Rheumatology/European League Against Rheumatism criteria. In this context, a novel imaging technique, ultra-high frequency ultrasound (UHFUS), is being explored. Compared to the frequencies used in conventional ultrasound (US) (up to 22 MHz), UHFUS operates with higher frequencies (30–100 MHz) allowing for outstanding image resolution, up to 30 μm. UHFUS permits the scn of both major and minor SGs, opening new avenues for the integration of tissue and imaging biomarkers. Although further studies are needed to confirm its role, this novel imaging technique might lead to several potential improvements, including earlier diagnosis, reduction of unnecessary and inadequate biopsies and better management and follow-up of patients with primary SS

Average absorbed breast dose (2ABD): an easy radiation dose index for digital breast tomosynthesis

Background: To propose a practical and simple method to individually evaluate the average absorbed dose for digital breast tomosynthesis. Methods: The method is based on the estimate of incident air kerma (ka,i) on the breast surface. An analytical model was developed to calculate the ka,i from the tube voltage, tube load, breast thickness, x-ray tube yield, and anode-filter combination. A homogeneous phantom was employed to simulate the breast in experimental measurements and to assess the dose-depth relationship. The ka,i values were employed to calculate the “average absorbed breast dose” (2ABD) index. Four mammographic units were used to develop and test our method under many conditions close to clinical settings. The average glandular dose (AGD) calculated following the method described by Dance et al., and the 2ABD computed through our method (i.e., from the exposure parameters) were compared in a number of conditions. Results: A good agreement was obtained between the ka,i computed through our model and that measured under different clinical conditions: discrepancies < 6% were found in all conditions. 2ABD matches with a good accuracy the AGD for a 100% glandular-breast: the minimum, maximum, and mean differences were < 0.1%, 7%, and 2.4%, respectively; the discrepancies increase with decreasing breast glandularity. Conclusions: The proposed model, based on only few exposure parameters, represents a simple way to individually calculate an index, 2ABD, which can be interpreted as the average absorbed dose in a homogeneous phantom, approximating a 100% glandular breast. The method could be easily implemented in any mammographic device performing DBT

Actual implementation of sick children's rights in Italian pediatric units: a descriptive study based on nurses' perceptions

BACKGROUND: Several charters of rights have been issued in Europe to solemnly proclaim the rights of children during their hospital stay. However, notwithstanding such general declarations, the actual implementation of hospitalized children’s rights is unclear. The purpose of this study was to understand to which extent such rights, as established by the two main existing charters of rights, are actually implemented and respected in Italian pediatric hospitals and the pediatric units of Italian general hospitals, as perceived by the nurses working in them. METHODS: Cross-sectional study. A 12-item online questionnaire was set up and an invitation was sent by email to Italian pediatric nurses using professional mailing lists and social networks. Responders were asked to score to what extent each right is respected in their hospital using a numeric scale from 1 (never) to 5 (always). RESULTS: 536 questionnaires were returned. The best implemented right is the right of children to have their mothers with them (mean score 4.47). The least respected one is the right of children to express their opinion about care (mean 3.01). Other rights considered were the right to play (4.29), the right to be informed (3.95), the right to the respect of privacy (3.75), the right to be hospitalized with peers (3.39), the right not to experience pain ever (3.41), and the right to school (3.07). According to the majority of nurses, the most important is the right to pain relief. Significant differences in the implementation of rights were found between areas of Italy and between pediatric hospitals and pediatric units of general hospitals. CONCLUSION: According to the perception of pediatric nurses, the implementation of the rights of hospitalized children in Italian pediatrics units is still limited

Clinical utility of dual energy computed tomography in gout: Current concepts and applications

Summary. Gout is the most common inflammatory arthritis and is increasing in prevalence and incidence in many countries worldwide. Dual Energy Computed Tomography (DECT) has a high diagnostic accuracy in established gout, but its diagnostic sensitivity is low in subjects with recent-onset gout. A meta-analysis of 17 studies showed a pooled sensitivity and specificity of 0.85 and 0.88, respectively. DECT is a useful diagnostic tool for patients with contraindications for joint aspiration or for those who refuse joint aspiration. This article aims to give an up to date review and summary of existing literature on the role and accuracy of DECT in the imaging of gout. (www.actabiomedica.it)

Incorporating dose–volume histogram parameters of swallowing organs at risk in a videofluoroscopy-based predictive model of radiation-induced dysphagia after head and neck cancer intensity-modulated radiation therapy

Purpose: To develop a videofluoroscopy-based predictive model of radiation-induced dysphagia (RID) by incorporating DVH parameters of swallowing organs at risk (SWOARs) in a machine learning analysis. Methods: Videofluoroscopy (VF) was performed to assess the penetration-aspiration score (P/A) at baseline and at 6 and 12 months after RT. An RID predictive model was developed using dose to nine SWOARs and P/A-VF data at 6 and 12 months after treatment. A total of 72 dosimetric features for each patient were extracted from DVH and analyzed with linear support vector machine classification (SVC), logistic regression classification (LRC), and random forest classification (RFC). Results: 38 patients were evaluable. The relevance of SWOARs DVH features emerged both at 6 months (AUC 0.82 with SVC; 0.80 with LRC; and 0.83 with RFC) and at 12 months (AUC 0.85 with SVC; 0.82 with LRC; and 0.94 with RFC). The SWOARs and the corresponding features with the highest relevance at 6 months resulted as the base of tongue (V65 and Dmean), the superior (Dmean) and medium constrictor muscle (V45, V55; V65; Dmp; Dmean; Dmax and Dmin), and the parotid glands (Dmean and Dmp). On the contrary, the features with the highest relevance at 12 months were the medium (V55; Dmin and Dmean) and inferior constrictor muscles (V55, V65 Dmin and Dmax), the glottis (V55 and Dmax), the cricopharyngeal muscle (Dmax), and the cervical esophagus (Dmax). Conclusion: We trained and cross-validated an RID predictive model with high discriminative ability at both 6 and 12 months after RT. We expect to improve the predictive power of this model by enlarging the number of training datasets

Evaluation of Dosimetric Properties in Full Field Digital Mammography (FFDM) - Development of a New Dose Index

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