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Simple Summary: Advances in systemic cancer management have improved survival for numerous types of solid cancer; therefore, the number of patients harboring BM is increasing. According to established guidelines, resection should be carried out in patients with single brain metastases and controlled primary disease or when histopathologic diagnosis is crucial for decision-making in cancer management. Post-surgery rates of local recurrence are high; hence, adjuvant local radiation therapy (RT) is indicated to improve outcomes. So far, there is no standard of care regarding dose and fractionation; furthermore, delineation of the cavity can be challenging. Lately, low-energy X-ray intraoperative radiation therapy (IORT) applied to the resection bed has emerged in clinical practice, offering local ablative treatment with steep dose gradients towards the surrounding healthy brain. We here retrospectively describe 18 patients with resected brain metastases, which had undergone IORT, demonstrating the effectiveness and safety of this technique in accordance with previous studies. Background: Resection followed by local radiation therapy (RT) is the standard of care for symptomatic brain metastases. However, the optimal technique, fractionation scheme and dose are still being debated. Lately, low-energy X-ray intraoperative RT (lex-IORT) has been of increasing interest. Method: Eighteen consecutive patients undergoing BM resection followed by immediate lex-IORT with 16–30 Gy applied to the spherical applicator were retrospectively analyzed. Demographic, RT-specific, radiographic and clinical data were reviewed to evaluate the effectiveness and safety of IORT for BM. Descriptive statistics and Kaplan–Meyer analysis were applied. Results: The mean follow-up time was 10.8 months (range, 0–39 months). The estimated local control (LC), distant brain control (DBC) and overall survival (OS) at 12 months post IORT were 92.9% (95%-CI 79.3–100%), 71.4% (95%-CI 50.2–92.6%) and 58.0% (95%-CI 34.1–81.9%), respectively. Two patients developed radiation necrosis (11.1%) and wound infection (CTCAE grade III); both had additional adjuvant treatment after IORT. For five patients (27.8%), the time to the start or continuation of systemic treatment was ≤15 days and hence shorter than wound healing and adjuvant RT would have required. Conclusion: In accordance with previous series, this study demonstrates the effectiveness and safety of IORT in the management of brain metastases despite the small cohort and the retrospective characteristic of this analysis. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the performance of artificial intelligence (AI) software in bone age (BA) assessment, according to the Greulich and Pyle (G&P) method in a German pediatric cohort., Materials and Methods: Hand radiographs of 306 pediatric patients aged 1-18 years (153 boys, 153 girls, 18 patients per year of life)-including a subgroup of patients in the age group for which the software is declared (243 patients)-were analyzed retrospectively. Two pediatric radiologists and one endocrinologist made independent blinded BA reads. Subsequently, AI software estimated BA from the same images. Both agreements, accuracy, and interchangeability between AI and expert readers were assessed., Results: The mean difference between the average of three expert readers and AI software was 0.39 months with a mean absolute difference (MAD) of 6.8 months (1.73 months for the mean difference and 6.0 months for MAD in the intended use subgroup). Performance in boys was slightly worse than in girls (MAD 6.3 months vs. 5.6 months). Regression analyses showed constant bias (slope of 1.01 with a 95% CI 0.99-1.02). The estimated equivalence index for interchangeability was - 14.3 (95% CI -27.6 to - 1.1)., Conclusion: In terms of BA assessment, the new AI software was interchangeable with expert readers using the G&P method., Clinical Relevance Statement: The use of AI software enables every physician to provide expert reader quality in bone age assessment., Key Points: • A novel artificial intelligence-based software for bone age estimation has not yet been clinically validated. • Artificial intelligence showed a good agreement and high accuracy with expert radiologists performing bone age assessment. • Artificial intelligence showed to be interchangeable with expert readers., (© 2023. The Author(s).)

Objectives: The objective of our study was to determine whether tin filtration reduces the radiation exposure received by patients and whether it affects the quality of imaging in low-dose computed tomography (LDCT) of sacroiliac joints (SIJ). The evaluation was performed on a group of patients with suspected ankylosing spondylitis. For comparison, the effective dose of a conventional X-ray was calculated. Method: Patients examined by LDCT SIJ at our workplace in 2019-2020 were divided into two groups. The first group underwent a low-dose protocol without the use of tin filtration and the second group underwent the same low-dose protocol with tin filtration. When a patient had an X-ray available in the clinical system, its effective dose was calculated. The dose evaluation were performed by a medical physicist using ImpactDose 2.3, patient model - real patient data (CT Imaging GmbH, Germany) and PCXMC 2.0 (X-ray, STUK Finland) programs. The quality of the image documentation was evaluated independently by two radiologists. Results: In our cohort, the median effective dose for LDCT with tin filtration was 0.1 mSv (0.05-0.18 mSv), for LDCT without tin filtration was 0.5 mSv (0.3-0.9 mSv) and for X-ray was 0.25 mSv (0.06-1.16 mSv). In both LDCT groups 90% of image documentation was of an excellent quality. Conclusion: Our results showed that the tin filtration decreases the radiation dose in comparison with the low-dose protocol by 80%. Compared to X-rays, the dose in our LDCT group with tin filtration was 50% lower. It follows that LDCT with tin filtration can be used in the diagnosis of ankylosing spondylitis instead of X-rays or in case of unclear findings or inability to perform MRI examination. [ABSTRACT FROM AUTHOR]

Here, high-throughput tomography (HiTT), a fast and versatile phase-contrast imaging platform for life-science samples on the EMBL beamline P14 at DESY in Hamburg, Germany, is presented. A high-photon-flux undulator beamline is used to perform tomographic phase-contrast acquisition in about two minutes which is linked to an automated data processing pipeline that delivers a 3D reconstructed data set less than a minute and a half after the completion of the X-ray scan. Combining this workflow with a sophisticated robotic sample changer enables the streamlined collection and reconstruction of X-ray imaging data from potentially hundreds of samples during a beam-time shift. HiTT permits optimal data collection for many different samples and makes possible the imaging of large sample cohorts thus allowing population studies to be attempted. The successful application of HiTT on various soft tissue samples in both liquid (hydrated and also dehydrated) and paraffin-embedded preparations is demonstrated. Furthermore, the feasibility of HiTT to be used as a targeting tool for volume electron microscopy, as well as using HiTT to study plant morphology, is demonstrated. It is also shown how the high-throughput nature of the work has allowed large numbers of `identical' samples to be imaged to enable statistically relevant sample volumes to be studied., (open access.)

Introduction: Transcutaneous Osseointegrated Prosthetic Systems (TOPS) offer a good alternative for patients who cannot be satisfactorily rehabilitated by conventional suspension sockets. The Endo-Exo-Prothesis (EEP, ESKA Orthopaedic Handels GmbH®, Deutschland) is the most implanted TOPS in Germany. Previous studies have shown that cortical thickness increases after implantation of TOPS. The aim of this study is to determine changes of cortical thickness in relation to the time after implantation of the Endo-Fix-Stem. Patients and methods: All transfemoral amputees treated by EEP from 2007 to 2013 were operated by the last author of this study. X-ray images of 4 follow-up intervals (postoperative, 3 months, 12 months, 3 years) were analyzed retrospectively. The femoral residuum was divided into 3 sections (proximal, middle, distal) with 2 measuring points in each section: medial and lateral. Cortical thickness was measured at these 6 points and compared at regular intervals using the Friedman test for non-parametric dependent variables. Results: Thirty-seven patients with 40 implants were included. The average age was 52.2 years (30–79 years). 83.7% of the patients were male. No statistical significance could be shown for any of the measuring points of the femoral residual (proximal medial, proximal lateral, middle medial, middle lateral, distal medial, distal lateral) among the mean values of the cortical thickness at the different follow-up times (p > 0.05 for all measuring points). Cortical remodeling processes (> 1 millimeter (mm)) occurred in all implants despite a missing statistical significance. Hypertrophy could be confirmed for 42.5% and atrophy for 37.5%. Twenty percent of the cases showed a parallel occurrence of both entities. Cortical changes greater than 5 mm were only observed at the distal end of the femur. Conclusion: Even if our results did not show any significant difference, it can be deduced that the osseointegration process leads to a remodeling of the bone structure, both in terms of increased bone formation and bone resorption. However, it has not yet been conclusively clarified which processes lead to hyper- or atrophy. The force transmission between prosthesis and bone and the facultative bacterial colonization of the stoma are still the main factors which may be responsible for the bone remodeling processes. [ABSTRACT FROM AUTHOR]

In Germany, people categorised as 'unaccompanied minor refugees' have special rights, entitlements and possibilities. It is, for example, legally complicated to deport them. Since age is such a crucial marker of difference, the age statement of individual migrants is often scrutinised in their registration process through administrative, pedagogic and forensic practices. This ethnographic analysis of forensic age estimations in Hamburg, Germany, shows that one cannot simply read age from a young migrant's bones. Rather, an individual's age is enacted in a practice whereby age is not only dependent on a body, but also on the specific bureaucratic and scientific traditions, technologies and standards involved in assessing it. Thus, citizenship practices based on age not only draw on 'the body', but also – and more crucially – on varied scientific and bureaucratic practices. I propose the concept of 'biorelational citizenship' to grasp these shifting relationalities of the body in citizenship practices. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the current practice regarding the prevalence and sequence of x-ray and CT scan in diagnostic algorithms for multiple injured patients., Methods: All primarily treated patients with ISS ≥ 9 were selected from the TraumaRegister DGU® (years 2008-2015; n = 109,257). Four subgroups of diagnostic algorithm were defined: CT only (group C; n = 63,763), CT before x-ray (group CX; n = 3711), x-ray followed by CT (group XC; n = 33,590), and x-ray only (group X, n = 8193). We analysed the type and sequence of diagnostic procedures and their association with hospital mortality and length-of-stay in the emergency room (ER-LOS)., Results: Predominant strategies were CT only (58.4%) and x-ray followed by CT (30.7%). Overall mortality was between 10 and 12% in all subgroups involving CT, and 6.6% in the x-ray only group. Expected mortality was within the 95% confidence of observed mortality except for the CX group (observed 10.0%; CI 95 8.9-11.0; expected 11.1%). Mean / median length of stay in the emergency room was shortest in the CT only subgroup: (60 / 50 min). Prior x-ray diagnostic resulted in additional 3 min (group XC). The use of additional x-ray diagnostic decreased from 51.6% (in 2008) to 35.4% (in 2015)., Conclusions: ER-LOS is significantly affected by diagnostic pathway. CT scan alone accelerates ER-LOS, which however was not associated with lower mortality rates. Performing completive x-ray examinations after an initial CT scan seems not to deteriorate mortality rates., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Objective: Our aim was to determine the prevalence of tuberculosis (TB), the number needed to screen (NNS), and the diagnostic accuracy of chest X-ray (CXR) screening to detect active pulmonary TB during the 2015 European refugee crisis.Materials and Methods: We evaluated data of all refugees who underwent CXR screening in a single-centre of one German metropolitan area in 2015. We determined the prevalence of TB, NNS, and accuracy of CXR to detect active pulmonary TB. Reference method for active TB was the database of all definite TB cases registered at the Department of Public Health.Results: A total of 17,487 immigrants underwent single-centre CXR screening in 2015; prevalence of definite pulmonary TB was 0.103%. The NNS for detecting one case of active pulmonary TB was 1749. CXR had a sensitivity of 55.6% [95% confidence interval (CI) 30.8-78.5%) and a specificity 98.3% (CI 98.1-98.5%) to reveal one case of active TB.Conclusion: Our single-centre study indicates that chest X-ray screening for TB during the 2015 European refugee crisis was of low yield due the low prevalence of TB and high number needed to screen, thus implicating the need for improved screening algorithms adapted to the overwhelming number of refugees.Key Points: • Prevalence of pulmonary tuberculosis (TB) among refugees in 2015 was low (0.103%). • The number needed to screen to detect one case of active pulmonary TB was 1749. • Tuberculosis X-ray screening resulted in a low sensitivity and high specificity. • Tuberculosis X-ray screening during the European refugee crisis is of low yield. • Improved screening algorithms are needed due to the overwhelming the number of refugees. [ABSTRACT FROM AUTHOR]

Shortly after Röntgen's publication about a new kind of rays, a dispute about priority claims began. Röntgen was not the first researcher to produce X-rays nor the first to take X-ray images. An analysis of the history of cathode ray research in the 19th century reveals ample evidence that researchers before Röntgen had already produced X-rays, albeit without knowing this. Most of them, for their part, did not claim any priority, some did so rather casually. The German-Hungarian physicist Philipp Lenard, a co-founder of German Physics, considered himself a "true discoverer". It remains to be said, however, that he, like many others before him, failed to recognize the character of the new radiation. It was Wilhelm Conrad Röntgen, with his three scientific publications on X-rays, who laid the foundations for their physical clarification and paved the way for the success story of their application in a variety of fields that continues to this day., (Copyright © 2022 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

Purpose: In the European Union tuberculosis prevalence-rates are among the lowest in the world. The prevalence of active tuberculosis in migrant populations has to be analyzed to get valid data on the risk of tuberculosis and for the decision of screening activities.Methods: Therefore, we prospectively quantified the risk of active tuberculosis among asylum seekers at time of arrival. Investigation was performed as regular part of the admission screenings for people arriving at Friedland, Germany, a primary major receiving center during one year.Results: In 11.773 newly arrived asylum seekers 16 X-ray investigations gave the suspicion of active tuberculosis, thereof 11 cases could be verified by culture, thereof 9 cases were classified as microscopically positive. These data translate into rates of 136 per 100.000 suspected cases, 93 per 100.000 verified cases, and finally 76 per 100.000 infectious cases, respectively. Prevalence was higher in asylum seekers coming from Eritrea and Russia compared to the main origins of current migration Syria, Afghanistan, Iraq, Iran, and Lebanon. One case of MDR-tuberculosis could be detected in a migrant from Russia.Conclusions: Prevalence rates of tuberculosis in newly arrived asylum seekers are higher than in native European populations. Rates seem to reflect the prevalence in the home countries. X-ray investigation during first examination may help identifying people needing further tests for detecting infectious tuberculosis and therefore may prevent transmission. However due to the low prevalence rates screening procedures have to be reviewed. [ABSTRACT FROM AUTHOR]

Previous studies investigating multi-sensor fusion for the collection of soil information have shown variable improvements, and the underlying prediction mechanisms are not sufficiently understood for spectrally-active and -inactive properties. Our objective was to study prediction mechanisms and benefits of model fusion by measuring mid-infrared (MIR) and X-ray fluorescence (XRF) spectra, texture, total and labile organic carbon (OC) and nitrogen (N) content, pH, and cation exchange capacity (CEC) for n = 117 soils from an arable field in Germany. Partial least squares regression models underwent a three-fold training/testing procedure using MIR spectra or elemental concentrations derived from XRF spectra. Additionally, two sequential hybrid and two high-level fusion approaches were tested. For the studied field, MIR was superior for organic properties (ratio of prediction to interquartile distance of validation (RPIQV) for total OC = 7.7 and N = 5.0)), while XRF was superior for inorganic properties (RPIQV for clay = 3.4, silt = 3.0, and sand = 1.8). Even the optimal fusion approach brought little to no accuracy improvement for these properties. The high XRF accuracy for clay and silt is explained by the large number of elements with variable importance in the projection scores >1 (Fe ≈ Ni > Si ≈ Al ≈ Mg > Mn ≈ K ≈ Pb (clay only) ≈ Cr) with strong spearman correlations (±0.57 < rs < ±0.90) with clay and silt. For spectrally-inactive properties relying on indirect prediction mechanisms, the relative improvements from the optimal fusion approach compared to the best single spectrometer were marginal for pH (3.2% increase in RPIQV versus MIR alone) but more pronounced for labile OC (9.3% versus MIR) and CEC (12% versus XRF). Dominance of a suboptimal spectrometer in a fusion approach worsened performance compared to the best single spectrometer. Granger-Ramanathan averaging, which weights predictions according to accuracy in training, is therefore recommended as a robust approach to capturing the potential benefits of multiple sensors.

A positive effect of intra-articular platelet-rich plasma (PRP) injection has been discussed for osteoarthritic joint conditions in the last years. The purpose of this study was to evaluate PRP injection into the trapeziometacarpal (TMC) joint. We report about ten patients with TMC joint osteoarthritis (OA) that were treated with 2 intra-articular PRP injections 4 weeks apart. PRP was produced using the Double Syringe System (Arthrex Inc., Naples, Florida, USA). A total volume of 1.47±0.25 mL PRP was injected at the first injection and 1.5±0.41 mL at the second injection, depending on the volume capacity of the joint. Patients were evaluated using VAS, strength measures, and the Mayo Wrist score and DASH score after 3 and 6 months. VAS significantly decreased from 6.2±1.6 to 5.4±2.2 at six-month follow-up (P<0.05). The DASH score was unaffected; however, the Mayo Wrist score significantly improved from 46.5±18.6 to 67.5±19.0 at six-month follow-up (P=0.05). Grip was unaffected, whereas pinch declined from 6.02±2.99 to 3.96±1.77 at six-month follow-up (P<0.05). We did not observe adverse events after the injection of PRP, except one occurrence of a palmar wrist ganglion, which resolved without treatment. PRP injection for symptomatic TMC OA is a reasonable therapeutic option in early stages TMC OA and can be performed with little to no morbidity. [ABSTRACT FROM AUTHOR]

The monastery of Attel, Upper Bavaria, which was founded in AD 1030, harbours a series of crypt burials from the time period between AD 1700 and 1750. Due to a restoration of the church, 16 crypts had to be removed and were subjected to an extensive anthropological-paleopathological and isotope analysis. The 16 crypts contained 19 burials in open wooden coffins. All bodies were covered by an extensive layer of calcium carbonate. Despite this “treatment,” bone and teeth were excellently preserved (mean degree of conservation > 75%, completeness > 85%). The anthropological investigation revealed a mean age of 38.5 years and a body height of 1.71 m. Paleopathologically, a surprisingly high rate of trauma was seen (13 injuries in 7 different individuals, i.e., 36.8% of individuals affected), 2 cases presented signs of extensive arthritis urica (gout), and several monks were affected by arthrosis of shoulder and knee joints. Extensive dental attrition, numerous foci of dental caries, and dentogenic abscesses coincided with considerable dental calculus indicating poor oral hygienic conditions. Stable isotope analysis showed adequate mixed carnivore-herbivore nutrition, comparable to that of contemporaneous upper class individuals. This extensive combined analysis provides considerable insight into the nutrition and disease pattern of a middle-class monastery of early 18th century South Germany. [ABSTRACT FROM AUTHOR]

Background: Growth restriction and retarded bone age are common findings in children with chronic kidney disease (CKD). We compared the automated BoneXpert™ method with the manual assessment of an X-ray of the non-dominant hand. Methods: In this retrospective multicenter study, 359 patients with CKD stages 2-5, aged 2-14.5 (girls) or 2.5-17 years (boys) were included. Bone age was determined manually by three experts (according to Greulich and Pyle). Automated determination of bone age was performed using the image analysis software BoneXpert™. Results: There was a strong correlation between the automatic and the manual method ( r = 0.983, p < 0.001). The automatic method tended to generate higher bone age values (0.64 ± 0.73 years) in the younger patients (4-5 years) and to underestimate retardation or acceleration of bone age. The so-called 'bone health index' (BHI) was reduced in comparison to the reference population. Bone health index standard deviation score (BHI-SDS) was not related to the stage of CKD, but weakly negatively correlated with plasma PTH concentrations ( r = 0.12, p = 0.019). Conclusions: BoneXpert™ allows an objective, time-saving, and in general valid bone age assessment in children with CKD. Possible underestimation of retarded or accelerated bone age should be taken into account. Validation of the BHI needs further study. [ABSTRACT FROM AUTHOR]

The present clinical trial was intended to clarify whether subjective assessments of diagnostic X-ray image quality achieved via hand-held (HH) Nomad Pro 2 (KaVo Kerr, Brea, CA, USA) X-ray device is non-inferior that of the wall-mounted (WM) KaVo Focus (KaVo Dental, Bieberich, Germany). A prospective, cross-over, and in vivo non-inferiority clinical trial was conducted to compare these two diagnostic modalities. Based on sampling calculations, 205 patients were selected for study, generating 410 paired bitewing radiographs in randomized sequence. The films were assessed independently, engaging three observers blinded to modality for random, side-by-side-comparisons. Diagnostic image quality was rated as follows: no preference, HH preference, or WM preference. Observer judgements were combined accordingly to reach a majority. Collective observer ratings indicated no preference for diagnostic image quality in 63.9% of cases, with WM preference at 16.6% and HH preference at 19.5%. The difference in HH and WM preferences (19.5%–16.6% = 2.9%) was within the expected 95% confidence interval. Majority agreement was reached in 82.7%. Subjectively assessed diagnostic image quality in bitewing radiographs acquired by HH and WM devices did not differ significantly. The hand-held device is thus non-inferior to the WM in this regard. Our data set of paired bitewing radiographs may subsequently aid in future research. [ABSTRACT FROM AUTHOR]

Background: Although advanced medical imaging technologies give detailed diagnostic information, a low-dose, fast, and inexpensive option for early detection of respiratory diseases and follow-ups is still lacking. The novel method of x-ray dark-field chest imaging might fill this gap but has not yet been studied in living humans. Enabling the assessment of microstructural changes in lung parenchyma, this technique presents a more sensitive alternative to conventional chest x-rays, and yet requires only a fraction of the dose applied in CT. We studied the application of this technique to assess pulmonary emphysema in patients with chronic obstructive pulmonary disease (COPD)., Methods: In this diagnostic accuracy study, we designed and built a novel dark-field chest x-ray system (Technical University of Munich, Munich, Germany)-which is also capable of simultaneously acquiring a conventional thorax radiograph (7 s, 0·035 mSv effective dose). Patients who had undergone a medically indicated chest CT were recruited from the department of Radiology and Pneumology of our site (Klinikum rechts der Isar, Technical University of Munich, Munich, Germany). Patients with pulmonary pathologies, or conditions other than COPD, that might influence lung parenchyma were excluded. For patients with different disease stages of pulmonary emphysema, x-ray dark-field images and CT images were acquired and visually assessed by five readers. Pulmonary function tests (spirometry and body plethysmography) were performed for every patient and for a subgroup of patients the measurement of diffusion capacity was performed. Individual patient datasets were statistically evaluated using correlation testing, rank-based analysis of variance, and pair-wise post-hoc comparison., Findings: Between October, 2018 and December, 2019 we enrolled 77 patients. Compared with CT-based parameters (quantitative emphysema ρ=-0·27, p=0·089 and visual emphysema ρ=-0·45, p=0·0028), the dark-field signal (ρ=0·62, p<0·0001) yields a stronger correlation with lung diffusion capacity in the evaluated cohort. Emphysema assessment based on dark-field chest x-ray features yields consistent conclusions with findings from visual CT image interpretation and shows improved diagnostic performance than conventional clinical tests characterising emphysema. Pair-wise comparison of corresponding test parameters between adjacent visual emphysema severity groups (CT-based, reference standard) showed higher effect sizes. The mean effect size over the group comparisons (absent-trace, trace-mild, mild-moderate, and moderate-confluent or advanced destructive visual emphysema grades) for the COPD assessment test score is 0·21, for forced expiratory volume in 1 s (FEV 1 )/functional vital capacity is 0·25, for FEV 1 % of predicted is 0·23, for residual volume % of predicted is 0·24, for CT emphysema index is 0·35, for dark-field signal homogeneity within lungs is 0·38, for dark-field signal texture within lungs is 0·38, and for dark-field-based emphysema severity is 0·42., Interpretation: X-ray dark-field chest imaging allows the diagnosis of pulmonary emphysema in patients with COPD because this technique provides relevant information representing the structural condition of lung parenchyma. This technique might offer a low radiation dose alternative to CT in COPD and potentially other lung disorders., Funding: European Research Council, Deutsche Forschungsgemeinschaft, Royal Philips, and Karlsruhe Nano Micro Facility., Competing Interests: Declaration of interests TK is an employee of Philips Innovative Technologies, Research Laboratories, which is part of Royal Philips. AY and TP are employees of Philips Medical System DMC, which is part of Royal Philips. GSZ receives payments for lectures from Boehringer Ingelheim, AstraZeneca, Novartis, GlaxoSmithKline, Bayer Healthcare, and Roche; and receives travel support from Novartis and Roche. FP received a European Research Council Advanced Grant and a hardware loan (x-ray source and detector) from Royal Philips. The authorship of patents related to technical implementation of the demonstrator system are KW has coauthored GB3687403B2 and US20200187893A1; FDM has coauthored GB3687403B2 and US20200187893A1; TU has coauthored PCT/EP2021/063949; TK has coauthored US10417761B2, US10945690B2, GB3687403B2, US10912532B2, PCT/EP2020/082799, PCT/EP2021/057524, PCT/EP2021/064497, PCT/EP2021/063949, and US20200187893A1; AY has coauthored GB3687403B2, US10912532B2, PCT/EP2020/082799, and US20200187893A1; TP has coauthored PCT/EP2020/082799; and FP has coauthored US10945690B2 and PCT/EP2021/063949. Royal Philips is the assignee for all patents listed. All other authors declare no competing interests., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Microbeam radiotherapy is a novel type of radiotherapy in which narrow beams of radiation (typically less than 500 μ m) are spatially fractionated, delivering a non-uniform distribution to the target tumour volume. Due to the very high dose gradients and very small beams involved, new dosimetric techniques are required for translation into clinical practise. Current real-time beam monitoring is typically performed using 1 dimensional silicon strip detectors or wire chambers, with 2D beam information measured offline using radiochromic film (requiring a minimum of 24 h to self-develop). Using an Xstrahl SARRP X-ray​ irradiation device with a bespoke microbeam collimator at the Technical University of Munich, Germany, the newly developed vM1212 detector was exposed to a variety of microbeams (220 kV, nominal slit widths 0– 100 μ m) for evaluation of in vivo real time verification. The performance of the detector was assessed by changing the collimator slit width (and thus microbeam FWHM) mid-irradiation. Microbeam FWHMs of 130– 190 μ m could be measured in this manner in addition to temporally monitoring other basic parameters such as the radiation intensity. More advanced parameters could be calculated as the tungsten slits within the microbeam collimator opened and closed such as the rate of change of FWHM; the peak–valley-dose-ratio (PVDR); and the sub-pixel movement of each microbeam peak. This work demonstrates the potential of radiation hard CMOS sensors in radiotherapy for in vivo real-time monitoring of X-ray microbeams FWHM, intensity and position. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

For decades projection radiography has been the standard in the diagnostics of fractures and injuries, including patients in childhood and adolescent; however, each examination with X‑rays should also be based on an individual assessment of the benefits and risks. The pediatric traumatology section of the DGU has developed a consensus paper on various aspects of imaging for diagnostics and assessment of progression, on setting options for intraoperative imaging, on X‑ray imaging of the opposite side, on polytrauma and computed tomography (CT), on postoperative radiological checks and the use of sonography after an accident.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Why took it nearly four decades, from the first evidence of artificial creation of bremsstrahlung, noted indirectly in literature in 1857 by Julius Pluecker, Professor of mathematics and physics in Bonn, Germany, to Professor Conrad Wilhelm Roentgen's breaking discovery and announcement of X-rays in 1895? Following introductory remarks on the difficulties adjusting the parameters required to generate X-rays and the way medical X-rays occupied clinical routine after Roentgen's revolutionary discovery, and answering the question at the beginning, this paper will discuss in depth the paths taken for improvement up to the present, and some of the culs-de-sac., (Copyright © 2020 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Inverse Compton scattering provides means to generate low-divergence partially coherent quasi-monochromatic, i.e. synchrotron-like, X-ray radiation on a laboratory scale. This enables the transfer of synchrotron techniques into university or industrial environments. Here, the Munich Compact Light Source is presented, which is such a compact synchrotron radiation facility based on an inverse Compton X-ray source (ICS). The recent improvements of the ICS are reported first and then the various experimental techniques which are most suited to the ICS installed at the Technical University of Munich are reviewed. For the latter, a multipurpose X-ray application beamline with two end-stations was designed. The beamline's design and geometry are presented in detail including the different set-ups as well as the available detector options. Application examples of the classes of experiments that can be performed are summarized afterwards. Among them are dynamic in vivo respiratory imaging, propagation-based phase-contrast imaging, grating-based phase-contrast imaging, X-ray microtomography, K-edge subtraction imaging and X-ray spectroscopy. Finally, plans to upgrade the beamline in order to enhance its capabilities are discussed., (open access.)

Background: The structured diagnosis of chest radiographs is an important basic competence in radiology and will be required in the student teaching with the implementation of the National Competency-Based Learning Catalog Medicine (NKLM) in Germany., Aim: The aim was to evaluate the extent to which second-year students gain confidence in the diagnosis of chest radiographs through a new curricular training for the diagnosis of chest radiographs with subsequent objective structured clinical examination (OSCE) and how confident they feel about meeting the expectations of the supervising medical colleagues during the clinical clerkship., Methods: The training included four lectures and ten commented instructional films on the diagnosis of radiographs. Two years later, the students were asked how often and in what form they had contact with chest radiographs in their clinical clerkship. They were also asked how confident they felt in dealing in different areas. The students with training were also asked to what extent the lectures and the instructional films were helpful. The results of students in the last year without and the first year with training and OSCE were compared using the Mann-Whitney U test for independent samples., Results: The frequency of dealing with chest radiographs was comparably high among students with and without training. The students with training and OSCE felt more confident and better prepared in dealing with chest radiographs than the students without training (varying between p < 0.001 and p = 0.148). They rated the educational films as more helpful than the lectures (mean 2.85 ± 0.76 vs. 3.41 ± 0.68 on a four-point scale)., Discussion: With early training, students' confidence in dealing with chest radiographs can be sustainably increased.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

In Germany, authorised experts are required to measure around an X-ray facility to determine supervised and controlled areas within the scope of a legal regulatory procedure. For this purpose, they have to use area dosemeters which are nationally type-approved by the PTB according to the German measurement and verification act. To date, all available type-approved area dosemeters are only tested in continuous radiation fields, and therefore the technical data of the measuring instruments are valid only for continuous radiation. In practice, however, the majority of facilities use pulsed radiation X-rays. Since no other measuring equipment is available, the authorised experts use supposedly unsuitable dosemeters. But is this really so? In the scope of this article, instruments typically used for these measurements were tested to investigate their behaviour in pulsed radiation fields. The approach is similar to that of Friedrich et al.

Purposes: The term 'radiosensitivity' appeared for the first time at the beginning of the 20th century, few years after the discovery of X-rays. Initially used by French and German radiologists, it illustrated the risk of radiation-induced (RI) skin reactions. From the 1950s, 'radiosensitivity' was progressively found to describe other features of RI response such as RI cancers or cataracts. To date, such confusion may raise legal issues and complexify the message addressed to general public. Here, through an historical review, we aimed to better understand how this confusion appeared., Methods: To support our historical review, a quantitative and qualitative wording analysis of the 'radiosensitivity' occurrences and its derived terms was performed with Google books, Pubmed, Web of Science™ databases, and in all the ICRP publications., Conclusions: While 'radiosensitivity' was historically related to RI adverse tissue events attributable to cell death, the first efforts to quantify the RI risk specific to each organ/tissue revealed some different semantic fields that are not necessarily compatible together (e.g. adverse tissue events for skin, cataracts for eyes, RI cancer for breast or thyroid). To avoid such confusion, we propose to keep the historical definition of 'radiosensitivity' to any clinical and cellular consequences of radiation attributable to cell death and to introduce the term 'radiosusceptibility' to describe the RI cancers or any feature that is attributable to cell transformation.

Purpose: The determination of attenuation compared to lead for lead-free and lead-reduced protective clothing depends strongly on the different methods of measurement. The standards EN 61331-1 (2002), DIN 6857-1 und IEC 61331-1 (2014) are now available for the testing of protective clothing. These standards define methods in the narrow beam and in the inverse broad beam geometry with partially different radiation qualities. In the narrow beam the scattered radiation and fluorescence are not considered due to the arrangement. Therefore, the protective effect of lead-free materials will be incorrectly estimated compared to lead material. The influence of the different methods of measurement on the lead equivalent and the required mass of radiation protection clothing was examined., Materials and Methods: The lead equivalents for material samples for commercially available protective clothing were determined. These samples were made of lead and lead-reduced and lead-free materials. For determination of the attenuation equivalents, certified lead foils with high purity and a precise thickness of 0.05 to 1.25 mm were used., Results: The measurements indicate that the lead equivalent depends on the method of measurement and the radiation quality. For X-ray tube voltages below 110 kV, lead-free or lead-reduced materials show a higher lead equivalent compared to lead material in some cases. Significant mass reductions of more than 10 % compared to lead material are only achievable with a limited range of use up to 100 kV., Conclusion: The implementation of an internationally accepted measuring standard for radiation protection clothing is reasonable and necessary. If standard IEC 61331-1 (2014) can fill this role is unknown. Key points • The attenuation factor and the lead equivalent depend strongly on the method of measurement.• The used X-ray spectra are only partially comparable with the spectra of scattered radiation.• Mass reductions for protective clothing are only achievable with a limited range of use. Citation Format: • Schöpf T, Pichler T. Radiation Protection Clothing in X-Ray Diagnostics - Influence of the Different Methods of Measurement on the Lead Equivalent and the Required Mass. Fortschr Röntgenstr 2016; 188: 768 - 775., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Exposure to medical ionizing radiation has been increasing over the past decades and constitutes the largest contributor to overall radiation exposure in the general population. While occupational exposures are generally monitored by national radiation protection agencies, individual data on medical radiation exposure for the general public are not regularly collected. The aim of this study was to determine the feasibility of assessing lifetime medical ionizing radiation exposure from diagnostic and therapeutic procedures retrospectively and prospectively within the framework of the German National Cohort study., Methods: Retrospective assessment of individual medical radiation exposure was done using an interviewer-based questionnaire among 199 participants (87 men and 112 women) aged 20-69 randomly drawn from the general population at two recruitment locations in Germany. X-ray cards were distributed to 97 participants at one recruitment center to prospectively collect medical radiation exposure over a 6-month period. The Wilcoxon-Mann-Whitney test was used to test differences in self-reported median examination frequencies for the variables age, sex, and recruitment center. To evaluate the self-reported information on radiological procedures, agreement was assessed using health insurance data as gold standard for the time period 2005 to 2010 from 8 participants., Results: Participants reported a median of 7 lifetime X-ray examinations (interquartile range 4-13), and 42% (n = 83) reported having had a CT scan (2, IQR = 1-3). Women reported statistically significant more X-ray examinations than men. Individual frequencies above the 75th percentile (≥15 X-ray examinations) were predominantly observed among women and in individuals >50 years of age. The prospective exposure assessment yielded a 60% return-rate of X-ray cards (n = 58). 16 (28%) of the returned cards reported radiological examinations conducted during the 6-month period but generally lacked more detailed exposure information. X-ray examinations reported for the period for which health insurance data were available provided a moderately valid measure of individual medical radiation exposure., Conclusions: The assessment of more recent medical examinations seems in the German National Cohort study feasible, whereas lifetime medical radiation exposure appears difficult to assess via self-reports. Health insurance data may be a potentially useful tool for the assessment of individual data on medical radiation exposure both retrospectively and prospectively.