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Intra Operative Radiation Therapy (IORT) is a technique based on delivery of a high dose of ionising radiation to the cancer tissue, after tumour ablation, during surgery, while reducing the exposure of normal surrounding tissue. The Novac7 is a new linear accelerator expressly conceived to perform in the operating room. This accelerator supplies electron beams with high dose rate. Because these peculiar characteristics, classical dosimetric techniques are not able to give at once a real-time response and an extensive measure of the absorbed dose. The new system is composed by a grid of scintillating optical fibres coupled with two arrays of photodiodes. The instrument samples the delivered beam at 100 Hz. The dedicated software collects the two projection-signals and reconstructs the bi-dimensional image. Moreover it provides a series of dosimetric parameters. We studied an appropriate reconstruction algorithm searching the best compromise between the computational complexity and an high precision. An accelerator having energies ranging from 3 to 12 MeV has been used for the tests. The system is able to give a real time response (within 30 seconds), the resolution is of 1 millimeter. The response is linear versus dose and the measures are not affected by the high dose rate. The conclusions confirm the capability of the instrument to overcome problems encountered with classic dosimetry, showing that the results obtained strongly encourage the continuation of this research. Index Terms--Digital system, dosimetry, electron beam, FOS, Intra Operative Radiation Therapy (IORT), photodiode array, real-time acquisition.

Synchrotron-based digital radiography and microtomography devices are powerful, nondestructive, high-resolution research tools. In this paper, we present a linear system with a pixel size of 22.5 [micro]m and a field-of-view (FOV) 13 cm long and about 1 mm high. The system is composed of a linear converter GOS screen coupled to an intensified electron-bombarded CCD (EBCCD) camera, by means of a rectangular-to-linear fiber optic adapter. This optical guide is composed of seven bundles, each one transporting light in a coherent way to preserve spatial information. In this way, a high spatial resolution over an extended FOV is obtained. The detector works as an X-ray scanner by means of a high-precision translation mechanical device with 18 cm travel range. The total FOV obtained this way is 13 cm long and 18 cm high. The aim of this paper is to demonstrate the feasibility of this system to investigate a large area of a bone and to calculate the appropriate histomorphometric parameters. Here we present an investigation gained at ELETTRA synchrotron facility at Trieste, Italy. A monochromatic 34-keV beam has been used for imaging a human proximal femur, about 9 cm in width, with our system. The reconstructed images (13 cm x 13 cm) were cross sections containing femoral head, femoral neck, and greater trochanter. The local variations in trabecular and cortical structure of the examined bone were clearly visible at a level not obtainable with medical CT scanners. The used spatial resolution allowed the visualization of thin trabeculae, which typically lie in a range of 100 [micro]m or lower. The quality of the reconstructed cross-section images confirmed that the system presented is a novel tool for high resolution three-dimensional (3-D) imaging of bone structure, with a pixel size over a volume of interest not achievable with conventional microCT scanners. Index Terms--Biomedical, X-ray detectors, X-ray tomography.

Objectives: To assess the incidence (1 year) and the cumulative incidence (3 years) of the condition of patients accruing cumulative effective doses (CED) of ≥ 100 mSv and their variability among different hospitals. To establish and validate a reference level for the CED in patients with recurrent exposures (RERL) and provide a RERL value., Methods: Data of CT exposure was collected in 9 similar hospitals. The database included 294,222 patient*years who underwent 442,278 CT exams in 3 years. The incidence proportion of patients with CED ≥ 100 mSv in a given year (I 100;1 ) and the 3-year cumulative incidence of patients with CED ≥ 100 mSv over 3 consecutive years (I 100;3 ) were calculated and compared among different institutions., Results: I 100;1 ranged from a minimum of 0.1% to a maximum of 5.1%. The percentage of recurrent patients was quite uniform among centres ranging from 23 to 38%. The I 100;3 ranged from a minimum of 1.1 to 11.4%. There was a strong positive correlation between the third quartile values of yearly CED and yearly incidence (r = 0.90; R 2  = 0.81; p < 0.0001). RERL value in our study was found at 34.0 mSv., Conclusion: The management of patients with recurrent exposures is highly variable among hospitals leading to a 50-fold variation in I 100;1 and to a tenfold variation in I 100;3 . RERL could be established and used by taking as a RERL quantity the CED and as a RERL value the 75th percentile of the third quartiles of the distribution of the yearly CED obtained by surveying different hospitals., Clinical Relevance Statement: This is the first ever multicentre study that quantifies recurrent exposures in terms of incidence and cumulative incidence of patients with CED ≥ 100 mSv. RERL establishment and use could benefit the optimisation of radioprotection of patients with recurrent exposures., Key Points: This is the first multicentre study estimating yearly incidence and 3-year cumulative incidence of patients with cumulative effective doses ≥ 100 mSv. In this study, a 50-fold inter centre variation between the maximum (5.1%) and the minimum value (0.1%) of yearly incidence of patients with cumulative effective doses ≥ 100 mSv was reported. The range of the 3-year cumulative incidence extended from 1.1 to 11.4% (a tenfold variation) The third quartile of the yearly cumulative effective doses in a centre showed a strong positive correlation with the yearly incidence of patients with cumulative effective doses ≥ 100 mSv, with a potential of being used to set reference levels for recurrent exposures., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Recent years have ushered in a transformative era in in vitro modeling with the advent of organoids, three-dimensional structures derived from stem cells or patient tumor cells. Still, fully harnessing the potential of organoids requires advanced imaging technologies and analytical tools to quantitatively monitor organoid growth. Optical coherence tomography (OCT) is a promising imaging modality for organoid analysis due to its high-resolution, label-free, non-destructive, and real-time 3D imaging capabilities, but accurately identifying and quantifying organoids in OCT images remain challenging due to various factors. Here, we propose an automatic deep learning-based pipeline with convolutional neural networks that synergistically includes optimized preprocessing steps, the implementation of a state-of-the-art deep learning model, and ad-hoc postprocessing methods, showcasing good generalizability and tracking capabilities over an extended period of 13 days. The proposed tracking algorithm thoroughly documents organoid evolution, utilizing reference volumes, a dual branch analysis, key attribute evaluation, and probability scoring for match identification. The proposed comprehensive approach enables the accurate tracking of organoid growth and morphological changes over time, advancing organoid analysis and serving as a solid foundation for future studies for drug screening and tumor drug sensitivity detection based on organoids.

Objective: Outpatient hysteroscopy can be a painful procedure for some patients and there is still no consensus regarding analgesia use. We evaluated which types and modalities of analgesia are most commonly used in a select group of hysteroscopists., Study Design: A 15-item questionnaire was created to assess the use of routine analgesia during office hysteroscopy. The SurveyMonkey portal (https://www.surveymonkey.com/) was used to administer the questionnaire. Of the 400 hysteroscopists who were approached, 229 replied., Results: Routine pre-procedural or intra-procedural analgesia was used by 34% of hysteroscopists (67% of these reported using NSAIDs, 12% paracetamol, 7% opioids 13.5% other). Among hysteroscopists who routinely used intra-procedural analgesia, 46.1% reported using a paracervical block, 15.4% used an intracervical blockage, 15.4% had the patient listen to music during the procedure, 3.8% used local anesthetics, as in a spray or gel on the surface of the cervix, and 19.2% used some other method. Regarding misoprostol use, 75% of hysteroscopists reported not using it routinely., Conclusion: Our results are consistent with poor evidence from published studies that there is a low prevalence of routine analgesia use during outpatient hysteroscopy.

Body composition assessment (BCA) represents a valid instrument to evaluate nutritional status through the quantification of lean and fat tissue, in healthy subjects and sick patients. According to the clinical indication, body composition (BC) can be assessed by different modalities. To better analyze radiation risks for patients involved, BCA procedures can be divided into two main groups: the first based on the use of ionizing radiation (IR), involving dual energy X-ray absorptiometry (DXA) and computed tomography (CT), and others based on non-ionizing radiation (NIR) [magnetic resonance imaging (MRI)]. Ultrasound (US) techniques using mechanical waves represent a separate group. The purpose of our study was to analyze publications about IR and NIR effects in order to make physicians aware about the risks for patients undergoing medical procedures to assess BCA providing to guide them towards choosing the most suitable method. To this end we reported the biological effects of IR and NIR and their associated risks, with a special regard to the excess risk of death from radio-induced cancer. Furthermore, we reported and compared doses obtained from different IR techniques, giving practical indications on the optimization process. We also summarized current recommendations and limits for techniques employing NIR and US. The authors conclude that IR imaging procedures carry relatively small individual risks that are usually justified by the medical need of patients, especially when the optimization principle is applied. As regards NIR imaging procedures, a few studies have been conducted on interactions between electromagnetic fields involved in MR exam and biological tissue. To date, no clear link exists between MRI or associated magnetic and pulsed radio frequency (RF) fields and subsequent health risks, whereas acute effects such as tissue burns and phosphenes are well-known; as regards the DNA damage and the capability of NIR to break chemical bonds, they are not yet robustly demonstrated. MRI is thus considered to be very safe for BCA as well US procedures., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-19-1035). The special issue “Body Composition Imaging” was commissioned by the editorial office without any funding or sponsorship. GG served as the unpaid Guest Editor of the special issue and serves as an unpaid editorial board member of Quantitative Imaging in Medicine and Surgery. The authors have no other conflicts of interest to declare., (2020 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Aim and Objectives: The aim of this article was to explore the implications of the new Euratom dose limit for occupational radiation protection in the context of medical occupational radiation exposures. The European Directive 2013/59/Euratom takes into account the new recommendations on reduction in the dose limit for the lens of the eye for planned occupational exposures released in 2012 by the International Commission on Radiological Protection (ICRP 118)., Materials and Methods: Different dose-monitoring procedures and devices were considered. Occupational eye lens doses reported by previous studies were analyzed, mainly considering workers involved in interventional procedures with X-rays. The current status of eye lens radiation protection and the main methods for dose reduction were investigated., Results: The analysis showed that the workers, potentially exceeding the new limit, are clinical staff performing interventional procedures with a relatively high X-ray dose. Regarding radiological protection issues, the considered literature reports that the proper use of personal protective equipment may reduce the eye lens absorbed dose., Conclusion: The evaluation of the occupational eye lens dose is essential to establish which method of personal dose monitoring should be preferred. Furthermore, education and training about the right use of personal protective equipment are important for medical staff working with ionizing radiation.

Aims and Objectives: The aim of this study was to properly define the information regarding patient exposure to Ionizing Radiations in the radiological report, according to the European Directive 2013/59/EURATOM (EU 2013/59 art.58(b)). For this purpose, we evaluated the results from other Member States EU 2013/59 transpositions and from Guidelines recommendation published by International Organizations involved in diagnostic radiology. A practical way for implementing art.58 is also traced., Materials and Methods: Dosimetric quantities, such as exposure, absorbed dose and effective dose which may be included in radiological report, were first analyzed; then, in order to define international state of art of Member States EU 2013/59 transposition, a Web research using French, English, Spanish and German key words was performed., Results: EU 2013/59 transposition for 5 Member States was reported. Especially regarding art.58, a European project reports that few European countries (11 of 28) have identified the dose metrics to be used in radiological report. Scientific organizations supporting clinical radiologists and medical physicists have published Guidelines reporting parameters useful to quantify the radiation output and to assess patient dose., Conclusions: Our research revealed that there is not a shared interpretation of patient exposure information to be included in radiological report. Nevertheless, according to scientific community, authors believe that the exposure is the most appropriate information that could be included in radiological report. Alternatively, but with more expensiveness, a risk index based on effective dose could be used. Moreover, the systematic exposure information recorded could be useful for dose estimates of population from medical exposure.

Congenital factor VII deficiency is a rare autosomal recessive disorder associated to different haemorrhagic manifestations. Labour and delivery may cause bleeding risk in patients with this coagulation deficit, thus it is appropriate to clarify whether prophylaxis of peripartum haemorrhage is necessary. To date, there are very few cases in scientific literature which report the management of women with congenital factor VII deficiency during labour, and a consensus for prophylaxis does not exist. In this manuscript we present the management of a 35 years old woman with factor VII deficiency, treated with recombinant factor VIIa before delivery, without haemorrhagic complications either for the woman and for the infant. Therefore, we present a review of similar cases managed with a peripartum prophylaxis with recombinant factor VIIa, and discuss its usefulness and effectiveness, in view of the severity of the deficit and the doses used., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Sarcopenia and osteoporosis are two major health problems worldwide, responsible for a serious clinical and financial burden due to the increasing life expectancy. Both when presented as a single entity and, in particular, in the form of "osteosarcopenia", they lead to an important increased risk of falls, fractures, hospitalization and mortality. In dealing with these two pathological conditions, it is important to understand that between bone and muscle there is not only a functional correlation but also a close relationship in the development and in maintenance, which is well expressed by the concept of "bone-muscle unit". This close relationship agrees with the existence of a linear association between sarcopenia and osteoporosis, in particular in elderly population. It is mandatory, in the clinical assessment of both diseases, to do an early diagnosis or to delay as far as possible the appearance of an established form in order to prevent the onset of complications. The aim of this review is to present the different imaging modalities available for a non-invasive investigation of bone and muscle mass and quality in osteoporosis and sarcopenia, with their application and limitations., Competing Interests: The authors have no conflict of interest., (Copyright: © 2018 Hylonome Publications.)

Osteoporosis is a common condition and an important cause of disability. For this reason, early detection of the disease and patients at higher risk of bone fractures is compulsory. In the recent years, conventional quantitative methods have been spreading for the diagnosis of osteoporosis; moreover, new improvements in computed tomography (CT) and magnetic resonance imaging (MRI) have been made in this field and imaging findings may correlate to the morphological and structural changes within the bone., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Purpose: To examine both anterior and posterior elements of the lumbar spine in patients with low back pain using MRI T2-weighted sequences with Fat Saturation (FS) and contrast enhanced T1-weighted sequences with FS., Materials and Methods: Two thousand eight hundred and twenty (2820) patients (1628 male, 1192 female, mean age 54) presenting low back pain underwent MRI standard examination (Sagittal T1w TSE and T2w TSE, axial T1 SE) with the addition of sagittal and axial T2w Fat Sat (FS) sequences. Among all the patients, 987 (35%) have been studied adding Contrast Enhanced (CE) T1w FS sequences after administration of contrast medium., Results: Among 987 patients studied with contrast medium, we found: active-inflammatory intervertebral osteochondrosis in 646 (65%) patients; degenerative-inflammatory changes in facet joints (facet joint effusion, synovitis, synovial cysts) in 462 (47%); spondylolysis in 69 (7%); degenerative-inflammatory changes of the flava, interspinous and supraspinous ligaments in 245 (25%); inflammatory changes of posterior perispinal muscles in 84 (8%) patients., Conclusions: In patients with suspected no-disc-related low back pain, the implementation of T2w FS and CE T1w FS sequences to the standard MR protocol could allow a better identification of degenerative-inflammatory changes more likely associated to the pain.

p53 is a central hub in controlling cell proliferation. To maintain genome integrity in response to cellular stress, p53 directly regulates the transcription of genes involved in cell cycle arrest, DNA repair, apoptosis and/or senescence. An array of post-translational modifications and protein-protein interactions modulates its stability and activities in order to avoid malignant transformation. However, to date it is still not clear how cells decide their own fate in response to different types of stress. We described here that the human TRIM8 protein, a member of the TRIM family, is a new modulator of the p53-mediated tumor suppression mechanism. We showed that under stress conditions, such as UV exposure, p53 induced the expression of TRIM8, which in turn stabilized p53 leading to cell cycle arrest and reduction of cell proliferation through enhancement of CDKN1A (p21) and GADD45 expression. TRIM8 silencing reduced the capacity of p53 to activate genes involved in cell cycle arrest and DNA repair, in response to cellular stress. Concurrently, TRIM8 overexpression induced the degradation of the MDM2 protein, the principal regulator of p53 stability. Co-immunoprecipitation experiments showed that TRIM8 physically interacted with p53, impairing its interaction with MDM2. Altogether, our results reveal a previously unknown regulatory pathway controlling p53 activity and suggest TRIM8 as a novel therapeutic target to enhance p53 tumor suppressor activity.