1
|
Folco G, Monti CB, Zanardo M, Silletta F, Capra D, Secchi F, Sardanelli F. MRI-derived extracellular volume as a biomarker of cancer therapy cardiotoxicity: systematic review and meta-analysis. Eur Radiol 2024; 34:2699-2710. [PMID: 37823922 PMCID: PMC10957707 DOI: 10.1007/s00330-023-10260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/23/2023] [Accepted: 08/04/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES MRI-derived extracellular volume (ECV) allows characterization of myocardial changes before the onset of overt pathology, which may be caused by cancer therapy cardiotoxicity. Our purpose was to review studies exploring the role of MRI-derived ECV as an early cardiotoxicity biomarker to guide timely intervention. MATERIALS AND METHODS In April 2022, we performed a systematic search on EMBASE and PubMed for articles on MRI-derived ECV as a biomarker of cancer therapy cardiotoxicity. Two blinded researchers screened the retrieved articles, including those reporting ECV values at least 3 months from cardiotoxic treatment. Data extraction was performed for each article, including clinical and technical data, and ECV values. Pooled ECV was calculated using the random effects model and compared among different treatment regimens and among those who did or did not experience overt cardiac dysfunction. Meta-regression analyses were conducted to appraise which clinical or technical variables yielded a significant impact on ECV. RESULTS Overall, 19 studies were included. Study populations ranged from 9 to 236 patients, for a total of 1123 individuals, with an average age ranging from 12.5 to 74 years. Most studies included patients with breast or esophageal cancer, treated with anthracyclines and chest radiotherapy. Pooled ECV was 28.44% (95% confidence interval, CI, 26.85-30.03%) among subjects who had undergone cardiotoxic cancer therapy, versus 25.23% (95%CI 23.31-27.14%) among those who had not (p = .003). CONCLUSION A higher ECV in patients who underwent cardiotoxic treatment could imply subclinical changes in the myocardium, present even before overt cardiac pathology is detectable. CLINICAL RELEVANCE STATEMENT The ability to detect subclinical changes in the myocardium displayed by ECV suggests its use as an early biomarker of cancer therapy-related cardiotoxicity. KEY POINTS • Cardiotoxicity is a common adverse effect of cancer therapy; therefore, its prompt detection could improve patient outcomes. • Pooled MRI-derived myocardial extracellular volume was higher in patients who underwent cardiotoxic cancer therapy than in those who did not (28.44% versus 25.23%, p = .003). • MRI-derived myocardial extracellular volume represents a potential early biomarker of cancer therapy cardiotoxicity.
Collapse
Affiliation(s)
- Gianluca Folco
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Caterina B Monti
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Silletta
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Davide Capra
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
2
|
Roletto A, Zanardo M, Bonfitto GR, Catania D, Sardanelli F, Zanoni S. The environmental impact of energy consumption and carbon emissions in radiology departments: a systematic review. Eur Radiol Exp 2024; 8:35. [PMID: 38418763 PMCID: PMC10902235 DOI: 10.1186/s41747-024-00424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES Energy consumption and carbon emissions from medical equipment like CT/MRI scanners and workstations contribute to the environmental impact of healthcare facilities. The aim of this systematic review was to identify all strategies to reduce energy use and carbon emissions in radiology. METHODS In June 2023, a systematic review (Medline/Embase/Web of Science) was performed to search original articles on environmental sustainability in radiology. The extracted data include environmental sustainability topics (e.g., energy consumption, carbon footprint) and radiological devices involved. Sustainable actions and environmental impact in radiology settings were analyzed. Study quality was assessed using the QualSyst tool. RESULTS From 918 retrieved articles, 16 met the inclusion criteria. Among them, main topics were energy consumption (10/16, 62.5%), life-cycle assessment (4/16, 25.0%), and carbon footprint (2/16, 12.5%). Eleven studies reported that 40-91% of the energy consumed by radiological devices can be defined as "nonproductive" (devices "on" but not working). Turning-off devices during idle periods 9/16 (56.2%) and implementing workflow informatic tools (2/16, 12.5%) were the sustainable actions identified. Energy-saving strategies were reported in 8/16 articles (50%), estimating annual savings of thousand kilowatt-hours (14,180-171,000 kWh). Cost-savings were identified in 7/16 (43.7%) articles, ranging from US $9,225 to 14,328 per device. Study quality was over or equal the 80% of high-quality level in 14/16 (87.5%) articles. CONCLUSION Energy consumption and environmental sustainability in radiology received attention in literature. Sustainable actions include turning-off radiological devices during idle periods, favoring the most energy-efficient imaging devices, and educating radiological staff on energy-saving practices, without compromising service quality. RELEVANCE STATEMENT A non-negligible number of articles - mainly coming from North America and Europe - highlighted the need for energy-saving strategies, attention to equipment life-cycle assessment, and carbon footprint reduction in radiology, with a potential for cost-saving outcome. KEY POINTS • Energy consumption and environmental sustainability in radiology received attention in the literature (16 articles published from 2010 to 2023). • A substantial portion (40-91%) of the energy consumed by radiological devices was classified as "non-productive" (devices "on" but not working). • Sustainable action such as shutting down devices during idle periods was identified, with potential annual energy savings ranging from 14,180 to 171,000 kWh.
Collapse
Affiliation(s)
- Andrea Roletto
- Department of Mechanical and Industrial Engineering, Università degli Studi di Brescia, Via Branze 38, 25123, Brescia, Italy.
| | - Moreno Zanardo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Giuseppe Roberto Bonfitto
- Department of Information Engineering, Università degli Studi di Brescia, Via Branze 38, 25123, Brescia, Italy
| | - Diego Catania
- Health Professions Leadership and Management Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Zanoni
- Department of Civil, Environmental, Architectural Engineering and Mathematics, Università degli Studi di Brescia, Via Branze 43, 25123, Brescia, Italy
| |
Collapse
|
3
|
Zanardo M, Mennini C, Glielmo P, Fusco S, Albano D, Messina C. Dual Energy X-ray Absorptiometry: Radiographer'S Role in Assessing Fracture Risk Assessment Tool (FRAX) Questionnaire Variables. J Clin Densitom 2024; 27:101458. [PMID: 38141277 DOI: 10.1016/j.jocd.2023.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND The FRAX® algorithm is a tool used to calculate the 10-year probability of fracture in patients with osteoporosis and is based the assessment of several risk factors. We assessed the performance and accuracy of the completion of the FRAX® anamnestic questionnaire by the radiographer without impact on the clinical workflow. METHODOLOGY We evaluated the accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm before and after specific training. A total of 100 women were enrolled in the study. The radiographer preliminarily administered the FRAX® questionnaire to all subjects before the execution of the DXA examination. After the end of the examination, a radiologist administered the questionnaire to the patient. Women were divided into two groups: group A (pre-training) and group B (post-training). The radiographer in group A completed the FRAX® questionnaire for the patients before training. For group B, the same radiographer completed the FRAX® questionnaire after training. The results of the FRAX® questionnaire completed by radiographer were compared with that completed by the referring physician. RESULTS Before training, radiographer's accuracy ranged from 92% (question 7, alcohol consumption) to 36% (question 6, secondary osteoporosis). After training, accuracy values improved substantially, ranging from 100% to 92%. Analysis of the absolute values of FRAX® showed that in the pre-training group data tended to be overestimated by the radiographer, with both major and fractures probabilities being significantly higher when assessed by the radiographer (12% and 5.8%, respectively). After the training, there was a marked decrease in the variation between the FRAX® data calculated by the radiographer and the radiologist. CONCLUSIONS The accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm is significantly improved after a specific training period. This study demonstrates the importance of dedicated training radiographers on the FRAX® algorithm.
Collapse
Affiliation(s)
- Moreno Zanardo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Cinzia Mennini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy
| | - Pierluigi Glielmo
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy
| | - Stefano Fusco
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy; Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| |
Collapse
|
4
|
Zanardo M, Rainford L, McGee A, Dowley A, McNulty JP, Buissink C, O'Connor M. An investigation into academic career pathways across Radiography education centres internationally. Radiography (Lond) 2023; 29:992-999. [PMID: 37634415 DOI: 10.1016/j.radi.2023.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Robust academic pathways are critical to support of radiography faculty within third level education. As the profession of Radiography grows its' research activity, it is important that academic opportunities meet the needs of the profession. The purpose of this research was to investigate current academic career pathways across radiography education centres internationally. METHODS An online survey was developed and administered to radiography academics and clinical/academic staff members internationally. The survey questions (n = 28) include demographic data; teaching and research requirements; academic promotion criteria; identification of the challenges and benefits of being an academic, including equality, diversity and inclusion (EDI) matters. RESULTS A total of 175 responses were obtained (6 continents and 39 countries), with a variety of experience levels amongst academics that primarily held permanent work contracts. Regarding the highest qualifications held, 31.4% (n = 55) had a Doctorate and 45.7% (n = 80) a Master's degree, and most respondents were employed as academic lecturers (40.6%; n = 71), with 17.7% (n = 31) employed at professorial level. The minimum time requirement to achieve a permanent contract was variable, ranging from no delay (5.7%; n = 10) to more than 10 years (12.6%; n = 22). Doctorate qualification is currently not necessary in order to career progression for 126 (72%) respondents, while 52% (n = 91) provided specific research requirements. 106 (60.6%) respondents indicated that their institution has EDI policy. CONCLUSION This study has captured details related to academic pathways across international radiography education centres. Whilst some heterogeneity exists, there are numerous differences impacting standardised academic career opportunities for Radiography academics. These may challenge academic career opportunities and discourage those interested in an academic career. IMPLICATIONS FOR PRACTICE The profile and educational background of these academics has been highlighted as well as the perceived barriers and advantages of a career in academic.
Collapse
Affiliation(s)
- M Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.
| | - L Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland.
| | - A McGee
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland.
| | - A Dowley
- School of Medicine, University College Dublin, Dublin, Ireland.
| | - J P McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland.
| | - C Buissink
- Department of Medical Imaging and Radiation Therapy, Hanze University of Applied Sciences, Groningen, the Netherlands.
| | - M O'Connor
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland.
| |
Collapse
|
5
|
Zanardo M, Cozzi A, Cardani R, Renna LV, Pomati F, Asmundo L, Di Leo G, Sardanelli F. Reducing contrast agent residuals in hospital wastewater: the GREENWATER study protocol. Eur Radiol Exp 2023; 7:27. [PMID: 37142839 PMCID: PMC10160294 DOI: 10.1186/s41747-023-00337-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/09/2023] [Indexed: 05/06/2023] Open
Abstract
The potential enviromental impact of iodinated (ICAs) and gadolinium-based contrast agents (GBCAs) have recently come under scrutiny, considering the current nonselective wastewater treatment. However, their rapid excretion after intravenous administration could allow their potential recovery by targeting hospital sewage. The GREENWATER study aims to appraise the effective quantities of ICAs and GBCAs retrievable from patients' urine collected after computed tomography (CT) and magnetic resonance imaging (MRI) exams, selecting ICA/GBCA per-patient urinary excretion and patients' acceptance rate as study endpoints. Within a prospective, observational, single-centre, 1-year framework, we will enrol outpatients aged ≥ 18 years, scheduled to perform contrast-enhanced CT or MRI, willing to collect post-examination urine in dedicated canisters by prolonging their hospital stay to 1 h after injection. Collected urine will be processed and partially stored in the institutional biobank. Patient-based analysis will be performed for the first 100 CT and 100 MRI patients, and then, all analyses will be conducted on the pooled urinary sample. Quantification of urinary iodine and gadolinium will be performed with spectroscopy after oxidative digestion. The evaluation of the acceptance rate will assess the "environmental awareness" of patients and will aid to model how procedures to reduce ICA/GBCA enviromental impact could be adapted in different settings. Key points • Enviromental impact of iodinated and gadolinium-based contrast agents represents a growing point of attention.• Current wastewater treatment is unable to retrieve and recycle contrast agents.• Prolonging hospital stay may allow contrast agents retrieval from patients' urine.• The GREENWATER study will assess the effectively retrievable contrast agents' quantities.• The enrolment acceptance rate will allow to evaluate patients' "green sensitivity".
Collapse
Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosanna Cardani
- Biobank BioCor, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | - Luigi Asmundo
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
6
|
Monti CB, Zanardo M, Capra D, Lastella G, Guarnieri G, Giambersio E, Pasqualin G, Sardanelli F, Secchi F. The predictive role of right ventricular late gadolinium enhancement in patients with tetralogy of Fallot undergoing pulmonary valve replacement. Eur Radiol Exp 2023; 7:9. [PMID: 36826698 PMCID: PMC9958209 DOI: 10.1186/s41747-023-00322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/05/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Our purpose was to evaluate the correlations between right ventricular (RV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in patients with tetralogy of Fallot (ToF) scheduled for pulmonary valve replacement (PVR) and post-PVR functional data. METHODS We retrospectively reviewed ToF patients scheduled for PVR who underwent two CMR examinations at our institution, one before the procedure (CMR-0), including contrast-enhanced sequences, and one after the procedure (CMR-1). Functional left and RV data were obtained by segmenting short-axis stacks on both CMR examinations, and normalised variations were calculated by dividing differences between CMR-1 and CMR-0 by the intercurring time interval, whereas the RV scar burden was assessed on CMR-0 LGE sequences both semiquantitatively and quantitatively. Data were reported as median and interquartile range, differences were appraised with the Mann-Whitney U test, while correlations were assessed with Spearman's ρ. RESULTS Fifteen patients with a median age of 25 years (16-29), including 9 (60%) males, with a median time interval between CMR-0 and CMR-1 of 17 months (12-23), were retrospectively reviewed. The semiquantitative LGE score at CMR-0 was 7 (6-9), and LGE volume was 4.49 mL (3.70-5.78), covering 5.63% (4.92-7.00) of the RV. RV LGE score showed a moderate positive correlation with the normalised variation of RV stroke volume (ρ = 0.662, p = 0.007) and a borderline moderate positive correlation with the normalised variation of RV end-diastolic indexed volume (ρ = 0.513, p = 0.050). CONCLUSIONS The assessment of RV LGE before PVR may provide insights on post-PVR functional data, potentially facilitating a patient-tailored treatment pathway.
Collapse
Affiliation(s)
- Caterina Beatrice Monti
- grid.4708.b0000 0004 1757 2822Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Moreno Zanardo
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy
| | - Davide Capra
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy.
| | - Giulia Lastella
- grid.432778.dUnit of Radiology, ASST Nord Milano, Viale Matteotti 83, 20099 Sesto San Giovanni, Italy
| | - Gianluca Guarnieri
- grid.4708.b0000 0004 1757 2822Postgraduation School in Cardiology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Emilia Giambersio
- grid.4708.b0000 0004 1757 2822Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Giulia Pasqualin
- grid.419557.b0000 0004 1766 7370Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Sardanelli
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy ,grid.419557.b0000 0004 1766 7370Department of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Secchi
- grid.4708.b0000 0004 1757 2822Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy ,grid.419557.b0000 0004 1766 7370Department of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| |
Collapse
|
7
|
Doniselli FM, Zanardo M, Mazon M, Cuccarini V, Rovira A, Costa A, Sconfienza LM, Arana E. A Critical Appraisal of the Quality of Vertigo Practice Guidelines Using the AGREE II Tool: A EuroAIM Initiative. Otol Neurotol 2022; 43:1108-1115. [PMID: 36214510 DOI: 10.1097/mao.0000000000003724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this review is to assess the methodological quality of guidelines for the management of vertigo and dizziness and to compare their recommendations, with specific focus on neuroimaging. DATABASES REVIEWED MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence database. METHODS In March 2022, a systematic search was performed to find practice guidelines of management of vertigo and dizziness. The evaluation of guidelines quality was performed independently by four authors using the AGREE II tool. We excluded from the results those guidelines that were not primarily focused on vertigo and dizziness, such as national/international guidelines in which vertigo and dizziness were only briefly mentioned. RESULTS Our strategy of literature search identified 161 studies, and 18 guidelines were selected for the appraisal. Only five guidelines reached the acceptance level in the overall result (at least 60%), with three of them reaching the highest scores (at least 80%). The highest scores were found in Domain 6 "Editorial Independence," Domain 1 "Scope and purpose," and Domain 4 "Clarity of presentation" (median value = 66%, 62%, and 61%, respectively). The remaining domains showed a low level of quality: Domain 2 "Stakeholder Involvement," Domain 3 "Rigor of development," and Domain 5 "Applicability" had median values of 27%, 27%, and 22%, respectively. The quality of these guidelines was very low, because of low involvement of multidisciplinary teams in writing guidelines recommendations. CONCLUSION Considering all guidelines, only three had a "high" overall score, whereas 13 of 18 (72%) of them were rated as of "low" quality. Future guidelines might take this into account to improve clinical applicability.
Collapse
Affiliation(s)
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano
| | - Miguel Mazon
- Radiology and Biomedical Imaging Research Group (GIBI230), La Fe University and Polytechnic Hospital and La Fe Health Research Institute, Valencia
| | - Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico "C. Besta", Milan, Italy
| | - Alex Rovira
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology (IDI), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonella Costa
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico
| | | | | |
Collapse
|
8
|
Roletto A, Catania D, Ciaralli C, Cozzi A, Di Feo D, Durante S, Pasini D, Raiano N, Zanardo M. National survey for investigating the diagnostic imaging departments reorganization and management during the COVID-19 pandemic. J Med Imaging Radiat Sci 2022. [PMCID: PMC9716005 DOI: 10.1016/j.jmir.2022.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction The COVID-19 pandemic has had a profound impact on radiography services globally. The objective of this study was to evaluate the impact of the COVID-19 pandemic on the management of radiology departments in Italy. Methods An online survey with 32 questions was developed and promoted by the Italian Federation of Scientific Radiographer Societies (FASTeR) and sent to all Radiology Service Managers (RSM) identified in the RSM committee of the Italian Federation of Radiographers and Health Professionals, counting for 39 Italian RSM, representing more than 1,200 radiographers. The survey included questions regarding RSM demographics data, the number of radiographers and specialties managed, the effects of the pandemic on the diagnostic imaging service, and any reorganizations that had been implemented, such as the partial or total suspension of diagnostic activities and the number of radiographers tested as positive to COVID-19. Results Twenty (52%) RSM from different Italian regions completed the questionnaire. A total of 70% of respondents had implemented reorganizations in terms of space, equipment, and pathways dedicated to COVID-19-infected patients, including an extension of the timing of acquisition of the exams. More than half of the respondents reported breast and DXA imaging unit had suffered the most suspension of activities. 70% of respondents reported that more than 50% of radiographers were resulted as COVID-19 positive. Conclusion These data show how challenging was of the reorganization of Italian diagnostic imaging departments during the COVID-19 pandemic, with impact on the suspension of some exams and the rescheduling of breast and DXA imaging. The reorganization of the services also had to consider the high number of radiographers suspended from activity due to the positivity to COVID-19, and the lengthening of the duration of the examinations due to the sanitation of the spaces.
Collapse
Affiliation(s)
- Andrea Roletto
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - D Catania
- Directorate General for Healthcare Professions, San Raffaele Research Hospital, Milan, Italy
| | - C Ciaralli
- Radiology department, Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - A Cozzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - D Di Feo
- Radiology Department, Meyer Children's Hospital, Florence, Italy
| | - S Durante
- Directorate of the Nursing, Technical and Rehabilitation Assistance Service, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - D Pasini
- Directorate General for Healthcare Professions, Agostino Gemelli University Policlinic, Rome, Italy
| | - N Raiano
- Radiology and Radiotherapy Department, Research Cancer Center “Pascale Foundation”, Naples, Italy
| | - M Zanardo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
9
|
Roletto A, Zanardo M, Cozzi A, Schiaffino S, Tritella S, Susini F, Gerra F, Sardanelli F. Analysis and management of the COVID-19 pandemic impact on a multispecialty diagnostic imaging department. J Med Imaging Radiat Sci 2022. [PMCID: PMC9715991 DOI: 10.1016/j.jmir.2022.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Introduction The propose of this study was to evaluate the impact of the first two waves of the COVID-19 pandemic on a multispecialty radiology department in a large tertiary university hospital in Northern Italy. Methods The numbers of all radiological exams performed in the radiology department of Scientific Institute for Research, Hospitalization and Healthcare (namely, IRCCS) Policlinico San Donato (San Donato Milanese, Italy) from March 2019 to March 2021 were collected and compared, subdividing them both temporally, modality, sub-specialty, and setting. Results Comparing the first 12 months of the COVID-19 pandemic (from March 2020 to February 2021) with the previous 12 months (from March 2019 to February 2020), there was an overall decrease in total radiological examinations equal to 26% (from 127,998 to 94,550). The most affected modality was DXA (from 4,706 to 2,989, -36%), followed by ultrasonography (from 17,212 to 11,644, -32%), digital radiography (from 66,050 to 47,374, -28%), MRI (from 13,332 to 10,140, -24%), CT (from 19,208 to 15,746, -18%), and mammograms (from 7,490 to 6,657, -11%). Chest CTs of inpatients saw a +15% surge (from 1,087 to 1,144), with far larger sizable increments being observed for chest X-ray examinations of outpatients (from 3,032 to 7,536, +131%). Further sub-analysis according to pandemic waves highlighted an overall -65% decrease of radiological services during the first wave (from March to May 2020), curtailed to -3% during the June–October period and then again rising to -23% during the second wave (from November 2020 to February 2021). Conclusion The COVID-19 pandemic led to a marked decrease of total radiological examinations during the two pandemic waves, limited to -26% by the implementation of safety protocols during the second wave and by increased activity during the inter-wave period.
Collapse
Affiliation(s)
- Andrea Roletto
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - M Zanardo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - A Cozzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - S Schiaffino
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - S Tritella
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - F Susini
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - F Gerra
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - F Sardanelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Melazzini L, Savoldi F, Chessa M, Vitali P, Zanardo M, Bertoldo EG, Fiolo V, Griffanti L, Carminati M, Frigiola A, Giamberti A, Secchi F, Callus E, Codari M, Sardanelli F. Adults with tetralogy of Fallot show specific features of cerebral small vessel disease: the BACH San Donato study. Brain Imaging Behav 2022; 16:1721-1731. [PMID: 35266099 PMCID: PMC8906830 DOI: 10.1007/s11682-022-00629-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
Life expectancy in adults with congenital heart disease (ACHD) has increased. As these patients grow older, they experience aging-related diseases more than their healthy peers. To better characterize this field, we launched the multi-disciplinary BACH (Brain Aging in Congenital Heart disease) San Donato study, that aimed at investigating signs of brain injury in ACHD. Twenty-three adults with repaired tetralogy of Fallot and 23 age- and sex-matched healthy controls were prospectively recruited and underwent brain magnetic resonance imaging. White matter hyperintensities (WMHs) were segmented using a machine-learning approach and automatically split into periventricular and deep. Cerebral microbleeds were manually counted. A subset of 14 patients were also assessed with an extensive neuropsychological battery. Age was 41.78 ± 10.33 years (mean ± standard deviation) for patients and 41.48 ± 10.28 years for controls (p = 0.921). Albeit not significantly, total brain (p = 0.282) and brain tissue volumes (p = 0.539 for cerebrospinal fluid, p = 0.661 for grey matter, p = 0.793 for white matter) were lower in ACHD, while total volume (p = 0.283) and sub-classes of WMHs (p = 0.386 for periventricular WMHs and p = 0.138 for deep WMHs) were higher in ACHD than in controls. Deep WMHs were associated with poorer performance at the frontal assessment battery (r = -0.650, p = 0.012). Also, patients had a much larger number of microbleeds than controls (median and interquartile range 5 [3–11] and 0 [0–0] respectively; p < 0.001). In this study, adults with tetralogy of Fallot showed specific signs of brain injury, with some clinical implications. Eventually, accurate characterization of brain health using neuroimaging and neuropsychological data would aid in the identification of ACHD patients at risk of cognitive deterioration.
Collapse
Affiliation(s)
- Luca Melazzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Filippo Savoldi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Massimo Chessa
- ACHD Unit, Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
- Vita-Salute San Raffaele University,, Via Olgettina 58, 20132, Milano, Italy
| | - Paolo Vitali
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Enrico Giuseppe Bertoldo
- Clinical Psychology Service, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Valentina Fiolo
- Clinical Psychology Service, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Ludovica Griffanti
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, Warneford Ln, Headington, OX3 7JX, Oxford, UK
| | - Mario Carminati
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Edward Callus
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
- Clinical Psychology Service, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Marina Codari
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-5105, USA
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|
11
|
Cozzi A, Magni V, Zanardo M, Schiaffino S, Sardanelli F. Contrast-enhanced Mammography: A Systematic Review and Meta-Analysis of Diagnostic Performance. Radiology 2021; 302:568-581. [PMID: 34904875 DOI: 10.1148/radiol.211412] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Contrast-enhanced mammography (CEM) is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. Purpose To perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Materials and Methods The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as the reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Summary diagnostic odds ratio and area under the receiver operating characteristic curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results Sixty studies (67 study parts, 11 049 CEM examinations in 10 605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled diagnostic odds ratio was 55.7 (95% CI: 42.7, 72.7) with high heterogeneity (τ2 = 0.3). At meta-regression, CEM interpretation with both low-energy and recombined images had higher sensitivity (95% vs 94%, P < .001) and specificity (81% vs 71%, P = .03) compared with recombined images alone. At subgroup analysis, CEM showed a 95% pooled sensitivity (95% CI: 92, 97) and a 78% pooled specificity (95% CI: 66, 87) from nine studies in patients with dense breasts, while in 10 studies on mammography-detected suspicious findings, CEM had a 92% pooled sensitivity (95% CI: 89, 94) and an 84% pooled specificity (95% CI: 73, 91). Conclusion Contrast-enhanced mammography demonstrated high performance in breast cancer detection, especially with joint interpretation of low-energy and recombined images. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Bahl in this issue.
Collapse
Affiliation(s)
- Andrea Cozzi
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Veronica Magni
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Moreno Zanardo
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Simone Schiaffino
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| | - Francesco Sardanelli
- From the Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy (A.C., V.M., M.Z., F.S.); and Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (S.S., F.S.)
| |
Collapse
|
12
|
Zanardo M, Cornacchione P, Marconi E, Dinapoli L, Fellin F, Gerasia R, Monti CB, Sardanelli F, Tagliaferri L, Jereczek-Fossa BA, Gambacorta MA. Occupational burnout among radiation therapy technologists in Italy before and during COVID-19 pandemic. J Med Imaging Radiat Sci 2021; 53:58-64. [PMID: 35115275 PMCID: PMC8763333 DOI: 10.1016/j.jmir.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/29/2021] [Accepted: 12/03/2021] [Indexed: 12/24/2022]
Abstract
Introduction Radiation therapy technologists (RTTs) are exposed to high stress levels which may lead to burnout, which could be further increased by the current pandemic. The aim of our study was to assess burnout and stress among Italian RTTs before and during the pandemic. Methods The Italian Association of Radiation Therapy and Medical Physics Technologists (AITRO) and the Italian Federation of Scientific Radiographers Societies (FASTeR) proposed a national online survey, including the Maslach Burnout Inventory assessing emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA) to RTTs before and during the pandemic. Multivariate regression analyses and χ2 tests were used for data analysis. Results We obtained 367 answers, 246 before and 121 during the pandemic. RTTs before and during the pandemic showed high EE and DP, intermediate PA. Median EE was 37 (interquartile range [IQR] 31–46] before and 37 (IQR 30–43) during the pandemic, median DP was 16 (IQR 13–21) and 15 (IQR 12–20), respectively. PA was 31 (IQR 28–34) and 32 (IQR 28–34), respectively. Through multivariate analysis, being female and having children led to higher EE scores before and during the pandemic (p≤0.026). Only the presence of workplace stress management courses was related to lower DP before and being female was related to higher DP during the pandemic (p<0.001). Being female, having children, and working with paediatric patients were related to lower PA before and during the pandemic (p≤0.015). Conclusion Our study highlighted high burnout levels for RTTs regardless of the pandemic. Future interventions aimed at preventing burnout should be implemented in their work environment, independently of the impact of exceptional events.
Collapse
|
13
|
Monti CB, Schiaffino S, Galimberti Ortiz MDM, Capra D, Zanardo M, De Benedictis E, Luporini AG, Spagnolo P, Secchi F, Sardanelli F. Potential role of epicardial adipose tissue as a biomarker of anthracycline cardiotoxicity. Insights Imaging 2021; 12:161. [PMID: 34741673 PMCID: PMC8571675 DOI: 10.1186/s13244-021-01069-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/07/2021] [Indexed: 01/21/2023] Open
Abstract
Background We investigated the radiodensity of epicardial (EAT), subcutaneous (SAT), and visceral adipose tissue (VAT) before and after treatment with anthracyclines in a population of breast cancer (BC) patients, and in controls not treated with anthracyclines, to detect a potential role of EAT density as a biomarker of changes related to chemotherapy cardiotoxicity. Methods We reviewed BC patients treated with anthracyclines who underwent CT before (CT-t0) and after (CT-t1) chemotherapy, and age- and sex-matched controls who underwent two CT examinations at comparable intervals. On non-contrast scans, EAT was segmented contouring the pericardium and thresholding between -190 and -30 Hounsfield units (HU), and SAT and VAT were segmented with two 15-mm diameter regions of interest thresholded between -195 and -45 HU. Results Thirty-two female patients and 32 controls were included. There were no differences in age (p = 0.439) and follow-up duration (p = 0.162) between patients and controls. Between CT-t0 and CT-t1, EAT density decreased in BC patients (-66 HU, interquartile range [IQR] -71 to -63 HU, to -71 HU, IQR -75 to -66 HU, p = 0.003), while it did not vary in controls (p = 0.955). SAT density increased from CT-t0 to CT-t1 in BC patients (-107 HU, IQR -111 to -105 HU, to -105 HU, IQR -110 to -100 HU, p = 0.014), whereas it did not change in controls (p = 0.477). VAT density did not vary in either BC patients (p = 0.911) or controls (p = 0.627). Conclusions EAT density appears to be influenced by anthracycline treatment for BC, well known for its cardiotoxicity, shifting towards lower values indicative of a less active metabolism.
Collapse
Affiliation(s)
- Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Maria Del Mar Galimberti Ortiz
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Elena De Benedictis
- Unit of Medical Oncology, Policlinico Di Monza, Via Amati 111, 20900, Monza, Italy
| | - Alberto Gianluigi Luporini
- Unit of Medical Oncology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Pietro Spagnolo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Via Mangiagalli 31, 20133, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|
14
|
Vitali P, Savoldi F, Segati F, Melazzini L, Zanardo M, Fedeli MP, Benedek A, Di Leo G, Menicanti L, Sardanelli F. MRI versus CT in the detection of brain lesions in patients with infective endocarditis before or after cardiac surgery. Neuroradiology 2021; 64:905-913. [PMID: 34647143 PMCID: PMC9005423 DOI: 10.1007/s00234-021-02810-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
Purpose Imaging of brain involvement in infective endocarditis can drive the clinical management of this serious condition. MRI is very sensitive, but CT is more readily available. In this retrospective study, we compared the detection rates of CT and MRI. Methods After Ethics Committee approval, we retrospectively reviewed a series of 20 patients (13 males, median age 64 years) who underwent both CT and MRI either before or after cardiac surgery for definite infective endocarditis. Plain CT and MRI were evaluated for acute ischemic lesions, both punctuate and large, intraparenchymal hemorrhages, cerebral microbleeds, subarachnoid hemorrhages, abscesses, microabscesses, and meningitis. Qualitative assessment and McNemar test were performed. The value of contrast-enhanced scans (MRI, n = 14; CT, n = 9) and cognitive status were also assessed. Results A total of 166 lesions were identified on either technique: 137 (83%) on MRI only, 4 (2%) on CT only, and 25 (15%) on both techniques (p < 0.001). For these last 25 lesions, concordance on lesion type was only 16/25 (64%). MRI detected more microbleeds and ischemic lesions, while the 4 CT-only findings were false positives. Contrast-enhanced scans identified 68 enhancing lesions, mainly abscesses and microabscesses, and allowed a better characterization for 61/117 lesions (52%) with MRI, and for 11/81 (14%) with CT. Follow-up identified mild cognitive impairment in 6/13 and dementia in 3/13 patients. Conclusion While CT rapidly excludes large hemorrhages in patients with infective endocarditis, MRI accurately distinguishes the whole spectrum of brain lesions, including small ischemic lesions, microbleeds, and microabscesses.
Collapse
Affiliation(s)
- Paolo Vitali
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy. .,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Filippo Savoldi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Flavia Segati
- Medicine and Surgery Medical School, Università degli Studi di Milano, Milan, Italy
| | - Luca Melazzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Maria Paola Fedeli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Adrienn Benedek
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Lorenzo Menicanti
- Cardiac Surgery Department, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| |
Collapse
|
15
|
Monti CB, Capra D, Zanardo M, Guarnieri G, Schiaffino S, Secchi F, Sardanelli F. CT-derived epicardial adipose tissue density: Systematic review and meta-analysis. Eur J Radiol 2021; 143:109902. [PMID: 34482178 DOI: 10.1016/j.ejrad.2021.109902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/22/2021] [Accepted: 08/05/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE The aim of our work was to systematically review and meta-analyze epicardial adipose tissue (EAT) density values reported in literature, assessing potential correlations of EAT density with segmentation thresholds and other technical and clinical variables. METHOD A systematic search was performed, aiming for papers reporting global EAT density values in Hounsfield Units (HU) in patients undergoing chest CT for any clinical indication. After screening titles, abstract and full text of each retrieved work, studies reporting mean and standard deviation for EAT density were ultimately included. Technical, clinical and EAT data were extracted, and divided into subgroups according to clinical conditions of reported subjects. Pooled density analyses were performed both overall and for subgroups according to clinical conditions. Metaregression analyses were done to appraise the impact of clinical and technical variables on EAT volume. RESULTS Out of 152 initially retrieved works, 13 were ultimately included, totaling for 7683 subjects. EAT density showed an overall pooled value of -85.86 HU (95% confidence interval [95% CI] -91.84, -79.89 HU), being -86.40 HU (95% CI -112.69, -60.12 HU) in healthy subjects and -80.71 HU (95% CI -87.43, -73.99 HU) in patients with coronary artery disease. EAT volume and lower and higher segmentation thresholds were found to be significantly correlated with EAT density (p = 0.044, p < 0.001 and p< 0.001 respectively). CONCLUSIONS Patients with coronary artery disease appear to present with higher EAT density values, while the correlations observed at metaregression highlight the need for well-established, shared thresholds for EAT segmentation.
Collapse
Affiliation(s)
- Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Gianluca Guarnieri
- Postgraduation School in Cardiology, Università degli Studi di Milano, Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| |
Collapse
|
16
|
Zanardo M, Gerasia R, Giovannelli L, Scurto G, Cornacchione P, Cozzi A, Durante S, Schiaffino S, Monfardini L, Sardanelli F. A critical appraisal of the quality of guidelines for radiation protection in interventional radiology using the AGREE II tool: A EuroAIM initiative. Eur J Radiol 2021; 143:109906. [PMID: 34479125 DOI: 10.1016/j.ejrad.2021.109906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To systematically review and assess the methodological quality of guidelines for radiation protection in interventional radiology. MATERIALS AND METHODS On April 15th, 2021, a systematic search for guidelines on radiation protection in interventional radiology was performed using MEDLINE, EMBASE, National Guideline Clearinghouse, and National Institute for Health and Clinical Excellence databases. Among retrieved guidelines, we then excluded those not primarily focused on radiation protection or on interventional radiology. Authors' professional role and year of publication were recorded for each included guideline. Guideline quality evaluation was performed independently by three authors using the six-domain tool "AGREE II", with an overall guideline quality score divided into three classes: low (<60%), acceptable (60-80%), and good quality (>80%). RESULTS Our literature search identified 106 citations: after applying exclusion criteria, 11 guidelines published between 2009 and 2018 were included, most of their authors being interventional radiologists (168/224, 75%). Overall quality of included guidelines was acceptable (median 72%, interquartile range 64-83%), with only one guideline (9%) with overall low quality and four guidelines (36%) with overall good quality. Among AGREE II domains, "Scope and Purpose", "Clarity of Presentations", and "Editorial Independence" had the best results (87%, 76%, and 75% respectively), while "Applicability", "Rigor of Development", and "Stakeholder Involvement" the worst (46%, 49%, and 52% respectively). CONCLUSION Considering all guidelines, the overall methodological quality was acceptable with one third of them reaching the highest score class. The "Applicability" domain had the lowest median score, highlighting a practical implementation gap to be addressed by future guidelines.
Collapse
Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Roberta Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; AITRI, Italian Association of Interventional Radiographers, Milan, Italy.
| | - Lorenzo Giovannelli
- Radiology Department, Ospedale Santa Maria del Carmine, Azienda Provinciale per i Servizi Sanitari di Trento, Viale Verona 4, 38068 Rovereto (TN), Italy; HTA team, FNO TSRM e PSTRP, Via Magna Grecia 30/A, 00183 Rome, Italy.
| | - Giuseppe Scurto
- HTA team, FNO TSRM e PSTRP, Via Magna Grecia 30/A, 00183 Rome, Italy; Radiology Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Viale Strasburgo 233, 90146 Palermo, Italy.
| | - Patrizia Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy.
| | - Lorenzo Monfardini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, Brescia, Italy.
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, San Donato Milanese, Italy.
| |
Collapse
|
17
|
Romanzi A, Gabaglio M, Milanesi M, Putortì A, Rossi F, Scolaro R, Vignati B, Zaccarelli A, Zanardo M, Vannelli A. Pain distraction during awake low anterior resection and Cuddle Delivery initiative for inpatient: frugal procedural options to support surgery in the COVID-19 era. Eur Rev Med Pharmacol Sci 2021; 25:3116-3121. [PMID: 33877680 DOI: 10.26355/eurrev_202104_25566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Since minimally invasive surgery and general anesthesia are both aerosol-generating procedures, their use became controversial during the outbreak of coronavirus disease 2019 (COVID-19). Moreover, social distancing resulted in serious psychological consequences for inpatients. This case report investigates pain distraction during awake laparotomy, as well as new possibilities for emotional postoperative support to inpatients. PATIENTS AND METHODS A 72-year-old man affected by middle rectal adenocarcinoma underwent lower anterior resection plus total mesorectal excision under combined spinal-epidural anesthesia. A 3D mobile theatre (3DMT) was intraoperatively used for pain distraction. A postoperative "Cuddle delivery" service was instituted: video-messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional correlations were investigated through a clinical interview by the psychologist of our Hospital. RESULTS Intraoperative, as well as postoperative pain, resulted well-controlled: visual analogue scale (VAS) ≤3. Conversion to general anesthesia and postoperative intensive support/monitoring were unnecessary. The "Cuddle delivery" initiative positively fed our patient's mood and attitude, strengthening his bond to life. CONCLUSIONS During pandemic, awake laparotomy under loco-regional anesthesia may be a crucial option in delivering acute care surgery to selected patients when intensive care beds are unavailable. Our procedure introduces potential ways to optimize this approach.
Collapse
Affiliation(s)
- A Romanzi
- Department of General Surgery, Valduce Hospital, Como, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Anderson J, Zanardo M, Smyth B, Fox L, Anderson A, Maher M, Louise Rainford L. AN INTERVENTIONAL CARDIOLOGY INVESTIGATION: PATIENT EXPOSURE TO RADIATION AND INTER-OPERATOR VARIABILITY IN AN IRISH SETTING. Radiat Prot Dosimetry 2020; 192:89-96. [PMID: 33313918 DOI: 10.1093/rpd/ncaa201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 06/12/2023]
Abstract
AIM To evaluate patient radiation exposure for Diagnostic Coronary Angiography (DCA) and Percutaneous Cardiac Intervention (PCI) performed by different operators. METHODS AND RESULTS Retrospective (n = 160) and prospective (n = 62) data for DCA (n = 179) and PCI (n = 43) examinations performed by interventional cardiologists (n = 3) using the same imaging equipment were reviewed. The operator with consistently low diagnostic reference levels (DRLs) was interviewed for their personal perceptions upon operator training. Retrospective Median [IQR] DAP was 18.8 [11.8-31.6] and 50.7 [35.3-85.6] Gy.cm2 for DCA and PCI, respectively. Prospective Median [IQR] DAP for DCA and PCI was 7.9 [5.2-10.6] and 15.9 [10.0-17.7] Gy.cm2, respectively. DRLs were within Irish and European DRLs; however, significant inter-operator variability (p < .001) was identified. CONCLUSION Radiation exposure in Interventional cardiology is highly operator dependent; further research is warranted in standardization of operator training with evolving technologies.
Collapse
Affiliation(s)
| | | | - Brian Smyth
- Radiology Department, Mater Private Hospital, Dublin, Ireland
| | - Lis Fox
- Bons Secours Hospital group, Ireland
| | | | | | | |
Collapse
|
19
|
Melazzini L, Vitali P, Olivieri E, Bolchini M, Zanardo M, Savoldi F, Di Leo G, Griffanti L, Baselli G, Sardanelli F, Codari M. White Matter Hyperintensities Quantification in Healthy Adults: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2020; 53:1732-1743. [PMID: 33345393 DOI: 10.1002/jmri.27479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although white matter hyperintensities (WMH) volumetric assessment is now customary in research studies, inconsistent WMH measures among homogenous populations may prevent the clinical usability of this biomarker. PURPOSE To determine whether a point estimate and reference standard for WMH volume in the healthy aging population could be determined. STUDY TYPE Systematic review and meta-analysis. POPULATION In all, 9716 adult subjects from 38 studies reporting WMH volume were retrieved following a systematic search on EMBASE. FIELD STRENGTH/SEQUENCE 1.0T, 1.5T, or 3.0T/fluid-attenuated inversion recovery (FLAIR) and/or proton density/T2 -weighted fast spin echo sequences or gradient echo T1 -weighted sequences. ASSESSMENT After a literature search, sample size, demographics, magnetic field strength, MRI sequences, level of automation in WMH assessment, study population, and WMH volume were extracted. STATISTICAL TESTS The pooled WMH volume with 95% confidence interval (CI) was calculated using the random-effect model. The I2 statistic was calculated as a measure of heterogeneity across studies. Meta-regression analysis of WMH volume on age was performed. RESULTS Of the 38 studies analyzed, 17 reported WMH volume as the mean and standard deviation (SD) and were included in the meta-analysis. Mean and SD of age was 66.11 ± 10.92 years (percentage of men 50.45% ± 21.48%). Heterogeneity was very high (I2 = 99%). The pooled WMH volume was 4.70 cm3 (95% CI: 3.88-5.53 cm3 ). At meta-regression analysis, WMH volume was positively associated with subjects' age (β = 0.358 cm3 per year, P < 0.05, R2 = 0.27). DATA CONCLUSION The lack of standardization in the definition of WMH together with the high technical variability in assessment may explain a large component of the observed heterogeneity. Currently, volumes of WMH in healthy subjects are not comparable between studies and an estimate and reference interval could not be determined. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
Collapse
Affiliation(s)
- Luca Melazzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Paolo Vitali
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuele Olivieri
- Medicine and Surgery Medical School, Università degli Studi di Milano, Milano, Italy
| | - Marco Bolchini
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Moreno Zanardo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Filippo Savoldi
- Postgraduate School in Radiology, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ludovica Griffanti
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, Oxford, UK
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marina Codari
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
20
|
Zanardo M, Doniselli FM, Esseridou A, Agrò M, Panarisi NAR, Monti CB, Di Leo G, Sardanelli F. Lean body weight versus total body weight to calculate the iodinated contrast media volume in abdominal CT: a randomised controlled trial. Insights Imaging 2020; 11:132. [PMID: 33296036 PMCID: PMC7726088 DOI: 10.1186/s13244-020-00920-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives Iodinated contrast media (ICM) could be more appropriately dosed on patient lean body weight (LBW) than on total body weight (TBW). Methods After Ethics Committee approval, trial registration NCT03384979, patients aged ≥ 18 years scheduled for multiphasic abdominal CT were randomised for ICM dose to LBW group (0.63 gI/kg of LBW) or TBW group (0.44 gI/kg of TBW). Abdominal 64-row CT was performed using 120 kVp, 100–200 mAs, rotation time 0.5 s, pitch 1, Iopamidol (370 mgI/mL), and flow rate 3 mL/s. Levene, Mann–Whitney U, and χ2 tests were used. The primary endpoint was liver contrast enhancement (LCE). Results Of 335 enrolled patients, 17 were screening failures; 44 dropped out after randomisation; 274 patients were analysed (133 LBW group, 141 TBW group). The median age of LBW group (66 years) was slightly lower than that of TBW group (70 years). Although the median ICM-injected volume was comparable between groups, its variability was larger in the former (interquartile range 27 mL versus 21 mL, p = 0.01). The same was for unenhanced liver density (IQR 10 versus 7 HU) (p = 0.02). Median LCE was 40 (35–46) HU in the LBW group and 40 (35–44) HU in the TBW group, without significant difference for median (p = 0.41) and variability (p = 0.23). Suboptimal LCE (< 40 HU) was found in 64/133 (48%) patients in the LBW group and 69/141 (49%) in the TBW group, but no examination needed repeating. Conclusions The calculation of the ICM volume to be administered for abdominal CT based on the LBW does not imply a more consistent LCE.
Collapse
Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Fabio Martino Doniselli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,Neuroradiology Department, Foundation IRCCS Neurological Institute "C. Besta", Via Celoria 11, 20133, Milan, Italy
| | - Anastassia Esseridou
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Massimiliano Agrò
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Nicol Antonina Rita Panarisi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|
21
|
Zanardo M, Doniselli FM, Monti CB, Cornacchione P, Durante S, Sconfienza LM, Sardanelli F. MRI physics and technical issues: Where do Italian radiographers search for information? J Med Imaging Radiat Sci 2020; 52:104-111. [PMID: 33214055 DOI: 10.1016/j.jmir.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/07/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Our aim was to investigate the means radiographers and radiographers in training (RTrs) use to seek information on magnetic resonance imaging (MRI) physics and technical issues. METHODS An estimated 3000 radiographers and RTrs were reached by e-mail. We proposed an online survey with eight English-language multiple choice questions investigating how often radiographers have doubts about MRI physics or technical issues, where and what kind of information they search for, and on which websites. The statistical χ2 test was used. RESULTS We obtained 300 answers from European professionals (228 radiographers, 72 RTrs) from 9 European countries, with 288 of 300 (96%) responses coming from Italy. Within the Italian respondents, 41% of RTrs have doubts about MRI physics versus 56% of radiographers (p = 0.028). Basic MRI sequences details are more searched by RTrs (36%) than radiographers (22%) (p = 0.088), as well as clinical protocols (64% versus 44%, p = 0.054). Radiographers and RTrs mostly search on the Internet (74% versus 81%, p = 0.404); "older colleagues" are more frequently asked for information by RTrs (27% versus 61%, p = 0.001), they consult the "MRI manufacturer" less frequently (11% versus 34%, p = 0.001); and 66% of radiographers and 72% of RTrs search "in mother-language and English" (p = 0.590). For clinical protocols RTrs prefer the website mriquestions.com (17% versus 44%, p = 0.001). Websites most used were: mriquestions.com (41%), radiopaedia.org (31%), and mrimaster.com (13%). In addition, 30 respondents mentioned using the Italian site fermononrespiri.com. CONCLUSION Italian radiographers and RTrs frequently search for information about MRI physics and technical issues, with slight differences between groups regarding sources and clinical protocols. Protocol setting, and MRI physics and sequences seem to be the main limitations of RTr knowledge. To remedy this gap, more time on training/university lectures and a rethinking of the practical training activities is required.
Collapse
Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - Fabio Martino Doniselli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Neuroradiology Unit, IRCCS Neurological Institute "C. Besta", Milan, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Patrizia Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy
| |
Collapse
|
22
|
Cozzi A, Buragina G, Spinelli D, Schiaffino S, Zanardo M, Di Leo G, Carbonaro LA, Sardanelli F. Accuracy and inter-reader agreement of breast MRI for cancer staging using 0.08 mmol/kg of gadobutrol. Clin Imaging 2020; 72:154-161. [PMID: 33249403 DOI: 10.1016/j.clinimag.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence on gadolinium brain accumulation after contrast-enhanced MRI prompted research in dose reduction. PURPOSE To estimate accuracy and inter-reader reproducibility of tumor size measurement in breast MRI using 0.08 mmol/kg of gadobutrol. METHODS We retrospectively analyzed all women who underwent 1.5-T breast MRI for cancer staging at our department with 0.08 mmol/kg of gadobutrol. Two readers (R1 and R2, 12 and 3 years-experience) measured the largest lesion diameter. Accuracy was estimated both as correlation with pathology and rate of absolute (>5 mm) overestimation and underestimation, inter-reader reproducibility using the Bland-Altman method. Data are given as median and interquartile range. RESULTS Thirty-six patients were analyzed (median age 56 years, 49-66) for a total of 38 lesions, 24 (63%) mass enhancement, 14 (37%) non-mass enhancement. Histopathological median size (mm) of all lesions was 15 (9-25): 13 (9-19) for mass lesions, 19 (11-39) for non-mass lesions. On MRI, R1 measured (mm) 14 (10-22) for all lesions, 13 (10-19) for mass lesions, 19 (11-49) for non-mass lesions. MRI-pathology correlation was very high for all lesion categories (ρ ≥ 0.766). On MRI, R1 overestimated lesion size in 6 cases (16%), and underestimated in 3 (8%); R2, overestimated 7 cases (18%) and underestimated 3 cases (8%). At inter-reader reproducibility analysis (mm): bias 0.9, coefficient of reproducibility 13 for all lesions; -0.1 and 6 for mass lesions; 2.5 and 20 for non-mass lesions. CONCLUSIONS Breast MRI may be performed using 0.08 mmol/kg of gadobutrol with high accuracy and acceptable inter-reader agreement.
Collapse
Affiliation(s)
- Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Giuseppe Buragina
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy.
| | - Diana Spinelli
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy.
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| | | | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| |
Collapse
|
23
|
Rainford LA, Zanardo M, Buissink C, Decoster R, Hennessy W, Knapp K, Kraus B, Lanca L, Lewis S, Mahlaola TB, McEntee M, O'Leary D, Precht H, Starc T, McNulty JP. The impact of COVID-19 upon student radiographers and clinical training. Radiography (Lond) 2020; 27:464-474. [PMID: 33223416 PMCID: PMC7834574 DOI: 10.1016/j.radi.2020.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Introduction To investigate student clinical placement concerns and opinions, during the initial COVID-19 pandemic outbreak and to inform educational institution support planning. Methods Between mid-June to mid-July 2020, educational institutions from 12 countries were invited to participate in an online survey designed to gain student radiographer opinion from a wide geographical spread and countries with varying levels of COVID-19 cases. Results 1277 respondents participated, of these 592 had completed clinical placements during January to June 2020. Accommodation and cohabiting risks were identified as challenging, as was isolation from family, travel to clinical placements, and to a lesser extent childcare. Students stated they had been affected by the feeling of isolation and concerns about the virus whilst on placement. Overall 35.4% of all respondents were ‘Not at all worried’ about being a radiographer, however, 64.6% expressed varying levels of concern and individual domestic or health situations significantly impacted responses (p ≤ 0.05). Year 4 students and recent graduates were significantly more likely to be ‘Not worried at all’ compared to Year 2 and 3 students (p ≤ 0.05). The need for improved communication regarding clinical placements scheduling was identified as almost 50% of students on clinical placements between January to June 2020 identified the completion of assessments as challenging. Furthermore, only 66% of respondents with COVID-19 imaging experience stated being confident with personal protective equipment (PPE) use. Conclusion Student radiographers identified key challenges which require consideration to ensure appropriate measures are in place to support their ongoing needs. Importantly PPE training is required before placement regardless of prior COVID-19 imaging experience. Implications for practice As the next academic year commences, the study findings identify important matters to be considered by education institutions with responsibility for Radiography training and as students commence clinical placements during the on-going global COVID-19 pandemic.
Collapse
Affiliation(s)
- L A Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - M Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy; Italian Federation of Scientific Radiographers Societies, Italy.
| | - C Buissink
- Department of Medical Imaging and Radiation Therapy, Hanze University of Applied Sciences, Groningen, Netherlands.
| | - R Decoster
- Medical Imaging and Radiotherapy, Odisee University of Applied Sciences, Brussels, Belgium.
| | - W Hennessy
- Diagnostic Imaging, Quinnipiac University, Connecticut, USA.
| | - K Knapp
- College of Medicine and Health, University of Exeter, UK.
| | - B Kraus
- Department Health Sciences, Radiological Technology, University of Applied Sciences, FH Campus Wien, Austria.
| | - L Lanca
- Singapore Institute of Technology, Health and Social Sciences Cluster, Singapore.
| | - S Lewis
- Discipline of Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - T B Mahlaola
- Department of Medical Imaging and Radiation Sciences, University of Johannesburg, South Africa.
| | - M McEntee
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Ireland.
| | - D O'Leary
- School of Allied Health Professionals, Keele University, UK.
| | - H Precht
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - T Starc
- Faculty of Health Sciences, University of Ljubljana, Slovenia.
| | - J P McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| |
Collapse
|
24
|
Zanardo M, Sardanelli F, Rainford L, Monti CB, Murray JG, Secchi F, Cradock A. Technique and protocols for cardiothoracic time-resolved contrast-enhanced magnetic resonance angiography sequences: a systematic review. Clin Radiol 2020; 76:156.e9-156.e18. [PMID: 33008622 DOI: 10.1016/j.crad.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022]
Abstract
AIM To review contrast medium administration protocols used for cardiothoracic applications of time-resolved, contrast-enhanced magnetic resonance angiography (MRA) sequences. MATERIALS AND METHODS A systematic search of the literature (Medline/EMBASE) was performed to identify articles utilising time-resolved MRA sequences, focusing on type of sequence, adopted technical parameters, contrast agent (CA) issues, and acquisition workflow. Study design, year of publication, population, magnetic field strength, type, dose, and injection parameters of CA, as well as technical parameters of time-resolved MRA sequences were extracted. RESULTS Of 117 retrieved articles, 16 matched the inclusion criteria. The study design was prospective in 9/16 (56%) articles, and study population ranged from 5 to 185 patients, for a total of 506 patients who underwent cardiothoracic time-resolved MRA. Magnetic field strength was 1.5 T in 13/16 (81%), and 3 T in 3/16 (19%) articles. The administered CA was gadobutrol (Gadovist) in 6/16 (37%) articles, gadopentetate dimeglumine (Magnevist) in 5/16 (31%), gadobenate dimeglumine (MultiHance) in 2/16 (13%), gadodiamide (Omniscan) in 2/16 (13%), gadofosveset trisodium (Ablavar, previously Vasovist) in 1/16 (6%). CA showed highly variable doses among studies: fixed amount or based on patient body weight (0.02-0.2 mmol/kg) and was injected with a flow rate ranging 1-5 ml/s. Sequences were TWIST in 13/16 (81%), TRICKS in 2/16 (13%), and CENTRA 1/16 articles (6%). CONCLUSION Time-resolved MRA sequences were adopted in different clinical settings with a large spectrum of technical approaches, mostly in association with different CA dose, type, and injection method. Further studies in relation to specific clinical indications are warranted to provide a common standardised acquisition protocol.
Collapse
Affiliation(s)
- M Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.
| | - F Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - L Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - C B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - J G Murray
- Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - F Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - A Cradock
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| |
Collapse
|
25
|
Trimboli RM, Giorgi Rossi P, Battisti NML, Cozzi A, Magni V, Zanardo M, Sardanelli F. Do we still need breast cancer screening in the era of targeted therapies and precision medicine? Insights Imaging 2020; 11:105. [PMID: 32975658 PMCID: PMC7519022 DOI: 10.1186/s13244-020-00905-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/20/2020] [Indexed: 12/27/2022] Open
Abstract
Breast cancer (BC) is the most common female cancer and the second cause of death among women worldwide. The 5-year relative survival rate recently improved up to 90% due to increased population coverage and women's attendance to organised mammography screening as well as to advances in therapies, especially systemic treatments. Screening attendance is associated with a mortality reduction of at least 30% and a 40% lower risk of advanced disease. The stage at diagnosis remains the strongest predictor of recurrences. Systemic treatments evolved dramatically over the last 20 years: aromatase inhibitors improved the treatment of early-stage luminal BC; targeted monoclonal antibodies changed the natural history of anti-human epidermal growth factor receptor 2-positive (HER2) disease; immunotherapy is currently investigated in patients with triple-negative BC; gene expression profiling is now used with the aim of personalising systemic treatments. In the era of precision medicine, it is a challenging task to define the relative contribution of early diagnosis by screening mammography and systemic treatments in determining BC survival. Estimated contributions before 2000 were 46% for screening and 54% for treatment advances and after 2000, 37% and 63%, respectively. A model showed that the 10-year recurrence rate would be 30% and 25% using respectively chemotherapy or novel treatments in the absence of screening, but would drop to 19% and 15% respectively if associated with mammography screening. Early detection per se has not a curative intent and systemic treatment has limited benefit on advanced stages. Both screening mammography and systemic therapies continue to positively contribute to BC prognosis.
Collapse
Affiliation(s)
- Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Nicolò Matteo Luca Battisti
- Breast Unit–Department of Medicine, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, London, SM2 5PT UK
- Breast Cancer Research Division, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Veronica Magni
- Medical School, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| |
Collapse
|
26
|
Zanardo M, Di Leo G. Reply to Letter to Editor: Abdominal CT: a radiologist-driven adjustment of the dose of iodinated contrast agent approaches a calculation per lean body weight. Eur Radiol Exp 2020; 4:46. [PMID: 32959168 PMCID: PMC7505903 DOI: 10.1186/s41747-020-00179-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|
27
|
Zanardo M, Schiaffino S, Sardanelli F. Bringing radiology to patient's home using mobile equipment: A weapon to fight COVID-19 pandemic. Clin Imaging 2020; 68:99-101. [PMID: 32585417 PMCID: PMC7301065 DOI: 10.1016/j.clinimag.2020.06.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
Abstract
Because of coronavirus disease 2019 (COVID-19) high contagiousness, it is crucial to identify and promptly isolate COVID-19 patients. In this context, chest imaging examinations, in particular chest x-ray (CXR), can play a pivotal role in different settings, to triage in case of unavailability, delay of or first negative result of reverse transcriptase-polymerase chain reaction (RT-PCR), and to stratify disease severity. Considering the need to reduce, as much as possible, hospital admission of patients with suspected or confirmed infection, the use of mobile x-ray equipment could represent a safe approach. We picture a potential sequence of events, involving a team composed by a radiographer and a nurse, going to patient's home to perform CXR, nasopharyngeal swab (and, if needed, also a blood sample), with fast radiologist tele-reporting, and resulting patient management approach (home isolation or emergency room admission, when needed). This approach brings healthcare to patient's home, reducing the risk of infected subjects referring to family doctors' office or emergency departments, and strengthening community medicine while maintaining a strong connection with radiology departments. Chest x-ray and computed tomography can play a pivotal role in COVID-19 pandemic. Mobile x-ray at patient's house or nursing home could represent a safe approach reducing social contacts during pandemic. Domiciliary radiography reduces the risk of infected subjects referring to family doctors’ office or emergency departments. This procedure can reduce general practitioner visit, nurse performing swab and transportation to the hospital costs.
Collapse
Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| |
Collapse
|
28
|
Monti CB, Zanardo M, Bosetti T, Alì M, De Benedictis E, Luporini A, Secchi F, Sardanelli F. Assessment of myocardial extracellular volume on body computed tomography in breast cancer patients treated with anthracyclines. Quant Imaging Med Surg 2020; 10:934-944. [PMID: 32489918 DOI: 10.21037/qims.2020.04.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Cancer treatment with anthracyclines may lead to an increased incidence of cardiac disease due to cardiotoxicity, as they may cause irreversible myocardial fibrosis. So far, the proposed methods for screening patients for cardiotoxicity have led to only limited success, while the analysis of myocardial extracellular volume (mECV) at cardiac magnetic resonance (CMR) has shown promising results, albeit requiring a dedicated exam. Recent studies have found strong correlations between mECV values obtained through computed tomography (CT), and those derived from CMR. Thus, our purpose was to evaluate the feasibility of estimating mECV on thoracic contrast-enhanced CT performed for staging or follow-up in breast cancer patients treated with anthracyclines, and, if feasible, to assess if a rise in mECV is associated with chemotherapy, and persistent over time. Methods After ethics committee approval, female patients with breast cancer who had undergone at least 2 staging or follow-up CT examinations at our institution, one before and one shortly after the end of chemotherapy including anthracyclines were retrospectively evaluated. Patients without available haematocrit, with artefacts in CT images, or who had undergone radiation therapy of the left breast were excluded. Follow-up CT examinations at longer time intervals were also analysed, when available. mECV was calculated on scans obtained at 1, and 7 min after contrast injection. Results Thirty-two female patients (aged 57±13 years) with pre-treatment haematocrit 38%±4%, and ejection fraction 64%±6% were analysed. Pre-treatment mECV was 27.0%±2.9% at 1 min, and 26.4%±3.8% at 7 min, similar to values reported for normal subjects in the literature. Post-treatment mECV (median interval: 89 days after treatment) was 31.1%±4.9%, and 30.0%±5.1%, respectively, values significantly higher than pre-treatment values at all times (P<0.005). mECV at follow-up (median interval: 135 days after post-treatment CT) was 31.0%±4.5%, and 27.7%±3.7%, respectively, without significant differences (P>0.548) when compared to post-treatment values. Conclusions mECV values from contrast-enhanced CT scans could play a role in the assessment of myocardial condition in breast cancer patients undergoing anthracycline-based chemotherapy. CT-derived ECV could be an imaging biomarker for the monitoring of therapy-related cardiotoxicity, allowing for potential secondary prevention of cardiac damage, using data derived from an examination that could be already part of patients' clinical workflow.
Collapse
Affiliation(s)
- Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy
| | - Tommaso Bosetti
- Medicine and Surgery School, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Marco Alì
- Unit of Diagnostic Imaging and Stereotactic Radiosurgery, CDI Centro Diagnostico Italiano S.p.A., Via Saint Bon 20, 20147 Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Elena De Benedictis
- Unit of Oncology I, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Alberto Luporini
- Unit of Oncology II, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Secchi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| |
Collapse
|
29
|
Zanardo M, Martini C, Monti CB, Cattaneo F, Ciaralli C, Cornacchione P, Durante S. Management of patients with suspected or confirmed COVID-19, in the radiology department. Radiography (Lond) 2020; 26:264-268. [PMID: 32340912 PMCID: PMC7167552 DOI: 10.1016/j.radi.2020.04.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES From December 2019, a novel coronavirus disease named COVID-19 was reported in China. Within 3 months, the World Health Organization defined COVID-19 as a pandemic, with more than 370,000 cases and 16,000 deaths worldwide. In consideration of the crucial role of diagnostic testing during COVID-19, the aim of this technical note was to provide a complete synthesis of approaches implemented for the management of suspected or confirmed COVID-19 patients. KEY FINDINGS The planning of a robust plan to prevent the transmission of the virus to patients and department staff members should be fundamental in each radiology service. Moreover, the speed of spread and the incidence of the pandemic make it necessary to optimize the use of personal protective devices and dedicated COVID-19 equipment, given the limited availability of supplies. CONCLUSION In the management of radiographic and CT imaging, staff should take special precautions to limit contamination between patients and other patients or professionals. IMPLICATIONS FOR PRACTICE An isolated imaging room should be dedicated to suspected or confirmed COVID-19 cases, including radiography and CT scanners. This paper will provide guidance concerning disposable protective gear to be utilized, as well as on the cleaning and sanitation of radiology room and equipment.
Collapse
Affiliation(s)
- M Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy; FASTeR, Italian Federation of Scientific Radiographers Societies, Italy.
| | - C Martini
- FASTeR, Italian Federation of Scientific Radiographers Societies, Italy; Department of Health Professions, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - C B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - F Cattaneo
- Department of Neuroscience, Centre of Sleep Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - C Ciaralli
- UOS Professioni Sanitarie Tecniche, INMI Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - P Cornacchione
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - S Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| |
Collapse
|
30
|
Codari M, Zanardo M, di Sabato ME, Nocerino E, Messina C, Sconfienza LM, Sardanelli F. MRI-Derived Biomarkers Related to Sarcopenia: A Systematic Review. J Magn Reson Imaging 2019; 51:1117-1127. [PMID: 31515891 DOI: 10.1002/jmri.26931] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND MRI allows quantitatively assessing muscle quantity and quality. PURPOSE To summarize the role of MRI as a noninvasive technique for the identification of in vivo surrogate biomarker of sarcopenia. STUDY TYPE Systematic review. POPULATION In April 2019, a systematic literature search (Medline/EMBASE) was performed to identify articles on the topic at issue. FIELD STRENGTH/SEQUENCE No field strength or sequence restrictions. ASSESSMENT After a literature search, study design, aim, sample size, demographics, magnetic field strength, imaged body region, MRI sequences, and imaging biomarker were extracted. STATISTICAL TESTS Data are presented as frequencies and percentages. RESULTS From 69 records identified through search query, 18 articles matched the inclusion criteria. All articles were published from 2012 and had a mainly prospective design (14/18, 78%). Sample size ranged from 9 to 284 subjects, for a total of 1706 enrolled subjects. Healthy subjects were enrolled or retrospectively selected in 8/18 (44%) articles, corresponding to 658 (39%) healthy subjects. Magnetic field strength was 1.5 or 3T in 14/18 (78%) studies. The most analyzed body regions were the thigh (7/18, 39%) and the trunk (6/18, 33%). Stratifying studies according to their aim, 13/18 (72%) studies focused on muscle quality and quantity, 3/18 (17%) studies on outcome prediction, and 2/18 articles (11%) addressed both aims. A wide set of MRI biomarkers have been proposed. Muscle cross-sectional area was the most used for muscle quantity estimation, while quantitative biomarkers of muscle fat content or fiber architecture were proposed to assess muscle quality. DATA CONCLUSION The proposed biomarkers were assessed using different MRI sequences for different body regions in different subjects/patient cohorts, pointing out a lack of standardization on this topic. Future studies should test and compare the performance of proposed MRI biomarkers for sarcopenia characterization and quantification using a standardized experimental setup. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:1117-1127.
Collapse
Affiliation(s)
- Marina Codari
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
| | - Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | | | - Carmelo Messina
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| |
Collapse
|
31
|
Zanardo M, Cozzi A, Trimboli RM, Labaj O, Monti CB, Schiaffino S, Carbonaro LA, Sardanelli F. Technique, protocols and adverse reactions for contrast-enhanced spectral mammography (CESM): a systematic review. Insights Imaging 2019; 10:76. [PMID: 31376021 PMCID: PMC6677840 DOI: 10.1186/s13244-019-0756-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
We reviewed technical parameters, acquisition protocols and adverse reactions (ARs) for contrast-enhanced spectral mammography (CESM). A systematic search in databases, including MEDLINE/EMBASE, was performed to extract publication year, country of origin, study design; patients; mammography unit/vendor, radiation dose, low-/high-energy tube voltage; contrast molecule, concentration and dose; injection modality, ARs and acquisition delay; order of views; examination time. Of 120 retrieved articles, 84 were included from 22 countries (September 2003-January 2019), totalling 14012 patients. Design was prospective in 44/84 studies (52%); in 70/84 articles (83%), a General Electric unit with factory-set kVp was used. Per-view average glandular dose, reported in 12/84 studies (14%), ranged 0.43-2.65 mGy. Contrast type/concentration was reported in 79/84 studies (94%), with Iohexol 350 mgI/mL mostly used (25/79, 32%), dose and flow rate in 72/84 (86%), with 1.5 mL/kg dose at 3 mL/s in 62/72 studies (86%). Injection was described in 69/84 articles (82%), automated in 59/69 (85%), manual in 10/69 (15%) and flush in 35/84 (42%), with 10-30 mL dose in 19/35 (54%). An examination time < 10 min was reported in 65/84 studies (77%), 120 s acquisition delay in 65/84 (77%) and order of views in 42/84 (50%) studies, beginning with the craniocaudal view of the non-suspected breast in 7/42 (17%). Thirty ARs were reported by 14/84 (17%) studies (26 mild, 3 moderate, 1 severe non-fatal) with a pooled rate of 0.82% (fixed-effect model). Only half of CESM studies were prospective; factory-set kVp, contrast 1.5 mL/kg at 3 mL/s and 120 s acquisition delay were mostly used; only 1 severe AR was reported. CESM protocol standardisation is advisable.
Collapse
Affiliation(s)
- Moreno Zanardo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Rubina Manuela Trimboli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Olgerta Labaj
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Caterina Beatrice Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | | | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|
32
|
Sardanelli F, Schiaffino S, Zanardo M, Secchi F, Cannaò PM, Ambrogi F, Di Leo G. Correction to: Point estimate and reference normality interval of MRI-derived myocardial extracellular volume in healthy subjects: a systematic review and meta-analysis. Eur Radiol 2019; 29:7076-7077. [PMID: 31278579 DOI: 10.1007/s00330-019-06271-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The original version of this article, published on 02 May 2019, unfortunately contained a mistake. The following correction has therefore been made in the original: The presentation of Fig. 2 was incorrect. The corrected figure is given below. The original article has been corrected.
Collapse
Affiliation(s)
- Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Simone Schiaffino
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Moreno Zanardo
- Integrative Biomedical Research, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Francesco Secchi
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Paola Maria Cannaò
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Vanzetti 5, 20133, Milan, Italy
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| |
Collapse
|
33
|
Sardanelli F, Schiaffino S, Zanardo M, Secchi F, Cannaò PM, Ambrogi F, Di Leo G. Point estimate and reference normality interval of MRI-derived myocardial extracellular volume in healthy subjects: a systematic review and meta-analysis. Eur Radiol 2019; 29:6620-6633. [DOI: 10.1007/s00330-019-06185-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/04/2019] [Accepted: 03/20/2019] [Indexed: 12/11/2022]
|
34
|
Zanardo M, Doniselli FM, Esseridou A, Tritella S, Mattiuz C, Menicagli L, Di Leo G, Sardanelli F. Abdominal CT: a radiologist-driven adjustment of the dose of iodinated contrast agent approaches a calculation per lean body weight. Eur Radiol Exp 2018; 2:41. [PMID: 30515613 PMCID: PMC6279751 DOI: 10.1186/s41747-018-0074-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background The contrast agent (CA) dose for abdominal computed tomography (CT) is typically based on patient total body weight (TBW), ignoring adipose tissue distribution. We report on our experience of dosing according to the lean body weight (LBW). Methods After Ethics Committee approval, we retrospectively screened 219 consecutive patients, 18 being excluded for not matching the inclusion criteria. Thus, 201 were analysed (106 males), all undergoing a contrast-enhanced abdominal CT with iopamidol (370 mgI/mL) or iomeprol (400 mgI/mL). LBW was estimated using validated formulas. Liver contrast-enhancement (CEL) was measured. Data were reported as mean ± standard deviation. Pearson correlation coefficient, ANOVA, and the Levene test were used. Results Mean age was 66 ± 13 years, TBW 72 ± 15 kg, LBW 53 ± 11 kg, and LBW/TBW ratio 74 ± 8%; body mass index was 26 ± 5 kg/m2, with 9 underweight patients (4%), 82 normal weight (41%), 76 overweight (38%), and 34 obese (17%). The administered CA dose was 0.46 ± 0.06 gI/kg of TBW, corresponding to 0.63 ± 0.09 gI/kg of LBW. A negative correlation was found between TBW and CA dose (r = -0.683, p < 0.001). CEL (Hounsfield units) was 51 ± 18 in underweight patients, 44 ± 8 in normal weight, 42 ± 9 in overweight, and 40 ± 6 in obese, with a significant difference for both mean (p = 0.004) and variance (p < 0.001). A low but significant positive correlation was found between CEL and CA dose in gI per TBW (r = 0.371, p < 0.001) or per LBW (r = 0.333, p < 0.001). Conclusions The injected CA dose was highly variable, with obese patients receiving a lower dose than underweight patients, as a radiologist-driven ‘compensation effect’. Diagnostic abdomen CT examinations may be obtained using 0.63 gI/kg of LBW.
Collapse
Affiliation(s)
- Moreno Zanardo
- PhD Course in Integrative Biomedical Research, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy.
| | - Fabio Martino Doniselli
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Anastassia Esseridou
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Stefania Tritella
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Chiara Mattiuz
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Laura Menicagli
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|
35
|
Abstract
The aim of the study was to estimate the rate of incidental cardiac findings (ICF) in patients undergoing noncardiac chest CT.An experienced radiologist retrospectively reviewed 237 consecutive patients (147 males and 90 females with median age of 69 years) undergoing a noncardiac chest CT. ICF at targeted review were compared to those mentioned in original reports (χ test).At review, ≥1 ICF was detected in 124/237 patients (52%), for a total of 229 ICF, 158 of them (69%) not originally mentioned. Valvular calcifications were unmentioned in 23/23 (100%) patients, main pulmonary artery dilation in 21/22 (96%), coronary calcifications in 69/86 (80%), right or left atrial dilation in 7/11 (64%), aortic atherosclerosis in 29/62 (47%), and ascending aorta dilatation in 8/18 (44%). All 6 pericardial effusions were originally mentioned. No association with sex (P ≥ .189); positive correlation with age (P < .001).Half of patients undergoing noncardiac chest CT presented ≥1 ICF, independently from sex but increasing with age. Moreover, 69% of detectable ICFs were not originally mentioned.
Collapse
Affiliation(s)
- Francesco Secchi
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese
| | - Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese
| | - Moreno Zanardo
- Integrative Biomedical Research, Università degli Studi di Milano, Via Mangiagalli, Milan
| | - Marco Alì
- Integrative Biomedical Research, Università degli Studi di Milano, Via Mangiagalli, Milan
| | - Paola Maria Cannaò
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, Italy
| |
Collapse
|
36
|
Di Leo G, Spadavecchia C, Zanardo M, Secchi F, Veronese I, Cantone MC, Sardanelli F. Should the automatic exposure control system of CT be disabled when scanning patients with endoaortic stents or mechanical heart valves? A phantom study. Eur Radiol 2016; 27:2989-2994. [PMID: 27957643 DOI: 10.1007/s00330-016-4676-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/05/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To estimate the impact of endoaortic stents/mechanical heart valves on the output of an automatic exposure control (AEC) system and CT radiation dose. METHODS In this phantom study, seven stents and two valves were scanned with varying tube voltage (80/100/120 kVp), AEC activation (enabled/disabled) and prosthesis (present/absent), for a total of 540 scans. For each prosthesis, the dose-length product (DLP) was compared between scans with the AEC enabled and disabled. Percentage confidence levels for differences due to the prosthesis were calculated. RESULTS Differences between results with the AEC enabled and disabled were not statistically significant (p ≥ 0.059). In the comparison with and without the prosthesis, DLP was unchanged at 80 kVp and 100 kVp, while a slight increase was observed at 120 kVp. The radiation dose varied from 1.8 mGy to 2.4 mGy without the prosthesis and from 1.8 mGy to 2.5 mGy with the prosthesis (confidence level 37-100%). CONCLUSIONS The effect of the prosthesis on the AEC system was negligible and not clinically relevant. Therefore, disabling the AEC system when scanning these patients is not likely to provide a benefit. KEY POINTS • CT-AEC system is not impaired in patients with endoaortic prostheses/heart valves. • Negligible differences may be observed only at 120 kVp. • Disabling the AEC system in these patients is not recommended.
Collapse
Affiliation(s)
- Giovanni Di Leo
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, San Donato Milanese, Italy.
| | - Chiara Spadavecchia
- Dipartimento di Fisica, Università degli Studi di Milano, Via Celoria 16, Milano, Italy
| | - Moreno Zanardo
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, San Donato Milanese, Italy
| | - Francesco Secchi
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, San Donato Milanese, Italy
| | - Ivan Veronese
- Dipartimento di Fisica, Università degli Studi di Milano, Via Celoria 16, Milano, Italy.,Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Celoria 16, Milano, Italy
| | - Marie Claire Cantone
- Istituto Nazionale di Fisica Nucleare, Sezione di Milano, Via Celoria 16, Milano, Italy.,Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Via Pascal 36, Milano, Italy
| | - Francesco Sardanelli
- Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, San Donato Milanese, Italy.,Department of Biomedical Science for Health, Università degli Studi di Milano, via Morandi 30, San Donato Milanese, Italy
| |
Collapse
|
37
|
Putortì A, Sabatino G, Murmura C, Zanardo M, Vannelli A. Gastric cancer and simultaneous care: Preliminary report about the take charge approach. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
38
|
Basilico V, Griffa B, Radaelli F, Zanardo M, Rossi F, Caizzone A, Vannelli A. Anastomotic leakage following colorectal resection for cancer: how to define, manage and treat it. MINERVA CHIR 2014; 69:245-252. [PMID: 24992323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Aim of the study was to report the experience of a single center in the surgical treatment of anastomotic leak after colorectal resection for cancer, focusing on its incidence, diagnosis and management, with particular attention to surgical options. METHODS Demograhic and clinical data from 1284 consecutive patients operated on for colorectal cancer during a period of 11 years, were prospectively collected and inserted into an electronic database. For the purpose of the study, only patients in whom an anastomosis was performed were considered. Therefore, 128 patients (9.9%) were excluded and 1156 represent the study population. All complications occurring after surgery were systematically recorded. The incidence of colorectal anastomotic leak (CAL), its management and outcome was analyzed. RESULTS An ileo-colic anastomosis was performed in 426 cases (36.8%), ileo-rectal in 29 (2.5%), colo-colic in 409 (35.4), colo-rectal with partial mesorectal excision in 211 (18.3%) and lower colorectal or coloanal anastomosis with total mesorectal excision and temporary loop ileostomy in 81 (7%). Colorectal anastomotic leak occurred in 78/1156 patients (6.7%), accounting for 19% of overall complications. Thirty-six out of 78 patients (46.2%) were successfully treated conservatively, whereas 42 (53.8%) underwent re-operation. Nine out of 78 patients (11.5%) with CAL died owing to an uncontrolled sepsis. All had undergone previous re-intervention, with a post-operative mortality rate of 21.4% (9 out of 42). CONCLUSION Mortality rate in patients undergoing re-operation for colorectal anastomotic leakeage is still high, and accounts for up to 40% of the deaths after colorectal resection for cancer. In the light of these data, strategic clinical decisions are mandatory to optimize the selection of patients who need an early and fast surgical approach. What does this paper add to the literature? Systematic and prospective data recording is an essential tool to assess the quality of healthcare and to plan quality improvement programs. Every effort should be done to reach an early diagnosis of CAL, possibly in a pre-clinical phase in which non clinical methods could be used to predict it.
Collapse
Affiliation(s)
- V Basilico
- Division of Gastrointestinal and Surgical Oncology Ospedale Valduce, Como, Italy -
| | | | | | | | | | | | | |
Collapse
|
39
|
Rossi A, Fantin F, Zanandrea V, Sant S, Confente S, Caliari C, Bertassello P, Zanardo M, Zoico E, Zivelonghi A, Zamboni M. P132: Predictors of physical performance and strength loss during hospitalization. Eur Geriatr Med 2014. [DOI: 10.1016/s1878-7649(14)70306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Rossi A, Mastrandrea V, Bertassello P, Mazzali G, Bissoli L, Zanardo M, Confente S, Fantin F, Zamboni M. Prognostic value of different sarcopenic obesity definitions for worsening disability in elderly men and women. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
41
|
Vannelli A, Basilico V, Zanardo M, Caizzone A, Rossi F, Battaglia L, Scaramuzza D. Pelvic lymphedema in rectal cancer: a magnetic resonance feasibility study: a preliminary report. Eur Rev Med Pharmacol Sci 2013; 17:929-935. [PMID: 23640440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Functional pelvic disorders in patients undergoing conservative surgical approach for rectal cancer are considered a major public health issue and represent one third of cost of colorectal cancer. We investigated the hypothesis that lymphadenectomy, involves the pelvic floor results in a localized hides or silent pelvic lymphedema characterized by symptoms without signs. PATIENTS AND METHODS We examined 13 colo-rectal cancer patients: five intra-peritoneal adenocarcinoma: 1 sigmoid and 4 upper third rectal cancer (1 male and 3 female) and 9 extra-peritoneal adenocarcinoma: 3 middle and 5 lower third rectal cancer (4 male and 5 female) using 1.5-T magnetic resonance, one week before and twelve months after discharged from hospital. RESULTS Lymphedema was discovered on post-operative magnetic resonance imaging of all 9 patients with extra-pertitoneal cancer, whereas preoperative magnetic resonance imaging as well as a post-operative examination of 4 intra-peritoneal adenocarcinoma, revealed no evidence of lymphedema. Unlike the common clinical skin signs that typify all other sites of lymphedema, pelvic lymphedema is hides or silent, with no skin changes or any single symptom manifested. Magnetic resonance imaging showed that pelvic illness alone is accompanied by lymphedema related exclusively to venous congestion, and accumulation of liquid in adipose tissue or lipedema. CONCLUSIONS Alteration of the pelvic lymphatic network during pelvic surgery can lead to lymphedema and, pelvic floor disease. Patients should be routinely examined for the possibility of developing this post-surgical syndrome and further studies are needed to establish diagnosis and to evaluate treatment preferences.
Collapse
Affiliation(s)
- A Vannelli
- Division of Gastrointestinal and Surgical Oncology, Ospedale Valduce, Como, Italy.
| | | | | | | | | | | | | |
Collapse
|
42
|
Puato M, Zanardo M, Ramonda R, Faggin E, Zanon M, Balbi G, Lo Nigro A, Rattazzi M, Doria A, Pauletto P. 378 IMPACT OF ANTI-TNFALPHA THERAPY ON SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH PSORIATIC ARTHRITIS. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70379-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Semplicini A, Inverso G, Realdi A, Macchini L, Maraffon M, Puato M, Zanardo M, Tirrito C, Amodio P, Schiff S, Mapelli D, Manara R. Blood pressure control has distinct effects on executive function, attention, memory and markers of cerebrovascular damage. J Hum Hypertens 2010; 25:80-7. [DOI: 10.1038/jhh.2010.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
44
|
Abstract
Carotid stenting is an alternative to endarterectomy for the treatment of carotid stenosis. To determine the role of vascular remodeling after stent placement, we studied 19 high surgical risk patients undergoing carotid stenting for severe stenosis. Using high-resolution ultrasound, we evaluated the intima-media thickness (IMT), the intima-intima diameter, and the adventitia-adventitia diameter at prespecified sites of the carotid artery tree during 3 years of follow-up. The IMT of internal carotid artery, at the site of maximum stenosis, increased significantly from 0 mm after 24 hours, to 0.41 mm at 3 months, to 0.48 mm at 6 months, and to 0.51 mm at 3 years of follow-up. In the same site, diameters and residual stenosis (range 29-24%) did not change over time. Our study showed that stent is self-expanding against the atherosclerotic plaque within the 3-year follow-up period. Despite neointima formation, the intima-intima diameter does not change without worsening of the residual stenosis.
Collapse
Affiliation(s)
- M. Puato
- Dipartimento di Medicina Clinica e Sperimentale
| | | | - M. Zanardo
- Dipartimento di Medicina Clinica e Sperimentale
| | - R. Rocchi
- Dipartimento di Medicina Clinica e Sperimentale
| | | | | | - P. Pauletto
- Dipartimento di Medicina Clinica e Sperimentale, Medicina I Azienda Ospedaliera di Treviso, Italy
| |
Collapse
|
45
|
Puato M, Migliorato I, Tirrito C, Ruvoletto M, Zanardo M, Pauletto P, Pontisso P. Does HCV infection have a more favourable outcome in Tanzanian people? Data from the Lugalawa study. Dig Liver Dis 2007; 39:891-2. [PMID: 17652046 DOI: 10.1016/j.dld.2007.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 05/11/2007] [Accepted: 05/21/2007] [Indexed: 12/11/2022]
|
46
|
Basilico V, Griffa B, Castiglione N, Giacci F, Zanardo M, Griffa A. [Anastomotic fistulas after colorectal resection for carcinoma: incidence and treatment in our recent experience]. MINERVA CHIR 2006; 61:373-80. [PMID: 17159744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM The incidence of anastomotic fistula after colorectal surgery did not significantly change in the literature during the last years, despite the advances in the treatment with the use of surgical staplers. Taking into account this and other considerations, the authors present their recent experience in the surgical treatment of colorectal carcinoma, referring in particular to anastomotic fistula, related postoperative mortality and results of consequent reoperations. METHODS From January 1, 2002 to December 31, 2005, 448 patients affected with colorectal cancer were operated on at the Surgical Department of Valduce Hospital in Como, and in 373 cases an anastomosis was performed, subdivided as follows: 144 ileocolic (38.6%), 10 ileorectal (2.7%), 219 colocolic or colorectal (58.7%). RESULTS Twenty-five out of 373 anastomotic leaks developed (6.7%). In 9 cases (36%), the fistulas spontaneously closed with conservative treatment, while in 16 (64%) reoperation was necessary. With reference to the anatomical site, the leak occurred in 9 out of 144 patients submitted to right hemicolectomy (6.3%), in 14 out of 219 patients after left hemicolectomy or anterior resection of the rectum (6.4%) and in 2 out of 10 patients (20%) after total colectomy. The following is a detailed report of the therapeutic choices adopted by the authors. Four out of 16 reoperated patients (25%) died postoperatively from infective complications related to the fistula, while the total postoperative mortality was 2.2% (10/448). Therefore, anastomotic dehiscence was responsible for 40% of all postoperative deaths. CONCLUSIONS Among all the different operative choices, the authors give their preference to the direct suture of the fistula and loop ileostomy, which they consider the best available choice. The subsequent operation of ileostomy closure is easier for the surgeon to perform and for the patient to withstand than colostomy closure, particularly after Hartmann's operation.
Collapse
Affiliation(s)
- V Basilico
- U.O. Chirurgia Oncologica Gastroenterologica, Dipartimento di Chirurgia, Ospedale Valduce, Como, Italy.
| | | | | | | | | | | |
Collapse
|
47
|
Griffa B, Basilico V, Clerici D, Bellotti R, Scognamiglio G, Zanardo M, Capriata G. [Angiosarcoma of the breast after conservative surgery and radiotherapy for early breast carcinoma. Description of a case]. MINERVA CHIR 2000; 55:799-802. [PMID: 11265154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The occurrence of an angiosarcoma of the residual breast after conservative surgery and adjuvant radiotherapy for early mammary carcinoma is a very rare event. In western countries only 57 cases have been published in the literature (5 in Italy) since the first described case in 1987. Radiotherapy seems to be the most important etiological factor in the development of the neoplasm. Diagnosis is often delayed, owing to the "benign" aspect of the lesion. The only effective treatment is residual mastectomy, because chemotherapy is ineffective. The prognosis is often dismal, because of the aggressive behaviour of the lesion in most cases. The case of a patient with a multicentric secondary angiosarcoma of the breast recently operated on is described.
Collapse
MESH Headings
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Female
- Hemangiosarcoma/pathology
- Hemangiosarcoma/surgery
- Humans
- Mastectomy, Segmental
- Neoplasms, Radiation-Induced/pathology
- Neoplasms, Radiation-Induced/surgery
- Radiotherapy, Adjuvant
Collapse
Affiliation(s)
- B Griffa
- I Divisione di Chirurgia, Ospedale Valduce
| | | | | | | | | | | | | |
Collapse
|
48
|
Sacchi F, Vischi S, Zanardo M, Capriata S, Capriata G. [Laparoscopic cholecystectomy. Our clinical experience from 1994 to 1996]. MINERVA CHIR 1999; 54:7-10. [PMID: 10230222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND AIM Videolaparocholecystectomy is now regarded as the gold standard of treatment for lithiasis of the gallbladder. METHODS The authors report a retrospective of 258 consecutive videolaparocholecystectomies performed by the Surgical Division of Valduce Hospital in Como between 1994 and 1996. The authors describe the indications for VLC, techniques for the induction of pneumoperitoneum and the realisation of VLC and the percentage and caused of conversion. RESULTS During this period a steady reduction was noted in the number of laparotomic cholecystectomies and a parallel increase in cholecystectomies performed using a laparoscopic technique (69.2 vs. 30.8% in 1994; 76.4 vs. 23.2% in 1995; 91.1 vs. 8.9% in 1996). A gradual extension of the indications for laparoscopic surgery can be seen leading to the application of this technique in patients suffering from acute cholecystic infection, hydros or empyema of the gallbladder. Conversion were required in 25 cases in this series (9.7%). During the last year analysed there were a total of 9 conversions (7.9%) even though the percentage of acute cholecystitis accounted for 38.9% of all cases of cholecystectomy. CONCLUSIONS In line with the experience of other centres, the authors, currently propose VLC as the treatment of choice for lithiasic pathologies of the cholecyst.
Collapse
Affiliation(s)
- F Sacchi
- Divisione di Chirurgia I, Ospedale Generale di Zona Valduce, Como
| | | | | | | | | |
Collapse
|