Purpose: In this retrospective study, we develop radiomics prediction models from synthetic mammograms(SM) and digital mammograms(DM) images to identify which imaging modality has the most predictive power when employed for prediction of breast density. Methods: Patients aged between 45 and 74 years, were included in the study. For each, a SM in standard resolution (ST) and High Resolution (HR) were obtained, and a 150 x 150 pixels square area was defined on the images to be used for texture analysis of the breast parenchyma. A semi-automated placing strategy was used to reduce user reliance on the segmentation location. S-IBEX software was employed to extract radiomics features. Feature robustness analysis was also done to ensure model reproducibility. The Least Absolute Shrinkage and Selection Operator(LASSO) logistic regression model was trained to predict dichotomized breast density according to BIRADS classification model performance was assessed through receiver operating curves (ROC) for DM, HR, and ST. Results: We extracted 123 features from the 10 ROIs of 96 patient. After robustness analysis, the most predictive features were employed to build logistic regression-based models. The average performance of the models were 0.74, 0.67, and 0.64 on DM, HR, and ST, respectively, suggesting that DM maintains the highest informative content on breast density. Conclusions: This study investigated how well radiomics models trained on various imaging modalities predicted breast density. Our results may be pertinent to the debate over screening mammography technique optimization using quantitative measures based on radiomics features.

We report a case of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, occurring in an adolescent resulting positive to SARS-CoV-2 nasopharyngeal swab. At the admission in Emergency Department, the child presented with left cervical and sternal pain, without respiratory symptoms. Radiological studies showed sizeable pneumomediastinum, bilateral apical pneumothorax, massive emphysema subcutaneous and pneumorrhachis. Patients’ clinical conditions stood stable during the monitoring and he only needed conservative management. To our knowledge, this is the first description of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, in a COVID-19 adolescent without concomitant pneumonia.

Purpose To perform a dosimetric characterization of a mammographic unit for 2DDM equipped with narrow-angle and wide-angle DBT in a clinical setting. Methods A retrospective dosimetric characterization was performed on Fujifilm Innovality system for three available modalities: 2DDM, Standard-DBT (DBT-ST, acquisition angle 15°) and High-Resolution DBT (DBT-HR, acquisition angle 40°). All images were obtained with the AEC enabled in normal mode and in a clinical setting between January and May 2017. Both cranio-caudal and mediolateral-oblique views were included in the study. Screening trial patients and patients that already underwent surgery were excluded. For each exam, an automated process obtained the values of compressed breast thickness (CBT) and AGD. AGD was evaluated against CBT. Exponential fitting was performed and compared with calibration curves at various thickness of polymethyl-methacrylate (PMMA). Results 1561 images of patients receiving 2DDM, 383 DBT-ST and 350 DBT-HR were included in the study. Dosimetric fitting curves showed different trends (Fig. 1). 2DDM and DBT-ST exponential fitting curves (Table 1) were established to be widely lower than achievable dose-limits for 2DDM, especially at high CBT. On the other hand, DBT-HR exponential fitting curve was significantly higher and then very close to acceptable dose-limit for 2DDM, especially at low CBT. For all modalities, although well-known inter-individual variability mainly due to the individual amount of glandular tissue inside the breast, PMMA calibration curves were reliable representation of clinical curves: about 75% of patients' AGD values took place in a neighbourhood ( ± 20%) of the respective calibration curves. Conclusions To perform a dosimetric characterization of a mammographic unit for 2DDM equipped with narrow-angle and wide-angle DBT in a clinical setting. A retrospective dosimetric characterization was performed on Fujifilm Innovality system for three available modalities: 2DDM, Standard-DBT (DBT-ST, acquisition angle 15°) and High-Resolution DBT (DBT-HR, acquisition angle 40°). All images were obtained with the AEC enabled in normal mode and in a clinical setting between January and May 2017. Both cranio-caudal and mediolateral-oblique views were included in the study. Screening trial patients and patients that already underwent surgery were excluded. For each exam, an automated process obtained the values of compressed breast thickness (CBT) and AGD. AGD was evaluated against CBT. Exponential fitting was performed and compared with calibration curves at various thickness of polymethyl-methacrylate (PMMA). 1561 images of patients receiving 2DDM, 383 DBT-ST and 350 DBT-HR were included in the study. Dosimetric fitting curves showed different trends (Fig. 1). 2DDM and DBT-ST exponential fitting curves (Table 1) were established to be widely lower than achievable dose-limits for 2DDM, especially at high CBT. On the other hand, DBT-HR exponential fitting curve was significantly higher and then very close to acceptable dose-limit for 2DDM, especially at low CBT. For all modalities, although well-known inter-individual variability mainly due to the individual amount of glandular tissue inside the breast, PMMA calibration curves were reliable representation of clinical curves: about 75% of patients' AGD values took place in a neighbourhood ( ± 20%) of the respective calibration curves.

Purpose The aim of this work was to undertake/experience an online survey to interact with user, patients and healthcare professionals. The survey had a twofold objective: first, to get users aware on the ongoing changes in Hospital-to-patient interaction due to the imminent transposition of the Directive EURATOM-59/2013, that is the communication of radiation dose data in X-ray medical exposures; therefore, to evaluate the perception of the radiation risk and to identify the participants' preferred way to communicate them the amount of radiation dose. Methods The survey was developed on the website SurveyMonkey and published at the address https://it.surveymonkey.com/r/NOSRadion. Users could access the survey by registering personal @mail address to a dedicated mailing-list, by visiting the Hospital website and by scanning a QR-code. No paper forms of the survey were proposed. The survey was developed to be brief and easy-to-read through three sections. In the first section personal data were recorded. In the second section, the personal feeling (interest and concern) with radiation risk connected to medical exposures was evaluated. In the last section, the preferred way to communicate dose to the patients was investigated by proposing several quantitative and qualitative options. Target recruiting group is established to 500 users. Results A recap of the preliminary analysis based on the answers collected from the first 143 survey users (covered by around 70% by non-professionals) are shown in Table 1 and indicates a strong interest in the topic of radiation dose due to medical exposure, even if it was not coupled to great concern. Numerical quantification of the dose data was chosen by most of participants. Mean time for survey completion was about 5 min. Conclusions Online survey showed to be an efficient and very low-cost way to interact with user/patients and a powerful tool to get qualitative information potentially useful to define management strategies. Survey outcomes are considered for future development of the Hospital environment. The aim of this work was to undertake/experience an online survey to interact with user, patients and healthcare professionals. The survey had a twofold objective: first, to get users aware on the ongoing changes in Hospital-to-patient interaction due to the imminent transposition of the Directive EURATOM-59/2013, that is the communication of radiation dose data in X-ray medical exposures; therefore, to evaluate the perception of the radiation risk and to identify the participants' preferred way to communicate them the amount of radiation dose. The survey was developed on the website SurveyMonkey and published at the address https://it.surveymonkey.com/r/NOSRadion. Users could access the survey by registering personal @mail address to a dedicated mailing-list, by visiting the Hospital website and by scanning a QR-code. No paper forms of the survey were proposed. The survey was developed to be brief and easy-to-read through three sections. In the first section personal data were recorded. In the second section, the personal feeling (interest and concern) with radiation risk connected to medical exposures was evaluated. In the last section, the preferred way to communicate dose to the patients was investigated by proposing several quantitative and qualitative options. Target recruiting group is established to 500 users. A recap of the preliminary analysis based on the answers collected from the first 143 survey users (covered by around 70% by non-professionals) are shown in Table 1 and indicates a strong interest in the topic of radiation dose due to medical exposure, even if it was not coupled to great concern. Numerical quantification of the dose data was chosen by most of participants. Mean time for survey completion was about 5 min. Online survey showed to be an efficient and very low-cost way to interact with user/patients and a powerful tool to get qualitative information potentially useful to define management strategies. Survey outcomes are considered for future development of the Hospital environment.

Purpose Purpose of this work is to compare image quality of Synthetic Mammography (SM) and Full Field Digital Mammography (FFDM) in four different Digital Breast Tomosynthesis (DBT) systems by using a semi-anthropomorphic phantom. Methods Four DBT systems (FujiFilm, GE, Hologic, IMS) were characterized by means of the semi-anthropomorphic CIRS-BR3D phantom. The phantom contains clusters of microcalcifications, fibers and masses embedded in a breast equivalent tissue having a heterogeneous background. For each DBT system two images (DBT and FFDM) were acquired applying clinical setup conditions. FFDM acquisitions were repeated in manual mode for each system with a fixed exposure ratio between DBT and FFDM. Comparative analyses were carried out on the contrasts and sizes of micro calcifications, on the contrasts and shapes of masses, and on the noise power spectrum of the background. The FFDM image acquired in clinical setup conditions was considered the gold standard of the metric. Results Considering the micro calcifications, contrasts were generally preserved by SM with respect to FFDM, while the sizes of the smaller details slightly increased, probably due to the blurring caused by the filtration stages of the tomographic reconstruction. Regarding the masses, no globally significant differences were noticeable in the contrasts, and the shapes were generally well preserved as well. Finally, concerning the noise power spectra, significant variations only appeared in the high frequency regime, in accordance with the above-mentioned blurring. Conclusions This preliminary analysis confirms for all systems the criticality of the synthetic image in terms of spatial resolution and noise but does not highlight significant differences in the detection capability of the details of interest. Further investigations will be made considering the DBT+SM combination compared to DBT+FFDM, as well as by extending the present analysis to other mammographic phantoms.

Cross-Reacting Material 197 (CRM197) is a diphtheria toxin non-toxic mutant that has shown antitumor activity in mice and humans. It is still unclear whether this anti-tumorigenic effect depends on its strong inflammatory-immunological property, its ability to inhibit heparin-binding epidermal growth factor (HB-EGF), or even its possible weak toxicity. CRM197 is utilized as a specific inhibitor of HB-EGF that competes for the epidermal growth factor receptor (EGFR), overexpressed in colorectal cancer and implicated in its progression. In this study we evaluate the effects of CRM197 on HT-29 human colon cancer cell line behaviour and, for CRM197 recognized ability to inhibit HB-EGF, its possible influence on EGFR activation. In particular, while HT-29 does not show any reduction of viability after CRM197 treatment (MTT modified assay), or changes in cell cycle distribution (flow cytometry), in EGFR localization, phospho-EGFR detected signals (immunohistochemistry) or in morphology (scanning electron microscopy, SEM) they show a change in the gene expression profile by microarray analysis (cDNA microarray SS-H19k8). The overexpression of genes like protein phosphatase 2, catalytic subunit, alpha isozyme (PPP2CA), guanine nucleotide-binding protein G subunit alpha-1(GNAIl) and butyrophilin, subfamily 2, member A1 (BTN2A1) has been confirmed with real-time-qPCR. This is the first study where the CRM197 treatment on HT-29 shows a possible scarce implication of endogenous HB-EGF on EGFR expression and cancer cell development. At the same time, our results show the alteration of a specific and selected number of genes.

Background: Digital mammography systems, thanks to a physical performance better than conventional screen-film units, have the potential of reducing the dose to patients, without decreasing the diagnostic accuracy.Purpose: To achieve a physical and clinical comparison between two systems: a screen-film plate and a dual-side computed radiography system (CRM; FUJIFILM FCR 5000 MA).Material and Methods: A unique feature of the FCR 5000 MA system is that it has a clear support medium, allowing light emitted during the scanning process to be detected on the "back" of the storage phosphor plate, considerably improving the system's efficiency. The system's physical performance was tested by means of a quantitative analysis, with calculation of the modulation transfer function, detective quantum efficiency, and contrast-detail analysis; subsequently, the results were compared with those achieved using a screen-film system (SFM; Eastmann Kodak MinR-MinR 2000). A receiver operating characteristic (ROC) analysis was then performed on 120 paired clinical images obtained in a craniocaudal projection with the conventional SFM system under standard exposure conditions and also with the CRM system working with a dose reduced by 35% (average breast thickness: 4.3 cm; mean glandular dose: 1.45 mGy). CRM clinical images were interpreted both in hard copy and in soft copy. Results: The ROC analysis revealed that the performances of the two systems (SFM and CRM with reduced dose) were similar (P > 0.05): the diagnostic accuracy of the two systems, when valued in terms of the area underneath the ROC curve, was found to be 0.74 for the SFM, 0.78 for the CRM (hard copy), and 0.79 for the CRM (soft copy).Conclusion: The outcome obtained from our experiments shows that the use of the dual-side CRM system is a very good alternative to the screen-film system.

Most noncemented total hip replacements combine a titanium alloy stem, a CoCrMo femoral head and an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. In spite of its nickel content of up to 1% and the resulting biocompatibility issues in some clinical situations, the higher cost and some difficulties in machining, CoCrMo alloy is preferred to titanium alloys thanks to its outstanding tribological properties, higher hardness and elastic modulus. Nowadays most of the heads of hip prostheses use CoCrMo as bearing material. The present study investigates the effect of various surface treatments and combinations of treatments, such as electrochemical oxidation (anodization), laser surface melting and barrel polishing, on the tribological properties of commercially pure grade 2 titanium. The aim of the study was to characterize surface treatments capable of improving the tribological properties of titanium surface to the same extent as CoCrMo. The tribological properties were characterized by multidirectional pin-on-flat screening wear tests, using UHMWPE pins as bearing surface. The experiments showed the possibility of improving the wear resistance of titanium to the degree of CoCrMo. Although further efforts will be required to optimize the treatments studied, the results are encouraging enough to warrant pursuing this direction of investigation.