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Background/Objective:The clinical conditions that lead to an alteration of the enamel structure are numerous. The diet high in sugars and acidifying substances, psychological stress that triggers parafunctional behaviors, the reduced intake of fiber-rich foods or alkalizing substances, together with other factors, contribute to demineralization of the tooth enamel. Dental mineralizing products on the current market are distinguished according to the dosage form, the active ingredient, the release technology, clinical indications and patient choice. Currently, it is necessary to propose to oral health professionals a guide to orient themselves in this chaotic choice, in order to prefer the most effective product for their own clinical target.Methods:Italian Society of Oral Hygiene Sciences-S.I.S.I.O. is one of the leading scientific Italian societies representing those dental hygienists working with high-quality standards and in agreement with scientific evidence: in the last year, the SISIO working group has carried out a study focused on remineralizing agents in dentistry, in order to give an authoritative point of view to indicate a guideline in the decision process of the choice of a remineralizing agent. We will report the results pointed out from the last consensus meeting in 2017.Results:We have reported the good the bad and the ugly have been discussed in a critical discussion of such topic.Conclusion:The SISIO experience has been reported in this position paper with the aim to serve as a useful aid in the daily choice of the clinical steps to perform, when dental professionals need to treat demineralized teeth.

Rationale and Objectives Audience response systems (ARS) have been proven to increase residents' retention in the short and long terms. The purpose of this study was to determine what teaching faculty members know about the ARS at one institution, what the obstacles are to its use, and ways to increase its use. Materials and Methods An anonymous and voluntary survey was sent to teaching faculty members. Fifty-two faculty members received the survey request and were included in the study set. The survey included questions regarding the faculty members' prior use of, understanding of, and ideas about ways to improve the ARS, as well as obstacles to its use. Results Thirty of 52 faculty members (58%) responded. Eight (27%) reported prior use of the ARS. Impediments to using the system more, for infrequent users, included “no need for it again,” that it was “a bit tedious to incorporate into lectures,” and time limitations. However, most users felt that the system was overall easy to use, and they did so by incorporating it into existing lectures. Perceptions that residents learned more effectively with the ARS motivated faculty members to use it more. They noted that residents seemed to like the ARS lectures more and were more engaged than with other didactic techniques. Faculty members would increase their use of the ARS if more information technology support were available, if training sessions were held, and if they had knowledge that residents preferred this lecture format. Conclusions Faculty members at the authors' academic institution used its ARS infrequently but expressed an overall desire to use it more. They suggested methods that would increase their use of the device and were particularly motivated by residents' satisfaction with their lectures. If their suggestions can be implemented, use of the ARS should increase.

OBJECTIVE. In an era of increasing clinical volume and longer workdays, the time devoted to education may be diminished in many medical centers. The goal of our study was to develop techniques for optimizing educational time.SUBJECTS AND METHODS. Radiology residents in our program were randomized into two groups stratified by level of training. The control group received a standard didactic midday lecture, and the experimental group received the identical lecture material with an audience response system integrated into the lecture delivery.RESULTS. The group who used the interactive audience response software had significantly higher learning (p = 0.02) and long-term retention (p = 0.001) scores on postlecture quizzes administered to both groups of residents on the day of the lecture and 3 months later.CONCLUSION. Use of appropriate interactive teaching techniques facilitates residents' learning and retention of material. In our study, long-term retention was especially improved with use of an interactiv...

Rationale and Objectives Most mammograms are obtained using screen-film technique and must be digitized for teaching purposes. Digitizing mammograms poses special problems because of high contrast and multiple views. We describe the equipment and process for digitizing and consolidating mammograms for teaching purposes. These techniques can be applied to any type of images where consolidation may be helpful. Materials and Methods Mammograms are digitized using a high optical density scanner. After the window and levels are adjusted, a four-view mammogram may be consolidated into a single image if desired. Results The high contrast of film screen mammograms is managed by using a high optical density scanner. Consolidation of image sets, such as a four-view mammogram, allows images to be easily inserted into text, slide, or poster documents. Conclusions Digitizing mammograms for teaching purposes is facilitated by use of a high optical density scanner and consolidation of image sets into single images. The techniques described are also useful for other areas of radiology in which display of multiple images or modalities is desirable.

We describe our pilot experience with percutaneous cryoablation of renal masses using real-time sonography.Three patients presented with 4 renal masses in 4 kidneys, which enhanced with contrast administration by computerized tomography or magnetic resonance imaging criteria. Renal neoplasm cryoablation was performed using general anesthesia with 17 gauge cryoneedles percutaneously placed into the renal tumor under real-time sonographic guidance. Followup cross-sectional imaging was performed 6 to 7 weeks following cryoablation in all patients.No perioperative complications were noted. All patients were discharged home within 24 hours of the procedure and postoperative pain was controlled with oral nonnarcotic medications. Followup cross-sectional imaging indicated that the lesions shrank an average 63% +/- 15% from initial pretreatment volume. Importantly none of the lesions showed contrast enhancement by computerized tomography or magnetic resonance imaging criteria.Our initial experience shows that percutaneous, sonographically guided renal neoplasm cryoablation can be a safe method for treating renal masses.

Teleradiology allows contemporaneous interpretation of imaging exams performed at some distance from the interpreting radiologist. The transmitted images are usually static. However, there is benefit to real-time review of full-motion ultrasound (US) exams as they are performed. Telesonography is transmission of full-motion sonographic data to a remote site. We hypothesize that US exams, read after having been compressed utilizing Motion Picture Experts Group version 4 (MPEG-4) compression scheme, transmitted over the Internet as streaming multimedia, decompressed, and displayed, are equivalent in diagnostic accuracy to reading the examinations locally. MPEG-4 uses variable compression on each image frame to achieve a constant output bit rate. With less compression, the bit rate rises, and the only way the encoder can contain bit rate within the set bandwidth is by lowering frame rate or reducing image quality. We review the relevant technologies and industry standard components that will enable low-cost telesonography.

Rationale and Objectives The authors' institution had decided to convert its radiology teaching files from film to digital media. This study was performed to determine the simplest method for converting the analog film images to digital images without a subsequent loss in diagnostic accuracy. Materials and Methods Twenty chest radiographs that demonstrated interstitial lung disease were randomly selected from the departmental teaching files and matched with 20 control radiographs from healthy adults. Analog film images were converted with both a diagnostic-quality film image digitizer (digitized) and a flatbed scanner equipped with a transparency adapter (scanned). Three radiology faculty members reviewed a mixed set of corresponding analog film, digitized, and scanned images. Reviewers judged whether each image depicted interstitial lung disease, indicated their level of confidence in the diagnosis, and rated each image for quality. Image quality was assessed by each reviewer subjectively at the time of viewing the individual image, without regard to other images. A one-way analysis of variance was performed to determine whether there was a statistically significant difference in diagnostic accuracy between the three image formats. Agreement in diagnosis between corresponding images in the three different formats was evaluated for each reviewer with the McNemar test. Results There was no statistically significant difference in diagnostic accuracy between analog film and scanned images, but there was such a difference between these two groups and digitized images. Accuracy was 97% for analog film, 94% for scanned, and 89% for digitized images. Results of the McNemar test showed no statistically significant difference in agreement between the analog film images and the scanned images for any of the reviewers ( P > .05). Conclusion A high-end flatbed scanner with transparency adapter provided accurate, simple, and inexpensive conversion of analog film teaching files to digital format, with no loss of the ability to detect or diagnose subtle abnormalities such as interstitial lung disease.

A method to define biodiversity hot spots as regards marine molluscs is proposed. Species richness of Italian marine molluscs is analysed by means of data collected by members of the Italian Malacological Society. Data are ordered in the database ‘Census of Italian Marine Molluscs’ available on the Internet. The Census contains about 20.000 records concerning 901 species sampled in 663 localities around all the Italian coasts. The records are divided into 59 lots; for each lot we formulate an index of species richness not related to the sampling effort. This index shows a positive correlation with the environmental diversity and with the proportion of hard substrates on the sea bottom. In the lots we assess the distribution of species worth of protection (according to literature) and of most rare species. Combining these data with the distribution of lots with higher values of species richness index, we identify hot spots available for conservation.

The purpose of this study was to report our experience in preoperative evaluation of right hepatic lobe donors with a comprehensive MR examination and to compare abdominal MR images, MR cholangiograms, and MR angiograms with findings at surgery, intraoperative cholangiography, and digital subtraction angiography.Twenty-eight right hepatic lobe donors underwent preoperative evaluation with MR imaging, MR cholangiography, and MR angiography. Two abdominal radiologists independently and randomly reviewed these studies. Points of assessment included focal and diffuse liver disease, calculation of right lobe volumes, depiction of the biliary tract and ductal anomalies, and depiction of the liver vasculature and vascular anomalies. Comparison was made with intraoperative cholangiograms (n = 20) and digital subtraction angiograms (n = 28).MR imaging revealed and characterized focal liver lesions in eight of 28 patients. Calculated right lobe volumes agreed with surgically determined volumes within 7% for reviewer 1 and within 15% for reviewer 2. Intrahepatic bile ducts were depicted completely with MR cholangiography in 25 of 28 patients and with intraoperative cholangiography in nine of 20 patients. MR cholangiography revealed ductal anomalies in six patients. MR imaging and MR angiography depicted the portal veins more completely than digital subtraction angiography. MR imaging and MR angiography correctly excluded portal venous anomalies in all patients and revealed surgically confirmed accessory hepatic veins in six of 28 patients. Angiographically confirmed arterial anomalies were correctly detected in three of 28 patients by at least one reviewer on MR imaging and MR angiography.MR imaging, MR cholangiography, and MR angiography provide a comprehensive, accurate means of evaluating donors for factors that may preclude or complicate right hepatic lobe donation.

Living donor liver transplantation is emerging as an alternative to cadaveric liver transplantation. The authors present multimodality images obtained in 44 cases of living donor liver transplantation. The images in this article were derived from the pre-, intra-, and postoperative imaging protocol for their institutional transplantation program. Preoperative magnetic resonance (MR) imaging in the donor allows detection of focal liver lesions and accurate determination of liver volume. The latter is crucial to ensure adequate postoperative liver function for donors and recipients. MR cholangiography depicts donor biliary anatomy. MR angiography and digital subtraction arteriography are performed to assess vascular anatomy. Intraoperative ultrasonography (US) helps determine the resection plane during donor hepatectomy. Postoperative MR imaging documents liver regrowth. MR imaging, US, and computed tomography help assess complications in donors and recipients.

Background and purpose Rectal toxicity presents a significant limiting factor in prostate radiotherapy regimens. This study evaluated the safety and efficacy of an implantable and biodegradable balloon specifically designed to protect rectal tissue during radiotherapy by increasing the prostate–rectum interspace. Patients and methods Balloons were transperineally implanted, under transrectal ultrasound guidance, into the prostate–rectum interspace in 27 patients with localized prostate cancer scheduled to undergo radiotherapy. Patients underwent two simulations for radiotherapy planning--the first simulation before implant, and the second simulation seven days post implant. The balloon position, the dimensions of the prostate, and the distance between the prostate and rectum were evaluated by CT/US examinations 1 week after the implant, weekly during the radiotherapy period, and at 3 and 6 months post implant. Dose-volume histograms of pre and post implantation were compared. Adverse events were recorded throughout the study period. Results Four of 27 patients were excluded from the evaluation. One was excluded due to a technical failure during implant, and three patients were excluded because the balloon prematurely deflated. The balloon status was evaluated for the duration of the radiotherapy period in 23 patients. With the balloon implant, the distance between the prostate and rectum increased 10-fold, from a mean 0.22 ± 0.2 cm to 2.47 ± 0.47 cm. During the radiotherapy period the balloon length changed from 4.25 ± 0.49 cm to 3.81 ± 0.84 cm and the balloon height from 1.86 ± 0.24 cm to 1.67 ± 0.22 cm. But the prostate-rectum interspace distance remained constant from beginning to end of radiotherapy: 2.47 ± 0.47 cm and 2.41 ± 0.43 cm, respectively. A significant mean reduction in calculated rectal radiation exposure was achieved. The implant procedure was well tolerated. The adverse events included mild pain at the perineal skin and in the anus. Three patients experienced acute urinary retention which resolved in a few hours following conservative treatment. No infections or thromboembolic events occurred during the implant procedure or during the radiotherapy period. Conclusion The transperineal implantation of the biodegradable balloon in patients scheduled to receive radiotherapy was safe and achieved a significant and constant gap between the prostate and rectum. This separation resulted in an important reduction in the rectal radiation dose. A prospective study to evaluate the acute and late rectal toxicity is needed.

Purpose: To evaluate dose reduction caused by the implantation of an interstitial inflatable and biodegradable balloon device aiming to achieve lower rectal doses with virtual 3D conformal external beam radiation treatment. Materials and methods: An inflatable balloon device was placed, interstitially and under transrectal ultrasound guidance, into the rectal–prostate interspace prior treatment initiation of 26 patients with localized prostate cancer, who elected to be treated with radiotherapy (3D CRT or IMRT). The pre- and post-implant CT imaging data of twenty two patients were collected (44 images) for the purpose of the 3D conformal virtual planning presented herein. Results: The dorsal prostate–ventral rectal wall separation resulted in an average reduction of the rectal V70% by 55.3% (±16.8%), V80% by 64.0% (±17.7%), V90% by 72.0% (±17.1%), and V100% by 82.3% (±24.1%). In parallel, rectal D2 ml and D0.1 ml were reduced by 15.8% (±11.4%) and 3.9% (±6.4%), respectively. Conclusions: Insertion of the biodegradable balloon into the prostate–rectum interspace is similar to other published invasive procedures. In this virtual dose distribution analysis, the balloon insertion resulted in a remarkable reduction of rectal volume exposed to high radiation doses. This effect has the potential to keep the rectal dose lower especially when higher than usual prostate dose escalation protocols or hypo-fractionated regimes are used. Further prospective clinical investigations on larger cohorts and more conformal radiation techniques will be necessary to define the clinical advantage of the biodegradable interstitial tissue separation device.

In this paper are presented the measurements of radon concentration taken in the period 1991 – May 1994 in the Gran Sasso Underground Laboratory, Assergi (L'Aquila), Italy. The radon level was reduced to acceptable values from the point of view of radiation protection and low background radiation to the experiments. The radon concentration depends strongly on the ventilation of the laboratory.

We created our imaging center (IC) to move outpatient imaging from our busy inpatient imaging suite off-site to a location that is more inviting to ambulatory patients. Nevertheless, patients scanned at our IC still represent the depth and breadth of illness complexity seen with our tertiary care population. Thus, we protocol exams on an individualized basis to ensure that the referring clinician’s question is fully answered by the exam performed. Previously, paper based protocoling was a laborious process for all those involved where the IC business office would fax the requests to various reading rooms for protocoling by the subspecialist radiologists who are 3 miles away at the main hospital. Once protocoled, reading room coordinators would fax back the protocoled request to the IC technical area in preparation for the next day’s scheduled exams. At any breakdown in this process (e.g., lost paperwork), patient exams were delayed and clinicians and patients became upset. To improve this process, we developed a paper free process whereby protocoling is accomplished through scanning of exam requests into our PACS. Using the common worklist functionality found in most PACS, we created “protocoling worklists” that contain these scanned documents. Radiologists protocol these studies in the PACS worklist (with the added benefit of having all imaging and report data available), and subsequently, the technologists can see and act on the protocols they find in PACS. This process has significantly decreased interruptions in our busy reading rooms and decreased rework of IC staff.

Providing an adequate method of distance learning is a challenge faced by many multicenter residency programs. The delivery of live didactics over the Internet is a convenient means of providing a uniform and equivalent educational experience to residents at distant sites. An application called MedCast has been developed with use of existing technologies, without the need for costly commercial products or equipment. MedCast captures the presenter's computer screen and audio from a microphone source to produce a streaming video that is transmitted online and archived on a local server. Offsite residents can view broadcasts in real time or access archived conference sessions for later viewing. MedCast is available for download at no cost and offers several advantages, including a user-friendly graphical display interface, near-perfect preservation of image quality, and cost efficiency. Future plans include objective assessment of the efficacy of MedCast by comparing postlecture examinations to help evaluate for any differences between on- and offsite residents in terms of knowledge gained. A movie clip to supplement this article is available online at http://radiographics.rsnajnls.org/cgi/content/full/285085701/DC1.

This article familiarizes the urologist with the most common pulse sequences used in MRI to evaluate the kidneys and adrenal glands. It serves as a basis on which interpretation of genitourinary MRI can be facilitated, and includes specifics on how to perform these studies. MRI analysis of renal masses, cysts, and cystic masses is reviewed thoroughly and the critical factor in determining enhancement in renal lesions is detailed. Adrenal imaging for metastatic disease is reviewed. MR urography is also discussed briefly.

Background and study aims Pancreatic pseudocysts are a complication in up to 20% of patients with pancreatitis. Endoscopic management of pseudocysts by a conventional transenteric technique, i. e. conventional transmural drainage (CTD), or by endoscopic ultrasound-guided drainage (EUD), is well described. Our aim was to prospectively compare the short-term and long-term results of CTD and EUD in the management of pseudocysts. Patients and methods A total of 99 consecutive patients underwent endoscopic management of pancreatic pseudocysts according to this predetermined treatment algorithm: patients with bulging lesions without obvious portal hypertension underwent CTD; all remaining patients underwent EUD. Patients were followed prospectively, with cross-sectional imaging during clinic visits. We compared short-term and long-term results (effectiveness and complications) at 1 and 6 months post procedure. Results 46 patients (37 men) underwent EUD and 53 patients (39 men) had CTD. The mean age of the entire group was 50 +/- 13 years. There were no significant differences between the two groups regarding short-term success (93% vs. 94%) or long-term success (84% vs. 91%); 68 of the 99 patients completed 6 months of follow-up. Complications occurred in 19% of EUD vs. 18% of CTD patients, and consisted of bleeding in three, infection of the collection in eight, stent migration into the pseudocyst in three, and pneumoperitoneum in five. All complications but one could be managed conservatively. Conclusions No clear differences in efficacy or safety were observed between conventional and EUS-guided cystenterostomy. The choice of technique is likely best predicated by individual patient presentation and local expertise.

Rationale and Objectives Most mammography teaching materials provide only diagnostic images, often with obvious findings due to space constraints. In this work, we describe a method of incorporating full resolution digitized screening mammograms in text teaching file documents to enhance teaching of screening mammography. Methods Teaching cases are constructed in a word processing document with images inserted. The four view screening mammogram is presented first and may be opened in an image viewing program using an embedded hyperlink to view at high resolution, similar to using a magnifying glass. The screening study is followed by feedback and presentation of diagnostic images. Feedback is again provided, followed by diagnosis, differential diagnosis, discussion, and references. A six-question survey of residents and fellows using 5-point Likert scales was used to assess performance. Results Teaching cases in this format mimic clinical practice by separately presenting screening and diagnostic views. Mammograms may be viewed at high resolution, allowing incorporation of subtle findings to build detection skills. Inclusion of diagnostic views builds judgment and management skills. Survey results from 15 residents and 2 fellows found a mean overall rating of the teaching file of 1.6 (1 = excellent, 5 = poor). Conclusions Screening mammograms with subtle findings can be incorporated into breast teaching cases by embedding hyperlinks to open images at high resolution in an image-processing program.

1Padova University Hospital, Urology Padova, Italy; 2Barzilai Medical Center, Urology, Ashkelon, Israel; 3VA Urology, Urology, Richmond, VA, USA; 4Montefiore Medical Center, Urology, New York City, NY, USA 5University Hospital Schleswig-Holstein, Urology, Lubeck, Germany; 6TASMC, Radiotherapy, Tel Aviv, Israel; 7VA Urology, Radiotherapy, Richmond, VA, USA; 8Montefiore Medical Center, Radiotherapy, New York City, NY, USA; 9University Hospital Schleswig-Holstein, Radiotherapy, Lubeck, Germany; 10Virginia Commonwealth University, Radiotherapy, Richmond, VA, USA; 11Padova University Hospital, Radiotherapy, Padova, Italy. 795

Low specific-activity scales consisting of alkaline earth metal carbonates and sulfates are often present in some gaseous and liquid hydrocarbon plants. These scales contain a certain concentration of radium, uranium, and thorium which can cause a risk of gamma irradiation and internal radiocontamination when they must be mechanically removed. The gamma dose rates and the 238U, 232Th, 226Ra concentrations were determined in sludges, scales, and waters of some gas and oil hydrocarbon plants located in Italy, Congo, and Tunisia. 238U and 232Th concentrations were were low. The isotopes 238U and 234U resulted in radioactive equilibrium, while 232Th and 228Th were not always equilibrium. A rough correlation was found between the gamma dose rate and the 226Ra concentration. Some considerations and conclusions about radiation protection problems are pointed out.

e15116 Background: Despite heightened awareness of risks from ionizing radiation, the use of image-guided therapy is rising. Our goal was to calculate the radiation effective dose (ED) received dur...

Previous studies have shown that cefoperazone given in frequent, large doses is effective in the treatment of infection in patients with cancer. The pharmacodynamics of 2- and 4-g doses of cefoperazone administered either as a single dose or at 12-hour intervals were studied in an in vitro model that simulates infection in a neutropenic patient. One strain each of Pseudomonas aeruginosa (minimal inhibitory concentration [MIC] = 2 micrograms/ml), Staphylococcus aureus (MIC = 1 microgram/ml), Escherichia coli (MIC = 0.06 micrograms/ml), and Klebsiella pneumoniae (MIC = 0.25 micrograms/ml) was studied. The initial dose reduced the inoculum by approximately 3 logs for the Pseudomonas and the staphylococci and 3 to 5 logs for the other organisms. No significant differences in killing were found between the 2- and 4-g doses. Regrowth of Pseudomonas and staphylococci occurred with the single dose but not with the every-12-hour regimen. These data support the clinical use of cefoperazone in doses every 12 hours.