Patient- and parent-reported outcome measures of developmental adaptive abilities in visually impaired children: The Visual Impairment Developmental Autonomy (VIDA) scale

In the pediatric context, parents’ and patients’ engagement in the care process is strongly recommended and could be pursued using patient-reported outcome measures (PROMs), which therefore become useful for planning and monitoring treatments. Nevertheless, few data are available from families of children with neurodevelopmental disorders such as visual impairment (VI). The Visual Impairment Developmental Autonomy (VIDA) project aims to develop and validate a patient- and parent-reported tool to measure the most relevant aspects concerning everyday adaptive abilities in children and adolescents with visual impairment: the VIDA scale. The present paper illustrates the Delphi process of item generation engaging parents and patients and presents a protocol for the validation of this new co-designed tool in an Italian visually impaired pediatric population. Twenty-three families and five adolescents provided a list of 192 items and assessed their relevance. Items were categorized in 5 areas of adaptive abilities (i.e., table manners, clothing, personal hygiene, orientation and mobility, and socio-affectivity) and into three age ranges based on the patient's age. The final 102-item Vida Scale will be administered to a minimum of 300 visually impaired children together with measures of quality of life and child adjustment to investigate its psychometric properties

Online measurement of fluence and position for protontherapy beams

Tumour therapy with proton beams has been used for several decades in many centres with very good results in terms of local control and overall survival. Typical pathologies treated with this technique are located in head and neck, eye, prostate and in general at big depths or close to critical organs. The Experimental Physics Department of the University of Turin and the local Section of INFN, in collaboration with INFN Laboratori Nazionali del Sud Catania and Centre de Protontherapie de Orsay Paris, have developed detector systems that allow the measurement of beam position and fluence, obtained in real time during beam delivery. The centre in Catania (CATANA: Centro di AdroTerapia ed Applicazioni Nucleari Avanzate) has been treating patients with eye pathologies since spring 2002 using a superconducting cyclotron accelerating protons up to 62 MeV. This kind of treatments need high-resolution monitor systems and for this reason we have developed a 256-strip segmented ionisation chamber, each strip being 400 μm wide, with a total sensitive area 13 × 13 cm2. The Centre de Protontherapie de Orsay (CPO) has been operational since 1991 and features a synchrocyclotron used for eye and head and neck tumours with proton beams up to 200 MeV. The monitor system has to work on a large surface and for this purpose we have designed a pixel-segmented ionisation chamber, each pixel being 5×5 mm2, for a total active area of 16 × 16 cm2. The results obtained with two prototypes of the pixel and strip chambers demonstrate that the detectors allow the measurement of fluence and centre of gravity as requested by clinical specifications

Effect of implementing digital breast tomosynthesis (DBT) instead of mammography on population screening outcomes including interval cancer rates: Results of the Trento DBT pilot evaluation

The Trento screening program transitioned to digital breast tomosynthesis (DBT) screening based on evidence that DBT improves breast cancer (BC) detection compared to mammography; an evaluation of the transition to DBT is reported in this pilot study. Prospective implementation of DBT screening included women aged ≥50 years who attended the Trento program for biennial screening. DBT screening included DBT acquisitions with synthesized 2D-images. A historical cohort of women who attended the program (January 2013–October 2014) and received digital mammography (DM) provided a comparison group. Independent double-reading (with a third arbitrating read for discordance) was used for DBT and DM screening. Screening outcomes included cancer detection rate (CDR/1000 screens), percentage of screens recalled to assessment (recall%), interval cancer rate (ICR/1000 screens) at 2-year follow-up, and screening sensitivity. Rate ratios (RR) and 95% confidence interval (95%CI) examined outcomes for DBT versus DM screening

a Solution for Dosimetry and Quality Assurance in Imrt and Hadrontherapy:. the Pixel Ionization Chamber

The new radiotherapy techniques require new detectors to monitor and measure the clinical field. The Intensity Modulated Radiation Therapy (IMRT) techniques like step and shoot, sliding window, dynamic wedge or scanning beam add the time variable to the treatment field. In this case the water phantom with a single ionization chamber moving inside the field needs very long measurement time. Linear arrays of ionization chambers or diodes measure the field only along a line. 2D detectors like radiographic or gafchromic film are not suitable to be used as on line detectors. We have developed, built and tested an ionization chamber segmented in pixels that measure the dose in a plane at several points. Every channel has a dedicated electronic chain that digitizes the collected charge and data from all the channels are sent to the computer that performs the data acquisition. One read out cycle is very fast allowing to measure in real time the fluency and the shape of the field. The chamber can be used in two different ways, as monitor chamber and as relative dosemeter. A description of the detector, the electronics, and test results with both photon and hadron beams will be reported

How I report breast magnetic resonance imaging studies for breast cancer staging and screening

Magnetic resonance imaging (MRI) of the breast is the most sensitive imaging technique for the diagnosis and local staging of primary breast cancer and yet, despite the fact that it has been in use for 20 years, there is little evidence that its widespread uncritical adoption has had a positive impact on patient-related outcomes. This has been attributed previously to the low specificity that might be expected with such a sensitive modality, but with modern techniques and protocols, the specificity and positive predictive value for malignancy can exceed that of breast ultrasound and mammography. A more likely explanation is that historically, clinicians have acted on MRI findings and altered surgical plans without prior histological confirmation. Furthermore, modern adjuvant therapy for breast cancer has improved so much that it has become a very tall order to show a an improvement in outcomes such as local recurrence rates. In order to obtain clinically useful information, it is necessary to understand the strengths and weaknesses of the technique and the physiological processes reflected in breast MRI. An appropriate indication for the scan, proper patient preparation and good scan technique, with rigorous quality assurance, are all essential prerequisites for a diagnostically relevant study. The use of recognised descriptors from a standardised lexicon is helpful, since assessment can then dictate subsequent recommendations for management, as in the American College of Radiology BI-RADS (Breast Imaging Reporting and Data System) lexicon (Morris et al., ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System, 2013). It also enables audit of the service. However, perhaps the most critical factor in the generation of a meaningful report is for the reporting radiologist to have a thorough understanding of the clinical question and of the findings that will influence management. This has never been more important than at present, when we are in the throes of a remarkable paradigm shift in the treatment of both early stage and locally advanced breast cancer. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40644-016-0078-0) contains supplementary material, which is available to authorized users

Deficit visivi e sviluppo neuropsichico nei primi anni di vita: criteri di diagnosi e di intervento

Ospedali riuniti di Bergam

I disturbi delle funzioni visive

Napol