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The collection of information on the achievement of the water related Sustainable Development Goals (SDGs), as well as their analysis through research, is defined as being difficult especially in the absence of data and tools that can model these performances. An analysis of SDG indicators at the level of 2015, for 41 countries where the population has high and medium incomes shows that a special level of complexity in monitoring is given by the fact that each country measures certain indicators specifically, and these cannot be compared. It is recommended to formulate methods of measurement and monitoring that can be compared. All these consistent methods between countries must be subject to data protection rules, both in terms of access to them and in terms of their management. Present paper shows the main challenges in monitoring water related SDGs (mainly 6, 11 and 13) in Romania, what is the status so far and what are the challenges for the future.

The collection of information on the achievement of the water related Sustainable Development Goals (SDGs), as well as their analysis through research, is defined as being difficult especially in the absence of data and tools that can model these performances. An analysis of SDG indicators at the level of 2015, for 41 countries where the population has high and medium incomes shows that a special level of complexity in monitoring is given by the fact that each country measures certain indicators specifically, and these cannot be compared. It is recommended to formulate methods of measurement and monitoring that can be compared. All these consistent methods between countries must be subject to data protection rules, both in terms of access to them and in terms of their management. Present paper shows the main challenges in monitoring water related SDGs (mainly 6, 11 and 13) in Romania, what is the status so far and what are the challenges for the future.

Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the “classical”, ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging.

Functional tricuspid regurgitation (FTR) is a strong and independent predictor of patient morbidity and mortality if left untreated. The development of transcatheter procedures to either repair or replace the tricuspid valve (TV) has fueled the interest in the pathophysiology, severity assessment, and clinical consequences of FTR. FTR has been considered to be secondary to tricuspid annulus (TA) dilation and leaflet tethering, associated to right ventricular (RV) dilation and/or dysfunction (the “classical”, ventricular form of FTR, V-FTR) for a long time. Atrial FTR (A-FTR) has recently emerged as a distinct pathophysiological entity. A-FTR typically occurs in patients with persistent/permanent atrial fibrillation, in whom an imbalance between the TA and leaflet areas results in leaflets malcoaptation, associated with the dilation and loss of the sphincter-like function of the TA, due to right atrium enlargement and dysfunction. According to its distinct pathophysiology, A-FTR poses different needs of clinical management, and the various interventional treatment options will likely have different outcomes than in V-FTR patients. This review aims to provide an insight into the anatomy of the TV, and the distinct pathophysiology of A-FTR, which are key concepts to understanding the objectives of therapy, the choice of transcatheter TV interventions, and to properly use pre-, intra-, and post-procedural imaging.

AIMS: Atrial functional tricuspid regurgitation (A-FTR) is a recently defined phenotype of functional tricuspid regurgitation (FTR) associated with persistent/permanent atrial fibrillation. Differently from the classical ventricular form of FTR (V-FTR), patients with A-FTR might present with severely dilated right atrium and tricuspid annulus (TA), and with preserved right ventricular (RV) size and systolic function. However, the geometry and function of the right ventricle, right atrium, and TA in patients with A-FTR and V-FTR remain to be systematically evaluated. Accordingly, we sought to: (i) study the geometry and function of the right ventricle, right atrium, and TA in A-FTR by two- and three-dimensional transthoracic echocardiography; and (ii) compare them with those found in V-FTR. METHODS AND RESULTS: We prospectively analysed 113 (44 men, age 68 ± 18 years) FTR patients (A-FTR = 55 and V-FTR = 58) that were compared to two groups of age- and sex-matched controls to develop the respective Z-scores. Severity of FTR was similar in A-FTR and V-FTR patients. Z-scores of RV size were significantly larger, and those of RV function were significantly lower in V-FTR than in A-FTR (P < 0.001 for all). The right atrium was significantly enlarged in both A-FTR and V-FTR compared to controls (P < 0.001, Z-scores > 2), with similar right atrial (RA) maximum volume (RAVmax) between A-FTR and V-FTR (P = 0.2). Whereas, the RA minimum volumes (RAVmin) were significantly larger in A-FTR than in V-FTR (P = 0.001). CONCLUSION: Despite similar degrees of FTR and RAVmax size, A-FTR patients show larger RAVmin and smaller TA areas than V-FTR patients. Conversely, V-FTR patients show dilated, more elliptic and dysfunctional right ventricle than A-FTR patients.

Prostate cancer (PCa) is the second most frequent type of cancer found in men worldwide, with around one in nine men being diagnosed with PCa within their lifetime. PCa often shows no symptoms in its early stages and its diagnosis techniques are either invasive, resource intensive, or has low efficacy, making widespread early detection onerous. Inspired by the recent success of deep convolutional neural networks (CNN) in computer aided detection (CADe), we propose a new CNN based framework for incidental detection of clinically significant prostate cancer (csPCa) in patients who had a CT scan of the abdomen/pelvis for other reasons. While CT is generally considered insufficient to diagnose PCa due to its inferior soft tissue characterisation, our evaluations on a relatively large dataset consisting of 139 clinically significant PCa patients and 432 controls show that the proposed deep neural network pipeline can detect csPCa patients at a level that is suitable for incidental detection. The proposed pipeline achieved an area under the receiver operating characteristic curve (ROC-AUC) of 0.88 (95% Confidence Interval: 0.86-0.90) at patient level csPCa detection on CT, significantly higher than the AUCs achieved by two radiologists (0.61 and 0.70) on the same task.

Background: Urological investigation in children frequently involves high radiation doses; however, the issue of radiation for these investigations receives little attention compared with CT. Objective(s): To compare the radiation dose from paediatric urological investigations with CT, which is commonly regarded as the more major source of radiation exposure. Material(s) and Method(s): We conducted a retrospective audit in a tertiary paediatric centre of the number and radiation dose of CT scans, micturating cystourethrography exams and urological nuclear medicine scans from 2006 to 2011. This was compared with radiation doses in the literature and an audit of the frequency of these studies in Australia. Result(s): The tertiary centre audit demonstrated that the ratio of the frequency of urological to CT examinations was 0.8:1 in children younger than 17 years. The ratio of the radiation dose of urological to CT examinations was 0.7:1. The ratio in children younger than 5 years was 1.9:1. In Australia the frequency of urological procedures compared with CT was 0.4:1 in children younger than 17 years and 3.1:1 in those younger than 5 years. The ratio of radiation-related publications was 1:9 favouring CT. Conclusion(s): The incidence and radiation dose of paediatric urological studies is comparable to those of CT. Nevertheless the radiation dose of urological procedures receives considerably less attention in the literature. © 2013 Springer-Verlag Berlin Heidelberg.

Background: Urological investigation in children frequently involves high radiation doses; however, the issue of radiation for these investigations receives little attention compared with CT. Objective(s): To compare the radiation dose from paediatric urological investigations with CT, which is commonly regarded as the more major source of radiation exposure. Material(s) and Method(s): We conducted a retrospective audit in a tertiary paediatric centre of the number and radiation dose of CT scans, micturating cystourethrography exams and urological nuclear medicine scans from 2006 to 2011. This was compared with radiation doses in the literature and an audit of the frequency of these studies in Australia. Result(s): The tertiary centre audit demonstrated that the ratio of the frequency of urological to CT examinations was 0.8:1 in children younger than 17 years. The ratio of the radiation dose of urological to CT examinations was 0.7:1. The ratio in children younger than 5 years was 1.9:1. In Australia the frequency of urological procedures compared with CT was 0.4:1 in children younger than 17 years and 3.1:1 in those younger than 5 years. The ratio of radiation-related publications was 1:9 favouring CT. Conclusion(s): The incidence and radiation dose of paediatric urological studies is comparable to those of CT. Nevertheless the radiation dose of urological procedures receives considerably less attention in the literature. © 2013 Springer-Verlag Berlin Heidelberg.

Purpose: To compare the extent and intensity of FLAIR CSF flow related artefacts with and without BLADE (motion correction with multiple radial blade acquisition). Methods and materials: Retrospective review of 22 patients who received FLAIR with and without BLADE. Patients were scanned on three different scanners, two of which are 1.5T, the remainder being 3T. The CSF spaces in the pre-pontine cistern were evaluated for presence of flow related artefact. The cases were blindly assessed by an experienced neuroradiologist (SS) and an MRI fellow (CF). Extent/ Intensity of artefact was assessed on a four point scale (ranked 0-3). Result(s): Flow related artefact was identified on 17 of 22 BLADE studies and 16 of 22 rectilinear FLAIR. The average score based on the four point scale was 1.67 for BLADE and 0.81 for rectilinear FLAIR. The effect was much more pronounced at 3T. Average scores for 3T BLADE was 2.13 compared to 1.00 on rectilinear FLAIR. At 1.5T average scores were 0.43 for BLADE and 0.29 for FLAIR. Conclusion(s): Despite being widely regarded as having less pulsation, ghosting and movement artefacts when compared to conventional FLAIR sequences; BLADE FLAIR images demonstrate increased CSF flow related artefact extent and intensity in the prepontine cistern. The FLAIR with BLADE appearances may mimic the appearance of subarachnoid haemorrhage whereas conventional FLAIR on modern MRI equipment is less likely to result in this appearance. This effect is more pronounced on 3T field strengths when compared to 1.5T. Awareness of this difference may assist in avoiding a false positive subarachnoid haemorrhage diagnosis when FLAIR has been acquired with the BLADE technique.

Purpose - Objective. To compare the frequency and radiation exposure of the most common CT scans performed in our department with common fluoroscopic and nuclear medicine examinations used in urological assessment. Material and methods. A retrospective audit from July 2009-Dec 2011 of the most common CT scans, micturating cystourethrogram (MCU), DTPA, DMSA and MAG3 scans used for urological assessment performed in children <16 years in a tertiary paediatric centre. Radiation doses of these procedures was obtained from the literature. Results. A total of 3851 patients had a CT with a total dose of all exams 9,589 mSv and an average of 2.4 mSv/exam. A total of 828 patients had nuclear medicine examinations with a total dose of 819 mSv and an average of 1.0 mSv/ exam. A total of 118 patients had a MCU with a total dose of 59 mSv and an average of 0.5 mSv/exam. Discussion and conclusions. Urological assessment with MCU and nuclear medicine are commonly used in the assessment of the urinary tract, frequently used in tandem and frequently repeated. The radiation dose of investigation of the urinary tract often overlaps with CT. This is important in determining the risk/benefit ratio for investigating conditions such as antenatal hydronephrosis or urinary infection.

Purpose: To compare the conspicuity of subarachnoid blood on CT with MRI FLAIR and susceptibility weighted imaging (SWI) sequences in the setting of acute subarachnoid haemorrahge. Methods and materials: Retrospective, blinded review of 20 patients presenting with aneurysmal subarachnoid haemorrhage has been performed by two experienced neuroradiologists (WC and MH). Patients who presented with aneurysmal subarachnoid haemorrhage and underwent CT and MRI prior to undergoing craniotomy were included. Each modality/sequence was evaluated independently at two week intervals. The subarachnoid space was divided into 7 sections: interhemispheric, frontoparietal, occipitotemporal, sylvian fissure, perimesencephalic, posterior fossa, intra-ventricular. Result(s): When the subarachnoid space was considered in its seven sections blood was detected in 358 instances on either CT, SWI or FLAIR - 97 for CT, 115 for FLAIR and 146 for SWI. Haemorrhage was seen on all three on 57 occasions. It was detected on only one on 73 occasions - 18 for CT, 19 for FLAIR and 36 for SWI. Blood was detected only on MRI on 88 occasions - 19 FLAIR exclusively, 36 SWI exclusively, 33 both FLAIR and SWI. In addition there were 6 instances where blood was identified on CT and FLAIR only and 19 instances of blood on CT and SWI only. Overall blood was detected the most on SWI, followed by FLAIR and then CT. When considering individual patients blood was identified in all modalities in 17 cases. Of the remaining patients one had blood only on CT, one only on FLAIR and one on both CT and SWI. In the interhemispheric region, cerebral convexity sulci and intraventricular locations SWI and FLAIR appeared to outperform CT. Conclusion(s): There are instances where aneurysmal subarachnoid haemorrage may be detected on MRI, but not CT. This was seen more frequently with SWI than FLAIR. SWI and FLAIR appear more sensitive in the interhemispheric region, cerebral convexity sulci and intraventricular locations. Thi

Purpose: To compare the extent and intensity of FLAIR CSF flow related artefacts with and without BLADE (motion correction with multiple radial blade acquisition). Methods and materials: Retrospective review of 22 patients who received FLAIR with and without BLADE. Patients were scanned on three different scanners, two of which are 1.5T, the remainder being 3T. The CSF spaces in the pre-pontine cistern were evaluated for presence of flow related artefact. The cases were blindly assessed by an experienced neuroradiologist (SS) and an MRI fellow (CF). Extent/ Intensity of artefact was assessed on a four point scale (ranked 0-3). Result(s): Flow related artefact was identified on 17 of 22 BLADE studies and 16 of 22 rectilinear FLAIR. The average score based on the four point scale was 1.67 for BLADE and 0.81 for rectilinear FLAIR. The effect was much more pronounced at 3T. Average scores for 3T BLADE was 2.13 compared to 1.00 on rectilinear FLAIR. At 1.5T average scores were 0.43 for BLADE and 0.29 for FLAIR. Conclusion(s): Despite being widely regarded as having less pulsation, ghosting and movement artefacts when compared to conventional FLAIR sequences; BLADE FLAIR images demonstrate increased CSF flow related artefact extent and intensity in the prepontine cistern. The FLAIR with BLADE appearances may mimic the appearance of subarachnoid haemorrhage whereas conventional FLAIR on modern MRI equipment is less likely to result in this appearance. This effect is more pronounced on 3T field strengths when compared to 1.5T. Awareness of this difference may assist in avoiding a false positive subarachnoid haemorrhage diagnosis when FLAIR has been acquired with the BLADE technique.

Purpose - Objective. To compare the frequency and radiation exposure of the most common CT scans performed in our department with common fluoroscopic and nuclear medicine examinations used in urological assessment. Material and methods. A retrospective audit from July 2009-Dec 2011 of the most common CT scans, micturating cystourethrogram (MCU), DTPA, DMSA and MAG3 scans used for urological assessment performed in children <16 years in a tertiary paediatric centre. Radiation doses of these procedures was obtained from the literature. Results. A total of 3851 patients had a CT with a total dose of all exams 9,589 mSv and an average of 2.4 mSv/exam. A total of 828 patients had nuclear medicine examinations with a total dose of 819 mSv and an average of 1.0 mSv/ exam. A total of 118 patients had a MCU with a total dose of 59 mSv and an average of 0.5 mSv/exam. Discussion and conclusions. Urological assessment with MCU and nuclear medicine are commonly used in the assessment of the urinary tract, frequently used in tandem and frequently repeated. The radiation dose of investigation of the urinary tract often overlaps with CT. This is important in determining the risk/benefit ratio for investigating conditions such as antenatal hydronephrosis or urinary infection.

Purpose: To compare the conspicuity of subarachnoid blood on CT with MRI FLAIR and susceptibility weighted imaging (SWI) sequences in the setting of acute subarachnoid haemorrahge. Methods and materials: Retrospective, blinded review of 20 patients presenting with aneurysmal subarachnoid haemorrhage has been performed by two experienced neuroradiologists (WC and MH). Patients who presented with aneurysmal subarachnoid haemorrhage and underwent CT and MRI prior to undergoing craniotomy were included. Each modality/sequence was evaluated independently at two week intervals. The subarachnoid space was divided into 7 sections: interhemispheric, frontoparietal, occipitotemporal, sylvian fissure, perimesencephalic, posterior fossa, intra-ventricular. Result(s): When the subarachnoid space was considered in its seven sections blood was detected in 358 instances on either CT, SWI or FLAIR - 97 for CT, 115 for FLAIR and 146 for SWI. Haemorrhage was seen on all three on 57 occasions. It was detected on only one on 73 occasions - 18 for CT, 19 for FLAIR and 36 for SWI. Blood was detected only on MRI on 88 occasions - 19 FLAIR exclusively, 36 SWI exclusively, 33 both FLAIR and SWI. In addition there were 6 instances where blood was identified on CT and FLAIR only and 19 instances of blood on CT and SWI only. Overall blood was detected the most on SWI, followed by FLAIR and then CT. When considering individual patients blood was identified in all modalities in 17 cases. Of the remaining patients one had blood only on CT, one only on FLAIR and one on both CT and SWI. In the interhemispheric region, cerebral convexity sulci and intraventricular locations SWI and FLAIR appeared to outperform CT. Conclusion(s): There are instances where aneurysmal subarachnoid haemorrage may be detected on MRI, but not CT. This was seen more frequently with SWI than FLAIR. SWI and FLAIR appear more sensitive in the interhemispheric region, cerebral convexity sulci and intraventricular locations. Thi

This study aimed to determine whether documentation of the result of standardised risk assessment of emergency department patients with suspected head or cervical spine injury or venous thromboembolism was associated with a higher rate of positive imaging. A pilot audit of three metropolitan emergency departments (EDs) was conducted over a 7-week period between February and May 2009. On randomly selected days that were not known by ED medical staff, electronic referrals for imaging were read by two radiology trainees with the aim of determining whether or not the result of risk assessment using previously implemented, standardised risk assessment tools (NEXUS, NICE, Kline and Wells, Royal Children's Hospital, Melbournel head injury guideline) had been documented on the request for imaging. After this was recorded, the report was read to determine whether the study (CT brain adult and child, CT cervical spine adult and child, lower limb venous ultrasound, CT pulmonary angiogram) showed any clinically significant pathology. Scoring of referrals as positive or negative for documentation of risk assessment outcome was checked by a consultant radiologist for the first 2-week period with feedback to the trainees regarding coding of requests. A total of 160 examinations were audited. There was >85% agreement between the trainees and consultant for coding of referrals with regard to risk assessment. At Hospital 1, 8.2% (95% CI: 3.0-17.2%) of imaging in 61 patients was positive and 50% of patients had a valid risk assessment documented. For Hospital 2, 17% (95% CI: 8.6-29%) of 52 studies were positive with an 87% risk assessment documentation. For Hospital 3, 15% (95%CI: 6.8-27.3%) of imaging was positive with 81% risk assessment documentation. Imaging was positive substantially more often in EDs where risk assessment documentation occurred most frequently. Small sample size may be the reason for this difference being non-statistically significant at this early point in the

This study aimed to determine whether documentation of the result of standardised risk assessment of emergency department patients with suspected head or cervical spine injury or venous thromboembolism was associated with a higher rate of positive imaging. A pilot audit of three metropolitan emergency departments (EDs) was conducted over a 7-week period between February and May 2009. On randomly selected days that were not known by ED medical staff, electronic referrals for imaging were read by two radiology trainees with the aim of determining whether or not the result of risk assessment using previously implemented, standardised risk assessment tools (NEXUS, NICE, Kline and Wells, Royal Children's Hospital, Melbournel head injury guideline) had been documented on the request for imaging. After this was recorded, the report was read to determine whether the study (CT brain adult and child, CT cervical spine adult and child, lower limb venous ultrasound, CT pulmonary angiogram) showed any clinically significant pathology. Scoring of referrals as positive or negative for documentation of risk assessment outcome was checked by a consultant radiologist for the first 2-week period with feedback to the trainees regarding coding of requests. A total of 160 examinations were audited. There was >85% agreement between the trainees and consultant for coding of referrals with regard to risk assessment. At Hospital 1, 8.2% (95% CI: 3.0-17.2%) of imaging in 61 patients was positive and 50% of patients had a valid risk assessment documented. For Hospital 2, 17% (95% CI: 8.6-29%) of 52 studies were positive with an 87% risk assessment documentation. For Hospital 3, 15% (95%CI: 6.8-27.3%) of imaging was positive with 81% risk assessment documentation. Imaging was positive substantially more often in EDs where risk assessment documentation occurred most frequently. Small sample size may be the reason for this difference being non-statistically significant at this early point in the