Integrating blue-green and grey infrastructure through an adaptation pathways approach to surface water flooding.

A range of solutions to future flood risk are available ranging from blue-green infrastructure (BGI) as commonly incorporated in sustainable drainage systems (SuDS) to traditional grey infrastructure (e.g. pipe networks, storage tanks, flood walls). Each offers a different profile with respect to costs, flexibility of implementation and the ability to deliver a range of wider benefits beyond their flood protection function. An important question that must be addressed when considering these approaches is what is the most suitable mix of grey and blue-green solutions to urban flooding at any location and at any future time? This paper uses an adaptation pathways approach to compare a range of alternative options to deal with current and expected future flood risk in part of a London borough. Solutions considered separately and in combination include grey pipe expansion, bioretention cells, permeable pavements and storage ponds. A methodological framework combines a range of existing tools to develop, assess and characterize each pathway, including a storm water management model (SWMM), a SuDs opportunity selection tool, an adaptation pathway generator and the CIRIA B£ST tool for monetizing multiple benefits. Climate change is represented by the UK Water Industry Research method for establishing future rainfall intensities for sewer and BGI design. The results showed that by extending the way in which adaptation pathways are compared and evaluated through the wider consideration of multiple benefits there is a trade-off between deferring interventions until they are needed for flood risk mitigation and delivering the multiple benefits associated with interventions so that performance thresholds do not need to be met before introducing new options. The relative contribution of each option's capital and operation and maintenance costs has implications on when the option is implemented as well as the rate of implementation. The monetization of the multiple benefits associated with each pathway shows that their economic co-evaluation alongside infrastructure costs can change the preference for one pathway over another. This article is part of the theme issue 'Urban flood resilience'.EPSR

Understanding the implementation challenges of urban resilience policies : investigating the influence of urban geological risk in Thessaloniki, Greece

Urban Resilience has recently emerged as a systematic approach to urban sustainability. The malleable definition of resilience has rendered its operationalisation an intriguing task for contemporary cities trying to address their organisational problems and confront uncertainty in a holistic manner. In this article we investigate the implementation challenges emerging for Resilient Strategies by the inattention paid to urban geological risk. We conceptualise urban geological risk as the combination of urban geohazards, geological vulnerability and exposure of the built environment and focus on the case study of Thessaloniki, Greece, a city that joined the 100 Resilient Cities initiative in 2014 and published its “Resilience Strategy 2030” (RS) in 2017. After a review of the RS, historical records of natural hazard events and with evidence gathered through interviews with city officials, we emphasize on earthquakes and surface flooding as the most relevant geohazards for Thessaloniki to tackle in its journey towards urban resilience. First, we examine geological vulnerability to earthquakes in conjunction with exposure of the built environment, as an outcome of ageing building stock, high building densities and the urban configuration, in Acheiropoietos neighbourhood, within the historic centre of the city. Then, we explore geological risk to surface flooding in Perea, in Thermaikos Municipality, with a particular focus on flash floods, by demonstrating how limited consideration of local geomorphology as well as semi-regulated urban expansion and its limited connection with emergency planning increase exposure of the built environment to surface flooding. Finally, we come up with the major implementation challenges Thessaloniki’s RS faces with regard to urban geohazards

Understanding the implementation challenges of urban resilience policies : investigating the influence of urban geological risk in Thessaloniki, Greece

Urban Resilience has recently emerged as a systematic approach to urban sustainability. The malleable definition of resilience has rendered its operationalisation an intriguing task for contemporary cities trying to address their organisational problems and confront uncertainty in a holistic manner. In this article we investigate the implementation challenges emerging for Resilient Strategies by the inattention paid to urban geological risk. We conceptualise urban geological risk as the combination of urban geohazards, geological vulnerability and exposure of the built environment and focus on the case study of Thessaloniki, Greece, a city that joined the 100 Resilient Cities initiative in 2014 and published its “Resilience Strategy 2030” (RS) in 2017. After a review of the RS, historical records of natural hazard events and with evidence gathered through interviews with city officials, we emphasize on earthquakes and surface flooding as the most relevant geohazards for Thessaloniki to tackle in its journey towards urban resilience. First, we examine geological vulnerability to earthquakes in conjunction with exposure of the built environment, as an outcome of ageing building stock, high building densities and the urban configuration, in Acheiropoietos neighbourhood, within the historic centre of the city. Then, we explore geological risk to surface flooding in Perea, in Thermaikos Municipality, with a particular focus on flash floods, by demonstrating how limited consideration of local geomorphology as well as semi-regulated urban expansion and its limited connection with emergency planning increase exposure of the built environment to surface flooding. Finally, we come up with the major implementation challenges Thessaloniki’s RS faces with regard to urban geohazards

Building Resilience in Flood Disaster Management in Northern Peru

This report provides a detailed account of the Newton Fund Peru Researcher Links Workshop held between 20th and 23rd August 2018 in Piura, Peru, entitled ‘Building Resilience in Flood Disaster Management in Northern Peru’. The report provides some background to the workshop, the aim and objectives, problem definition, as well as an account of the workshop process and key workshop findings and recommendations. The workshop was run jointly by Birmingham City University (BCU) in partnership with Instituto Geofísico del Perú (IGP) and was hosted by the Universidad de Piura (UDEP). The workshop was a response to the severe flooding experienced in Piura during the El Niño event of March 2017 which caused a number of fatalities, damaged over 100,000 homes and destroyed much local infrastructure including around 100 bridges. El Niño is a recurrent event and there is concern that its frequency and intensity may change in the future as a consequence of climate change. The four-day workshop adopted a structured facilitation approach to encourage participants to work together towards a common goal. Forty researchers and practitioners from the UK and Perú were challenged with working across disciplines to identify key cross-cutting themes and make recommendations for building resilience to future flood events. The activities included the identification of key themes facilitated by some key expert presentations, a full day of site visits to communities in the Piura and Catacaos area, meeting people who had been affected by the flooding events of 2017; and culminating in the development of key findings and recommendations which were presented on the final day. Six key and integrated themes emerged from the workshop activities as: i) Governance; ii) Risk Information; iii) Healthy Communities; iv) Infrastructure; v) Urban and regional planning; and vi) the River System. For each of these themes, the report provides an overview of the problem as well as some detailed suggestions and recommendations for addressing the difficulties and challenges identified. The key messages across these dimensions are: Governance: The importance of establishing participative planning in Chira-Piura Basins was identified for building collaboration and enabling integration. This can be done in three steps: (1) problem analysis and prioritization involving stakeholder mapping; (2) defining new governance arrangements that improve integration and communication; and (3) detailed action planning which creates collaborative implementation and monitoring. Risk Information: There is a clear need for the adoption of a risk model for the lowland basin of the Río Piura. An ideal risk model is comprised of data on hazard, exposure and vulnerability, with both outputs and inputs designed specifically to meet the needs and requirements of different stakeholders in the basin

Virtual Touch IQ elastography reduces unnecessary breast biopsies by applying quantitative "rule-in" and "rule-out" threshold values.

Our purpose was to evaluate Virtual Touch IQ (VTIQ) elastography and identify quantitative "rule-in" and "rule-out" thresholds for the probability of malignancy, which can help avoid unnecessary breast biopsies. 189 patients with 196 sonographically evident lesions were included in this retrospective, IRB-approved study. Quantitative VTIQ images of each lesion measuring the respective maximum Shear Wave Velocity (SWV) were obtained. Paired and unpaired, non-parametric statistics were applied for comparisons as appropriate. ROC-curve analysis was used to analyse the diagnostic performance of VTIQ and to specify "rule-in" and "rule-out" thresholds for the probability of malignancy. The standard of reference was either histopathology or follow-up stability for >24 months. 84 lesions were malignant and 112 benign. Median SWV of benign lesions was significantly lower than that of malignant lesions (p 98% with a concomitant significant (p = 0.032) reduction in false positive cases of almost 15%, whereas a "rule-in" threshold of 6.5 m/s suggested a probability of malignancy of >95%. In conclusion, VTIQ elastography accurately differentiates malignant from benign breast lesions. The application of quantitative "rule-in" and "rule-out" thresholds is feasible and allows reduction of unnecessary benign breast biopsies by almost 15%

A Simple Ultrasound Based Classification Algorithm Allows Differentiation of Benign from Malignant Breast Lesions by Using Only Quantitative Parameters.

PURPOSE: We hypothesized that different quantitative ultrasound (US) parameters may be used as complementary diagnostic criteria and aimed to develop a simple classification algorithm to distinguish benign from malignant breast lesions and aid in the decision to perform biopsy or not. PROCEDURES: One hundred twenty-four patients, each with one biopsy-proven, sonographically evident breast lesion, were included in this prospective, IRB-approved study. Each lesion was examined with B-mode US, Color/Power Doppler US and elastography (Acoustic Radiation Force Impulse-ARFI). Different quantitative parameters were recorded for each technique, including pulsatility (PI) and resistive Index (RI) for Doppler US and lesion maximum, intermediate, and minimum shear wave velocity (SWVmax, SWVinterm, and SWVmin) as well as lesion-to-fat SWV ratio for ARFI. Receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic performance of each quantitative parameter. Classification analysis was performed using the exhaustive chi-squared automatic interaction detection method. Results include the probability for malignancy for every descriptor combination in the classification algorithm. RESULTS: Sixty-five lesions were malignant and 59 benign. Out of all quantitative indices, maximum SWV (SWVmax), and RI were included in the classification algorithm, which showed a depth of three ramifications (SWVmax ≤ or > 3.16; if SWVmax ≤ 3.16 then RI ≤ 0.66, 0.66-0.77 or > 0.77; if RI ≤ 0.66 then SWVmax ≤ or > 2.71). The classification algorithm leads to an AUC of 0.887 (95 % CI 0.818-0.937, p < 0.0001), a sensitivity of 98.46 % (95 % CI 91.7-100 %), and a specificity of 61.02 % (95 % CI 47.4-73.5 %). By applying the proposed algorithm, a false-positive biopsy could have been avoided in 61 % of the cases. CONCLUSIONS: A simple classification algorithm incorporating two quantitative US parameters (SWVmax and RI) shows a high diagnostic performance, being able to accurately differentiate benign from malignant breast lesions and lower the number of unnecessary breast biopsies in up to 60 % of all cases, avoiding any subjective interpretation bias

Breast lesion detection and characterization with contrast-enhanced magnetic resonance imaging: Prospective randomized intraindividual comparison of gadoterate meglumine (0.15 mmol/kg) and gadobenate dimeglumine (0.075 mmol/kg) at 3T.

BACKGROUND: Contrast-enhanced magnetic resonance imaging (CE-MRI) of the breast is highly sensitive for breast cancer detection. Multichannel coils and 3T scanners can increase signal, spatial, and temporal resolution. In addition, the T1 -reduction effect of a gadolinium-based contrast agent (GBCA) is higher at 3T. Thus, it might be possible to reduce the dose of GBCA at 3T without losing diagnostic information. PURPOSE: To compare a three-quarter (0.075 mmol/kg) dose of the high-relaxivity GBCA gadobenate dimeglumine, with a 1.5-fold higher than on-label dose (0.15 mmol/kg) of gadoterate meglumine for breast lesion detection and characterization at 3T CE-MRI. STUDY TYPE: Prospective, randomized, intraindividual comparative study. POPULATION: Eligible were patients with imaging abnormalities (BI-RADS 0, 4, 5) on conventional imaging. Each patient underwent two examinations, 24-72 hours apart, one with 0.075 mmol/kg gadobenate and the other with 0.15 mmol/kg gadoterate administered in a randomized order. In all, 109 patients were prospectively recruited. FIELD STRENGTH/SEQUENCE: 3T MRI with a standard breast protocol (dynamic-CE, T2 w-TSE, STIR-T2 w, DWI). ASSESSMENT: Histopathology was the standard of reference. Three blinded, off-site breast radiologists evaluated the examinations using the BI-RADS lexicon. STATISTICAL TESTS: Lesion detection, sensitivity, specificity, and diagnostic accuracy were calculated per-lesion and per-region, and compared by univariate and multivariate analysis (Generalized Estimating Equations, GEE). RESULTS: Five patients were excluded, leaving 104 women with 142 histologically verified breast lesions (109 malignant, 33 benign) available for evaluation. Lesion detection with gadobenate (84.5-88.7%) was not inferior to gadoterate (84.5-90.8%) (P ≥ 0.165). At per-region analysis, gadobenate demonstrated higher specificity (96.4-98.7% vs. 92.6-97.3%, P ≤ 0.007) and accuracy (96.3-97.8% vs. 93.6-96.1%, P ≤ 0.001) compared with gadoterate. Multivariate analysis demonstrated superior, reader-independent diagnostic accuracy with gadobenate (odds ratio = 1.7, P < 0.001 using GEE). DATA CONCLUSION: A 0.075 mmol/kg dose of the high-relaxivity contrast agent gadobenate was not inferior to a 0.15 mmol/kg dose of gadoterate for breast lesion detection. Gadobenate allowed increased specificity and accuracy. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1157-1165

Microstructural breast tissue characterization: A head-to-head comparison of Diffusion Weighted Imaging and Acoustic Radiation Force Impulse elastography with clinical implications

Abstract Purpose Head-to-head comparison of Diffusion Weighted Imaging (DWI) and Acoustic Radiation Force Impulse (ARFI) elastography regarding the characterization of breast lesions in an assessment setting. Method Patients undergoing an ultrasound examination including ARFI and an MRI protocol including DWI for the characterization of a BI-RADS 3–5 breast lesion between 06/2013 and 10/2016 were eligible for inclusion in this retrospective, IRB-approved study. 60 patients (30–84 years, median 50) with a median lesion size of 16 mm (range 5–55 mm) were included. The maximum shear wave velocity (SWVmax) and mean apparent diffusion coefficient (ADCmean) for each lesion were retrospectively evaluated by a radiologist experienced in the technique. Histology was the reference standard. Diagnostic performances of ARFI and DWI were assessed using ROC curve analysis. Spearman's rank correlation coefficient and multivariate logistic regression were used to investigate the independence of both tests regarding their diagnostic information to distinguish benign from malignant lesions. Results Corresponding areas under the ROC curve for differentiation of benign (n = 16) and malignant (n = 49) lesions were 0.822 (ARFI) and 0.871 (DWI, p-value = 0.48). SWVmax and ADCmean values showed a significant negative correlation (ρ = −0.501, p-value Conclusion Significant correlation between quantitative findings of ARFI and DWI in breast lesions exists. Thus, ARFI provides similar diagnostic information as a DWI-including protocol of an additional "problem-solving" MRI for the characterization of a sonographically evident breast lesion, improving the immediate patient management in the assessment setting

Inter- and intra-observer agreement of BI-RADS-based subjective visual estimation of amount of fibroglandular breast tissue with magnetic resonance imaging: comparison to automated quantitative assessment.

PURPOSE: To evaluate the inter-/intra-observer agreement of BI-RADS-based subjective visual estimation of the amount of fibroglandular tissue (FGT) with magnetic resonance imaging (MRI), and to investigate whether FGT assessment benefits from an automated, observer-independent, quantitative MRI measurement by comparing both approaches. MATERIALS AND METHODS: Eighty women with no imaging abnormalities (BI-RADS 1 and 2) were included in this institutional review board (IRB)-approved prospective study. All women underwent un-enhanced breast MRI. Four radiologists independently assessed FGT with MRI by subjective visual estimation according to BI-RADS. Automated observer-independent quantitative measurement of FGT with MRI was performed using a previously described measurement system. Inter-/intra-observer agreements of qualitative and quantitative FGT measurements were assessed using Cohen's kappa (k). RESULTS: Inexperienced readers achieved moderate inter-/intra-observer agreement and experienced readers a substantial inter- and perfect intra-observer agreement for subjective visual estimation of FGT. Practice and experience reduced observer-dependency. Automated observer-independent quantitative measurement of FGT was successfully performed and revealed only fair to moderate agreement (k = 0.209-0.497) with subjective visual estimations of FGT. CONCLUSION: Subjective visual estimation of FGT with MRI shows moderate intra-/inter-observer agreement, which can be improved by practice and experience. Automated observer-independent quantitative measurements of FGT are necessary to allow a standardized risk evaluation. KEY POINTS: • Subjective FGT estimation with MRI shows moderate intra-/inter-observer agreement in inexperienced readers. • Inter-observer agreement can be improved by practice and experience. • Automated observer-independent quantitative measurements can provide reliable and standardized assessment of FGT with MRI