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Summary: A complex particle accelerator has been built at the Italian National Centre for Oncological Adrotherapy in Pavia, called synchrotron, which is able to decompose atoms and create beams of particles to be directed to tumour cells in order to destroy them. It is the hadrontherapy, a very advanced radiation therapy for the treatment of X-ray resistant or inoperable tumours. In particular, the CNAO synchrotron in Pavia is the only one in Italy capable of extracting carbon ions from the atom, which are the most powerful particles capable of destroying the DNA of cancer cells while preserving the surrounding healthy tissues. Hadrontherapy has been recently included by the Italian Ministry of Health into the essential levels of assistance, recognizing its scientific validity. All Italian citizens can access treatments within the National Health System, according to defined modalities. More than 50 patients are treated at CNAO every day and to date more than 2300 cancer patients from all over Italy have been able to benefit from hadrontherapy. The article will illustrate the technological innovation of the centre in Pavia and will focus on the most interesting research and development projects., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

Summary: The Centro Nazionale di Adroterapia Oncologica (CNAO) of Pavia is the only Italian structure capable of administering therapeutic radiotherapy treatments with heavy particles (carbon ions, protons) accelerated; in addition to this, it hosts significant research activity, both as basic research and for health-related applications. From the perspective of radioprotection, the most significant risk profile is that linked to external irradiation, from three categories of sources: accelerated external beams (in addition to the treatment beams there are conventional linear accelerators), materials activated following irradiation during treatment or during research activities, unstable isotopes used for diagnostic purposes. The CNAO building has been designed and built to guarantee maximum safety both to the operator and to the patient or visitor, with widely redundant systems in order to exclude the occurrence of accidental irradiation, and to minimize the risk of exposure to activated materials. The cohort of workers shows "atypical" characteristics for healthcare safacilities due to the absolute disproportion between classified and unclassified personnel, the homogeneity of training paths, and demographic characteristics. The health surveillance of the exposed, all classified in category B pursuant to Legislative Decree 230/95, is based on the adoption of the AIRM Protocol, tempered on the specific characteristics of the work process. The main critical issues related to the health surveillance of the exposed CNAO workers come from the energies used, with significant activation capacity, and from the presence of personnel in training., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

The structure of currently used contrast media is based on the fully substituted benzoic acid with 3 iodine atoms at positions 2, 4 and 6 of the benzene ring. Contrast media can be differentiated according to their physicochemical characteristics as follows: a) iodine content, b) osmolality (hyper-, low- and iso-osmolar), c) level of ionization (ionic, non-ionic), and d) degree of polymerization (monomeric, dimeric). The non-ionic, low- or iso-osmolal contrast media are the most used in clinical practice due to their excellent tolerability and safety profile. Concerns exist on the higher tolerability of iodixanol, a non-ionic, dimer, iso-osmolal contrast medium, as compared to the low-osmolal contrast media. While early studies suggested a role for osmolality in the pathogenesis of contrast-induced nephropathy at high osmolalities (> 1000 mOsm/kg of H2O), it may be that either osmolality in the range of 290 to approximately 800 is not toxic to the kidney, or that for contrast media within this range of osmolality other characteristics of contrast media, such as direct molecular toxicity or viscosity, play a greater role. Iodixanol, indeed, is more viscous than low-osmolal contrast media. Finally, because of the higher cost of iodixanol, a cost-effectiveness analysis is mandatory.

Among various methods and models to evaluate the dialysis dose, the on-line measure of ionic dialysance gives good results. Compared to measured KT/V, ionic dialysance does not require blood sampling and, consequently, it reduces the risks and the costs. Functional evaluations during acetate free biofiltration (AFB treatments) confirm the usefulness of the on-line continuous measure by biosensors, especially when they are integrated in the dialysis machinery.