Cost-effectiveness of CTA, MRA and DSA in patients with non-traumatic subarachnoid haemorrhage

OBJECTIVES: Intra-arterial digital subtraction angiography (DSA), magnetic resonance angiography (MRA) and computed tomographic angiography (CTA) are imaging modalities used for diagnostic work-up of non-traumatic subarachnoid haemorrhage. The aim of our study was to compare the cost-effectiveness of MRA, DSA and CTA in the first year after the bleed. METHODS: A decision model was used to calculate costs and benefits (in quality-adjusted life-years [QALYs]) that accrued to cohorts of 1,000 patients. Costs and characteristics of diagnostic tests, therapy, patients’ quality of life and associated costs were respected. The diagnostic strategy with highest QALYs and lowest costs was considered most cost-effective. RESULTS: DSA was the most effective diagnostic option, yielding on average 0.6039 QALYs (95 % CI, 0.5761–0.6327) per patient, followed by CTA 0.5983 QALYs (95 % CI, 0.5704–0.6278) and MRA 0.5947 QALYs (95 % CI, 0.5674–0.6237). Cost was lowest for DSA (39,808 €; 95 % CI, 37,182–42,663), followed by CTA (40,748 €; 95 % CI, 37,937–43,831) and MRA (41,814 €; 95 % CI, 38,730–45,146). A strategy of CTA followed by DSA if CTA was negative or coiling deemed not feasible, was as effective as DSA alone at average costs of 39,767€ (95 % CI, 36,903–42,402). CONCLUSION: A combined strategy of CTA and DSA was found to be the most cost-effective diagnostic approach. MAIN MESSAGES: • We defined a standard model for cost-effectiveness analysis in diagnostic imaging. • Comparing total 1-year health costs and benefits, CTA is superior to MRA. • A strategy of combining CTA and DSA was found to be the most cost-effective diagnostic approach

Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring

Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) A mu Sv/Gy cm(2) versus (phase 2) 0.08 (0.02-0.24) A mu Sv/Gy cm(2), p = 0.002]. Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions

Study of exclusive one-pion and one-eta production using hadron and dielectron channels in pp reactions at kinetic beam energies of 1.25 GeV and 2.2 GeV with HADES

We present measurements of exclusive ensuremathπ+,0 and η production in pp reactions at 1.25GeV and 2.2GeV beam kinetic energy in hadron and dielectron channels. In the case of π+ and π0 , high-statistics invariant-mass and angular distributions are obtained within the HADES acceptance as well as acceptance-corrected distributions, which are compared to a resonance model. The sensitivity of the data to the yield and production angular distribution of Δ (1232) and higher-lying baryon resonances is shown, and an improved parameterization is proposed. The extracted cross-sections are of special interest in the case of pp → pp η , since controversial data exist at 2.0GeV; we find \ensuremathσ=0.142±0.022 mb. Using the dielectron channels, the π0 and η Dalitz decay signals are reconstructed with yields fully consistent with the hadronic channels. The electron invariant masses and acceptance-corrected helicity angle distributions are found in good agreement with model predictions

Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) in Uncomplicated Type B Aortic Dissection: Study Design and Rationale

PURPOSE To describe the design and methodological approach of a multicenter, retrospective study to externally validate a clinical and imaging-based model for predicting the risk of late adverse events in patients with initially uncomplicated type B aortic dissection (uTBAD). MATERIALS AND METHODS The Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) is a collaboration between 10 academic aortic centers in North America and Europe. Two centers have previously developed and internally validated a recently developed risk prediction model. Clinical and imaging data from eight ROADMAP centers will be used for external validation. Patients with uTBAD who survived the initial hospitalization between January 1, 2001, and December 31, 2013, with follow-up until 2020, will be retrospectively identified. Clinical and imaging data from the index hospitalization and all follow-up encounters will be collected at each center and transferred to the coordinating center for analysis. Baseline and follow-up CT scans will be evaluated by cardiovascular imaging experts using a standardized technique. RESULTS The primary end point is the occurrence of late adverse events, defined as aneurysm formation (≥6 cm), rapid expansion of the aorta (≥1 cm/y), fatal or nonfatal aortic rupture, new refractory pain, uncontrollable hypertension, and organ or limb malperfusion. The previously derived multivariable model will be externally validated by using Cox proportional hazards regression modeling. CONCLUSION This study will show whether a recent clinical and imaging-based risk prediction model for patients with uTBAD can be generalized to a larger population, which is an important step toward individualized risk stratification and therapy.Keywords: CT Angiography, Vascular, Aorta, Dissection, Outcomes Analysis, Aortic Dissection, MRI, TEVAR© RSNA, 2022See also the commentary by Rajiah in this issue

The Comprehensive Native Interactome of a Fully Functional Tagged Prion Protein

The enumeration of the interaction partners of the cellular prion protein, PrPC, may help clarifying its elusive molecular function. Here we added a carboxy proximal myc epitope tag to PrPC. When expressed in transgenic mice, PrPmyc carried a GPI anchor, was targeted to lipid rafts, and was glycosylated similarly to PrPC. PrPmyc antagonized the toxicity of truncated PrP, restored prion infectibility of PrPC-deficient mice, and was physically incorporated into PrPSc aggregates, indicating that it possessed all functional characteristics of genuine PrPC. We then immunopurified myc epitope-containing protein complexes from PrPmyc transgenic mouse brains. Gentle differential elution with epitope-mimetic decapeptides, or a scrambled version thereof, yielded 96 specifically released proteins. Quantitative mass spectrometry with isotope-coded tags identified seven proteins which co-eluted equimolarly with PrPC and may represent component of a multiprotein complex. Selected PrPC interactors were validated using independent methods. Several of these proteins appear to exert functions in axomyelinic maintenance

Detection of extended TeV emission around the Geminga pulsar with H.E.S.S.

Highly extended gamma-ray emission around the Geminga pulsar was discovered by Milagro and verified by HAWC. Despite many observations with Imaging Atmospheric Cherenkov Telescopes (IACTs), detection of gamma-ray emission on angular scales exceeding the IACT field-of-view has proven challenging. Recent developments in analysis techniques have enabled the detection of significant emission around Geminga in archival data with H.E.S.S.. In 2019, further data on the Geminga region were obtained with an adapted observation strategy. Following the announcement of the detection of significant TeV emission around Geminga in archival data, in this contribution we present the detection in an independent dataset. New analysis results will be presented, and emphasis given to the technical challenges involved in observations of highly extended gamma-ray emission with IACTs

Astronomy outreach in Namibia : H.E.S.S. and beyond

Astronomy plays a major role in the scientific landscape of Namibia. Because of its excellent sky conditions, Namibia is home to ground-based observatories like the High Energy Spectroscopic System (H.E.S.S.), in operation since 2002. Located near the Gamsberg mountain, H.E.S.S. performs groundbreaking science by detecting very-high-energy gamma rays from astronomical objects. The fascinating stories behind many of them are featured regularly in the "Source of the Month", a blog-like format intended for the general public with more than 170 features to date. In addition to other online communication via social media, H.E.S.S. outreach activities have been covered locally, e.g. through 'open days' and guided tours on the site itself. An overview of the H.E.S.S. outreach activities are presented in this contribution, along with discussions relating to the current landscape of astronomy outreach and education in Namibia. There has also been significant activity in the country in recent months, whereby astronomy is being used to further sustainable development via human capacity-building. Finally, as we take into account the future prospects of radio astronomy in the country, momentum for a wider range of astrophysics research is clearly building — this presents a great opportunity for the astronomy community to come together to capitalise on this movement and support astronomy outreach, with the overarching aim to advance sustainable development in Namibia

Detection of new Extreme BL Lac objects with H.E.S.S. and Swift XRT

Extreme high synchrotron peaked blazars (EHBLs) are amongst the most powerful accelerators found in nature. Usually the synchrotron peak frequency of an EHBL is above 10$^{17}$ Hz, i.e., lies in the range of medium to hard X-rays making them ideal sources to study particle acceleration and radiative processes. EHBL objects are commonly observed at energies beyond several TeV, making them powerful probes of gamma-ray absorption in the intergalactic medium. During the last decade, several attempts have been made to increase the number of EHBL detected at TeV energies and probe their spectral characteristics. Here we report new detections of EHBLs in the TeV energy regime, each at a redshift of less than 0.2, by the High Energy Stereoscopic System (H.E.S.S.). Also, we report on X-ray observations of these EHBLs candidates with Swift-XRT. In conjunction with the very high energy observations, this allows us to probe the radiation mechanisms and the underlying particle acceleration processes

Evidence of 100 TeV γ-ray emission from HESS J1702-420 : a new PeVatron candidate

The identification of active PeVatrons, hadronic particle accelerators reaching the knee of the cosmic-ray spectrum (at the energy of few PeV), is crucial to understand the origin of cosmic rays in the Galaxy. In this context, we report on new H.E.S.S. observations of the PeVatron candidate HESS J1702-420, which bring evidence for the presence of γ-rays up to 100 TeV. This is the first time in the history of H.E.S.S. that photons with such high energy are observed. Remarkably, the new deep observations allowed the discovery of a new γ-ray source component, called HESS J1702-420A, that was previously hidden under the bulk emission traditionally associated with HESS J1702-420. This new object has a power-law spectral slope < 2 and a γ-ray spectrum that, extending with no sign of curvature up to 100 TeV, makes it an excellent candidate site for the presence of PeV-energy cosmic rays. This discovery brings new information to the ongoing debate on the nature of the unidentified source HESSJ1702-420, and on the origin of Galactic cosmic rays

Search for dark matter annihilation signals from unidentified Fermi-LAT objects with H.E.S.S.

Cosmological N-body simulations show that Milky-Way-sized galaxies harbor a population of unmerged dark matter subhalos. These subhalos could shine in gamma rays and be eventually detected in gamma-ray surveys as unidentified sources. We search for very-high-energy (VHE, E $\geq$ 100~GeV) gamma-ray emission using H.E.S.S. observations carried out from a thorough selection of unidentified Fermi-LAT Objects (UFOs) as dark matter subhalo candidates. Provided that the dark matter mass is higher than a few hundred GeV, the emission of the UFOs can be well described by dark matter annihilation models. No significant VHE gamma-ray emission is detected in any UFO dataset nor in their combination. We, therefore, derive constraints on the product of the velocity-weighted annihilation cross-section \left by the J-factor on dark matter models describing the UFO emissions. Upper limits at 95% confidence level are derived on \left J in W$^{+}$W$^{-}$ and τ$^{+}$τ$^{-}$ annihilation channels for the TeV dark matter particles. Focusing on thermal WIMPs, strong constraints on the J-factors are obtained from H.E.S.S. observations. Adopting model-dependent predictions from cosmological N-body simulations on the J-factor distribution function for Milky Way (MW)-sized galaxies, only $\lesssim$ 0.3 ~TeV mass dark matter models marginally allow to explain observed UFO emission