From tissue treatment to human being treatment: Is radiotherapy ready to change?

The increasing request of radiotherapy in the next years, according to recent past trend, could be an opportunity to include new characters in the process of radiotherapy renewing that is involving all the modern medicine. "Tissue" has been till now the key word in radiotherapy, while scientists seem not to care about the fact that their real substrate is “humans”

The significant role of multimodality imaging with 18Fluorocholine PET/CT in relapsed intracranial hemangiopericytoma

A un varón de 69 a˜nos de edad con ptosis palpebral y sensación de compresión en la órbita izquierda sin causa aparente, se le practicó una resonancia magnética (RM) de cabeza y cuello que mostró una formación de morfología redondeada y un margen bien delimitado en la porción súpero-lateral de la órbita izquierda. El paciente fue sometido a exéresis quirúrgica de dicha lesión, obteniéndose el diagnóstico histopatológico de hemangiopericitoma (HPC) (fig. 1). Tres a˜nos más tarde, con la reaparición de los síntomas, la RM detectó una lesión sospechosa de recidiva en la misma localización orbitaria izquierda. Con el fin de establecer la actividad metabólica del tejido orbitario y poder planificar el tratamiento más adecuado

Imaging of long head biceps tendon : a multimodality pictorial essay

The aim of this article is to provide an imaging review of normal anatomy, most common anatomical variants and pathologies of the long head of the biceps tendon (LHB) encountered during the daily practice. (www.actabiomedica.it)

Imaging in breast cancer follow-up: preliminary investigation on clinical practice adherence to the guidelines

PURPOSE: The aim of this study was to assess compliance with guidelines recommendations in the follow-up of patients with breast cancer. In this setting of patients we analyzed the appropriateness of the imaging exams recommended by different specialists in the management of follow-up. MATERIALS AND METHODS: From January 2019 to December 2019 we analyzed the clinical data and the results of the imaging exams of 146 asymptomatic patients followed for follow-up in different regional radiotherapy centers. A logistic regression analysis was performed taking into account the advanced pathological stage, the absence of surgical staging of the lymph nodes, the dubious results from previous basic imaging tests, correlating them to the excessive use of advanced imaging. The association was expressed in terms of odds ratio (OR) together with their 95% confidence intervals (CI). RESULTS: For 96% of patients, a frequent prescription of at least one basic imaging exam (complete abdomen ETG and chest X-ray 2p) was observed in contrast to the guidelines. A finding of a large number of bone scans suggested their use as routine surveillance A positive correlation with advanced imaging (OR <1) was seen in patients with borderline basic imaging. CONCLUSIONS: Follow-up with intensive imaging is poorly effective both for the early diagnosis of relapses and for any remote localizations

Structured reporting of computed tomography in the staging of colon cancer: a Delphi consensus proposal

Background: Structured reporting (SR) in radiology is becoming increasingly necessary and has been recognized recently by major scientific societies. This study aims to build structured CT-based reports in colon cancer during the staging phase in order to improve communication between the radiologist, members of multidisciplinary teams and patients. Materials and methods: A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology, was established. A modified Delphi process was used to develop the SR and to assess a level of agreement for all report sections. Cronbach’s alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to measure quality analysis according to the average inter-item correlation. Results: The final SR version was built by including n = 18 items in the “Patient Clinical Data” section, n = 7 items in the “Clinical Evaluation” section, n = 9 items in the “Imaging Protocol” section and n = 29 items in the “Report” section. Overall, 63 items were included in the final version of the SR. Both in the first and second round, all sections received a higher than good rating: a mean value of 4.6 and range 3.6–4.9 in the first round; a mean value of 5.0 and range 4.9–5 in the second round. In the first round, Cronbach’s alpha (Cα) correlation coefficient was a questionable 0.61. In the first round, the overall mean score of the experts and the sum of scores for the structured report were 4.6 (range 1–5) and 1111 (mean value 74.07, STD 4.85), respectively. In the second round, Cronbach’s alpha (Cα) correlation coefficient was an acceptable 0.70. In the second round, the overall mean score of the experts and the sum of score for structured report were 4.9 (range 4–5) and 1108 (mean value 79.14, STD 1.83), respectively. The overall mean score obtained by the experts in the second round was higher than the overall mean score of the first round, with a lower standard deviation value to underline greater agreement among the experts for the structured report reached in this round. Conclusions: A wide implementation of SR is of critical importance in order to offer referring physicians and patients optimum quality of service and to provide researchers with the best quality data in the context of big data exploitation of available clinical data. Implementation is a complex procedure, requiring mature technology to successfully address the multiple challenges of user-friendliness, organization and interoperability

Whole body MR-DWIBS vs 18F-FDG-PET/CT in the study of malignant tumors: a retrospective study

Aim: to assess the overall diagnostic accuracy of whole-body MR-DWIBS compared to 18FDG-PET/CT, considered the reference standard of whole body tumour imaging modalities, in a series of consecutive patients with malignant tumour. Methods: 14 patients diagnosed with a malignant tumour over a four-month period were enrolled in this retrospective, observational study. The PET/CT and MR-DWIBS images were reviewed, in double blind, by a nuclear medicine physician and radiologists with 4 years experience. Lesion size, SUV and ADC were measured and calculated for each lesion. Results: The qualitative analysis of MR-DWIBS and 18FDG-PET/CT showed that one patient was negative at both techniques. MR-DWIBS was positive in 13 patients, 9 of whom were positive and 4 negative at 18FDG-PET/CT, respectively. 94 lesions were identified by MR-DWIBS and 68 by 18FDG-PET/CT, a significative discordance was found. The correlation between SUV and ADC of the lesions positive at both techniques was not statistically significant. The mean difference between the lesion size in 18FDG-PET/CT and MR-DWIBS was not statistically significant. No correlation was found between glucose metabolism and water motion. Conclusions: The results of this observational, retrospective study show that MR-DWIBS may be used to evaluate localization of parenchymal neoplasms but is less efficacious in characterizing lymphnode and skeletal lesions. 18FDG-PET/CT remains the best whole-body technique to identify lymphnode and skeletal lesions. 18FDG-PET/CT limit is identifying tumours with low glucose metabolism as in mucinous neoplasms. MR-DWIBS evaluation must be integrated with morphological images in order to increase the diagnostic accuracy of MR