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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).)

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.)

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.)

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.)

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.

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.)