Sociodemographic determinants of knowledge on the figure of radiologist: results of a survey in large university hospital

Introduction Despite overlaying an irreplaceable role as a key diagnostic tool in modern medicine, the role of radiologist still appears to be unclear to patients. Methods We conducted a survey in outpatient clinic of Radiological Sciences Department of the University Hospital “A. Gemelli” in Rome, aiming to assess how correct patients identify the figure of the radiologist. The patients were interviewed by the trained physician using structured questionnaire. Results We included the number of 259 patients. Majority were female 63.3%, most were 60-69 years old (24.3%), have finished second grade secondary school (35.1%) and were subjected to magnetic resonance (28.6%) while the least were subjected to chest X-ray (8.1%). Only 38.7% answered correctly to question No 1 “Who performed your examination?”, and only 30.9% correctly identified the radiologist as a person interpreting the exam (question No 2 “Who is going to interpret your radiological examination?”). Overall, 16.8% responded correctly to the both questions. Significantly less patients with primary school (OR: 0.18, CI 95% 0.06-0.49) and first grade secondary school (OR: 0.37, CI 95% 0.18-0.75) correctly addressed the question No 1 in compare to those with second grade secondary school. The first grade secondary education (OR: 0.43, CI 95% 0.20-0.92) was inversely associated with correct answer to question No 2.  Patients with primary education were significantly less prone to give both correct answers (OR: 0.12, CI 95% 0.02-0.60). Conclusion We report insufficient knowledge among patients on radiologist’s role in healthcare system. The level of knowledge is associated with level of education

Tailoring protocols for chest CT applications: when and how?

In the medical era of early detection of diseases and tailored therapies, an accurate characterization and staging of the disease is pivotal for treatment planning. The widespread use of computed tomography (CT)—often with the use of contrast material (CM)—probably represents the most important advance in diagnostic radiology. The result is a marked increase in radiation exposure of the population for medical purposes, with its intrinsic carcinogenic potential, and CM affecting kidney function. The radiologists should aim to minimize patient’s risk by reducing radiation exposure and CM amount, while maintaining the highest image quality. To achieve this goal, it is necessary to perform “patient-centric imaging”. The purpose of this review is to provide radiologists with “tips and tricks” to control radiation dose at CT, summarizing technical artifices in order to reduce image noise and increase image contrast. Also chest CT tailored protocols are supplied, with particular attention to three most common thoracic CT protocols: aortic/cardiac CT angiography (CTA), pulmonary CTA, and routine chest CT

Operator learning curve for transradial liver cancer embolization: implications for the initiation of a transradial access program

PURPOSEWe aimed to analyze transradial access (TRA) learning curve on patients undergoing hepatic chemoembolization, investigating the relationship between procedural volumes and various benchmarks of procedural success.METHODSWe enrolled 60 consecutive patients who received two unilobar hepatic chemoembolizations within a 4-week interval performed by a single interventional radiologist, highly-trained in conventional transfemoral access (TFA) procedures, but without any previous practical experience in TRA procedures and with a preliminary 2-day theoretical training only. Consecutive patients were prospectively enrolled and analyzed in 3 groups: A (cases 1 to 20), B (cases 21 to 40), and C (cases 41 to 60). All patients underwent one hepatic chemoembolization using TRA and the other one using TFA in random order. All TFA procedures performed by the same operator in the same series of patients were considered as the control group. Primary endpoint was to analyze the relationship between TRA procedure operator experience and benchmarks of procedural success, to define the optimal procedural learning curve.RESULTSTechnical success was obtained in all patients, with a crossover rate (radial to femoral access) of 0%. An association between incremental TRA operator experience (in terms of performed procedures) and decrease of preparation, puncture, fluoroscopy, and total examination times was observed. Similarly, inverse associations between incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 0.001) were also observed. Compared with TFA, CM volumes and RD values were significantly higher only in group A (cases 1–20). Procedure success remained high in all TRA groups and no significant association between TRA incremental experience and postprocedural outcomes was found. Higher postprocedural complaints at the access route and more limitations in performing basic activities were recorded after TFA vs. TRA (P < 0.001).CONCLUSIONTRA catheterizations can be safely performed in patients treated for liver cancer embolization after a relatively short training in controlled conditions and with a better performance in comparison with TFA. Operator proficiency improves with greater TRA experience, with a threshold needed to overcome the learning curve represented by about 20 procedures

Sociodemographic determinants of knowledge on the figure of radiologist: results of a survey in large university hospital

<p><strong>Introduction</strong></p><p>Despite overlaying an irreplaceable role as a key diagnostic tool in modern medicine, the role of radiologist still appears to be unclear to patients.</p><p><strong>Methods </strong>We conducted a survey in outpatient clinic of Radiological Sciences Department of the University Hospital “A. Gemelli” in Rome, aiming to assess how correct patients identify the figure of the radiologist. The patients were interviewed by the trained physician using structured questionnaire.</p><p><strong>Results </strong>We included the number of 259 patients. Majority were female 63.3%, most were 60-69 years old (24.3%), have finished second grade secondary school (35.1%) and were subjected to magnetic resonance (28.6%) while the least were subjected to chest X-ray (8.1%). Only 38.7% answered correctly to question No 1 <em>“Who performed your examination?”</em>, and only 30.9% correctly identified the radiologist as a person interpreting the exam (question No 2 <em>“Who is going to interpret your radiological examination?”</em>). Overall, 16.8% responded correctly to the both questions. Significantly less patients with primary school (OR: 0.18, CI 95% 0.06-0.49) and first grade secondary school (OR: 0.37, CI 95% 0.18-0.75) correctly addressed the question No 1 in compare to those with second grade secondary school. The first grade secondary education (OR: 0.43, CI 95% 0.20-0.92) was inversely associated with correct answer to question No 2.  Patients with primary education were significantly less prone to give both correct answers (OR: 0.12, CI 95% 0.02-0.60).</p><p><strong>Conclusion </strong>We report insufficient knowledge among patients on radiologist’s role in healthcare system. The level of knowledge is associated with level of education.</p

Integrated software suite for magnetocardiographic data analysis--a proposal based on an interactive programming environment

OBJECTIVES: This paper describes an integrated software suite (ISS) for the processing of magnetocardiographic (MCG) recordings obtained with super-conducting multi-channel systems having different characteristics. We aimed to develop a highly flexible suite including toolboxes for current MCG applications, organized consistently with an open architecture that allows function integrations and upgrades with minimal modifications; the suite was designed for the compliance not only of physicists and engineers but also of physicians, who have a different professional profile and are accustomed to retrieve information in different ways. METHODS: The MCG-ISS was designed to work with all common graphical user interface operative systems. MATLAB was chosen as the interactive programming environment (IPE), and the software was developed to achieve usability, interactivity, reliability, modularity, expansibility, interoperability, adaptability and graphics style tailoring. Three users, already experienced in MCG data analysis, have intensively tested MCG-ISS for six months. A great amount of MCG data on normal subjects and patients was used to assess software performances in terms of user compliance and confidence and total analysis time. RESULTS: The proposed suite is an all-in-one analysis tool that succeeded in speeding MCG data analysis up to about 55% with respect to standard reference routines; it consequently enhanced analysis performance and user compliance. CONCLUSIONS: Those results, together with the MCG-ISS advantage of being independent on the acquisition system, suggest that software suites like the proposed one could uphold a wider diffusion of MCG as a diagnostic tool in the clinical setting.status: publishe

Osteoblastoma of the sacrum: report of 18 cases and analysis of the literature

Retrospective case series.(1) To analyze clinical and radiographical characteristics, treatment, and outcome in patients with sacral osteoblastoma, (2) to evaluate progression-free survival and local recurrence rate, and (3) to identify prognostic factors.Osteoblastoma is a rare tumor that has been reported to affect the sacrum from 7% to 17%. Symptoms are various and the diagnosis is often delayed.From 1980 to 2010, 18 patients with sacral osteoblastoma (16 males and 2 females) were treated at Rizzoli Institute. Lesion involved S1 (2 cases), S1–S2 (3 cases), S2 (1 case), S2–S3 (1 case), S2–S4 (1 case), S3 (2 cases), S3–S4 (5 cases), S4 (1 case), and almost the entire sacrum in 2 cases. According to Enneking classifi cation for benign bone tumors, 13 (72%) were diagnosed at stage 2 and 5 (28%) at stage 3. Mean tumor volume was 64 cm 3 (range, 2–441 cm 3 ). Nine patients had preoperative magnetic resonance imaging. Five patients had a previous inadequate intralesional surgery elsewhere. Treatment consisted in intralesional surgery (16 cases), intralesional surgery and radiotherapy (1 case), and wide resection (1 case). Local adjuvants used were phenol (7 patients), cryocoagulation with “iceball” technique (1 case). Embolizations were performed in 7 patients.At a mean of 8.4 years (range, 1-28 yr), 15 patients (83%) remained continuously disease free, whereas 3 patients had local recurrence (17%). Progression-free survival was 87% at 5 years and 74% at 10 years. No statistical difference was found between patients who received or not local adjuvants (P = 1.254), older or younger than 20 years (P = 0.970), at stage 2 or 3 (P = 0.826), evaluated preoperatively with or without magnetic resonance imaging (P = 0.160), primarily treated versus patients with previous intralesional surgery elsewhere (P = 0.131).In our series, curettage was successful in most of the patients. Local adjuvants did not seem to reduce the risk of local recurrence when combined with intralesional surgery

Meningeal hemangiopericytoma only diagnosed at the time of late bone metastasis

Hemangiopericytoma is a rare neoplasm. Primary meningeal hemangiopericytomas account for 1 to 7% of all meningeal tumors. In the literature, meningeal hemangiopericytomas are mainly case reports, which confirm an aggressive behavior with a high rate of local recurrence and extracranial metastasis. Metastasis can be seen many years after initial surgical excision of the primary tumor, and the most common sites include the bone, liver and lung. We present a pathological study of four meningeal hemangiopericytomas with bone metastases. All patients are male with a mean age of 46.5 years. Metastases only involved bone. Three out of four lesions were initially misdiagnosed as meningiomas. Only one case was initially correctly diagnosed as meningeal hemangiopericytoma. All patients underwent surgery with complete resection. Only the patient immediately diagnosed with meningeal hemangiopericytoma received postoperative radiation therapy. Three patients had bone metastases without local recurrence including the one who received radiation therapy. One patient recurred locally after 7 years, and bone metastasis was found at the same time. Our cases confirm that meningeal hemangiopericytomas are a separate entity and have a high recurrence rate despite complete surgical resection, with extracranial metastases, mainly to bone, even after long intervals

Stromal Activation by Tumor Cells: An in Vitro Study in Breast Cancer

Background: The tumor microenvironment participates in the regulation of tumor progression and influences treatment sensitivity. In breast cancer, it also may play a role in determining the fate of non-invasive lesions such as ductal carcinoma in situ (DCIS), a non-obligate precursor of invasive diseases, which is aggressively treated despite its indolent nature in many patients since no biomarkers are available to predict the progression of DCIS to invasive disease. In vitro models of stromal activation by breast tumor cells might provide clues as to specific stromal genes crucial for the transition from DCIS to invasive disease. Methods: normal human dermal fibroblasts (NHDF) were treated under serum-free conditions with cell culture media conditioned by breast cancer cell lines (SkBr3, MDA-MB-468, T47D) for 72 h and subjected to gene expression profiling with Illumina platform. Results: TGM2, coding for a tissue transglutaminase, was identified as candidate gene for stromal activation. In public transcriptomic datasets of invasive breast tumors TGM2 expression proved to provide prognostic information. Conversely, its role as an early biosensor of tumor invasiveness needs to be further investigated by in situ analyses. Conclusion: Stromal TGM2 might probably be associated with precancerous evolution at earlier stages compared to DCIS

Beat-to-beat estimate of fetal cardiac time intervals using magnetocardiography: longitudinal charts of normality ranges and individual trends

BACKGROUND: Fetal magnetocardiography (fMCG) records fetal cardiac electro-physiological activity during the second half of gestation. We aimed at assessing normality values, related variability, and trends of fetal cardiac time intervals (fCTI) evaluated longitudinally from beat-to-beat fMCG analysis in uncomplicated pregnancies. MATERIALS AND METHODS: The fMCG were recorded with multi-channel system in shielded room. FCTI were estimated on more than 2600 fetal cardiac cycles from 51 fMCG data sets of uncomplicated pregnancies. Independent component analysis (ICA) allowed reconstructing reliable fetal signals for beat-to-beat identification of fCTI (RR, P wave, PQ, PR, QT, QTc, QRS, ST, and T wave); intra-individual variability analysis and trends were calculated; reference longitudinal charts accounted for intra- and inter-individual variations and were compared with figures estimated on averaged signals. RESULTS: For each data set, fCTI were calculated beat-to-beat on rhythm strips of more than 50 beats (95% overall detection rate). FCTI values, variability, and trends were in good agreement with available reference figures; intervals related to P and T waves were, respectively, underestimated and overestimated with respect to those estimated on averaged signals or obtained by other research groups. Errors were reduced and individual trends could be drawn. CONCLUSIONS: ICA permitted the reconstruction of reliable time course of fetal cardiac signals and the beat-to-beat calculation of time intervals, and normality ranges, with smaller errors with respect to previous studies. The retrieval of fetal traces with clear morphology and the longitudinal character of the study allowed estimating individual trends and beat-to-beat characterization, impossible with cross-sectional studies on averaged beats.status: publishe