Optimising whole body computed tomography doses for paediatric trauma patients: a Swiss retrospective analysis.

We aimed to evaluate the impact of a low-dose whole-body computed tomography (WBCT) protocol on radiation doses in paediatric major trauma patients. Retrospective cohort study of paediatric trauma patients (<16 years) at a national level 1 paediatric trauma centre (PTC) over a 6 year period prior and post introduction of a low-dose WBCT protocol (2014-2019). Demographic data, patient characteristics, CT device, and exposure information including scan range, dose-length product, and volume CT dose index were collected. Effective dose (ED) and exposure parameters were compared before and after protocol introduction. Forty-eight patients underwent WBCT during the study period. Prior to introduction of the low-dose protocol (n= 18), the ED was 20.6 mSv (median 20.1 ± 5.3 mSv [range 12.5-30.7]). After introduction of the low-dose WBCT protocol (n= 30), mean ED was 4.8 mSv (median 2.6 ± 5.0 [range: 0.8-19.1]). This resulted in a reduction of 77% in mean ED (pvalue <0.001). Significant radiation dose reduction of 77% can be achieved with low-dose WBCT protocols in PTCs

Swiss survey on hybrid imaging CTs doses in Nuclear Medicine and proposed national dose reference levels.

A multidisciplinary working group led by the Swiss Federal Office of Public Health was formed to plan and perform a nationwide survey of patient radiation exposure from computed tomography (CT) in hybrid devices across Nuclear Medicine departments. The survey included 16 departments (of which 5 were university hospitals) and the submitted responses included 10,673 entries for the 33 different protocols proposed (11 in PET and 22 in SPECT). The working group determined the selection and exclusion criteria applied to the analysis. This work presents the survey preparation and data analysis including the exclusion criteria used. The results are used to inform recommendations for National Diagnostic Reference Levels (DRL) for CT procedures in Nuclear Medicine in Switzerland. Of the 33 protocols initially proposed, 10 protocols for both PET and SPECT modalities were retained after exclusion criteria and thresholds were applied. The results obtained in terms of volume-weighted computed tomography dose index (CTDI <sub>vol</sub> ) and dose length product (DLP) have been put forward as recommendations for national Diagnostic Reference Levels for protocols in hybrid imaging devices in Nuclear Medicine in Switzerland and will be published by the Federal Office of Public Health

A multicenter study on observed discrepancies between vendor-stated and PET measured 90Y activities for both glass and resin microsphere devices.

Dosimetry-guided treatment planning in selective internal radiation therapy relies on accurate and reproducible measurement of administrated activity. This multi-center (n <sub>center</sub> =4), multi-device (n <sub>PET</sub> =5) study compared the manufacturer-declared <sup>90</sup> Y activity in vials with quantitative <sup>90</sup> Y PET/CT-assessment of the same vials. We compared <sup>90</sup> Y PET-measured activity (A <sub>PET</sub> ) for <sup>90</sup> Y-labeled glass (n <sub>g</sub> =56) and resin (n <sub>r</sub> =18) microsphere vials with the calibrated activity specified by the manufacturer (A <sub>M</sub> ). Additionally, the same analysis was performed for <sup>90</sup> Y-chloride vials (n <sub>cl</sub> =4). The mean A <sub>PET</sub> /A <sub>M</sub> ratio for glass microspheres was 0.79±0.04 [range: 0.71-0.89] and for resin microspheres was 1.15±0.06 [range: 1.05-1.25]. Mean A <sub>PET</sub> /A <sub>M</sub> ratio for <sup>90</sup> Y-chloride vials was 1.00±0.04 [range: 0.96-1.06]. Thus, we found an average difference of 46% between glass and resin microsphere activity calibrations while a close agreement was found for chloride solutions. We expect the reported discrepancies will promote further investigations to establish reliable and accurate patient dosimetry and dose-effect assessments

Impact of metal implants on xSPECT/CT Bone reconstruction: the "shining metal artefact".

Novel reconstruction algorithms, such as xSPECT Bone, are gaining more and more importance in Nuclear Medicine. With xSPECT Bone, the reconstructed emission image is enhanced by the information obtained in the corresponding CT image. The CT defines tissue classes according to the Hounsfield units. In the iterative reconstruction, each tissue class is handled separately in the forward projection step, and all together in the back projection step. As a consequence, xSPECT Bone reconstruction generates images with improved boundary delineation and better anatomic representation of tracer activity. Applying this technique, however, showed that artefacts may occur, when no uptake regions, like metal implants, exhibit fictitious uniform tracer uptake. Due to limitations in spatial resolution in gamma cameras, the xSPECT Bone reconstructed image resulted in spill-out activity from surrounding high uptake region being uniformly distributed over the metal implants. This new technology of xSPECT Bone reconstruction in general enhances the image quality of SPECT/CT; however, the potential introduction of specific artefacts which inadvertently come along with this new technology and their frequency have not yet been addressed in the literature. Therefore, the purpose of this work was to identify and characterize these specific metal artefacts (the so-called shining metal artefact) in order to reduce false positives and avoid potentially misdiagnosing loosened or infected implants. In this work, we report five cases imaged with bone SPECT/CT of 5 anatomical regions (foot, elbow, spine, shoulder, ribs and knee). All cases demonstrated "shining metal artefacts" in xSPECT Bone reconstruction. While xSPECT Bone reconstruction algorithm significantly improves image quality for the diagnosis of bone and joint disorders with SPECT/CT, specific "shining metal artefacts" caused by the xSPECT Bone have to be recognized in order to avoid image misinterpretation suggesting metallic implant loosening or possible infection. The simultaneous analysis of conventionally reconstructed SPECT images (for Siemens the Flash3D reconstruction) helps to avoid misinterpretation of potential artefacts introduced by xSPECT Bone reconstruction

Phantom-based image quality assessment of clinical ¹⁸F-FDG protocols in digital PET/CT and comparison to conventional PMT-based PET/CT.

We assessed and compared image quality obtained with clinical <sup>18</sup> F-FDG whole-body oncologic PET protocols used in three different, state-of-the-art digital PET/CT and two conventional PMT-based PET/CT devices. Our goal was to evaluate an improved trade-off between administered activity (patient dose exposure/signal-to-noise ratio) and acquisition time (patient comfort) while preserving diagnostic information achievable with the recently introduced digital detector technology compared to previous analogue PET technology. We performed list-mode (LM) PET acquisitions using a NEMA/IEC NU2 phantom, with activity concentrations of 5 kBq/mL and 25 kBq/mL for the background (9.5 L) and sphere inserts, respectively. For each device, reconstructions were obtained varying the image statistics (10, 30, 60, 90, 120, 180, and 300 s from LM data) and the number of iterations (range 1 to 10) in addition to the employed local clinical protocol setup. We measured for each reconstructed dataset: the quantitative cross-calibration, the image noise on the uniform background assessed by the coefficient of variation (COV), and the recovery coefficients (RCs) evaluated in the hot spheres. Additionally, we compared the characteristic time-activity-product (TAP) that is the product of scan time per bed position × mass-activity administered (in min·MBq/kg) across datasets. Good system cross-calibration was obtained for all tested datasets with < 6% deviation from the expected value was observed. For all clinical protocol settings, image noise was compatible with clinical interpretation (COV < 15%). Digital PET showed an improved background signal-to-noise ratio as compared to conventional PMT-based PET. RCs were comparable between digital and PMT-based PET datasets. Compared to PMT-based PET, digital systems provided comparable image quality with lower TAP (from ~ 40% less and up to 70% less). This study compared the achievable clinical image quality in three state-of-the-art digital PET/CT devices (from different vendors) as well as in two conventional PMT-based PET. Reported results show that a comparable image quality is achievable with a TAP reduction of ~ 40% in digital PET. This could lead to a significant reduction of the administered mass-activity and/or scan time with direct benefits in terms of dose exposure and patient comfort

Characterization and genetic variability of coat protein genes of Apple chlorotic leaf spot virus isolates from southern Brazil.

Apple chlorotic leaf spot virus(ACLSV) infects temperate rosaceous fruit trees worldwide and causes a wide range of diseases that are economically highly damaging. This study was carried out to analyze genetic variability of regional ACLSV isolates and compare it with ACLSV isolates from other parts of the world. Nineteen amplicons of ACLSV, corresponding to the coat protein (CP) gene of isolates from apple, plum, and nectarine, from two states in southern Brazil, have been analyzed for genetic variation and compared phylogenetically among themselves and with other sequences available in GenBank. Sequences identities among complete CP genes of these isolates ranged from 87.5 to 100% and 92.2 to 100% at the nucleotide (nt) and the deduced amino acid (daa) levels, respectively. In the comparison with isolates from Asia, Europe and North America, identities were 68.4 to 100% and 72.5 to 100% at nt and daa levels, respectively. Phylogenetic trees based on nucleotide sequences showed that these isolates grouped into two clusters, cluster 1 containing apple isolates and cluster 2 comprising apple, plum and nec- tarine isolates. Most Brazilian isolates showed conserved signatures (Ser 40 ,Leu 59 ,Tyr 75 ,Thr 130 and Leu 184 )intheirCPs, which place them with type B6 isolates. However, some Brazilian isolates were found to be variants of type B6. These analyzes indicated that Brazilian isolates had lower genetic variability compared to isolates from China, India and Japan and that the CP genes were under negative selection. The greatest diversity of nucleotides was observed in the central portion of the CP gene, represented predominantly by synonymous substitutions. One natural recombinant was detected among ACLSV isolates from Brazil. Keywords ACLSV . Molecular characterization. Variability. Phylogeny. Recombination. Selection.https://doi.org/10.1007/s40858-017-0197-

Phylogenetic analysis of viruses in tuscan vitis vinifera sylvestris (Gmeli) hegi

The health status of the native grapevine Vitis vinifera subsp. sylvestris (Gmeli) Hegi in natural areas in Europe has received little attention. A survey was carried out on wild grapevines in Tuscany (Italy), where isolates of the Grapevine rupestris stem pitting virus (GRSPaV), Grapevine leafroll-associated virus 1 and 3 (GLRaV-1 and GLRaV-3) and Grapevine virus A (GVA) were detected. The complete coat protein (CP) region of these isolates was sequenced to investigate the relationship of the viral variants from Tuscan wild grapevines with isolates from different geographical origins. According to the phylogenetic analyses, GLRaV-1 and GLRaV-3 isolates from Tuscan wild grapevines clustered with isolates from cultivated grapevines with nucleotide sequence identities ranging from 66% to 87% and from 72.5% to 99% respectively, without any correlation between the distribution and geographical origin. Conversely, GRSPaV and GVA isolates clustered together with other Italian isolates from V. vinifera with nucleotide sequence identities ranging from 71.14% to 96.12% and from 73.5% to 92%, respectively. Our analysis of the whole amino acid sequences revealed a high conservation level for the studied proteins explained by a selective pressure on this genomic region, probably due to functional constraints imposed on CP, such as specific interactions with cellular receptors in the insect vectors necessary for successful transmission. In addition, analyses of genetic recombination suggest no significant point mutations that might play a significant role in genetic diversification. The dN/dS ratio also estimated a low number of non-silent mutations, highlighting the purifying selective pressure. The widespread distribution of the Rugose wood complex (GRSPaV and GVA associated disease) in comparison with the Grapevine Leafroll associated viruses (GLRaV-1 and -3) could explain the major geographical correlation found for the viral variants detected in Tuscany