Fabio Paolicchi

Optimizing the Balance Between Radiation Dose and Image Quality in Pediatric Head CT: Findings Before and After Intensive Radiologic Staff Training

OBJECTIVE The purpose of this study was to assess the radiation dose and image quality of pediatric head CT examinations before and after radiologic staff training. MATERIALS AND METHODS Outpatients 1 month to 14 years old underwent 215 unenhanced head CT examinations before and after intensive training of staff radiologists and technologists in optimization of CT technique. Patients were divided into three age groups (0-4, 5-9, and 10-14 years), and CT dose index, dose-length product, tube voltage, and tube current-rotation time product values before and after training were retrieved from the hospital PACS. Gray matter conspicuity and contrast-to-noise ratio before and after training were calculated, and subjective image quality in terms of artifacts, gray-white matter differentiation, noise, visualization of posterior fossa structures, and need for repeat CT examination was visually evaluated by three neuroradiologists. RESULTS The median CT dose index and dose-length product values were significantly lower after than before training in all age groups (27 mGy and 338 mGy ∙ cm vs 107 mGy and 1444 mGy ∙ cm in the 0- to 4-year-old group, 41 mGy and 483 mGy ∙ cm vs 68 mGy and 976 mGy ∙ cm in the 5- to 9-year-old group, and 51 mGy and 679 mGy ∙ cm vs 107 mGy and 1480 mGy ∙ cm in the 10- to 14-year-old group; p < 0.001). The tube voltage and tube current-time values after training were significantly lower than the levels before training (p < 0.001). Subjective posttraining image quality was not inferior to pretraining levels for any item except noise (p < 0.05), which, however, was never diagnostically unacceptable. CONCLUSION Radiologic staff training can be effective in reducing radiation dose while preserving diagnostic image quality in pediatric head CT examinations.

Endogenous auxins and embryogenesis in Phaseolus coccineus

The occurrence and the dynamics of free and bound indole-3-acetic acid (IAA) in different parts of Phaseolus coccineus L. seeds were investigated at various developmental stages. Results show that free and bound IAA content in the single seed parts is quite different, and changes with different patterns during seed growth. The highest concentration of total IAA was found in early-heart stage embryos, while the total IAA concentration in the suspensor at early-heart stage is much lower than in the embryos, and remains almost constant in the later stages. Integuments have an intermediate content at the first two developmental stages, while showing the highest concentration of total IAA at the cotyledonary stage. Concerning the percentage of free IAA in relation to the total pool, we found that in the embryos free IAA accounts for 26-28% in the first two stages then increases up to 44% at the cotyledonary stage. In suspensors, the percentage of free IAA is much higher (90%) in all developmental stages. We discuss the idea that the different level of auxin between embryos and the suspensor might play an important role in the establishment of embryo polarity.

Real practice radiation dose and dosimetric impact of radiological staff training in body CT examinations.

ObjectivesTo evaluate the radiation dose of the main body CT examinations performed routinely in four regional diagnostic centres, the specific contribution of radiologists and technologists in determining CT dose levels, and the role of radiological staff training in reducing radiation doses.MethodsWe retrospectively evaluated the radiation dose in terms of dose-length product (DLP) values of 2,016 adult CT examinations (chest, abdomen-pelvis, and whole body) collected in four different centres in our region. DLP values for contrast-unenhanced and contrast-enhanced CT examinations performed at each centre were compared for each anatomical area. DLP values for CT examinations performed before and after radiological staff training were also compared.ResultsDLP values for the same CT examinations varied among centres depending on radiologists’ preferences, variable training of technologists, and diversified CT image acquisition protocols. A specific training programme designed for the radiological staff led to a significant overall reduction of DLP values, along with a significant reduction of DLP variability.ConclusionsTraining of both radiologists and technologists plays a key role in optimising CT acquisition procedures and lowering the radiation dose delivered to patients.Main messagesThe effective dose for similar CT examinations varies significantly among radiological centres.Staff training can significantly reduce and harmonise the radiation dose.Training of radiologists and technologists is key to optimise CT acquisition protocols.

Are retinal and retinal-binding proteins involved in stomatal response to blue light?

Stomata respond to blue light and it is generally believed that the photoreceptor for this response is located inside the guard cells. Only a small number of blue light photoreceptors have been identified so far, namely cryptochromes and phototropins, and they show overlapping functions in regulating many different responses to light. The possibility that plants may possess other receptors regulating blue light responses under different light conditions cannot be excluded. In this paper we show the presence of two retinal-binding proteins in Commelina communis and we report the identification of retinal, a chromophore usually bound to the photoreceptor rhodopsin and previously identified in algae and other higher plants. We show that, under our experimental conditions, stomata open promptly when exposed to blue light and we demonstrated that this response is dependent on retinal. We hypothesise that rhodopsin-like retinal-binding proteins might be involved in stomatal response to blue light.

Awareness of radiation protection and dose levels of imaging procedures among medical students, radiography students, and radiology residents at an academic hospital: Results of a comprehensive survey

PURPOSE To evaluate the awareness of radiation protection issues and the knowledge of dose levels of imaging procedures among medical students, radiology residents, and radiography students at an academic hospital. MATERIAL AND METHODS A total of 159 young doctors and students (including 60 radiology residents, 56 medical students, and 43 radiography students) were issued a questionnaire consisting of 16 multiple choice questions divided into three separated sections (i.e., demographic data, awareness about radiation protection issues, and knowledge about radiation dose levels of common radiological examinations). RESULTS Medical students claimed to have at least a good knowledge of radiation protection issues more frequently than radiology residents and radiography students (94.4% vs 55% and 35.7%, respectively; P<0.05), with no cases of perceived excellent knowledge among radiography students. However, the actual knowledge of essential radiation protection topics such as regulations, patient and tissue susceptibility to radiation damage, professional radiation risk and dose optimisation, as well as of radiation doses delivered by common radiological procedures was significantly worse among medical students than radiology residents and radiography students (P<0.05). Those latter significantly outperformed radiology residents as to knowledge of radiation protection issues (P<0.01). Overall, less than 50% of survey respondents correctly answered all questions of the survey. CONCLUSIONS Radiology residents, radiography students and medical students have a limited awareness about radiation protection, with a specific gap of knowledge concerning real radiation doses of daily radiological examinations. Both undergraduate and postgraduate teaching needs to be effectively implemented with radiation safety courses.

Automated contrast medium monitoring system for computed tomography - Intra-institutional audit

The aim of this study was to analyze the usage and the data recorded by a RIS-PACS-connected contrast medium (CM) monitoring system (Certegra(®), Bayer Healthcare, Leverkusen, Germany) over 19 months of CT activity. The system used was connected to two dual syringe power injectors (each associated with a 16-row and a high definition 64-row multidetector CT scanner, respectively), allowing to manage contrast medium injection parameters and to send and retrieve CT study-related information via RIS/PACS for any scheduled contrast-enhanced CT examination. The system can handle up to 64 variables and can be accessed via touchscreen by CT operators as well as via a web interface by registered users with three different hierarchy levels. Data related to CM injection parameters (i.e. iodine concentration, volume and flow rate of CM, iodine delivery rate and iodine dose, CM injection pressure, and volume and flow rate of saline), patient weight and height, and type of CT study over a testing period spanning from 1 June 2013 to 10 January 2015 were retrieved from the system. Technical alerts occurred for each injection event (such as system disarm due to technical failure, disarm due to operators stop, incomplete filling of patient data fields, or excessively high injection pressure), as well as interoperability issues related to data sending and receiving to/from the RIS/PACS were also recorded. During the testing period, the CM monitoring system generated a total of 8609 reports, of which 7629 relative to successful injection events (88.6%). 331 alerts were generated, of which 40 resulted in injection interruption and 291 in CM flow rate limitation due to excessively high injection pressure (>325 psi). Average CM volume and flow rate were 93.73 ± 17.58 mL and 3.53 ± 0.89 mL/s, and contrast injection pressure ranged between 5 and 167 psi. A statistically significant correlation was found between iodine concentration and peak IDR (rs=0.2744, p<0.0001), as well as between iodine concentration and iodine dose (rs=0.3862, p<0.0001) for all CT studies. Automated contrast management systems can provide a full report of contrast use with the possibility to systematically compare different contrast injection protocols, minimize errors, and optimize organ-specific contrast enhancement for any given patient and clinical application. This can be useful to improve and harmonize the quality and consistency of contrast CT procedures within the same radiological department and across the hospital, as well as to monitor potential adverse events and overall costs.

Effect of clinorotation on in vitro cultured explants of Mentha piperita L.

An in vitro culture system was used to study the influence of gravity on axillary shoot formation and adventitious root regeneration in Mentha piperita L. The direction of the gravity vector was altered by displacing stem node explants in different orientations. Also, microgravity conditions were simulated by rotating the explants on a horizontal clinostat so that the main axis of nodes was either parallel (Cpa) or perpendicular to the clinostat axis (Ccp and Ccf, centripetally and centrifugally oriented, respectively). Mint nodes were cultured on solidified Linsmaier and Skoogs medium [Physiol. Plant. 18 (1965) 100] adding a filter-sterilized aqueous solution of 2 mg/l benzyladenine (BA) in half of the cultures. The proliferation of axillary shoots as well as adventitious root formation were not affected by altering upright explant orientation. On the contrary clinorotation was able to modify plantlet development. In absence of BA, leaf width was hindered by Cpa treatment and penultimate internode length was enhanced by Ccp. Furthermore, a negative effect of Cpa treatment was observed in root length parameter, while Ccp increased the root number both in absence and in presence of BA. An effect strictly connected to clinorotation in presence of BA was the occurrence of hyperhydricity. Moreover, explants under clinorotation treatments switched their gravitropic response modifying shoot curvature.

In vitro Culture of Immature Embryos of Cytisus laburnum

Immature embryos of Cytisus laburnum L. were cultivated in vitro and four culture media, different techniques of substrate preparation, sucrose concentration and the effect of suspensor removal were tested. The best results were obtained with N6 medium supplemented with 2 mg dm−3 glycine and set up using a double-layer culture system, in which the top layer had a higher osmotic potential than the bottom one. These conditions allowed normal embryogenic development in up to 45 % of early globular embryos, that were able to develop until a complete maturity. Osmotic potential and mineral nutrients of the medium demonstrated to be crucial for the successful culture and their effects were dependent on embryo age at the time of excision. The presence of an intact suspensor showed to be beneficial only for early globular embryos while older developmental stage embryos were not significantly affected.

Radiation dose exposure in patients affected by lymphoma undergoing repeat CT examinations: how to manage the radiation dose variability

PurposeTo assess the variability of radiation dose exposure in patients affected by lymphoma undergoing repeat CT (computed tomography) examinations and to evaluate the influence of different scan parameters on the overall radiation dose.Materials and methodsA series of 34 patients (12 men and 22 women with a median age of 34.4 years) with lymphoma, after the initial staging CT underwent repeat follow-up CT examinations. For each patient and each repeat examination, age, sex, use of AEC system (Automated Exposure Control, i.e. current modulation), scan length, kV value, number of acquired scans (i.e. number of phases), abdominal size diameter and dose length product (DLP) were recorded. The radiation dose of just one venous phase was singled out from the DLP of the entire examination. All scan data were retrieved by our PACS (Picture Archiving and Communication System) by means of a dose monitoring software.ResultsAmong the variables we considered, no significant difference of radiation dose was observed among patients of different ages nor concerning tube voltage. On the contrary the dose delivered to the patients varied depending on sex, scan length and usage of AEC. No significant difference was observed depending on the behaviour of technologists, while radiologists’ choices had indirectly an impact on the radiation dose due to the different number of scans requested by each of them.ConclusionsOur results demonstrate that patients affected by lymphoma who undergo repeat whole body CT scanning may receive unnecessary overexposure. We quantified and analyzed the most relevant variables in order to provide a useful tool to manage properly CT dose variability, estimating the amount of additional radiation dose for every single significant variable. Additional scans, incorrect scan length and incorrect usage of AEC system are the most relevant cause of patient radiation exposure.

Principi della TC convenzionale e della TC spirale

Nella radiografia convenzionale il fascio di raggi X diretto al paziente fuoriesce dalla superficie opposta con intensita variabile a seconda dell’attenuazione differenziale che incontra durante il suo percorso e viene infine registrato su un dispositivo di visualizzazione bidimensionale. La principale limitazione della radiografia convenzionale e dovuta alla sovrapposizione di strutture tridimensionali su una superficie bidimensionale, fenomeno che rende spesso impossibile visualizzare dettagli anatomici. Sebbene le immagini possano essere acquisite da diverse angolazioni (proiezioni laterali, oblique ecc.), il problema della sovrapposizione dei tessuti non puo essere risolto e rende assai difficile differenziare organi e tessuti con densita poco diverse. Per questo motivo, prima dell’introduzione delle tecniche di imaging tridimensionale i radiologi necessitavano di un “allenamento mentale” per ricostruire l’anatomia tridimensionale del paziente basandosi su una o piu proiezioni radiografiche e rilevare eventuali alterazioni.