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The objective of our work was to assess the accuracy in terms of spatial and contrast resolution, respiratory movement artifacts and synchronization of the “triple arterial phase” (TAP) sequence and compare it with the conventionally acquired arterial phase (AP). Between June 2021 and September 2021 16 patients underwent liver MRI for characterization and/or follow-up of focal hepatic lesions, and the TAP sequence was used. With the aim to obtain a TAP sequence we applied the KEYHOLE technique (modified to 35%) and the CENTRA-Keyhole method (Contrast Enhanced Timing Robust Angiography) for the K-space sampling, to the basic e-THRIVE sequence. 6/16 patients had previous MRI examinations performed with the classic single AP. Five radiologists experienced in the interpretation of liver imaging independently examined MRI studies. They were asked to provide their opinion, by using a qualitative evaluation scale, on spatial resolution, contrast/noise ratio (CNR), presence of breath-hold artifacts, synchronization of the TAP and its quality and usefulness for the characterization of liver lesions. The same questions were used for the evaluation of the 6/16 previous MRI examinations acquired with the conventional AP. For all readers, with TAP, the synchronization of the arterial study, the spatial resolution, the evaluation of artifacts from incorrect breath-hold were deemed good or excellent. The contrast resolution in the TAP was excellent for almost all cases. TAP was overall judged superior to AP. These preliminary results obtained are promising and require confirmation on a larger sample study to assess the diagnostic benefit of the TAP.

Communicating radiological findings to hepatobiliary surgeons is not an easy task due to the complexity of liver imaging, coexistence of multiple hepatic lesions and different surgical treatment options. Recently, the adoption and implementation of structured report in everyday clinical practice has been supported to achieve higher quality, more reproducibility in communication and closer adherence to current guidelines. In this review article, we will illustrate the main benefits, strengths and limitations of structured reporting, with particular attention on the advantages and challenges of structured template in the preoperative evaluation of cirrhotic and non-cirrhotic patients with focal liver lesions. Structured reporting may improve the preoperative evaluation, focusing on answering specific clinical questions that are requested by hepatobiliary surgeons in candidates to liver resection.

Purpose: To compare imaging features of pancreatic metastases (PM) with those of pancreatic ductal adenocarcinomas (PDAC). Methods: CT and MR scans of 24 patients with 54 PM and 30 patients with PDAC were reviewed to evaluate the imaging features, which were compared by using a Chi square test. Results: We found a statistically significant difference between PM and PDAC based on location (P < 0.001), margins (P < 0.001), arterial enhancement (P = 0.004), rim enhancement (P < 0.001), pancreatic duct dilatation (P = 0.01), common bile duct dilatation (P = 0.003), vascular involvement (P = 0.02), parenchymal atrophy (P < 0.001), peripancreatic fluid (P = 0.03). Conclusion: Imaging features might be helpful to differentiate PM from PDAC.

Dilated Cardiomyopathy is a high-incident disease, which diagnosis of and treatments are clinical priority. The aim of our study was to evaluate the diagnostic potential of cardiac magnetic resonance (CMR) imaging; echocardiography and the biochemical parameters that can help us differentiate between the post-ischemic and non-ischemic dilated cardiomyopathy. Materials and methods. The study enrolled 134 patients with dilated cardiomyopathy: 74 with the post-ischemic form and 60 with the non-ischemic one. All patients underwent a coronary imaging test, with echocardiogram, cardiac magnetic resonance and a blood test. Pro-inflammatory cytokines were evaluated using Luminex kit. Data was compared between the two groups. Results. Echocardiography allowed recognition of Left Ventricular Non Compaction in 2 patients. Longitudinal and circumferential strains were significantly different in the two groups (p

The aim of our study was to evaluate the atherosclerotic pattern of patients with coronary myocardial bridging (MB) by means of CT Coronary Angiography (CT-CA). 254 consecutive patients (166 male, mean age 58.6 +/- A 10.3) who underwent 64-slice CT-CA according to current clinical indications were reviewed for the presence of MB and concomitant segmental atherosclerotic pattern. Coronary plaques were assessed in all patients enrolled. 73 patients (29%) presented single (90%) or multiple (10%) MB, frequently (93%) localized in the mid-distal left anterior descending artery. The MB segment was always free of atherosclerosis. Segments proximal to the MB presented: no atherosclerotic disease (n = 37), positive remodeling (n = 23), < 50% (n = 14), or > 50% stenoses (n = 7). Distal segments presented a different atherosclerosis pattern (P < 0.0001): absence of disease (n = 73), no significant lesions (n = 8). No significant differences were found between segments proximal to MB and proximal coronary segments apart from left main trunk. Pattern of atherosclerotic lesions located in segments 6 and 7 significantly differs between patients with MB and patients without MB (P < 0.05). CT-CA is a reliable method to non-invasively demonstrate MB and related atherosclerotic pattern. CT-CA provides new insight regarding atherosclerosis distribution in segments close to MB.

Gastrointestinal lymphomas represent 5–20% of extranodal lymphomas and mainly occur in the stomach and small intestine. Clinical findings are not specific, thus often determining a delay in the diagnosis. Imaging features at conventional and cross-sectional imaging must be known by the radiologist since he/she plays a pivotal role in the diagnosis and disease assessment, thus assisting in the choice of the optimal treatment to patients. This review focuses on the wide variety of imaging presentation of esophageal, gastric, and small and large bowel lymphoma presenting their main imaging appearances at conventional and cross-sectional imaging, mainly focusing on computed tomography and magnetic resonance, helping in the choice of the best imaging technique for the disease characterization and assessment and the recognition of potential complications.

Since the first studies suggesting its possible role in the management of Crohn’s disease patients, multidetector computed tomography has usually been considered a useful diagnostic technique in Crohn’s disease for the detection of extraenteric complications, as intra-abdominal abscesses, the study of strictures, prestenotic dilatations, fistulas, and postsurgical complications. Moreover, it is a widely available technique and is considered the gold standard in emergency.

The aim of the study was to assess the prognostic value of multidetector-row CT coronary angiography (MDCT-CA) in patients with suspected coronary artery disease (CAD) in a routine clinical context.A total of 125 patients (82 men, age 57.4±10.3 years) with suspected CAD underwent MDCT-CA. All patients were assessed for cardiovascular risk factors, symptoms and coronary calcium score. A 2-year follow-up study for the occurrence of major adverse cardiac events was performed.According to the Morise pretest score, 76 patients (60.8%) were at intermediate risk. Patients with suspected CAD presented the following prognostic outcome (p0.0001): in 41 patients with normal coronary arteries at MDCT-CA, the event rate was 0%; five of 49 patients with nonobstructive CAD had major cardiac events; two of 35 patients with obstructive CAD suffered cardiac death and 19 underwent revascularisation. At multivariate analysis, the presence of obstructive CAD is the only significant independent prognostic variable (hazard ratio, 10.1393; 95% confidence interval 3.2189-31.9379; p0.0001).Routine clinical MDCT-CA provides an excellent prognostic value at 2-year follow-up in patients with normal coronary arteries. The cardiac event rate increases with CAD severity.

Purpose. This study was performed to evaluate the usefulness of digital cineradiography in detecting swallowing disorders in dysphagic patients affected by amyotrophic lateral sclerosis (ALS) with a view to planning an adequate therapeutic approach. Material and methods. From January 2005 to September 2006, 23 patients (10 men and 13 women; mean age 41.3±8.6 years) affected by ALS were evaluated with digital cineradiography to assess the grade of dysphagia. All patients were classified using the Hillel ALS Severity Scale (ALSSS). All examinations were performed with radiocontrolled equipment provided with a digital C-arm. Results. The cineradiographic technique enabled us to differentiate patients with disorders of the oral (17/23) and/or pharyngeal (19/23) swallowing phase from those without swallowing dysfunction (4/23). In 14/23 patients, passage of contrast medium into the upper airways was observed during swallowing, whereas in 5/23 cases, aspiration of contrast medium into the lower airways was recorded. Conclusions. The videofluoroscopic swallowing study has high diagnostic capabilities in the evaluation of swallowing disorders, as it is able to identify the degree and causes of impairment. In addition, the study proved useful for planning speech therapy and for follow-up in patients with ALS.

In recent years, the widespread diffusion of pervasive sensing devices and the increasing need for reducing energy consumption have encouraged research in the energy-aware management of smart environments. Following this direction, this paper proposes a hybrid intelligent system which exploits a fog-based architecture to achieve energy efficiency in smart buildings. Our proposal combines reactive intelligence, for quick adaptation to the ever-changing environment, and deliberative intelligence, for performing complex learning and optimization. Such hybrid nature allows our system to be adaptive, by reacting in real time to relevant events occurring in the environment and, at the same time, to constantly improve its performance by learning users' needs. The effectiveness of our approach is validated in the application scenario of a smart home by extensive experiments on real sensor traces. Experimental results show that our system achieves substantial energy savings in the management of a smart environment, whilst satisfying users' needs and preferences.

The applications of forensic radiology involve both Virtopsy both studies on living people - to demonstrate bone age, search for foreign bodies, such as voluntary injection of drug ovules or surgical sponges accidentally forgotten, to assess gunshot wounds, to evaluate injuries by road accidents, and cases of violence or abuse (both in adults and in children). Computed tomography is the most used imaging tool used in forensic pathology and its indications are mainly focused on cases of unnatural deaths or when a crime is suspected. It is preferred over the standard autopsy in selected cases, such as in putrefied, carbonized or badly damaged bodies; or as a preliminary evaluation in mass disasters.

This book offers a comprehensive overview of the forensic and radiological aspects of pathological findings, focusing on the most relevant medico-legal issues, such as virtual autopsy (virtopsy), anthropometric identification, post-mortem decomposition features and the latest radiological applications used in forensic investigations. Forensic medicine and radiology are becoming increasingly relevant in the international medical and legal field as they offer essential techniques for determining cause of death and for anthropometric identification. This is highly topical in light of public safety and economic concerns arising as a result of mass migration and international tensions. The book discusses the latest technologies applied in the forensic field, in particular computed tomography and magnetic resonance, which are continuously being updated. Radiological techniques are fundamental in rapidly providing a full description of the damage inflicted to add to witness and medical testimonies, and forensic/radiological anthropology supplies valuable evidence in cases of violence and abuse. Written by international experts, it is of interest to students and residents in forensic medicine and radiology. It also presents a new approach to forensic investigation for lawyers and police special corps as well as law enforcement agencies.

Objective: The aim of this study was to acknowledge errors in patients positioning in CT colonography (CTC) and their effect in radiation exposure. Materials and methods: CTC studies of a total of 199 patients coming from two different referral hospitals were retrospectively reviewed. Two parameters have been considered for the analysis: patient position in relation to gantry isocentre and scan length related to the area of interest. CTDI vol and DLP were extracted for each patient. In order to evaluate the estimated effective total dose and the dose to various organs, we used the CT-EXPO ® software version 2.2. This software provides estimates of effective dose and doses to the other various organs. Results: Average value of the patients’ position is found to be below the isocentre for 48 ± 25mm and 29 ± 27mm in the prone and supine position. It was observed that the increase in CTDI and DLP values for patients in Group 1, due to the inaccurate positioning, was estimated at about 30% and 20% for prone and supine position, respectively, while in Group 2, a decrease in CTDI and DLP values was estimated at about 16% and 18% for prone and supine position, respectively, due to an average position above isocentre. A dose increase ranging from 4 up to 13% was calculated with increasing the over-scanned region below anal orifice. Conclusion: Radiographers and radiologists need to be aware of dose variation and noise effects on vertical positioning and over-scanning. More accurate training need to be achieved even so when examination protocol varies from general practice.

The upper cervical spine has unique anatomical features that distinguish it from the remainder of the cervical spine. Its motion segments make up a large amount of total cervical spine motion and, as a result,predispose it to a unique set of injuries. Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to section of the spinal cord. The use of post mortem CT (PMCT), and the subsequent multi-planar and volume rendering reconstruction techniques can provide non-invasive, objective operator-independent imaging data set that may be further reviewed by other specialists. and can substantially add to forensic examinations of the skeleton, especially in areas of the body such as the cervical spine

Age assessment by skeletal age estimation of unknown individuals is of paramount importance in forensic science, both for assessing imputability (if the author of a crime is old enough to be tried and judged), both in case of unaccompanied minors, or whether refugees and asylum seekers are adults or juveniles, which implies different legal issues and procedures. The aim of this article is to review the age estimation methods used in forensic practice.

In recent years, the increasing diffusion of malicious software has encouraged the adoption of advanced machine learning algorithms to timely detect new threats. A cloud-based approach allows to exploit the big data produced by client agents to train such algorithms, but on the other hand, poses severe challenges on their scalability and performance. We propose a hybrid cloud-based malware detection system in which static and dynamic analyses are combined in order to find a good trade-off between response time and detection accuracy. Our system performs a continuous learning process of its models, based on deep networks, by exploiting the growing amount of data provided by clients. The preliminary experimental evaluation confirms the suitability of the approach proposed here.

In recent years, the increasing number of cyber-attacks has gained the development of innovative tools to quickly detect new threats. A recent approach to this problem is to analyze the content of Social Networks to discover the rising of new malicious software. Twitter is a popular social network which allows millions of users to share their opinions on what happens all over the world. The subscribers can insert messages, called tweet, that are usually related to international news. In this work, we present a system for real-time malware alerting using a set of tweets captured through the Twitter API’s, and analyzed by means of a Bayes naïve classifier. Then, groups of tweets discussing the same topic, e.g, a new malware infection, are summarized in order to produce an alert. Tests have been performed to evaluate the performance of the system and results show the effectiveness of our implementation.

Patients with neurologic diseases almost inevitably develop various degrees of swallowing disorders during their life. Dysphagia is one of the main negative prognostic factors in this class of patients, leading to severe morbidity (i.e. aspiration pneumonia, dehydration, malnutrition, and life quality deterioration) and to a noticeable increase in public health spending. Videofluorographic swallowing study is considered the gold standard technique for swallowing impairment assessment. It is aimed at early identification of the risk of aspiration, definition of the kind and grade of dysphagia, and an indication to suspend oral nutrition and adopt other feeding strategies, and define when the patient is able to return to physiological nutrition. Every radiologist should be familiar with the main videofluorographic swallowing features in neurological patients, not only because early diagnosis of deglutition disorders widely improves their prognosis, but also because customising feeding strategies has a great impact on patients' quality of life.

In this paper a new technique for classification of patients affected by Crohn’s disease (CD) is proposed. The proposed technique is based on a Kernel Support Vector Machine (KSVM) and it adopts a Stratified K-Fold Cross-Validation strategy to enhance the KSVM classifier reliability. Traditional manual classification methods require radiological expertise and they usually are very time-consuming. Accordingly to three expert radiologists, a dataset composed of 300 patients has been selected for KSVM training and validation. Each patient was codified by 22 extracted qualitative features and classified as Positive or Negative as the related histological specimen result showed the CD. The effectiveness of the proposed technique has been proved using a real human patient dataset collected at the University of Palermo Policlin-ico Hospital (UPPH dataset) and composed of 300 patients. The KSVM classification results have been compared against the histological specimen results, which are the adopted Ground-Truth for CD diagnosis. The achieved results (Sensitivity: 94,80%; Specificity: 100,00%; Negative Predictive Value: 95,06%; Precision: 100,00%; Accuracy: 97,40%; Error: 2,60%) show that the proposed technique results are comparable or even better than manual reference methods reported in literature.

Nowadays, the population's average age is constantly increasing, and thus the need for specialized home assistance is on the rise. Smart homes especially tailored to meet elderly and disabled people's needs can help them maintaining their autonomy, whilst ensuring their safety and well-being. This paper proposes a complete context-aware system for Ambient Assisted Living (AAL), which infers user's actions and context, analyzing its past and current behavior to detect anomalies and prevent possible emergencies. The proposed system exploits Dynamic Bayesian Networks to merge raw data coming from heterogeneous sensors and infer user's behavior and health conditions. A rule-based reasoner is able to detect and predict anomalies in such data, sending appropriate alerts to caregivers and family members. The effectiveness of the proposed AAL system is demonstrated by extensive experimental results carried out in a simulated smart home.

Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.