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Radiotherapy (RT) is rarely used in the palliative management of muscle-invasive bladder cancer (MIBC). This survey aims to explore current care patterns within the Italian Radiation Oncologist community on this topic. In 2020, the uro-oncological study group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) conducted a survey evaluating the RT role in advanced MIBC. An electronic questionnaire was administered online to the society members asking for: general considerations, patients' selection, and aim of the treatment, RT schedule and practical consideration, past and future perspective. Sixty-one questionnaires were returned (33% response rate). Most responders (62.30%) declared to work in a Center with a multidisciplinary uro-oncological team, and 8.20% to evaluate more than 20 patients with MIBC/year for palliative RT. Elderly patients were the most frequently evaluated (46.7%) and life expectancy was the most common selection criteria (44.60%). Thirty Gy in 10 fractions (58.9%), whole bladder as GTV (62.5%), PTV isotropic margins of 1.5-2 cm (44.6%) and IMRT/VMAT technique (58.14%) were the most common treatment choices. Patients amenable for bladder palliative RT were most commonly referred by the urologist (43.86%) or the multidisciplinary team (38%). The reported main reasons for the low involvement of radiation oncologist in the management of MIBC patients were low attention to the palliative setting in bladder cancer (37.5%); radiation oncologist not involved in the management of these patients (32.1%); cases not discussed in the multidisciplinary board (26.8%). This survey illustrated the current use of palliative RT for patients with advanced MIBC in Italy and suggested the need for a greater involvement of radiation oncologists in their management. [ABSTRACT FROM AUTHOR]

Aims: To investigate the present attitude of the Italian Radiation Oncologists in the management of breast cancer (BC) concerning hypofractionated radiotherapy (hRT), partial-breast irradiation (PBI), re-irradiation (rRT) and radiotherapy after neoadjuvant chemotherapy (post-NAC RT). Methods: A nationwide, 21-point questionnaire was distributed online via SurveyMonkey. Results: Seventy-four Italian Radiotherapy Centers answered to the survey. In most cases, the responding centers treated more than 100 BC patients/year between January 2016 and December 2017. Almost half of responding centers (49%) treated patients with hRT, out of these, 95% as routine practice for early-stage BC. Dose prescriptions ranged between 39 and 45 Gy indicating a high use of moderate hRT. The chest wall and regional lymph nodes were irradiated with hRT by 13% and 15% of the responding centers, respectively. PBI was used by 60% of responders, with different techniques. Only 0.6% of participants perform rRT after BC recurrence. Finally, only 11% of the interviewed centers responded to their attitude toward post-NAC RT, which, however, was indicated in 97% of patients after breast-conserving surgery. Conclusions: This survey shows a fairly good use of hRT and a moderate practice of PBI in Italy. Some practices like hRT to the chest wall and regional lymph nodes as well as rRT need further verification. Likewise, the management of post-NAC RT is very heterogeneous. Future national clinical collaborative studies are advocated in order to investigate these controversial topics about breast cancer radiotherapy. [ABSTRACT FROM AUTHOR]

The aim of this document is to share the action plan from the young Italian Association of Radiotherapy and Clinical Oncology (yAIRO). We believe it is important to enhance a constructive dialog between societies. The hope is to offer to young radiation oncologists a wealth of opportunities to refine their skills and gain access to the latest developments, according to a shared European vision. [ABSTRACT FROM AUTHOR]

The Bogota company El Áncora Editores was founded by Patricia Hoher and Felipe Escobar in 1980 and is still in operation. The purpose of this text is to present an approach to the history of El Áncora publishing house, analyze its editorial line based on study of the reconstructed catalog and show how the company was inserted into the publishing market of the last decades of the twentieth century and throughout the 21st century; all of this having as a theoretical-methodological framework the sociology of literature and the publishing studies. [ABSTRACT FROM AUTHOR]

Aim: To conduct a survey among Sicilian centers of radiation oncology belonging to Associazione Italiana di Radioterapia ed Oncologia Clinica (AIRO), to record the different methods of integration of radio-chemotherapy both in neoadjuvant and adjuvant settings, to evaluate surgical procedures in relation to the sphincter preservation and to report the different toxicity profiles of the treatment strategies. Methods: A questionnaire was sent at the end of 2017 to all the radiation oncology centers of Sicily region in order to collect the data from individual centers and the treatment characteristics retrospectively over the previous 5 years, from 2012 to 2016. The required data were collected from 13 centers out of 17 which, in relation to the single catchment areas, correspond to approximately 85% of the Sicilian population. The requested data concerned the type of integrated treatment (neoadjuvant vs adjuvant vs radical), combination with chemotherapy (induction, concomitant, adjuvant), type of surgical intervention (sphincter-saving vs abdomino-perineal resection), disease stage, schedule and radiotherapy technique adopted, as well as toxicity detected over the treatment period. Results: A total of 784 pts (M/F: 509/275) were treated between 2012 and 2016, with a median age of 67 years (range 25–92). The majority of patients was treated in the neoadjuvant phase (62% of the total) compared to the adjuvant phase (31%) and to those treated radically (7%). Twenty-five percent of patients did not receive combination chemotherapy mainly for cardiovascular problems. Chemotherapy used concomitantly to radiotherapy was single-agent capecitabine (73% of patients) or 5-fluorouracil (27%). The use of chemotherapy alone before concomitant treatment is more common for patients treated in the adjuvant phase (64% of this subgroup), while 14% of patients treated in the neoadjuvant phase received induction chemotherapy before the concomitant phase; in both cases of chemotherapy alone, the majority of patients (91%) received oxaliplatin-based protocols (FOLFOX/XELOX/CAPOX). Few patients (3%) received chemotherapy alone after the concomitant phase. Information on the surgical treatment received is available for 88% of the sample. Of these, 93% received a surgical treatment. The overall rate of sphincter-saving surgery (anterior resection) was 72%, but the contribution of neoadjuvant treatment allowed to reach a rate of 83% in this subgroup (against 65% found in the subgroup of patients treated in adjuvant phase). Traditional radiotherapy schedule (45–50 Gy in 25–28 fractions) was used in 90% of patients, of which an intensified treatment in neoadjuvant phase (45 Gy + boost of 9–10 Gy) was used in 11% of patients. A short-course regimen (25 Gy in 5 fraction) in neoadjuvant setting was opted rarely (7%). Three-dimensional conformal technique was preferred over intensity-modulated ones (73% vs 27%). Toxicity was mainly of grade I–II CTCAE (skin 23%, gastrointestinal 39%, genitourinary 14%) compared to grade III (gastrointestinal 4%, genitourinary and hematological < 1%). Interestingly, the toxicity rates were significantly higher in the adjuvant group compared to the neoadjuvant (GI: 58% vs 31%, GU: 21% vs 10%). Conclusion: The present survey shows that in the Sicily region integrated therapies for rectal cancer have allowed a neoadjuvant approach in the majority of patients, thus resulting in a greater use of sphincter conservative surgery. The toxicity has also been reported to be significantly less in this treatment setting. [ABSTRACT FROM AUTHOR]

Background Minimally invasive surgery using a mini-open lateral retropleural or retroperitoneal approach for corpectomy is a well-described procedure for treating unstable thoracolumbar burst fractures. Most surgeons have incorporated fluoroscopy for localization and determination of hardware placement accuracy; however, the utility of computer-assisted image-guided spinal navigation has not been well described. We report a series of mini-open lateral approach thoracolumbar corpectomy cases using either fluoroscopy or intraoperative computed tomography (iCT) with computer-assisted navigation and discuss the technical nuances and advantages of using iCT with navigation versus fluoroscopy. Methods A retrospective review and analysis was performed of the cases of 20 patients with thoracolumbar burst fractures surgically managed via mini-open lateral corpectomy with fluoroscopy (2013–2015) or iCT navigation (2015–2017). The surgical outcomes were evaluated by the estimated blood loss, operative time, hospital stay, and need for revision. The clinical outcomes were evaluated using the numerical rating scale pain score. Radiographic outcomes were assessed with follow-up CT scans. The results were statistically analyzed using the Wilcoxon-Mann-Whitney test. Results The mean follow-up period was 13.4 months for the fluoroscopy group and 14.7 months for the iCT group. No surgical complications developed and no revisions were required. No statistically significant differences were found between the groups in surgical or clinical outcomes. However, the radiation exposure to the surgeons was significantly less with the iCT group (P < 0.003). Conclusions The use of iCT with spinal navigation for mini-open lateral corpectomy for thoracolumbar burst fractures yields perioperative and clinical outcomes comparable to those using traditional fluoroscopy, with decreased radiation exposure to surgeons. [ABSTRACT FROM AUTHOR]

Objective Pedicle screw placement remains challenging. The present study focuses on the comparison between 2 intraoperative-based neuronavigation systems (O-Arm and AIRO) during thoracolumbar screw instrumentation. Methods This is a prospective, comparative, nonrandomized study conducted in 2 French academic centers. The O-Arm was used at the University Hospital of Bordeaux, whereas the AIRO was used at the University Hospital of Marseille. Routine computed tomography was performed on postoperative day 2 to evaluate pedicle screw placement. Measures of radiation exposure were extracted directly from reports provided by each system. The effective dose was calculated. Results Overall, 74 screws were placed in 11 patients in the O-Arm group and 84 in 11 patients in the AIRO group. In the first group, 90.8% were rated as acceptable and 92.2% in the second (P > 0.05) according to the Heary and Gertzbein classifications, respectively, for thoracic and lumbar spine. Differences between both implantation systems were significant (P < 0.05) concerning dose length product (235 and 1039 mGy/cm, in O-Arm and AIRO, respectively), overall mean radiation dose received by 1 patient (3.52 and 15.6 mSv in O-Arm and AIRO, respectively), mean radiation dose per single scan (2.58 and 8.7 mSv in O-Arm and AIRO, respectively), mean effective dose per instrumented level (1.04 and 3.9 mSv in O-Arm and AIRO, respectively), and radiation dose received by the primary surgeon (0.63 and 0 μSv in O-Arm and AIRO, respectively). Conclusions Intraoperative computed tomography–based navigation is a major innovation that improves the accuracy of pedicle screw positioning with acceptable patient radiation exposure and reduced surgical team exposure. Highlights • A comparison between 2 iCT-based neuronavigation systems, O-Arm and AIRO, is proposed. • iCT-based navigation is a major innovation that improves patient safety regarding pedicle screw positioning. • Acceptable patient radiation exposure and reduced surgical team exposure is noted. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to characterize the Mobius AIRO Mobile CT System for localization and image-guided proton therapy. This is the first known application of the AIRO for proton therapy. Methods: Five CT images of a Catphan ®504 phantom were acquired on the AIRO Mobile CT System, Varian EDGE radiosurgery system cone beam CT (CBCT), Philips Brilliance Big Bore 16 slice CT simulator, and Siemens SOMATOM Definition AS 20 slice CT simulator. DoseLAB software v.6.6 was utilized for image quality analysis. Modulation transfer function, scaling discrepancy, geometric distortion, spatial resolution, overall uniformity, minimum uniformity, contrast, high CNR, and maximum HU deviation were acquired. Low CNR was acquired manually using the CTP515 module. Localization accuracy and CT Dose Index were measured and compared to reported values on each imaging device. For treatment delivery systems (Edge and Mevion), the localization accuracy of the 3D imaging systems were compared to 2D imaging systems on each system. Results: The AIRO spatial resolution was 0.21 lp mm-1 compared with 0.40 lp mm-1 for the Philips CT Simulator, 0.37 lp mm-1 for the Edge CBCT, and 0.35 lp mm-1 for the Siemens CT Simulator. AIRO/Siemens and AIRO/Philips differences exceeded 100% for scaling discrepancy (191.2% and 145.8%). The AIRO exhibited higher dose (>27 mGy) than the Philips CT Simulator. Localization accuracy (based on the MIMI phantom) was 0.6° and 0.5 mm. Localization accuracy (based on Stereophan) demonstrated maximum AIRO-kV/kV shift differences of 0.1 mm in the x-direction, 0.1 mm in the y-direction, and 0.2 mm in the z-direction. Conclusions: The localization accuracy of AIRO was determined to be within 0.6° and 0.5 mm despite its slightly lower image quality overall compared to other CT imaging systems at our institution. Based on our study, the Mobile AIRO CT system can be utilized accurately and reliably for image-guided proton therapy. [ABSTRACT FROM AUTHOR]

Purpose: Current solutions for navigated spine surgery remain hampered by restrictions in surgical workflow as well as a limited versatility and applicability. Against this background, we report the first experience of navigated spinal instrumentation with the mobile AIRO(®) intraoperative computed tomography (iCT) scanner.Methods: AIRO(®) iCT was used for navigated posterior spinal instrumentation of 170 screws in 23 consecutive patients operated on in our Department between the first use of the system in May 2014 and August 2014. The indications for AIRO(®) were based on the surgical region, anatomical complexity and the need for >3 segment instrumentation. Following navigated screw insertion, screw positions were confirmed intraoperatively by a second iCT scan. CT data on screw placement accuracy were retrospectively reviewed and analyzed by an independent observer.Results: AIRO(®)-based spinal navigation was easy to implement and successfully accomplished in all patients, adding around 18-34 min to the net surgery time. A systematic description of the authors' approach, setup in the OR and workflow integration of the AIRO(®) is presented. Analysis of screw placement accuracy revealed 9 (5.3%) screws with minor pedicle breaches (<2 mm). A total of 7 screws (4.1%) were misplaced >2 mm, resulting in an accuracy rate of 95.9%.Conclusions: The AIRO(®) system is an easy-to-use and versatile iCT for navigated spinal instrumentation and provides high pedicle screw accuracy rates. Although the authors' experience suggests that the learning curve associated with AIRO(®)-based spinal navigation is steep, a systematic user-based approach to the technology is required. [ABSTRACT FROM AUTHOR]

Radiation dose and image quality from a recently introduced mobile CT imaging system are presented. Radiation dose was measured using a conventional 100 mm pencil ionization chamber and CT polymethylmetacrylate (PMMA) body and head phantoms. Image quality was evaluated with a CATPHAN 500 phantom. Spatial resolution, low contrast resolution, Modulation Transfer Function (MTF), and Normalized Noise Power Spectrum (NNPS) were analyzed. Radiation dose and image quality were compared to those from a multi-detector CT scanner (Siemens Sensation 64). Under identical technique factors radiation dose (mGy/mAs) from the AIRO mobile CT system (AIRO) is higher than that from a 64 slice CT scanner. Based on MTF analysis, both Soft and Standard filters of the AIRO system lost resolution quickly compared to the Sensation 64 slice CT. The Siemens scanner had up to 7 lp/cm for the head FOV and H40 kernel and up to 5 lp/cm at body FOV for the B40f kernel. The Standard kernel in the AIRO system was evaluated to have 3 lp/cm and 4 lp/cm for the body and head FOVs respectively. NNPS of the AIRO shows low frequency noise due to ring-like artifacts which may be caused by detector calibration or lack of artifact reducing image post-processing. Due to a higher dose in terms of mGy/mAs at both head and body FOV, the contrast to noise ratio is higher in the AIRO system than in the Siemens scanner. However detectability of the low contrast objects is poorer in the AIRO due to the presence of ring artifacts in the location of the targets. [ABSTRACT FROM AUTHOR]

Background: For complex spinal cases, especially when robotic guidance is used, preoperative planning of pedicle screws can be helpful. Transfer of these preoperatively planned pedicle screws to intraoperative 3-dimensional imaging is challenging because of changes in anatomic alignment between preoperative supine and intraoperative prone imaging, especially when multiple levels are involved. In the spine, where each individual vertebra is subject to independent movement from adjacent level, rigid image fusion is confined to a single vertebra and can display fusion inaccuracies on adjacent levels. A novel elastic fusion algorithm is introduced to overcome these disadvantages. This study aimed to investigate image registration accuracy of preoperatively planned pedicle screws with an elastic fusion algorithm vs. rigid fusion for intraoperative placement with image-guided surgery., Methods: A total of 12 patients, were selected depending on the availability of a preoperative spinal computed tomography (CT) and an intraoperative AIRO CT scan (BrainLAB AG, Munich, Germany) of the same spinal region. To verify accuracy differences between rigid fusion and elastic fusion 76 bilateral screw trajectories were virtually defined in the preoperative CT image, and they were transferred via either rigid fusion or elastic fusion to the intraoperative CT scan. Accuracy of the transferred screws in the rigid and elastic fusion group was determined by measuring pedicle breaches on the intraoperative CT., Results: In the rigid fusion group 1.3% of screws showed a breach of less than 2 mm, 9.2% showed breaches between 2 and 4 mm, and 18.4% of the screws showed an error above 4 mm. The elastic fusion group showed no breaches and provided high accuracy between preoperative and intraoperative screw placement., Conclusion: Elastic fusion provides high registration accuracy and represents a considerable step towards efficiency and safety in CT-based image-guided surgery., Level of Evidence: 3., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS.)

Minimally invasive spine surgery techniques for pedicle screw instrumentation are being more frequently used. They offer shorter operative times, shorter hospital stays for patients, faster recovery, less blood loss, and less damage to surrounding tissues. However, they may rely heavily on fluoroscopic imaging, and confer radiation exposure to the surgeon and team members. Use of the AIRO Mobile Intraoperative CT by Brainlab during surgery is a way to eliminate radiation exposure to staff and may improve accuracy rates for pedicle screw instrumentation. We designed a retrospective analysis of our first 12 patients who had a total of 59 pedicle screws inserted when we began to incorporate the AIRO iCT scanner to our surgical workflow. During pedicle screw insertion, projection images were saved, and compared to CT scans gone at the end of the case. We measured the distances between the projected and postprocedural screw locations, at both the screw tips and tulip heads. We observed a mean of 2.8 mm difference between the projection and postprocedural images. None of the screws inserted had any clinically significant complications, and no patient required revision surgery. Overall, iCT guided navigation with the AIRO system is a safe adjunct to spinal surgery. It decreased operator and staff radiation exposure, and helped facilitate successful MIS surgery without fluoroscopic imaging. Additional studies and research can be done to further improve accuracy and reliability., (Published by Elsevier B.V.)