Search Results (63)

Growing awareness of the environmental impact of radiology departments highlights the importance of adopting mitigation strategies to increase the energy sustainability of diagnostic activities. This study aims to estimate the energy usage of imaging activities in a radiology department to plan and evaluate different energy waste mitigation strategies. A retrospective analysis of the energy usage of imaging equipment, including computed tomography (CT), magnetic resonance imaging (MRI), X-ray (XR), and workstations of radiology department in Italy, was carried out. The energy used was estimated based on equivalent mean power demand values in kWh. From this analysis, mitigation strategies were planned to reduce energy waste. The daily energy usage of the department is 877.5 kWh. The cone beam CT scanner is the imaging device with the lowest daily energy usage (6.6 kWh). Modalities with the highest mean daily energy usage are XR (18.4 kWh), CT (58.3 kWh), and MRI (214.6 kWh). The proposed mitigation strategies led to a reduction in energy waste quantified between 16.6% and 80.4%. The analysis of the energy usage of all imaging devices and workstations makes it possible to assess the energy waste of a radiology department. Understanding these elements is essential to develop strategies to reduce energy waste in radiology. Full article

Magnetic Resonance (MR) technology is extensively used in academic and industrial research laboratories and represents one of the most significant methodologies in clinical radiology. Although MR does not use ionizing radiation, it cannot be considered risk-free due to the strong static magnetic fields and time-varying electromagnetic fields employed in the technology. To mitigate risks for MR operators, the European Community and ICNIRP have established safety limits based on the existing literature, primarily related to diagnostic MR. However, the literature on occupational exposure in non-clinical nuclear magnetic resonance (NMR) spectroscopy is limited. Due to their specificity, non-medical NMR environments present unique challenges from the point of view of operator exposure. NMR spectrometers are characterized by extremely high static magnetic fields, reaching up to 28 T in commercial systems; moreover, routine activities performed near the magnet, where field gradients are highest, increase operator exposure. Such environments are not typically perceived as hazardous and are frequented by various types of personnel, often without specific training. This study aims to highlight the critical issues in managing a preclinical MR laboratory equipped with a high-field NMR spectrometer, discussing operator safety challenges and presenting risk assessment data. Full article

Background: The implementation of radiological artificial intelligence (AI) solutions remains challenging due to limitations in existing testing methodologies. This study assesses the efficacy of a comprehensive methodology for performance testing and monitoring of commercial-grade mammographic AI models. Methods: We utilized a combination of retrospective and prospective multicenter approaches to evaluate a neural network based on the Faster R-CNN architecture with a ResNet-50 backbone, trained on a dataset of 3641 mammograms. The methodology encompassed functional and calibration testing, coupled with routine technical and clinical monitoring. Feedback from testers and radiologists was relayed to the developers, who made updates to the AI model. The test dataset comprised 112 medical organizations, representing 10 manufacturers of mammography equipment and encompassing 593,365 studies. The evaluation metrics included the area under the curve (AUC), accuracy, sensitivity, specificity, technical defects, and clinical assessment scores. Results: The results demonstrated significant enhancement in the AI model’s performance through collaborative efforts among developers, testers, and radiologists. Notable improvements included functionality, diagnostic accuracy, and technical stability. Specifically, the AUC rose by 24.7% (from 0.73 to 0.91), the accuracy improved by 15.6% (from 0.77 to 0.89), sensitivity grew by 37.1% (from 0.62 to 0.85), and specificity increased by 10.7% (from 0.84 to 0.93). The average proportion of technical defects declined from 9.0% to 1.0%, while the clinical assessment score improved from 63.4 to 72.0. Following 2 years and 9 months of testing, the AI solution was integrated into the compulsory health insurance system. Conclusions: The multi-stage, lifecycle-based testing methodology demonstrated substantial potential in software enhancement and integration into clinical practice. Key elements of this methodology include robust functional and diagnostic requirements, continuous testing and updates, systematic feedback collection from testers and radiologists, and prospective monitoring. Full article

Background/Objectives: Guidelines for the risk stratification of thyroid nodules are based on certain well-recognized sonographic features of nodules. However, significant variations in reported sensitivity and specificity values are observed due to the overlap of imaging characteristics between benign and malignant nodules. Additionally, differences in ultrasound (US) equipment and the varying experience levels of radiologists performing the imaging procedures contribute to these discrepancies. Inevitably, there are also interobserver differences. The aim of this study was to investigate interobserver agreement on these criteria using the international thyroid imaging reporting and data system (I-TIRADS) thyroid evaluation framework, independently assessed by three residents and one consultant. Methods: We included 393 patients who underwent ultrasound-guided fine needle aspiration biopsy (FNAB) within four months. In each case, longitudinal and transverse video images of the thyroid gland, neck chain, and biopsied nodules were recorded. The evaluations of the parameters defined in the I-TIRADS dictionary were then performed by a radiologist with 15 years of experience and radiology assistants with 3, 3, and 2 years of experience, respectively, blinded to the images, pathology data, and patient demographics. The parameters evaluated included composition, echogenicity, margin, direction of growth, calcification, extension beyond the thyroid, and lymph node. An interobserver comparison between the US lexicon classifications of thyroid nodules was then performed. Results: The results of our study showed that the highest level of consensus was observed in the ‘mixed predominantly cystic’ classification, indicating a solid consistency between the assessors (κ = 0.729). Conversely, the subcategories ‘Solid’, ‘Mixed Predominantly Solid’ and ‘Spongiform’ showed moderate agreement, while the “Pure Cyst” subcategory exhibited the lowest level of agreement among the assessors (κ = 0.292). Agreement among the three radiology assistants was strong concerning the evaluation of nodule composition, growth direction, and lymph node assessment. In contrast, a moderate level of consensus was noted regarding the assessment of extrathyroidal extension, margins, and echogenicity. Notably, the parameter exhibiting moderate agreement across all readers was the presence of echogenic foci or calcifications. Conclusions: the reproducibility observed in the parameters defined within the lexicon supports its potential to enhance consistency and interobserver agreement in thyroid nodule assessment. Full article

Background/Objectives: Interventional radiology (IR) utilizing X-rays can lead to occupational radiation exposure, posing health risks for medical personnel in the field. We previously conducted a survey on the occupational radiation exposure of IR nurses in three designated emergency hospitals in Japan. Our findings indicated that a hospital with 214 beds showed a higher lens-equivalent dose than hospitals with 678 and 1182 beds because the distance between the X-ray irradiation field and the IR nurse’s position of the hospital with 214 beds was shorter than those of 678 and 1182 beds. Based on these observations, we hypothesized that the number of hospital beds affects the distance between the X-ray irradiation field and the IR nurse’s position. Methods: To verify this hypothesis, we conducted a more extensive online questionnaire survey, focusing exclusively on hospitals that perform cardiovascular IR. Results: We analyzed data from 78 facilities. The results of this study confirmed our earlier findings, showing that both the number of physicians performing IR procedures and the distance from the X-ray irradiation field to the IR nurse’s position are influenced by the number of hospital beds. Additionally, factors such as the type of hospital, emergency medical system, annual number of IR sessions, location of medical equipment, and the positioning of IR nurses appear to be associated with the number of hospital beds. Conclusions: Understanding these relationships could enable the development of individualized and prioritized radiation exposure reduction measures for IR nurses in high-risk settings, provided that comprehensive occupational radiation risk assessments for cardiovascular IR consider the number of hospital beds and related factors. This study was not registered. Full article

Background/Objectives: Mummy studies allow to reconstruct the characteristic of a population in a specific spatiotemporal context, in terms of living conditions, pathologies and death. Radiology represents an efficient diagnostic technique able to establish the preservation state of mummified organs and to estimate the patient's pathological conditions. However, the radiological approach shows some limitations. Although bone structures are easy to differentiate, soft tissue components are much more challenging, especially when they overlap. For this reason, computed tomography, a well-established approach that achieves optimal image contrast and three-dimensional reconstruction, has been introduced. This original article focuses attention on the role of virtual dissection as a promising technology for exploring human mummy anatomy and considers the potential of environmental scanning electron microscopy and X-ray spectroscopy as complementary approaches useful to understand the state of preservation of mummified remains. Methods: Ancient mummy corps have been analyzed through Anatomage Table 10 and environmental scanning electron microscope equipped with X-ray spectrometer; Results: Anatomage Table 10 through various volumetric renderings allows us to describe spine alteration due to osteoarthritis, dental state, and other clinical-pathological characteristics of different mummies. Environmental scanning electron microscope, with the advantage of observing mummified samples without prior specimen preparation, details on the state of tissue fragments. Skin, tendon and muscle show a preserved morphology and keratinocytes, collagen fibers and tendon structures are easily recognizable. Furthermore, X-ray spectrometer reveals in our tissue remains, the presence of compounds related to soil contamination. This investigation identifies a plethora of organic and inorganic substances where the mummies were found, providing crucial information about the mummification environment. Conclusions: These morphological and analytical techniques make it possible to study mummified bodies and describe their anatomical details in real size, in a non-invasive and innovative way, demonstrating that these interdisciplinary approaches could have great potential for improving knowledge in the study of ancient corpses. Full article

The priority during an emergency, regardless of the type, is to rescue as many lives as possible. Field hospitals are usually installed to provide the primary relief to the affected population when hospitals are compromised or absent. There are several sanitary units worldwide ready to be transported to disaster areas. An average field hospital is equipped with an operating room, laboratory, and radiological equipment, but it does not include a unit for the infectious hospital solid waste treatment, which results in improper management with high infection risks and emissions due to incorrect operations (e.g., open incineration). Therefore, the present study identified two market-available solutions (an incinerator and a sterilizer) designed to be transported even under the challenging conditions typical of disasters and are suitable for treating infectious waste. The systems were assessed by a life cycle assessment (LCA), proving an emission savings >90% (considering all impact categories) using the sterilization system. The avoided combustion allows to halve the effect on climate change due to a portable incinerator. This study supplies interesting food for thought for the emergency managers, proving the possibility of integrating the sustainability also in the planning of the response to catastrophic events. Full article

Background/Objectives: Computed tomography (CT)-guided transbronchial metallic coil marking is useful for identifying the locations of small peripheral pulmonary lesions. Even deeply located lesions may be accurately identified and resected with adequate margins. This method is also applicable to multiple lesions. The present study examined the efficacy of our marking method using cone-beam CT (CBCT) under general anesthesia in a hybrid operation room. Methods: In the hybrid operation room, an ultrathin bronchoscope was inserted into the objective bronchus under virtual bronchoscopic navigation, and a metallic coil was installed under CBCT guidance. The lesion was then resected with wedge resection by single- or 3-port video-assisted thoracoscopic surgery under fluorescence guidance. Eighty-seven patients with 90 lesions were treated between October 2016 and December 2022. The median lesion size was 11 mm and the median distance from the pleural surface was 8.7 mm. Lesions comprised 19 pure ground-glass nodule (GGN), 35 partly solid, and 36 solid types. Results: All lesions were visualized by CBCT, and metallic coils were installed into the objective bronchi. The median distance from lesions to coils was 3.6 mm, and the median marking time was 23.5 min. All lesions were resected with sufficient margins. In total, 57 lesions were diagnosed as primary lung cancer, 26 as metastatic lung tumors, 3 as nodular lymphoid hyperplasia, and 4 as others. There were no complications associated with the marking procedure. Conclusions: CBCT represents an alternative modality for identifying peripheral lung lesions due to its ability to visualize even small GGNs. It is a minimally invasive technique because the treatment sequence is completed under general anesthesia with the same quality as previous methods performed in a CT-equipped interventional radiology suite. Full article

(1) Background: 3D printable materials with accurately defined iodine content enable the development and production of radiological phantoms that simulate human tissues, including lesions after contrast administration in medical imaging with X-rays. These phantoms provide accurate, stable and reproducible models with defined iodine concentrations, and 3D printing allows maximum flexibility and minimal development and production time, allowing the simulation of anatomically correct anthropomorphic replication of lesions and the production of calibration and QA standards in a typical medical research facility. (2) Methods: Standard printing resins were doped with an iodine contrast agent and printed using a consumer 3D printer, both (resins and printer) available from major online marketplaces, to produce printed specimens with iodine contents ranging from 0 to 3.0% by weight, equivalent to 0 to 3.85% elemental iodine per volume, covering the typical levels found in patients. The printed samples were scanned in a micro-CT scanner to measure the properties of the materials in the range of the iodine concentrations used. (3) Results: Both mass density and attenuation show a linear dependence on iodine concentration (R² = 1.00), allowing highly accurate, stable, and predictable results. (4) Conclusions: Standard 3D printing resins can be doped with liquids, avoiding the problem of sedimentation, resulting in perfectly homogeneous prints with accurate dopant content. Iodine contrast agents are perfectly suited to dope resins with appropriate iodine concentrations to radiologically mimic tissues after iodine uptake. In combination with computer-aided design, this can be used to produce printed objects with precisely defined iodine concentrations in the range of up to a few percent of elemental iodine, with high precision and anthropomorphic shapes. Applications include radiographic phantoms for detectability studies and calibration standards in projective X-ray imaging modalities, such as contrast-enhanced dual energy mammography (abbreviated CEDEM, CEDM, TICEM, or CESM depending on the equipment manufacturer), and 3-dimensional modalities like CT, including spectral and dual energy CT (DECT), and breast tomosynthesis. Full article

Hepatocellular carcinoma is currently the most common malignancy of the liver. It typically occurs due to a series of oncogenic mutations that lead to aberrant cell replication. Most commonly, hepatocellular carcinoma (HCC) occurs as a result of pre-occurring liver diseases, such as hepatitis and cirrhosis. Given its aggressive nature and poor prognosis, the early screening and diagnosis of HCC are crucial. However, due to its plethora of underlying risk factors and pathophysiologies, patient presentation often varies in the early stages, with many patients presenting with few, if any, specific symptoms in the early stages. Conventionally, screening and diagnosis are performed through radiological examination, with diagnosis confirmed by biopsy. Imaging modalities tend to be limited by their requirement of large, expensive equipment; time-consuming operation; and a lack of accurate diagnosis, whereas a biopsy’s invasive nature makes it unappealing for repetitive use. Recently, biosensors have gained attention for their potential to detect numerous conditions rapidly, cheaply, accurately, and without complex equipment and training. Through their sensing platforms, they aim to detect various biomarkers, such as nucleic acids, proteins, and even whole cells extracted by a liquid biopsy. Numerous biosensors have been developed that may detect HCC in its early stages. We discuss the recent updates in biosensing technology, highlighting its competitive potential compared to conventional methodology and its prospects as a tool for screening and diagnosis. Full article

Brachytherapy is a practical, effective procedure for the local treatment of cancer; it delivers a high radiation dose to a limited tissue volume while sparing the surrounding normal tissues. Although the clinical benefit of brachytherapy is clear, there have been very few studies on the radiation dose received by physicians during the procedure. Furthermore, no study has investigated the eye radiation dose received by physicians performing ¹⁹⁸Au grain (seed) brachytherapy, using an eye dosimeter. Recently, the International Commission on Radiological Protection (ICRP) recommended significantly reducing the occupational lens dose limit, from 150 to 20 mSv/yr (100 mSv/5 years). Therefore, it has become essential to evaluate the eye radiation doses of medical workers. We evaluated the eye radiation dose of a brachytherapy physician performing ¹⁹⁸Au permanent grain implantation for tongue cancer; this is the first study on this topic. The maximum eye dose was ~0.1 mSv/procedure, suggesting that it is unlikely to exceed the ICRP limit (20 mSv/yr) for the lens, unless many procedures are performed with inappropriate radiation protection. To reduce the dose of radiation received by ¹⁹⁸Au grain brachytherapy physicians, it is necessary to use additional lead shielding equipment when preparing the treatment needles, i.e., when loading the grains. This study provides useful information on radiation exposure of physicians conducting ¹⁹⁸Au permanent grain brachytherapy. Full article

Background/Objectives: To evaluate radiation exposure in standard interventional radiology procedures using a twin robotic X-ray system compared to a state-of-the-art conventional angiography system. Methods: Standard interventional radiology procedures (port implantation, SIRT, and pelvic angiography) were simulated using an anthropomorphic Alderson RANDO phantom (Alderson Research Laboratories Inc. Stamford, CT, USA) on an above-the-table twin robotic X-ray scanner (Multitom Rax, Siemens Healthineers, Forchheim, Germany) and a conventional below-the-table angiography system (Artis Zeego, Siemens Healthineers, Forchheim, Germany). The phantom’s radiation exposure (representing the potential patient on the procedure table) was measured with thermoluminescent dosimeters. Height-dependent dose curves were generated for examiners and radiation technologists in representative positions using a RaySafe X2 system (RaySafe, Billdal, Sweden). Results: For all scenarios, the device-specific dose distribution differs depending on the imaging chain, with specific advantages and disadvantages. Radiation exposure for the patient is significantly increased when using the Multitom Rax for pelvic angiography compared to the Artis Zeego, which is evident in the dose progression through the phantom’s body as well as in the organ-related radiation exposure. In line with these findings, there is an increased radiation exposure for the performing proceduralist, especially at eye level, which can be significantly minimized by using protective equipment (p < 0.001). Conclusions: In this study, the state-of-the-art conventional below-the-table angiography system is associated with lower radiation dose exposures for both the patient and the interventional radiology physician compared to an above-the-table twin robotic X-ray system for pelvic angiographies. However, in other clinical scenarios (port implantation or SIRT), both devices are suitable options with acceptable radiation exposure. Full article

(Background) Domiciliary radiology, which originated in pioneering studies in 1958, has transformed healthcare, particularly during the COVID-19 pandemic, through advancements such as miniaturization and digitization. This evolution, driven by the synergy of advanced technologies and robust data networks, reshapes the intersection of domiciliary radiology and mobile technology in healthcare delivery. (Objective) The objective of this study is to overview the reviews in this field with reference to the last five years to face the state of development and integration of this practice in the health domain. (Methods) A review was conducted on PubMed and Scopus, applying a standard checklist and a qualification process. The outcome detected 21 studies. (Key Content and Findings) The exploration of mobile and domiciliary radiology unveils a compelling and optimistic perspective. Notable strides in this dynamic field include the integration of Artificial Intelligence (AI), revolutionary applications in telemedicine, and the educational potential of mobile devices. Post-COVID-19, telemedicine advances and the influential role of AI in pediatric radiology signify significant progress. Mobile mammography units emerge as a solution for underserved women, highlighting the crucial importance of early breast cancer detection. The investigation into domiciliary radiology, especially with mobile X-ray equipment, points toward a promising frontier, prompting in-depth research for comprehensive insights into its potential benefits for diverse populations. The study also identifies limitations and suggests future exploration in various domains of mobile and domiciliary radiology. A key recommendation stresses the strategic prioritization of multi-domain technology assessment initiatives, with scientific societies’ endorsement, emphasizing regulatory considerations for responsible and ethical technology integration in healthcare practices. The broader landscape of technology assessment should aim to be innovative, ethical, and aligned with societal needs and regulatory standards. (Conclusions) The dynamic state of the field is evident, with active exploration of new frontiers. This overview also provides a roadmap, urging scholars, industry players, and regulators to collectively contribute to the further integration of this technology in the health domain. Full article

With the International Commission on Radiological Protection’s (ICRP) reduction in the radiation dose threshold for cataracts, evaluating and preventing radiation exposure to the lens of the eye among interventional radiology (IR) staff have become urgent tasks. In this study, we focused on differences in lens-equivalent dose (H_T Lens) to which IR nurses in three hospitals were exposed and aimed to identify factors underlying these differences. According to analyses of time-, distance-, and shielding-related factors, the magnitude of the H_T Lens dose to which IR nurses were exposed could be explained not by time or shielding but by the distance between the X-ray exposure field and the location of the IR nurse. This distance tended to be shorter in hospitals with fewer staff. The most effective means of reducing the exposure of the lenses of IR nurses’ eyes to radiation is to position them at least two meters from the radiation source during angiography procedures. However, some hospitals must provide IR departments with comparatively few staff. In work environments where it is infeasible to reduce exposure by increasing distance, interventions to reduce time by managing working practices and investment in shielding equipment are also important. This study was not registered. Full article

Dynamic digital radiography (DDR) is a high-resolution radiographic imaging technique using pulsed X-ray emission to acquire a multiframe cine-loop of the target anatomical area. The first DDR technology was orthostatic chest acquisitions, but new portable equipment that can be positioned at the patient’s bedside was recently released, significantly expanding its potential applications, particularly in chest examination. It provides anatomical and functional information on the motion of different anatomical structures, such as the lungs, pleura, rib cage, and trachea. Native images can be further analyzed with dedicated post-processing software to extract quantitative parameters, including diaphragm motility, automatically projected lung area and area changing rate, a colorimetric map of the signal value change related to respiration and motility, and lung perfusion. The dynamic diagnostic information along with the significant advantages of this technique in terms of portability, versatility, and cost-effectiveness represents a potential game changer for radiological diagnosis and monitoring at the patient’s bedside. DDR has several applications in daily clinical practice, and in this narrative review, we will focus on chest imaging, which is the main application explored to date in the literature. However, studies are still needed to understand deeply the clinical impact of this method. Full article