[The Dosage and Quality of Imaging program and quality assurance in mammography]. / Il programma DQM e la garanzia della qualità nella mammografia.

The aim of the optimization program for mammography (DQM) in Italy is to achieve the best compromise between image quality and dose to patient. 272 centers agreed to the second phase of the program, from February 1987 to January 1990. Exposure, half-value layer (HVL) and focal spot size were measured according to the same methods employed in the first phase of the DQM program (1985), while image quality was evaluated by means of a new performance phantom. The average exposure was 0.96 R (2.48 x 10(-4) C/kg); in 173 (64.3%) centers exposure was less than 1 R (2.58 x 10(-4) C/kg), and only in 3 centers, where a direct X-ray film was employed, was exposure greater than 5 R (12.9 x 10(-4) C/kg). In every center the average whole-breast dose to a reference organ (5 cm thick, composed of 50% fat + 50% water) was calculated on the basis of entrance exposure, HVL, and focus-skin distance; in 63.2% of the centers doses less than 0.15 cGy were employed. The results allowed dose and image quality to be correlated in order to divide the centers (using a film-screen system) into groups with a different efficiency level: in 101 centers dose and image quality were good, in 64 centers too high a dose was employed, in 66 centers image quality was poor, and in 38 centers dose was too high and image quality was poor. It must be stressed that the DQM program can play its role only if each center carries out its Quality Assurance activity after the methods recommended by the World Health Organization.

[Comparison between phantoms for quality control in xeromammography]. / Confronto tra i fantocci per i controlli di qualità in xeromammografia.

An indicator of operating technique (phantom) is very useful for quality control in diagnostic radiology. We tested experimentally that the "Random Phantom" is the most suitable between those commercially available for xeromammography. In fact this indicator points out image quality alterations caused even by very small variations of the physical parameters affecting image quality. We did not test the phantoms for mammographic technique but we believe that the "Random" is the most suitable in this field too.

[Current role of interventional radiology of the bile ducts]. / Ruolo attuale della Radiologia interventistica delle vie biliari.

Interventional Biliary Radiology, born from the development of the instrumental procedures linked to transhepatic cholangiography, plays a leading role in the management of patients with obstructive jaundice. In fact it includes several diagnostic tools, such as cytological examination of the bile, transhepatic brushing and biopsy, percutaneous cholangioscopy, manometric and perfusional biliary studies, which are extremely successful in the diagnosis of nature of the obstructive lesions. On the other hand it includes some therapeutical procedures, deriving from angiographic techniques, which allow the placement of drainage catheters into the biliary tree. These drainage systems, used to decompress the bile ducts, are the external drainage catheter, which divert the bile out of the organism; the external-internal drainage catheter, which restores the physiological biliary flow; the endoprosthesis, a cylindric tube, with sideholes, pushed into the obstructive lesion. All these devices may have a preoperative or definitive-palliative finality.

Breast cancer risk factors in Italian women: a multicentric case-control study.

To evaluate the importance of several risk factors for breast cancer in the Italian female population, a large multicentric case-control study was conducted in 10 breast clinics in Italy. The study included 1,556 women affected by breast cancer, histologically and/or cytologically confirmed. Controls were 1,505 women admitted to a hospital in the same town, matched with cases for residence and with the same age distribution of the Italian female population. The risk factors considered in this study were family history of breast cancer, reproductive history, height and weight, use of oral contraceptives, other hormonal therapies and smoking history. The results of this study confirm the significant role of a positive family history of breast cancer (RR = 2.37); the relative risk was even higher when a first-degree relative was affected or the breast cancer was bilateral. The analysis of the reproductive history showed a significant trend of increasing risk with increasing age at first birth and, although less evident, with increasing number of children. Quetelet's index (kg/m-2) was positively correlated with breast cancer risk, mostly in postmenopausal women. Among other studied factors, only late age at menopause confirmed an increased risk for breast cancer, whereas age at menarche, use of oral contraceptives and smoking histories did not show any significant correlation with breast cancer risk. These results are in substantial agreement with other international studies, but represent an interesting contribution to studies about the Italian female population.

[Transvenous xeroangiography of arteriovenous fistulas of patients undergoing periodic hemodialysis]. / La xeroangiografia transvenosa delle fistole artero-venose dei pazienti in emodialisi periodica.

Xeroradiography allows visualisation of the arterial system after intravenous injection of contrast media. This method has proved particularly useful for diagnosis of changes in the arteriovenous fistulas of 20 patients on chronic haemodialysis. In all cases transvenous xeroangiography gave information about morphologic alterations of vessels and soft tissues. Among the commonly used angiographic methods, transvenous xeroangiography appears the technique of choice.

[Xeroangiography. Technical principals and applied developments]. / La xeroangiografia. Principi tecnici e sviluppi applicativi.

The physical patterns ruling the information of a xeroradiographic image allow the visualization of the arterial system with a lower concentration of contrast medium. So you can visualize the arterial branches both with intravenous injection of the usual angiographic concentration of contrast medium or with intraarterial injection of diluted contrast medium at a very low concentration. A prerequisite to successful xeroangiography was the commercial diffusion of a changer for xerox cassettes allowing several exposures according to standardized programs.

[The heterozygote beta-thalassemic patient with regard to radiological hazards]. / Il beta-talassemico eterozigote di fronte al rischio radiologico.

Since anaemia of varying degree is a quite common finding in heterozygous beta-thalassaemia, a research was done to see if beta-thalassaemia heterozygotes occupationally exposed to long-term continuous external radiation should be more susceptible to haematopoietic damage than non thalassaemic subjects. We examined peripheral haematological findings of 20 beta-thalassaemia heterozygotes previously exposed to a mean of 10.7 mSv, compared with 22 non thalassaemic subjects exposed to 6 mSv, and with 50 not exposed beta-thalassaemia heterozygotes. The obtained results suggest that whole-body external irradiation--with the mean doses reported--does not cause noteworthy changes in beta-thalassaemia heterozygotes.

[Ultrasonographic study in breast immersion]. / L'esame ultrasonografico in immersione della mammella.

100 breast symptomatic patients have been examined with ultrasound, using an automated water-path scanner (Senomatic 3D CGR), and commercial B-mode or real-time scanners. All the patients were also examined with xeromammography. Normal breast patterns, as well as benign and malignant breast lesions, are presented.

Possible indication of breast cancer risk through discriminant functions.

In the Ferrara province of Italy, a screening programme for the detection of breast cancer was initiated in 1965; by 1976, 21,120 women had been examined. The biologic history of the women participating in the program is routinely collected at registration. Several biological variables can be extracted from the history. We used 15 biologic variables in order to construct discriminant functions between women affected by breast cancer and a group of control women. It was found that four variables suffice to separate the group of the women with breast cancer from the control group, although with some degree of uncertainty. The theory was advanced that the individual values of a discriminant function may be associated with the risk of healthy women for developing breast cancer. Data collected after the construction of the discriminant function hint at such an association. We have attempted to calculate a discriminant value for healthy women participating in screening programs, so that those having a discriminant value below a given threshold may be considered at higher risk than those above the threshold. The women in the high-risk group may then be submitted to an appropriate examination schedule.

[Phagocytic lymphocyte-like elements (PLLE) and irradiation in vitro]. / Elementi simil-linfocitari fagocitanti (E.S.L.F.) e irradiazione in vitro.

The peripheral blood of rats contains lymphocyte-like phagocytes after intracardial injection of India ink. In vitro irradiation of whole blood (1000 r - 60Co), causes marked reduction in whole lymphocytes but does not modify the number and morphological integrity of the phagocytes, which can therefore be held to be comparatively radioresistant: as such, they could belong either to the mononucleate phagocyte system or to the lymphatic system (T4 lymphocytes). Since T-lymphocytes are not capable of phagocytosis, the former hypothesis would appear the most probable.