energy-resolved X-ray detectors: the future of diagnostic imaging

Danilo Pacella ENEA-Frascati, Rome, Italy Abstract: This paper presents recent progress in the field of X-ray detectors, which could play a role in medical imaging in the near future, with special attention to the new generation of complementary metal-oxide semiconductor (C-MOS) imagers, working in photon counting, that opened the way to the energy-resolved X-ray imaging. A brief description of the detectors used so far in medical imaging (photographic films, imaging plates, flat panel detectors), together with the most relevant imaging quality parameters, shows differences between, and advantages of these new C-MOS imagers. X-ray energy-resolved imaging is very attractive not only for the increase of contrast but even for the capability of detecting the nature and composition of the material or tissue to be investigated. Since the X-ray absorption coefficients of the different parts or organs of the patient (object) are strongly dependent on the X-ray photon energy, this multienergy ("colored") X-ray imaging could increase enormously the probing capabilities. While dual-energy imaging is now a reality in medical practice, multienergy is still in its early stage, but a promising research activity. Based on this new technique of color X-ray imaging, the entire scheme of source–object–detector could be revised in the future, optimizing spectrum and detector to the nature and composition of the target to be investigated. In this view, a transition to a set of monoenergetic X-ray lines, suitably chosen in energy and intensity, could be envisaged, instead of the present continuous spectra. Keywords: X-ray detectors, X-ray medical imaging, C-MOS imagers, dual and multienergy C

Energy stability for a class of semilinear elliptic problems

In this paper, we consider semilinear elliptic problems in a bounded domain $\Omega$ contained in a given unbounded Lipschitz domain $\mathcal C \subset \mathbb R^N$. Our aim is to study how the energy of a solution behaves with respect to volume-preserving variations of the domain $\Omega$ inside $\mathcal C$. Once a rigorous variational approach to this question is set, we focus on the cases when $\mathcal C$ is a cone or a cylinder and we consider spherical sectors and radial solutions or bounded cylinders and special one-dimensional solutions, respectively. In these cases, we show both stability and instability results, which have connections with related overdetermined problems

Energy stability for a class of semilinear elliptic problems

In this paper, we consider semilinear elliptic problems in a bounded domain $\Omega$ contained in a given unbounded Lipschitz domain $\mathcal C \subset \mathbb R^N$. Our aim is to study how the energy of a solution behaves with respect to volume-preserving variations of the domain $\Omega$ inside $\mathcal C$. Once a rigorous variational approach to this question is set, we focus on the cases when $\mathcal C$ is a cone or a cylinder and we consider spherical sectors and radial solutions or bounded cylinders and special one-dimensional solutions, respectively. In these cases, we show both stability and instability results, which have connections with related overdetermined problems.Comment: 33 page

Polycapillary optics for soft X-ray imaging and tomography

Magnetic plasmas are extended volumetric sources of X-rays, and these emissions could reveal a lot of information about the processes occurring into the plasmas. Unfortunately, the constraints posed by these toroidal devices (high neutron flux, gamma and hard-X background, extremely high radiofrequency powers, high magnetic fields, optical limitations and so on) are very severe and limit strongly the possibility to install X-ray detectors directly into or close to the machine. Soft X-ray diagnostics are meant both as tomography and imaging. We started, therefore, to investigate the feasibility of using polycapillary optics for these purposes, in collaboration between Istituto Nazionale di Fisica Nucleare (INFN)- Frascati, Ente per le Nuove tecnologie, l’Energia e l’Ambiente (ENEA)-Frascati and the Commissariat de l’Energie Atomique (CEA)-Cadarache. The first tests were performed in order to characterize the polycapillary lenses (convergence, divergence, efficiency, spectral dispersion, etc.) for distances much larger than the optical focal length of the lenses, both for the detector and for the source. A silicon-based C-MOS imager (Medipix 2) has been used as a detector and the micro focus X-ray tubes as point-like sources. Results of these preliminary tests are presented, and the imaging capabilities of a polycapillary lens as well

Fatty acid metabolism complements glycolysis in th selective regulatory t cell expansion during tumor growth

The tumor microenvironment restrains conventional T cell (Tconv) activation while facilitating the expansion of Tregs. Here we showed that Tregs’ advantage in the tumor milieu relies on supplemental energetic routes involving lipid metabolism. In murine models, tumor-infiltrating Tregs displayed intracellular lipid accumulation, which was attributable to an increased rate of fatty acid (FA) synthesis. Since the relative advantage in glucose uptake may fuel FA synthesis in intratumoral Tregs, we demonstrated that both glycolytic and oxidative metabolism contribute to Tregs’ expansion. We corroborated our data in human tumors showing that Tregs displayed a gene signature oriented toward glycolysis and lipid synthesis. Our data support a model in which signals from the tumor microenvironment induce a circuitry of glycolysis, FA synthesis, and oxidation that confers a preferential proliferative advantage to Tregs, whose targeting might represent a strategy for cancer treatment

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

PRIN 2017 Fibres - A Multidisciplinary Mineralogical, Crystal-Chemical and Biological Project. What have we learned after four years of research?

This opening paper introduces the contributions of this special issue on mineral fibres and reports a gallery of the major results accomplished within the multidisciplinary project PRIN (PROGETTI DI RICERCA DI RILEVANTE INTERESSE NAZIONALE) 2017 “FIBRES: a multidisciplinary mineralogical, crystal-chemical and biological project to amend the paradigm of toxicity and cancerogenicity of mineral fibres” by the six different Research Units from the Universities of Ancona, Genova, Modena, Rome, Pisa-Parma, and Urbino. The main goal of the project was to increase the knowledge of the mechanisms by which mineral fibres, with special attention to asbestos and fibrous erionite, prompt adverse effects in vivo, linking the fibres’ crystal-chemical-physical parameters to their toxicity/carcinogenicity potential and recasting the existing mechanistic ‘fibre toxicity paradigms’. This special issue contains specific contributions from each Research Unit of the project. The implications of the findings of the project are beyond the advance of the knowledge in the world of mineralogy/crystallography and constitute a remarkable progress in the understanding of the biological activity of mineral fibres in vivo. © 2023 Edizioni Nuova Cultura. All rights reserved

Confirmation of the topology of the Wendelstein 7-X magnetic field to better than 1:100,000

Fusion energy research has in the past 40 years focused primarily on the tokamak concept, but recent advances in plasma theory and computational power have led to renewed interest in stellarators. The largest and most sophisticated stellarator in the world, Wendelstein 7-X (W7-X), has just started operation, with the aim to show that the earlier weaknesses of this concept have been addressed successfully, and that the intrinsic advantages of the concept persist, also at plasma parameters approaching those of a future fusion power plant. Here we show the first physics results, obtained before plasma operation: that the carefully tailored topology of nested magnetic surfaces needed for good confinement is realized, and that the measured deviations are smaller than one part in 100,000. This is a significant step forward in stellarator research, since it shows that the complicated and delicate magnetic topology can be created and verified with the required accuracy

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted