Analytical estimation of ultrasound properties, thermal diffusivity, and perfusion using magnetic resonance-guided focused ultrasound temperature data.

For thermal modeling to play a significant role in treatment planning, monitoring, and control of magnetic resonance-guided focused ultrasound (MRgFUS) thermal therapies, accurate knowledge of ultrasound and thermal properties is essential. This study develops a new analytical solution for the temperature change observed in MRgFUS which can be used with experimental MR temperature data to provide estimates of the ultrasound initial heating rate, Gaussian beam variance, tissue thermal diffusivity, and Pennes perfusion parameter. Simulations demonstrate that this technique provides accurate and robust property estimates that are independent of the beam size, thermal diffusivity, and perfusion levels in the presence of realistic MR noise. The technique is also demonstrated in vivo using MRgFUS heating data in rabbit back muscle. Errors in property estimates are kept less than 5% by applying a third order Taylor series approximation of the perfusion term and ensuring the ratio of the fitting time (the duration of experimental data utilized for optimization) to the perfusion time constant remains less than one.

Physical and clinical comparison between a screen-film system and a dual-side reading mammography-dedicated computed radiography system.

BACKGROUND: Digital mammography systems, thanks to a physical performance better than conventional screen-film units, have the potential of reducing the dose to patients, without decreasing the diagnostic accuracy. PURPOSE: To achieve a physical and clinical comparison between two systems: a screen-film plate and a dual-side computed radiography system (CRM; FUJIFILM FCR 5000 MA). MATERIAL AND METHODS: A unique feature of the FCR 5000 MA system is that it has a clear support medium, allowing light emitted during the scanning process to be detected on the "back" of the storage phosphor plate, considerably improving the system's efficiency. The system's physical performance was tested by means of a quantitative analysis, with calculation of the modulation transfer function, detective quantum efficiency, and contrast-detail analysis; subsequently, the results were compared with those achieved using a screen-film system (SFM; Eastmann Kodak MinR-MinR 2000). A receiver operating characteristic (ROC) analysis was then performed on 120 paired clinical images obtained in a craniocaudal projection with the conventional SFM system under standard exposure conditions and also with the CRM system working with a dose reduced by 35% (average breast thickness: 4.3 cm; mean glandular dose: 1.45 mGy). CRM clinical images were interpreted both in hard copy and in soft copy. RESULTS: The ROC analysis revealed that the performances of the two systems (SFM and CRM with reduced dose) were similar (P>0.05): the diagnostic accuracy of the two systems, when valued in terms of the area underneath the ROC curve, was found to be 0.74 for the SFM, 0.78 for the CRM (hard copy), and 0.79 for the CRM (soft copy). CONCLUSION: The outcome obtained from our experiments shows that the use of the dual-side CRM system is a very good alternative to the screen-film system.

MRI patterns of invasive lobular cancer: T1 and T2 features.

PURPOSE: The aim of this study was to describe magnetic resonance imaging (MRI) patterns in 21 patients with histologically proven invasive lobular cancer (ILC) of the breast. MATERIALS AND METHODS: We retrospectively reviewed MR images of 21 out of 24 women with ILC of the breast. Three women were excluded from the study because they underwent neoadjuvant chemotherapy after MRI. Thirteen of the 24 women had positive clinical findings. All 24 patients underwent mammography, sonography and MRI. MRI was performed to evaluate disease extent and multifocality/multicentricity before modified radical mastectomy (n=5) or quadrantectomy (n=16). Two experienced radiologists reviewed the MRI scans and described the tumour patterns. RESULTS: We identified five morphological patterns of ILC: a solitary mass with irregular margins (n=8); a mass with smooth margins (n=5); multiple small enhancing foci with interconnecting enhancing strands (n=4); dominant lesion surrounded by small foci (n=3); one MR examination was negative. CONCLUSIONS: Architectural and dynamic features are important in the interpretation of breast MRI findings. ILC may be detected on MRI as solitary or multiple lesions that correspond to tumour morphology on pathologic examination. False-negative MRI findings do occur in a small percentage of ILC.

Purification by ozonolysis of (18)O enriched water after cyclotron irradiation and the utilization of the purified water for the production of [18F]-FDG (2-deoxy-2-[18F]-fluoro-d-glucose).

The high cost of virgin (18)O-enriched water has forced many researchers to study methods to purify and recycle enriched water after the first irradiation for the production of radiopharmaceuticals. In our study, [(18)O]H(2)O was purified by ozonolysis and distillation. Analyses showed a large decrease in impurities after this treatment. The purification procedure was carried out after the production of 94 batches of [18F]-FDG, which were manufactured using a GE Minitrace cyclotron and a GE Mx TracerLab synthesizer. Saturation yields after bombardment, using virgin and re-purified water were, respectively, 2864+/-204MBq/muA and 2727+/-167MBq/muA, a decrease of 5.5%. The decrease in [18F]-FDG yield, from 67.2+/-0.7% to 65.5+/-0.9%, can be ascribed to the irradiation step only.

Wiener spectrum of radiographic systems: comparison of different evaluation methods.

The noise power spectrum, or Wiener spectrum, of the radiographic mottle is a fundamental quantity in film-screen image quality evaluation. In this paper, using a high-quality computerized microdensitometer, two different acquisition and calculation methods for noise evaluation are compared. The first one is the classic (unidimensional) method used in film noise evaluation: a long and narrow slit (10 x 400 microns2) is used to delimit the microdensitometer light beam and the transmission data are collected by scanning the sample in a rectilinear pattern. A section of the two-dimensional Wiener spectrum is thus obtained. The second (two-dimensional) method is similar to that used in digital image noise evaluation: a square slit is used on the microdensitometer window and data are collected by scanning the sample on a square pattern. To evaluate the effect of different sampling frequencies, our data were acquired both selecting a 50 x 50 microns2 square slit and a 20 x 20 microns2 square slit. The two-dimensional Wiener spectrum thus obtained is then reduced to a unidimensional function. The measurements were made on two different films (Kodak Ortho G e Kodak T-MAT G) exposed with the same screen (Kodak Lanex Regular). These films have the same sensitivity but a different emulsion structure. One film (Ortho G) is made of irregular halide silver grains and the other (T-MAT G) of tabular grains. A satisfactory agreement between the two procedures was found which makes the comparison of data from the laboratories using microdensitometers and those using TV-grabbing system for film-screen evaluation meaningful.

[Quality evaluation of a personal dosimetry service]. / Valutazione della qualità del servizio di dosimetria individuale.

In a hospital environment high quality personal dosimetry is demanded by two different considerations: first, the marked reduction in the radiation exposure levels of hospital workers during the last 10 years and second, the recent decrease in the allowed absorbed dose thresholds for the different categories of workers and for the general population. In fact, according to the new Italian Radioprotection Law (D.L. vo 230/95), the dose equivalent limit for the general population has been decreased to 1 mSv per year. This means that a dosimetric system should be able to measure, with acceptable precision and accuracy, dose levels as low as 0.1 mSv per observation period (generally 1 month or 45 days). This is quite a stringent requirement for this kind of dosimetry. During a tender, the performances of the whole body personal dosimetry systems by four Italian service providers were analyzed by irradiating more than 60 test samples for each provider with four different energies in a wide dose interval (0.01-100 mSv). The results show that all systems perform quite well in the 0.2-100 mSv dose range; on the contrary, in the 0.01-0.2 mSv dose range, significant differences appear between the services and TLD based systems perform better than film based ones. In particular, one of the two TLD based systems measured doses as low as 0.01 mSv. To conclude this very high sensitivity level really opens a new "observation window" on the low doses world. The use of higher quality (and, of course, more expensive) materials by this provider seems to be the key of its success.

[Radiotherapy of the breast: changes in the volume of the lung covered in the treatment fields and resulting changes in dose distribution]. / Radioterapia della mammella: variazioni del volume del polmone compreso nei campi del trattamento e conseguenti modificazioni della distribuzione della dose.

In breast cancer adjuvant therapy, respiratory movements continuously modify the irradiated volumes and the anatomical shape of this body region. Fifteen patients were submitted to 3 Computed Tomography (CT) sequences for treatment planning: the first one without any indications to the patient (the standard sequence) and the second and the third one with spontaneous stopped inspiration and expiration, respectively; the patient was always in the same position. The treatment was planned on standard CT images and then applied to the other sequences, maintaining all parameters unvaried, including isocenter position and treatment time. The lung volumes within the fields (and those included in the 95%, 100%, 105% isodoses referred to the prescribed dose) were evaluated with dose/volume histograms. The average irradiated lung was 69 cm3 (DS 28) in standard sequences, 136 cm3 (DS 67) in inspiration and 41 cm3 (DS 25) in expiration. The pulmonary volume within the above isodoses exhibited similar changes. In other words, the lung volume actually irradiated during the whole treatment is smaller than the one which can be calculated on standard CT sequences and it corresponds to expiration volume. The remaining part falls into a wide "twilight zone" relative to dose. Therefore, the true risk of lung toxicity can be similarly lower than the calculable one on standard CT images. Thus, the complication risk (based on dose/volume histograms and normal tissue control probability parameters) could be assessed in new prospective studies, introducing a corrective factor for the irradiated lung volume, because the latter is smaller than that shown by standard CT.

[Quality assurance in radiology: quality control of radiographic cassettes]. / Assicurazione della qualità nella radiologia: il controllo della qualità delle cassette radiografiche.

A "quality team" in radiology, whose members are the authors of this paper, has implemented a quality control program to test the cassettes with intensifying screen systems used in radiology departments. 149 systems-124 of them for general purpose radiology and 25 for mammography-were submitted to the following tests: visual inspection of radiographic cassettes and intensifying screens, screen-film contact, intensifying screen cleanliness and relative sensitivity of the intensifying screens. The results of each type of test are reported in detail in the paper, on a 3-point scale: good, sufficient and poor. The overall results of the quality control tests show 78% of general purpose radiology cassettes to qualify as good (69%) or sufficient (9%), while 22% were of poor quality. 88% of the mammographic cassettes qualified as good (76%) or sufficient (12%), while 12% were of poor quality. All tests were easy to perform and required limited resources. The necessary procedures to keep quality high over time are also reported. To conclude, the results obtained with our quality control program could be used as an effective tool to address and plan the turnover of the cassettes with intensifying screens which are usually used in diagnostic radiology practice.

Radiation transport in a radiotherapy room.

The photoneutron dose equivalent in a linac radiotherapy room and its entrance maze was investigated by means of Monte Carlo simulations under different conditions. Particularly, the effect of neutron absorbers and moderator layers placed on the maze walls was considered. The contribution of prompt gamma rays emitted in absorption reactions of thermal neutrons was also taken into account. The simulation results are compared with some experimental measurements in the therapy room and in the maze.

Transfer kinetics and coefficients of 90Sr, 134Cs, and 137Cs from forage contaminated by Chernobyl fallout to milk of cows.

A experiment was conducted to study kinetics, transfer coefficients, and biological half-lives of 90Sr, 134Cs, and 137Cs from feed to milk. A cow was fed a diet containing alfalfa hay contaminated by Chernobyl fallout for 14.5 wk. The time-dependent activity in milk was approximated by a two-compartment model with fast biological half-lives of 2, 0.9, and 1 d and slow biological half-lives of 36.9, 8.7, and 12.4 d for 90Sr, 134Cs, and 137Cs, respectively. The transfer coefficients determined in the experiment were 0.0008 d L-1 for 90Sr, 0.0029 d L-1 for 134Cs, and 0.0031 d L-1 for 137Cs. The biological elimination phases of 134Cs and 137Cs were described by a two-compartment model while a one-compartment model was proposed for 90Sr.

The choice of radiographic film-screen systems: quality evaluation and purchasing specifications drafting. Report on A.I.F.B. Working Group activity.

The comparative evaluation of radiographic screen-film systems presents several problems from both the theoretical and the experimental points of view. From the theoretical point of view the main difficulties are related to the choice of the parameters best suited to express the "overall quality" of a system. This quantity is expressed as a product of image quality index and system sensitivity. As image quality index we assumed the signal-to-noise power ratio: this index depends in an explicit way on contrast, resolution and noise of the system. From the experimental point of view the main problem is that to measure some basic quantities, sophisticated and expensive equipment, like computer-controlled microdensitometers, is generally required. In this paper, we report the Italian Association of Biomedical Physicists Task group suggestions for measuring the basic physical parameters (with particular reference to the use of cost-effective equipment and for purchasing specification drafting). Using synthetic quality indices, the evaluation criteria of radiographic materials are directly derived from the general theory of radiographic image perception.

[Evaluation of the quality of screen-film radiographic systems: physical principles and methods of measurement]. / Valutazione della qualità di sistemi radiografici schermo-pellicola: principi fisici e metodi di misura.

Comparative evaluation of radiographic film-screen systems presents several problems from both the theoretical and the experimental point of view. From the theoretical point of view the main difficulties are related to the choice of the parameters best suited to express the "overall quality" of a system. From the practical point of view the main problem is that to measure some basic quantities (resolution and noise) sophisticated and expensive instruments are required. This paper deals with both these problems. To express image quality we have assumed the signal-to-noise power ratio: this index depends in a explicit way on contrast, resolution and noise of the system. The dependence on sensitivity is implicit and was derived using literature data. From a knowledge of the dependence of image quality on sensitivity it is possible to develop an "overall quality" index which is considered to express the "technological level" of the system. This index can be used in the comparative evaluation of the different systems. In this work some basic physical quantities (characteristic curve, sensitivity) were evaluated using standard instruments. To measure spatial resolution and noise an inexpensive, PC-based, TV-digitizer system was developed. As an example, both image and overall quality indices were evaluated on three mammographic systems which are typical of the three different "phases" of the development of this technique.

[En-bloc treatment of tumors of the hypopharyngeal-laryngeal-tracheal tract with a new isocentric multipendular technic]. / Trattamento in blocco dei tumori del tratto ipofaringo-laringo-tracheale con una nuova tecnica multipendolare isocentrica.

The authors propose a new technique for the treatment of hypopharyngeal-laryngeal-tracheal tract tumors using cobalt-60 irradiation. This technique allows the simultaneous irradiation of both primary tumor and cervical lymph nodes. Therapeutically effective doses can be administered without affecting the spinal cord. The above-mentioned technique consists of 3 isocentric rotations, the widest one carried out by interposing a small lead bar shielding in the middle of the field. Dose distributions obtained in an Alderson-Rando phantom and in a patient are reported.

Three-dimensional display of myocardial perfusion: detection of ischemic lesions using a new image subtraction method.

A recent, commercially available computer program for the three-dimensional (3D) display of single-photon emission tomography (SPET) data was used to study myocardial perfusion in patients with coronary artery disease (CAD). To enable the detection of small ischemic lesions, the authors proposed a new "distance-substraction" method: after suitable centering of the axial slices, 3D "distance-shaded" images of the stress study were subtracted from the corresponding views of the rest study. With this technique, small changes in surface-to-observer distance were highlighted, thus enabling us to detect nontransmural ischemic areas of the myocardium. General characteristics and possibilities of the subtraction technique were tested on a simple myocardial phantom. Some clinical results of the application of this method on CAD patients are presented and discussed. In CAD patients in whom only nontransmural ischemic lesions are present, the subtraction of "distance-shaded" images is decisive for a correct diagnosis.

[Myocardial perfusion visualized with SPECT: three-dimensional representation]. / Perfusione del miocardio con SPECT: rappresentazione tridimensionale.

A recently developed computer program for three-dimensional (3D) reconstruction of SPECT images has been employed to study myocardial perfusion in coronaropathic patients using MIBI-99mTc or 201Tl chloride. By subtracting after-stress from at-rest 3D reconstructed images, even small ischemic lesions could be located in the myocardium, with good morphological definition. The general characteristics of the method and some clinical results are here presented.

[Radiation exposure of the embryo and the fetus: real risks or unjustified fears?]. / Esposizione alle radiazioni dell'embrione e del feto: rischi reali o ingiustificati timori?

The authors discuss the problem of radiation damage to the individual developing in utero, and summarize the information available in the literature on the subject. Additional risks induced by ionizing radiations are classified with reference to gestational age and dose absorbed by the fetus. Such risks concern the possibility of mental retardation from the 8th to the 15th gestational week, and of developing a malignant disease from the 3rd to the 15th gestational week. We report the dose values received by the fetus as a result of both radiodiagnostic examinations and the Chernobyl nuclear accident: the doses were generally very low, which leads us to the conclusion that additional risks are of the same order of magnitude as the fluctuations in the natural congenital malformations. Thus, prenatal irradiation for diagnostic examinations does not generally represent a reason to recommend therapeutic abortion. However, it is always important to carry out a careful evaluation of the dose absorbed by the fetus and to correctly inform the mother about eventual radiation-induced risks.

High-resolution 1H NMR spectroscopy in the diagnosis of breast cancer.

Surgical specimens from 22 patients with infiltrating ductal carcinoma of the breast were analyzed by high-resolution 1H NMR spectroscopy at 80 and 300 MHz. Results were compared with those obtained from 9 benign (proliferative dysplasia without atypia) breast samples. NMR spectra at 80 MHz showed well-resolved water and lipid peaks so it was possible to calculate specific T1 and T2 relaxation times. The longitudinal T1 relaxation process of the water was found to be properly represented by a monoexponential function, whereas the transverse T2 decay was well accounted for by a biexponential model. Relaxation time measurements of the water were found to be a valuable tool in breast tissue characterization, in particular (a) mean T1 values from malignant and control populations are well distinguished (P less than 0.0008); (b) mean T2 values of both fast and slow components from the two populations are statistically different (P less than 0.0001) and no overlap exists in the distributions of the second component. Three-hundred-megahertz spectra allowed a detailed analysis of the lipidic component of the sample: malignant tumors were found to present in the region 1.3-1.2 ppm a species characterized by a very slow transverse relaxation time (T2 = 200-1000 ms).

Human chorionic gonadotropin regression following removal of ectopic pregnancy.

Plasmatic Human Chorionic Gonadotropin (hCG) was studied in 41 patients undergoing salpingectomy for tubal pregnancy. On the temporal scale of our research, a biexponential model proved to be adequate to describe hCG clearance; the combined reading of the results of this research and those of other Authors have led us to maintain that hCG clearance is characterised by at least three components. HCG clearance was faster in patients with a higher initial hCG. Nevertheless the problem of hCG clearance depending on its initial value remains unsolved and requires further investigation. The regression curve and relative hCG values obtained in this study can be used as reliable models of comparison in the monitoring of patients undergoing conservative surgical treatment of tubal pregnancy.