Adult exposures from MDCT including multiphase studies: first Italian nationwide survey.

OBJECTIVES: To evaluate the radiation dose in routine multidetector computed tomography (MDCT) examinations in Italian population. METHODS: This was a retrospective multicentre study included 5,668 patients from 65 radiology departments who had undergone common CT protocols: head, chest, abdomen, chest–abdomen–pelvis (CAP), spine and cardiac. Data included patient characteristics, CT parameters, volumetric CT dose index (CTDIvol) and dose length product (DLP) for each CT acquisition phase. Descriptive statistics were calculated, and a multi-regression analysis was used to outline the main factors affecting exposure. RESULTS: The 75th percentiles of CTDIvol (mGy) and DLP (mGy cm) for whole head were 69 mGy and 1,312 mGy cm, respectively; for chest, 15 mGy and 569 mGy cm; spine, 42 mGy and 888 mGy cm; cardiac, 7 mGy and 131 mGy cm for calcium score, and 61 mGy and 1,208 mGy cm for angiographic CT studies. High variability was present in the DLP of abdomen and CAP protocols, where multiphase examinations dominated (71 % and 73 % respectively): for abdomen, 18 mGy, with 555 and 920 mGy cm in abdomen and abdomen–pelvis acquisitions respectively; for CAP, 17 mGy, with 508, 850 and 1,200 mGy cm in abdomen, abdomen–pelvis and CAP acquisitions respectively. CONCLUSION: The results of this survey could help in the definition of updated diagnostic reference levels (DRL)

Radiation dose from multidetector CT studies in children: results from the first Italian nationwide survey

Background Multidetector CT (MDCT) scanners have con- tributed to the widespread use of CT in paediatric imaging. However, concerns are raised for the associated radiation exposure. Very few surveys on radiation exposure from MDCT studies in children are available. Objective The aim of this study was to outline the status of radiation exposure in children from MDCT practice in Italy. Materials and methods In this retrospective multicentre study we asked Italian radiology units with an MDCT scanner with at least 16 slices to provide dosimetric and acquisition param- eters of CT examinations in three age groups (1–5, 6–10, 11– 15 years) for studies of head, chest and abdomen. The dosi- metric results were reported in terms of third-quartile volu- metric CT dose index (CTDIvol) (mGy), size-specific dose estimate (SSDE) (mGy), dose length product (DLP) (mGy cm), and total DLP for multiphase studies. These results were compared with paediatric European and adult Italian published data. A multivariate analysis assessed the association of CTDIvol with patient characteristics and scanning modalities. Results We collected data from 993 MDCT examinations performed at 25 centres. For age groups 1–5 years, 6–10 years and 11–15 years, the CTDIvol, DLP and total DLP values were statistically significantly below the values observed in our analogous national survey in adults, although the difference decreased with increasing age. CTDIvol variability among centres was statistically significant (variance = 0.07; 95% confidence interval = 0.03–0.16; P < 0.001). Conclusions This study reviewed practice in Italian centres performing paediatric imaging with MDCT scanners. The variability of doses among centres suggests that the use of standardised CT protocols should be encourage

Epistemic Vigilance

Humans massively depend on communication with others, but this leaves them open to the risk of being accidentally or intentionally misinformed. To ensure that, despite this risk, communication remains advantageous, humans have, we claim, a suite of cognitive mechanisms for epistemic vigilance. Here we outline this claim and consider some of the ways in which epistemic vigilance works in mental and social life by surveying issues, research and theories in different domains of philosophy, linguistics, cognitive psychology and the social sciences

Radiomics : the facts and the challenges of image analysis

Radiomics is an emerging translational field of research aiming to extract mineable high-dimensional data from clinical images. The radiomic process can be divided into distinct steps with definable inputs and outputs, such as image acquisition and reconstruction, image segmentation, features extraction and qualification, analysis, and model building. Each step needs careful evaluation for the construction of robust and reliable models to be transferred into clinical practice for the purposes of prognosis, non-invasive disease tracking, and evaluation of disease response to treatment. After the definition of texture parameters (shape features; first-, second-, and higher-order features), we briefly discuss the origin of the term radiomics and the methods for selecting the parameters useful for a radiomic approach, including cluster analysis, principal component analysis, random forest, neural network, linear/logistic regression, and other. Reproducibility and clinical value of parameters should be firstly tested with internal cross-validation and then validated on independent external cohorts. This article summarises the major issues regarding this multi-step process, focussing in particular on challenges of the extraction of radiomic features from data sets provided by computed tomography, positron emission tomography, and magnetic resonance imaging

Systematic Lab Knowledge Integration for Management of Lipid Excess in High-Risk Patients : Rationale and Design of the SKIM LEAN Project

SKIM LEAN aims at exploiting Electronic Health Records (EHRs) to integrate knowledge derived from routine laboratory tests with background analysis of clinical databases, for the identification and early referral to specialist care, where appropriate, of patients with hypercholesterolemia, who may be inadequately controlled according to their cardiovascular (CV) risk level. SKIM LEAN addresses gaps in care that may occur through the lack of coordination between primary and specialist care, incomplete adherence to clinical guidelines, or poor patient's compliance to the physician's prescriptions because of comorbidities or drug side effects. Key project objectives include: (1) improved health professionals' competence and patient empowerment through a two-tiered educational website for general practitioners (GPs) and patients, and (2) implementation of a hospital-community shared care pathway to increase the proportion of patients at high/very-high CV risk (Familial Hypercholesterolemia, previous CV events) who achieve target LDL cholesterol (LDL-C) levels. Thanks to a close collaboration between clinical and information technology partners, SKIM LEAN will fully exploit the value of big data deriving from EHRs, and filter such knowledge using clinically-derived algorithms to risk-stratify patients. Alerts for GPs will be generated with interpreted test results. GPs will be able to refer patients with uncontrolled LDL-C within the shared pathway to the lipid or secondary prevention outpatient clinics of NIG hospital. Metrics to verify the project achievements include web-site visits, the number of alerts generated, numbers of patients referred by GPs, the proportion of secondary prevention patients who achieve LDL-C 50% decrease from baseline

The golden jackal (Canis aureus): A new host for Echinococcus multilocularis and Trichinella britovi in Switzerland.

INTRODUCTION The golden jackal (Canis aureus) is a wild canid new to Switzerland. It is an officially monitored species and all deceased individuals are submitted for post-mortem examination to collect baseline health data. This includes parasitological examinations, with an emphasis on zoonotic, reportable infections, such as those caused by Trichinella spp. or Echinococcus spp. From 2016 to 2021, five golden jackals originating from four Swiss cantons were submitted for full post-mortem examination. In one case only organ samples were available, and therefore parasitological examination was not possible. Parasite stages recovered during necropsy, as well as by routine coproscopical techniques, were morphologically identified. Taeniid eggs and adult tapeworms were processed for molecular species identification. Additionally, tongue and diaphragm were analysed for Trichinella spp. by the artificial digestion technique followed by multiplex-PCR in positive cases. Of the four jackals investigated for parasites, hookworm eggs were detected in one animal, both adult worms and eggs of Echinococcus multilocularis were present in another case, and one animal was free of parasites. Eggs of E. multilocularis as well as eggs of Toxocara canis and sporocysts of Sarcocystis sp. were detected in the intestinal content, and Trichinella britovi larvae were found in the muscle samples of the last case. The health monitoring programme in place for protected carnivores in Switzerland allowed us to add the golden jackal to the list of hosts for the endemic zoonotic parasites E. multilocularis and T. britovi in this country. Hunters, farmers, and other persons who could come in contact with golden jackals should be aware of the associated health risk and handle faeces and carcasses with caution

Association of insulin resistance, hyperleptinemia, and impaired nitric oxide release with in-stent restenosis in patients undergoing coronary stenting

Previously undiagnosed diabetes, impaired glucose tolerance, and insulin resistance are common in patients with acute myocardial infarction and coronary heart disease (CHD) and might be involved in early restenosis after stent implantation. To evaluate whether markers of insulin resistance syndrome, including leptin, and endothelial dysfunction are related to increased rate of early restenosis, we studied nondiabetic patients with CHD after successful coronary stenting

Observational Study Design in Veterinary Pathology, Part 2: Methodology

Observational studies are a basis for much of our knowledge of veterinary pathology, yet considerations for conducting pathology-based observational studies are not readily available. In part 1 of this series, we offered advice on planning and carrying out an observational study. Part 2 of the series focuses on methodology. Our general recommendations are to consider using already-validated methods, published guidelines, data from primary sources, and quantitative analyses. We discuss 3 common methods in pathology research—histopathologic scoring, immunohistochemistry, and polymerase chain reaction—to illustrate principles of method validation. Some aspects of quality control include use of clear objective grading criteria, validation of key reagents, assessing sample quality, determining specificity and sensitivity, use of technical and biologic negative and positive controls, blinding of investigators, approaches to minimizing operator-dependent variation, measuring technical variation, and consistency in analysis of the different study groups. We close by discussing approaches to increasing the rigor of observational studies by corroborating results with complementary methods, using sufficiently large numbers of study subjects, consideration of the data in light of similar published studies, replicating the results in a second study population, and critical analysis of the study findings