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The aim of the present study was to retrospectively analyze clinical outcomes of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) treated with yttrium-90 radioembolization stratified by Milan PVTT score according to PVTT extension, tumor burden, and bilirubin levels. Seventy patients were included and classified into good (n = 15; 21.4%), intermediate (n = 33; 47.1%), and dismal (n = 22; 31.4%) prognostic groups. Median overall survival durations were 24.6 mo, 13 mo (hazard ratio = 3.2; 95% confidence interval [CI], 1.2–9.7; P = .016), and 5.9 mo (hazard ratio = 4.1; 95% CI, 1.4–13.4; P = .0096), respectively. The Milan score represents an easy tool to select patients with HCC with PVTT who may benefit from radioembolization.

This study describes patient social networks within a new hemodialysis clinic and models the association between social network participation and kidney transplantation. Survey and observational data collected between August 2012 and February 2015 were used to observe the formation of a social network of 46 hemodialysis patients in a newly opened clinic. Thirty-two (70%) patients formed a social network, discussing health (59%) and transplantation (44%) with other patients. While transplant-eligible women participated in the network less often than men (56% vs. 90%, p = 0.02), women who participated discussed their health more often than men (90% vs. 45.5%, p = 0.02). Patients in the social network completed a median of two steps toward transplantation compared with a median of 0 for socially isolated patients (p = 0.003). Patients also completed more steps if network members were closely connected (β = 2.23, 95% confidence interval [CI] 0.16-4.29, p = 0.03) and if network members themselves completed more steps (β = 2.84, 95% CI 0.11-5.57, p = 0.04). The hemodialysis clinic patient social network had a net positive effect on completion of transplant steps, and patients who interacted with each other completed a similar number of steps.

Although federal mandate prohibits the allocation of solid organs for transplantation based on “accidents of geography,” geographic variation of transplantable organs is well documented. This study explores regional differences in communication in requests for organ donation. Administrative data from 9 partnering Organ Procurement Organizations and interview data from 1,339 family decision makers (FDMs) were compared across 8 geographically distinct US donor service areas (DSA). Authorization to organ donation ranged from 60.4% to 98.1% across DSAs. FDMs from the three regions with the lowest authorization rates reported the lowest levels of satisfaction with the time spent discussing donation and with the request process; discussion of the least donation-related topics; the highest levels of pressure to donate; and, the least comfort with the donation decision. OPO region predicted authorization (Odds Ratios ranged from 8.14 to 0.24), as did time spent discussing donation (OR = 2.11), the number of donation-related topics discussed (OR = 1.14), and requesters’ communication skill (OR = 1.14). Standardized training for organ donation request staff is needed to ensure the highest quality communication during requests, optimize rates of family authorization to donation in all regions, and increase the supply of organs available for transplantation. This article is protected by copyright. All rights reserved.

Available literature points to healthcare providers’ discomfort with donation after cardiac death (DCD) and their perception of the public's reluctance toward the procedure. Using a national sample, we report on the communication content of actual DCD and donation after brain death (DBD) approaches by organ procurement organization (OPO) requesters and compare family decision makers’ (FDMs’) experiences of both modalities. We recruited 1,601 FDMs using a validated protocol; 347 (21.7%) were of potential DCD donors. Semi-structured telephone interviews yielded FDMs’ sociodemographic data, predisposition toward donation, assessment of approach, final outcomes, and substantiating reasons. Initial analysis consisted of bivariate analyses. Multilevel mixture models compared groups representing authorization outcome and DCD/DBD status. No significant differences in family authorization were found between DCD and DBD cases. Statistically significant associations were found between sociodemographic characteristics and authorization, with White FDMs more likely to authorize DCD or DBD than Black FDMs. FDMs of both modalities had similar evaluations of requester skills, topics discussed, satisfaction, and reasons for refusal. The findings suggest that the DCD/DBD distinction may not be notable to families. We recommend the use of similar communication skills and strategies during approaches and the development of education campaigns about the public's acceptance of DCD. This article is protected by copyright. All rights reserved.

There are many ethical considerations regarding the return of genetic results to biobanking participants, especially when biobanks collect samples from deceased organ and tissue donors that require the authorization of a family decision maker (FDM). This article explores FDM knowledge and opinions regarding return of genetic results in the context of the Genotype-Tissue Expression (GTEx) Project, which does not return results to participants. Data collection included a survey completed by Organ Procurement Organization requesters (n = 22) and semistructured telephone interviews with FDM (n = 55). Nearly every FDM wanted some form of genetic results returned. Information regarding treatable diseases (94.3%) and diseases that could affect their children (84.9%) were more desirable than that regarding untreatable diseases (71.7%). Sixty percent of FDMs understood that GTEx would not return genetic results. FDMs were four times more likely to have correct knowledge of the GTEx policy when their GTEx requester reported discussing the topic with them. FDMs from the GTEx project were interested in receiving genetic test results. Marked changes in the infrastructure of the GTEx would be required to alter the policy. Regardless, care must be taken to ensure that the return policy is clearly communicated with FDMs to dispel misconceptions. Genet Med 18 1, 82–88.

In this paper we report on a successful management of multiple bone metastases from differentiated thyroid cancer. In 2007, a 75-year-old female patient, previously referred for thyroidectomy for multinodular goiter, underwent surgical removal of a lumbar mass with histological findings of metastasis from well differentiated thyroid cancer. After surgery, serum thyroglobulin (sTg) was 204.4 ng/mL. A diagnostic/dosimetric 123I WBS was performed, following stimulation by rTSH. Serial WBSs were acquired, along with SPECT/CT and bone scan for localization of lesions. sTg raised to 3.810 ng/mL, and 123I WBS showed thyroid remnants and numerous areas with high iodine-uptake corresponding to skeletal sites, the two largest loading on the skull, with osteolytic pattern. Calculated radiation absorbed dose for skull lesions, determined by mean of MIRD methodology, was 63.5 mGy/MBq. The patient underwent surgical removal of the two major skull lesions. Successively, 100 mCi 131I was administered after stimulation by rTSH, with stimulated sTg 297 ng/mL. After 8 months, diagnostic WBS was negative both for remnants and metastases and rTSH-stimulated Tg was 0.6 ng/mL. To date, the patient has maintained sTg values

A commercial silicon PIN-photodiode was tested and characterized as ionizing radiation detector for radiological applications. A current-to-voltage amplification stage was designed and realized in order to acquire the photodiode signal in current mode. The system was tested with clinical beams routinely used for radiography and mammography. A Monte Carlo simulation of the detector was performed with the MCNPX code in order to model and fully understand, in particular, the impact of the sensor casing on the low energy response of the device. A reproducible output linearity was found over the dose range 0.03–4.5 mGy of great clinical relevance. The system sensitivity was found to be stable at 0.2 V s Gy−1 for effective X-ray energies between 17 and 40 keV. The batch-to-batch reproducibility of the diodes was also experimentally investigated for two different batches of 14 diodes each. An inter-comparison with dosimeters routinely used in medical physics (i.e. Barracuda MPD RTI) showed a linear correlation between PIN-photodiode readout and absorbed dose measured with Barracuda, in the range of doses received by mammography and radiology patients.

Objective Many patients with chronic and end-stage renal disease (ESRD) have reported difficulties initiating and managing discussions about kidney transplantation, particularly live donor transplantation (LDT). Limited communication has demonstrable impact on patients’ access to transplantation, the duration of dialysis treatments, and the length of time awaiting a transplantable kidney. This formative study sought to identify the specific communicative and conversational elements impeding ESRD patients’ discussions about transplantation to inform the design of an educational program facilitating transplant-related discussions. Methods From March to July 2012, semi-structured telephone interviews (n = 63) were conducted with ESRD patients waitlisted for kidney transplantation at one mid-Atlantic transplant center. Results Although 85.7% (n = 54) of patients reported holding discussions about transplantation, qualitative analyses of open-ended responses revealed that the majority (66.7%) had limited conversations. Patients reported difficulties managing a variety of logistical and content-related aspects of LDT discussions. Moderate levels of communication self-efficacy were also found (mean = 19.2 out of 28); self-efficacy was highest among respondents having held discussions and was significantly related to perceived magnitude of difficulty handling conversational aspects. Conclusion Results support comprehensive communication skills training for ESRD patients awaiting kidney transplantation. Practice implications Potential topics to be included in such training are discussed.

Purpose Medical exposures are the main source of artificial exposure to ionizing radiation for developed countries. In recent years there has been a significant improvement in imaging techniques but also a substantial increase of patient exposures. The harmful effects of radiations used for diagnostic purposes are essentially stochastic. Exposure to ionizing radiation is known to increase the future incidence of cancer (solid tumors and leukemias). The latest EU radiation protection recommendations of the Directive 2013/59/EURATOM layied down basic safety standards for exposure to ionizing radiation. The region of Tuscany (through resolution No 994/2014) has planned a project aimed to assess the annual per-capita and collective effective doses due to medical exposures. Methods The total number of examinations was evaluated by data recorded on the Radiological Information System (RIS) of each regional hospital and by the regional database for Outpatient services (SPA) and Hospitalized Patients (SDO). Relevant exposure parameters for effective dose estimation were collected by a questionnaire that allowed a sampling of dosimetry aspects of radiological and nuclear medicine practices throughout the region. These data were used to evaluate the effective dose associated with each examination by simulations with dedicated software. A different approach has been used for interventional radiology. Due to the intrinsic variability characterizing this kind of procedures, the exposure and dosimetric parameters of each exam were extracted from databases implemented by commercially available dose monitoring software packages and then processed with specific simulation software for effective dose estimate. Results We derived per-capita and collective effective dose for the Tuscany Region population due to radiology (computed tomography, conventional radiology, interventional radiology and mammography) and nuclear medicine procedures. Conclusions We compared the current data with those of previous surveys to outline any statistically significant trend.

Radiological personnel represent workers exposed to low cumulative doses of radiation. As their surveillance is generally based on physical dosimetry, there is little or inconclusive information on biological effects due to radiation exposure at these doses. We aimed to explore the extent of chromosomal damage in circulating lymphocytes of hospital workers (technicians, nurses and physicians) chronically exposed to a very low level of radiation using conventional and molecular cytogenetic analyses (chromosome painting with chromosomes #2, #3 and #10 as probe cocktail). Compared with controls, exposed workers displayed a significant increase in the frequency of aberrant lymphocytes (1.26 ± 0.11/100 cells versus 1.63 ± 0.17/100 cells). In particular, exposed technicians showed significantly higher mean values than nurses or physicians (3.68 ± 1.17/100 cells versus 1.36 ± 0.18/100 cells and 1.36 ± 0.09/100 cells, respectively). Interestingly, we found that the chromosomal damage was prevalently expressed as chromatid-type aberrations. Chromosome painting indicated that the frequency of chromosome rearrangements (CR; translocations and dicentrics pooled together) was approximately comparable between radiological workers and the control group. Moreover, we did not detect any significant difference due to radiation exposure when CR rates were considered separately for each of the three chromosomes in the probe cocktail.

The capability of the mammography-scintimammography combination to distinguish between benign and malignant isolated clusters of breast microcalcifications is discussed. Scintimammography using Tc 99m-Sestamibi was performed in 97 women with an isolated cluster of microcalcifications on mammograms. Seventy-two women had final histopathologic diagnoses (24 cancer and 48 benign pathology). The other 25 patients had follow-up to 3 years. The results of mammography, scintimammography and mammography-scintimammography combination were divided into five groups, based on the suspicion of malignancy. The sensitivity, specificity, false negative fraction, false positive fraction, predictive positive value, predictive negative value and diagnostic accuracy were calculated varying the diagnostic threshold. The Receiver Operating Characteristic (ROC) statistical technique was employed to compare the diagnostic value of mammography to mammography-scintimammography combination. The area under the ROC curves was calculated by the Wilcoxon statistic without any hypothesis on data distribution. The detected difference between areas under the mammography ROC curve (area=0.854, standard error=0.049) and mammography-scintimammography ROC curve (area=0.897, standard error 0.033) was statistically significant (P>0.05, one tail). The area under a ROC curve represents the probability that a randomly chosen diseased or non-diseased subject could be correctly classified. From this point of view this paper demonstrates that, if properly used, scintimammography can add to mammography in the characterization of an isolated cluster of microcalcifications, even if it is not able to replace FNAB and core biopsy.

The use of digital image resampling can be highly suitable for diagnostic radiology. It can be applied not only to obtain zoom effects but also to solve various problems related to the comparison of images of different origin (NMR, CT, NM). The mathematical approach to this kind of algorithm, based on rational assumptions, can be very wide and diversified. In this work the principles of the stochastic and of the analytical methods have been analyzed. In particular, a complete mathematical treatment of the integral analytical methods, which are both the most theoretically interesting and analytically complex, has been performed. The practice of these techniques has to be determined each time from the analysis of the specific problem to which they are to be applied in the routine, and after a retrospective analysis of the results obtained.