Search

Haematopoietic stem cell transplantation (HSCT) is an effective treatment for many malignant and nonmalignant diseases both in adults and children, but this procedure can be burdened by the so-called “late-onset non-infectious pulmonary complications” (LONIPCs), which are characterised by significant morbidity and mortality [1]. LONIPCs include different forms of inflammatory lung involvement, occurring after 100 days and within 2–3 years following HSCT [2]., Ruxolitinib could be considered as an option in the treatment of LONIPCs in children when other treatments are ineffective. Spirometry is a valuable tool for both diagnosis and follow-up of LONIPCs in children. https://bit.ly/3BmOYfb

Simple Summary Computed tomography plays a pivotal role in malignant pleural mesothelioma imaging management, ranging from diagnosis, differential diagnosis and staging to assessment of therapy response. Indeed, CT still presents some intrinsic limitations such as a poor contrast resolution between tumor and contiguous soft tissues, resulting in a challenging assessment of locoregional staging. Moreover, the current response evaluation criteria are based on unidimensional criteria, while malignant pleural mesothelioma has a complex tridimensional pattern of growth. To overcome these limits, the recent efforts in literature focused on computer-based methods, such as radiomics or automated segmentation, and magnetic resonance imaging. This review aims to describe their potential role in diagnosis, staging and assessment of therapy response in malignant pleural mesothelioma. Abstract Malignant pleural mesothelioma is a rare neoplasm with poor prognosis. CT is the first imaging technique used for diagnosis, staging, and assessment of therapy response. Although, CT has intrinsic limitations due to low soft tissue contrast and the current staging system as well as criteria for evaluating response, it does not consider the complex growth pattern of this tumor. Computer-based methods have proven their potentiality in diagnosis, staging, prognosis, and assessment of therapy response; moreover, computer-based methods can make feasible tasks like segmentation that would otherwise be impracticable. MRI, thanks to its high soft tissue contrast evaluation of contrast enhancement and through diffusion-weighted-images, could replace CT in many clinical settings.

Objectives Lung ultrasound (LUS), through assessment of B-lines and pleural line alterations, is able to evaluate interstitial lung disease (ILD), a frequent complication of SSc. Different scanning schemes and counting methods have been proposed but no clear cut-off values have been indicated for screening. We aimed to evaluate the accuracy of different LUS methodological approaches to detect ILD compared with high-resolution CT (HRCT) as the gold standard. Methods Sixty-nine SSc patients underwent LUS and chest HRCT on the same day. Both exams were scored by expert readers. The accuracy of different scanning schemes and counting methods was assessed and clinical and functional data were compared with imaging findings. Results B-lines were more numerous in patients with the diffuse skin subset and Scl70 autoantibody positivity. The number of B-lines correlated with the Scleroderma Lung Study (SLS) I HRCT score (R = 0.754, P 10 B-lines on the whole chest or >1 B-line on the postero-basal chest showed 97% sensitivity for detecting even very early ILD signs (corresponding to an SLS I score of 1). Sensitivity increased to 100% when pleural line alterations were included in the analysis. Conclusions LUS has a very high sensitivity in detecting SSc-related ILD. A cut-off value of >10 B-lines on the whole chest or >1 B-line on the postero-basal chest can be used for the screening of SSc-ILD. Assessing only the postero-basal chest seems to be mostly effective, combining high sensitivity with a less time-consuming approach.

[No Abstract Available], Wellcome Trust [209553/Z/17/Z]; UCLH Biomedical Research Centre, This study was supported by Wellcome Trust grant 209553/Z/17/Z and the UCLH Biomedical Research Centre. Funding information for this article has been deposited with the Crossref Funder Registry.

Interstitial lung diseases (ILDs) represent a heterogeneous group of entities, some of them characterized by an excessive deposition of extracellular matrix, in particular collagen, associated with a progressive destruction of the lung parenchyma. Thig group of diseases includes both idiopathic and secondary conditions. Although the underlying causes are different, some fibrotic lung diseases show a similar chronic progressive behavior, independently of the underlying etiology. An accurate diagnosis is mandatory to guide management and treatment of patients with interstitial lung diseases, in particular those with a fibrotic pattern. Imaging, and in particular high-resolution CT, plays a central role, therefore it is fundamental that radiologists become familiar with these diseases and their presentations, in order to be able to provide one or a limited number of possible differential diagnosis.

The aim of this study is to present the results of the Italian survey on the management of pulmonary nodules incidentally identified at computed tomography (CT). An online electronic survey, consisting of 23 multiple-choice questions, was created using the SurveyMonkey web-based tool. The questionnaire was developed by the Board of the Italian College of Chest Radiology of the Italian Society of Medical and Interventional Radiology (SIRM) and by an experienced group of Italian Academic Chest Radiologists. The link to the online electronic survey was submitted by email to all the SIRM members. A total of 767 radiologists, corresponding to 7.5% of all the SIRM members, participated in the online survey. The majority of participants (92%) routinely describe the attenuation of pulmonary nodules in the report, and 84.1% recommend the further follow-up, with 92.7% of respondents taking CT nodule morphological features into consideration. The 57.7% of participants adhere to the Fleischner Society guidelines for the management of incidental pulmonary nodules. However, 56.6% and 75.6% of respondents have a more cautious approach than that recommended by the guidelines and tend to use a shorter follow-up for both solid and ground-glass nodules, respectively. Finally, 94.5% of participants favor congresses and refresher courses dedicated to insights on lung nodule diagnosis and management. This survey demonstrates that the management of pulmonary nodules incidentally detected on CT is still complex and controversial. The majority of SIRM members express a need for an update on this topic.

Lung cancer has become a paradigm for precision medicine in oncology, and liquid biopsy (LB) together with radiomics may have a great potential in this scenario. They are both minimally invasive, easy to perform, and can be repeated during patient’s follow-up. Also, increasing evidence suggest that LB and radiomics may provide an efficient way to screen and diagnose tumors at an early stage, including the monitoring of any change in the tumor molecular profile. This could allow treatment optimization, improvement of patients' quality of life, and healthcare-related costs reduction. Latest reports on lung cancer patients suggest a combination of these two strategies, along with cutting-edge data analysis, to decode valuable information regarding tumor type, aggressiveness, progression, and response to treatment. The approach seems more compatible with clinical practice than the current standard, and provides new diagnostic companions being able to suggest the best treatment strategy compared to conventional methods. To implement radiomics and liquid biopsy directly into clinical practice, an artificial intelligence (AI)-based system could help to link patients' clinical data together with tumor molecular profiles and imaging characteristics. AI could also solve problems and limitations related to LB and radiomics methodologies. Further work is needed, including new health policies and the access to large amounts of high-quality and well-organized data, allowing a complementary and synergistic combination of LB and imaging, to provide an attractive choice e in the personalized treatment of lung cancer.

Purpose Chest imaging modalities play a key role for the management of patient with coronavirus disease (COVID-19). Unfortunately, there is no consensus on the optimal chest imaging approach in the evaluation of patients with COVID-19 pneumonia, and radiology departments tend to use different approaches. Thus, the main objective of this survey was to assess how chest imaging modalities have been used during the different phases of the first COVID-19 wave in Italy, and which diagnostic technique and reporting system would have been preferred based on the experience gained during the pandemic. Material and Methods The questionnaire of the survey consisted of 26 questions. The link to participate in the survey was sent to all members of the Italian Society of Medical and Interventional Radiology (SIRM). Results The survey gathered responses from 716 SIRM members. The most notable result was that the most used and preferred chest imaging modality to assess/exclude/monitor COVID-19 pneumonia during the different phases of the first COVID-19 wave was computed tomography (51.8% to 77.1% of participants). Additionally, while the narrative report was the most used reporting system (55.6% of respondents), one-third of participants would have preferred to utilize structured reporting systems. Conclusion This survey shows that the participants’ responses did not properly align with the imaging guidelines for managing COVID-19 that have been made by several scientific, including SIRM. Therefore, there is a need for continuing education to keep radiologists up to date and aware of the advantages and limitations of the chest imaging modalities and reporting systems.

Purpose Coronary artery calcifications (CAC) are very strong indicators for increased cardio-vascular (CV) risk and can be evaluated also in low-dose computed tomography (LDCT) for lung cancer screening. We assessed whether a simple and fast CAC visual score is associated with CV mortality. Methods CAC were retrospectively assessed by two observers using a 4-score (absent, mild, moderate and severe) scale in baseline LDCT obtained in 1364 participants to the ITALUNG trial who had 55–69 years of age and a smoking history ≥20 pack–years. Correlations with CV risk factors at baseline and with CV mortality after 11 years of follow-up were investigated. Results CAC were absent in 470 (34.5%), mild in 433 (31.7%), moderate in 357 (26.2%) and severe in 104 (7.6%) subjects. CAC severity correlated (≤0.001) with age, male sex, pack-years, history of arterial hypertension or diabetes, obesity and treated hypercholesterolemia. Twenty-one CV deaths occurred. Moderate or severe CAC were significantly associated with higher CV mortality after adjustment for all other known risk factors (ARR = 2.72; 95 %CI:1.04–7.11). Notably, also in subjects with none or one only additional CV risk factor, the presence of moderate-severe CAC allowed to identify a subgroup of subjects with higher CV death risk (RR = 3.66; CI95%:1.06–12.6). Conclusions Moderate or severe CAC visually assessed in LDCT examinations for lung cancer screening are independently associated with CV mortality.

Interstitial lung disease (ILD) are a large group of diffuse lung diseases characterized by similar clinical, pathological and radiological features. High resolution computed tomography (HRCT) has a central role in ILD diagnosis and management. In the last few years, computer-aided methods as Quantitative Computer Tomography (QCT) and Artificial Intelligence (AI) software were proposed as a source of reliable quantitative imaging biomarkers. The present review aimed to summarize and describe the current QCT and AI methods and to evaluate their potential diagnostic and prognostic role. The first attempt to a quantitative analysis of HRCT in ILD is represented by the density histogram analysis with the definition of two new parameter, Kurtosis and Skewness. Then texture analysis tools were developed as Adaptive Multiple Features Method (AMFM), Computer-Aided Lung Informatics for Pathology Evaluation and Ratings (CALIPER), Quantitative Lung Fibrosis (QLF) and Automated Quantification System (AQS). The introduction of AI technologies further increased the amount of objective and reproducible biomarkers. The diagnostic and prognostic role of QCT and AI methods was analyzed and confirmed in various studies, as reported in the review. QCT and AI technologies application led to the introduction of new objective biomarkers with relevant diagnostic and prognostic implications. However, there is still the need for more prospective study and the creation of open-source datasets would help to assess QCT and AI methods efficacy and to compare them.

A key step of the diagnosis of Idiopathic Pulmonary Fibrosis (IPF) is the examination of high-resolution computed tomography images (HRCT). IPF exhibits a typical radiological pattern, named Usual Interstitial Pneumoniae (UIP) pattern, which can be detected in non-invasive HRCT investigations, thus avoiding surgical lung biopsy. Unfortunately, the visual recognition and quantification of UIP pattern can be challenging even for experienced radiologists due to the poor inter and intra-reader agreement. This study aimed to develop a tool for the semantic segmentation and the quantification of UIP pattern in patients with IPF using a deep-learning method based on a Convolutional Neural Network (CNN), called UIP-net. The proposed CNN, based on an encoder-decoder architecture, takes as input a thoracic HRCT image and outputs a binary mask for the automatic discrimination between UIP pattern and healthy lung parenchyma. To train and evaluate the CNN, a dataset of 5000 images, derived by 20 CT scans of different patients, was used. The network performance yielded 96.7% BF-score and 85.9% sensitivity. Once trained and tested, the UIP-net was used to obtain the segmentations of other 60 CT scans of different patients to estimate the volume of lungs affected by the UIP pattern. The measurements were compared with those obtained using the reference software for the automatic detection of UIP pattern, named Computer Aided Lungs Informatics for Pathology Evaluation and Rating (CALIPER), through the Bland-Altman plot. The network performance assessed in terms of both BF-score and sensitivity on the test-set and resulting from the comparison with CALIPER demonstrated that CNNs have the potential to reliably detect and quantify pulmonary disease in order to evaluate its progression and become a supportive tool for radiologists.

Purpose: The aim of this study was to evaluate whether measurement of diaphragm thickness by ultrasonography may be a clinically useful noninvasive method for identifying patients at risk of adverse outcomes defined as need of invasive mechanical ventilation or death. Methods: We retrospectively reviewed the records of consecutive of 77 patients with laboratory-confirmed Covid-19 infection admitted to our intermediate care unit in Pisa between March 5 and March 30, 2020, with follow up until hospital discharge or death. Logistic regression was used identify variables potentially associated with adverse outcomes and those PResults: The main findings of this study are that 1) patients who developed adverse outcomes had thinner diaphragm than those who did not (2.0 vs 2.2 mm, p:0.001), 2) DT and lymphocyte count were independent significant predictors of adverse outcomes, with end-expiratory DT being the strongest (-708, OR: 0.492, p: 0.018).Conclusion: Diaphragmatic ultrasound may be a valid tool to evaluate the risk of respiratory failure. Evaluating the need of mechanical ventilation treatment should be based not only on PaO2/FiO2, but on a more comprehensive assessment including DT because if the lungs become less compliant a thinner diaphragm, albeit free of intrinsic abnormality, may become exhausted, thus contributing to severe respiratory failure.

BackgroundEGFR-positive Non-small Cell Lung Cancer (NSCLC) is a dynamic entity and tumor progression and resistance to tyrosine kinase inhibitors (TKIs) arise from the accumulation, over time and across different disease sites, of subclonal genetic mutations. For instance, the occurrence of EGFR T790M is associated with resistance to gefitinib, erlotinib, and afatinib, while EGFR C797S causes osimertinib to lose activity. Sensitive technologies as radiomics and liquid biopsy have great potential to monitor tumor heterogeneity since they are both minimally invasive, easy to perform, and can be repeated over patient’s follow-up, enabling the extraction of valuable information. Yet, to date, there are no reported cases associating liquid biopsy and radiomics during treatment.Case presentationIn this case series, seven patients with metastatic EGFR-positive NSCLC have been monitored during target therapy. Plasma-derived cell free DNA (cfDNA) was analyzed by a digital droplet PCR (ddPCR), while radiomic analyses were performed using the validated LifeX® software on computed tomography (CT)-images. The dynamics of EGFR mutations in cfDNA was compared with that of radiomic features. Then, for each EGFR mutation, a radiomic signature was defines as the sum of the most predictive features, weighted by their corresponding regression coefficients for the least absolute shrinkage and selection operator (LASSO) model. The receiver operating characteristic (ROC) curves were computed to estimate their diagnostic performance. The signatures achieved promising performance on predicting the presence of EGFR mutations (R2 = 0.447, p 2 = 0.301, p = 0.003 for T790M; and R2 = 0.354, p = 0.001 for activating plus resistance mutations), confirmed by ROC analysis.ConclusionTo our knowledge, these are the first cases to highlight a potentially promising strategy to detect clonal heterogeneity and ultimately identify patients at risk of progression during treatment. Together, radiomics and liquid biopsy could detect the appearance of new mutations and therefore suggest new therapeutic management.

Purpose To investigate the role of a quantitative analysis software (CALIPER) in identifying HRCT thresholds predicting IPF patients’ survival and lung function decline and its role in detecting changes of HRCT abnormalities related to treatment and their correlation with Forced Vital Capacity (FVC). Methods This retrospective study included 105 patients with a multidisciplinary diagnosis of IPF for whom one HRCT at baseline and concomitant FVC were available. HRCTs were evaluated with CALIPER and the correlation between FVC and radiological features were assessed. Radiological thresholds for survival prediction and functional decline were calculated for all patients. Fifty-nine patients with at least 2 serial HRCTs were classified into two groups based on treatment. For patients for whom a FVC within 3 months of the HRCT was available (n = 44), the correlation of radiological and clinical progression was evaluated. Results The correlation between FVC and CALIPER-derived features at baseline was significant and strong. A baseline CALIPER-derived interstitial lung disease (ILD%) extent higher than 20 % and pulmonary vascular related structures (PVRS%) score greater than 5 % defined a worse prognosis. A significant progression of CALIPER-derived features in all patients was found with a faster increase in untreated patients. ILD% and PVRS% changes during follow-up demonstrated strong correlations with FVC changes. Conclusions CALIPER quantification of fibrosis and vascular involvement could distinguish disease progression in treated versus untreated patients and predict the survival. The changes in CALIPER-derived variables over time were significantly correlated to changes in FVC.

Background:Interstitial lung disease (ILD), is common in patients with idiopathic inflammatory myopathies (IIM) and strongly impact on patients’ morbidity and mortality. Patients with anti-aminoacyl-transfer RNA-synthetases (anti-ARS) antibodies are associated with an increased risk of ILD.Objectives:Defining the radiological characteristics of IIM patients, with special focus on serological groups, through qualitative, semiquantitative and quantitative analysis of lung CT.Methods:This was a prospective study conducted from 2016 to 2019. Ninety-eight IIM patients (35 men, 63 women) were included. Myositis specific autoantibodies (MSA) were assessed with Myositis Prophyle III (Euroimmune, Lubeck).Each patient had a baseline CT; the total score of Warrick (WS) was obtained at semiquantitative analysis. The radiological scores ILD% (interstitial lung disease %) and PVRS% (pulmonary vascular related structure) were the result of quantitative analysis in 61 patients (CALIPER). Pulmonary function tests (PFTs) included TLC%, FVC% and DLCO% (65 patients). The analysis was conducted in the whole group and divided in subgroups based on their MSA pattern: in particular anti-ARS (Group 1) and patients negative to MSA (Group 2) were analysed.Results:Positive correlations between ILD% and PVRS% (Rho=0.916; ρ=0.000), WS and ILD% (Rho=0.663; ρ=0.000) and WS and PVRS% (Rho=0.637; ρThe most relevant inverse correlations were found between ILD% and DLCO% (Rho=-0.590; ρ=0.001), PVRS% and DLCO% (Rho=-0.549; ρStatistically significant higher values of WS, ILD% and PVRS% were found in Group 1 (WS=15, ILD%=11 and PVRS%=3.5), compared to Group 2 (WS=2.5, ILD%=0.84 and PVRS%=2.2). NSIP pattern resulted dominant represented in the two groups (80% Group 1, 75% Group 2). No statistically significant differences of DLCO%, FVC% and TLCO% were found.Conclusion:The inverse correlations between the radiological scores and the functional data TLC% and DLCO% (ρDisclosure of Interests:None declared

Background Interstitial lung disease (ILD) is very frequent and highly disabling in patients with systemic sclerosis (SSc). Magnetic resonance imaging (MRI) is not routinely used for the evaluation of the lung, since MRI generally provides a less detailed view of the pulmonary parenchyma, as well as poorer spatial resolution, compared to the non-invasive gold-standard of high resolution computed tomography (HRCT). Thus, its usefulness in the evaluation of interstitial lung disease (ILD) is limited at present. Objectives To evaluate MRI signals in different pathological and non-pathological lung areas, and to establish their clinical and instrumental correlations. Methods Thirty-two SSc patients underwent a cardiac MRI with dedicated lung scanning and chest HRCT on the same day. One-hundred-thirty-five regions of interest (ROIs) were identified, and STIR and T1 sequences were acquired[before (T0) and after 5 (T5), 10 (T10) and 15 (T15) minutes from gadolinium injection]. The ROIs were classified according to HRCT as normal, dependent areas (probably related to blood pooling in supine position) and pathological areas(ground glass ±reticulation on HRCT). Mean STIR and T1 times were also calculated for each patients, and correlated with FVC, DLco, B-lines on lung ultrasound and HRCT semi-quantitative scoring (Scleroderma Lung Study score). Patients were followed-up and lung worsening was defined on the basis of clinical judgement and at least >15% DLco decline. Results Mean STIR and mean T1 times were significantly different between normal, dependent and pathologic areas (p Conclusions Our data highlight the usefulness of lung MRI in SSc patients to differentiate normal, dependent and pathologic areas, without need for contrast medium administration, and with good correspondence to other functional and imaging parameters. STIR values may have prognostic implications to predict lung worsening. Lung MRI, although still very preliminary, is a promising imaging tool that in the future may integrate HRCT in SSc-related ILD. Disclosure of Interest None declared

Background Interstitial Lung Disease (ILD) is one of the most frequent and significant extra-muscular manifestations in Idiopathic Inflammatory Myopathies (IIM). Although high resolution computed tomography (HRCT) remains the gold standard technique for the evaluation of ILD, during the last years several authors proposed ultrasound (US) quantification of pleural irregularities (PIs) as a possible method to detect lung involvement in IIM patients. Objectives The objective of our study was to evaluate the prevalence of PIs and to compare the results obtained to the data provided by HRCT. Methods Thirtyseven patients (24 females,13 males, mean duration of the disease 5.21±7.6 and median age 62.24±1.8 years) with a diagnosis of IIM according to Bohan and Peter criteria (17PM,16DM,1MCI,3overlap syndromes) who required HRCT evaluation were enrolled. All patients underwent rheumatological clinical evaluation, including dyspnoea measurement by means MRC scale and disease activity assessment according to IMACS criteria (muscle enzymes, MMT8, VAS, HAQ, MYOACT). Patients were also asked to complete Patient Reported Outcome (PRO) questionnaires as Leicester Cough Questionnaire (LCQ). All the patients underwent a thoracic US evaluation in 53 anterior and posterior thoracic areas by Esaote MyLab Gold ultrasound device with 8–18 MHz linear probe. We evaluated the aspect of the pleural profile assigning each space a score according to a 3 points scale (regular=0, mild irregularity=1, irregularity=2) and summed the score in each space to obtain the PIs total score. HRCT was assessed by an expert radiologist to obtain a semiquantitative evaluation of parenchymal involvement by Warrick score. In a subgroup of patients, thoracic US was repeated by the same operator after two days from the first evaluation and by a second operator to valuate the intrareader and interreader agreement of the technique. Results The PIs total score obtained with lung US (24.70±13.66) was higher in patients with thoracic crackles at clinical examination (p=0.008) and in patients with positivity for antisynthetase autoantibodies, particularly anti-Jo1 (p Conclusions The US PIs total score is strictly correlated to clinical, serological and HRCT parameters and as the lung US is a non-invasive and relatively inexpensive technique, the results of our study suggest a possible role of this method in the screening of lung involvement in IIM patients. Follow up studies in a larger cohort of IIM patients are required. Disclosure of Interest None declared

Background High resolution computed tomography (HRCT) is an essential technique for the characterisation of interstitial lung disease (ILD) in patients with idiopathic inflammatory myopathies (IIM). Although several visual scores are available for a semiquantitative evaluation of ILD, an automatic quantitative analysis of lung involvement may represent a valuable improvement to reproducibly determine the extent of the disease. Objectives To compare the semiquantitative visual score to a volumetric texture and local volumetric histogram feature-based analysis software (CALLIPER) to quantify the lung involvement in IIM patients. Methods 21 consecutive IIM patients (Bohan and Peter criteria) who underwent a HRCT between November 2016 and November 2017 were prospectively enrolled. Twelve were affected by polymyositis and 9 by dermatomyositis. We collected smoking habits data and myositis specific autoantibodies positivity, respiratory symptoms according to MRC dyspnea scale and two patients reported outcome questionnaires: Leicester cough questionnaire (LCQ) and St. George’s Respiratory questionnaire (SGRQ). Patients underwent a non-contrast, supine, volumetric CT (≤2 mm slice thickness) that was evaluated by an expert radiologist according to Warrick’s score (WS) and also quantified by CALLIPER (Mayo Biomedical Imaging Resource – USA). CALLIPER analysis of the extent of interstitial lung abnormalities (ground glass, lung reticulation, honeycombing) was performed and a total score, expressed as percentage of lung involved (ILD%), was obtained. Analysis of the vascular involvement were performed as percent of pulmonary vessel volume (VESS%). Results Between the 21 patients, five (23.8%) were smokers. Four patients were positive for anti-synthetase autoantibodies -ASS (3 Jo-1, 1 Pl-7), 1 SRP, 1 Mi2. Dyspnea was present in 19 patients (90%): 9 grade 1, 7 grade 2, 3 grade 3 according to MRC scale. There were strict correlations between WS and ILD (r=0.802 p Conclusions CALLIPER represents an innovative technique to quantify the lung involvement in IIM patients: the main advantage of CALLIPER is the reproducibility that avoids the inter and intra-reader bias. Although more data are needed in larger cohorts, the use of CALLIPER may open new routes for the evaluation of ILD in IIM patients, both in medical practice and in randomised controlled trials. Disclosure of Interest None declared

Malignant pleural mesothelioma (MPM) in an uncommon neoplasia with high mortality rate, mostly related to professional asbestos exposure. Clinical manifestations are not specific so that diagnosis is performed at advanced stage and screening protocols are not feasible now. On the other hand, asbestos-exposed workers have a high incidence of developing lung cancer. Low-dose computed tomography (LDCT) is a volumetric acquisition technique with high spatial resolution and a low dose exposure; it is used in many trials to detect lung tumours at an early stage in screening protocols, reducing mortality rate in smoker subjects. In recent papers, the possibly role of lung cancer screening was evaluated and recommended also in subjects exposed to asbestos. This article summarizes previous and present clinical trials validated for lung cancer screening, to discuss the possibility of early diagnosis or screening programs in a population of asbestos exposed workers by LDCT.

Thin-slices multi-detector computed tomography (MDCT) plays a key role in the differential diagnosis of interstitial lung disease (ILD). However, thin-slices MDCT has a limited ability to detect active inflammation, which is an important target of newly developed ILD drug therapy. Magnetic resonance imaging (MRI), thanks to its multi-parameter capability, provides better tissue characterisation than thin-slices MDCT.Our aim was to summarise the current status of MRI applications in ILD and to propose an ILD-MRI protocol. A systematic literature search was conducted for relevant studies on chest MRI in patients with ILD.We retrieved 1246 papers of which 55 original papers were selected for the review. We identified 24 studies comparing image quality of thin-slices MDCT and MRI using several MRI sequences. These studies described new MRI sequences to assess ILD parenchymal abnormalities, such as honeycombing, reticulation and ground-glass opacity. Thin-slices MDCT remains superior to MRI for morphological imaging. However, recent studies with ultra-short echo-time MRI showed image quality comparable to thin-slices MDCT. Several studies demonstrated the added value of chest MRI by using functional imaging, especially to detect and quantify inflammatory changes.We concluded that chest MRI could play a role in ILD patients to differentiate inflammatory and fibrotic changes and to assess efficacy of new ILD drugs.

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.

The objective of the study was to determine whether HRCT criteria for Usual Interstitial Pneumonia (UIP), possible UIP or no-UIP pattern recommended by ATS/ERS/JRS/ALAT guidelines 2011 are able to predict progression and prognosis of the disease in a group of patients with fibrotic idiopathic interstitial pneumonia (IIP). This was a retrospective study conducted with the approval of the ethics committee. Two radiologists at baseline HRCT distributed 70 patients with fibrotic IIP into three groups on the basis of the 2011 guidelines: UIP pattern (group 1), possible UIP pattern (group 2), inconsistent with UIP pattern (group 3). The different abnormalities (honeycombing, reticulation, ground-glass and traction bronchiectasis), fibrotic score (reticulation + honeycombing) and overall CT score were visually scored at baseline and during the follow-up (total HRCT 178). The mortality rate of the three groups was compared. The baseline abnormalities were then correlated with the mortality rate in the UIP group. The inter-observer agreement in the classification of the abnormalities in the three groups was almost perfect (k = 0.92). After consensus, 44 patients were classified into group 1, 13 into group 2 and 13 into group 3. During a mean follow-up of 1386 days, overall CT score, fibrotic score, honeycombing and traction bronchiectasis showed a significant progression in group 1. The mortality rate was significantly higher in group 1 (18 deaths) versus group 2 and 3 (1 death each). In group 1, baseline honeycombing rate higher than 25 %, fibrotic score higher than 30, overall CT score greater than 45 and traction bronchiectasis in more than 4 lobes defined the worst prognosis. HRCT classification based on 2011 guidelines showed high accuracy in stratifying fibrotic changes because in our study UIP, possible UIP and inconsistent with UIP pattern seem to be correlated with different disease progression and mortality rate.

Anthropomorphic tissue-equivalent hand phantoms were achieved to measure the extremity dose involved in Zevalin (90)Y-labelling and patient delivering procedure for radioimmunotherapy treatment of non-Hodgkin lymphoma. The extremity doses to hands and wrists of operators were measured by using thermoluminescent detectors mounted on the developed phantoms. Measurements of chest- and lens-equivalent doses performed on a Rando phantom are also reported.