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

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

Diagnostic approaches in the follow-up of ileo-colonic anastomoses in Crohn's disease

22 cas traités par hémicolectomie droite et anastomose iléotransverse pour maladie de Crohn de l'iléon terminal et du côlon droit. Les résultats démontrent l'intérêt majeur de l'endoscopie dans le diagnostic précoce des récidives anastomotiques, à un stade où l'évaluation clinique, les tests de laboratoire et la radiologie sont peu ou non contributif

Radioimmunological detection of anti-transglutaminase autoantibodies in human saliva: a useful test to monitor coeliac desease follow up

Serum radioimmunoassay (RIA) tissue transglutaminase autoantibodies (tTG-Abs) proved to be a sensitive test also during coeliac disease (CD) follow-up. We demonstrated that RIA tTG-Abs could be detected in human saliva. AIM: To evaluate salivary RIA tTG-Abs in coeliac children on gluten-free diet (GFD). METHODS: Saliva and serum samples from 109 coeliac children were evaluated at diagnosis (group 1: 71 females, median age 9.4 years) and 58 of them on GFD: 36 after 3-6 months (group 2a), 34 at 9 months or more (group 2b). Two gender- and age-matched control groups: 89 gastroenterological patients (group 3) and 49 healthy subjects (group 4) participated in the study. Saliva and serum tTG-Abs were detected by RIA and compared with serum tTG-Abs ELISA and IgA anti-endomysium antibodies (EMA). RESULTS: Salivary RIA tTG-Abs were found in 94.5%, 66.7% and 50.0% of groups 1, 2a and 2b CD patients and in 98.2%, 72.2% and 50.0% of corresponding serum samples, respectively. tTG-Abs decreased with GFD progression and a correlation was found between saliva and serum titres (r = 0.75, P = 0.0001). During the CD follow-up, salivary and serum RIA sensitivities were comparable, and higher with respect to EMA and ELISA. CONCLUSIONS: This study demonstrates that it is possible to detect salivary tTG-Abs with high sensitivity not only at CD diagnosis, but also during GFD