Image evolution in conventional radiology: the analog image.
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Radiography↗
Biomedical subjects
T Pirronti
Publications and source records attributed to T Pirronti.
99mTc-human immunoglobulin (HIG) in AIDS patients: first results.
Scintigraphy with 99mTc labelled human polyclonal immunoglobulin was performed in 16 patients with ascertained or suspected AIDS-related infections. 99mTc-HIG lung scanning was compared, in 11 patients, with 67Ga scintigraphy, chest X-ray and high resolution lung CT. 67Ga and 99mTc-HIG were concordantly positive in five cases of BAL-ascertained Pneumocystis carinii pneumonia (PCP), while one of them was Rx and CT negative. X-ray, 67Ga and 99mTc were concordantly negative in 5 cases. 99mTc-HIG yielded negative results in two cases of Mycobacterium infection, both of which were 67Ga and Rx positive: Mycobacterium avium in diffuse lung involvement and Mycobacterium TBC in excavated infiltrate. 99mTc-HIG was also positive in other 3 AIDS patients: 1 case of intestinal cryptosporidiosis, 1 pulmonary abscess (Staphylococcus and Candida), and 1 sacral abscess; it was negative in 1 case of Kaposi sarcoma (also 201Tl negative). In conclusion, 99mTc-HIG scintigraphy in AIDS patients is feasible, and offers some practical advantages (continuous availability, fast response time, etc.). The initial results seem similar to those of 67Ga in lung scanning (and perhaps more specific for PCP).
Acquired Immunodeficiency Syndrome↗
[Radiological examination of the thorax in intensive therapy centers].
Bedside chest radiography plays a considerable role in the whole of the exams carried out in hospitals, especially in intensive care units. Many clinical problems (pulmonary, cardiac, and mediastinal) are related to this examination and can be dealt with only when the radiologist is provided with high-quality radiographs. Therefore, it is extremely important for the radiologist himself to be aware of the various factors implied in the making and reproducing of bedside chest radiographs, which is a fundamental step in the monitoring of the patients undergoing intensive care. These factors can be divided into methodological factors (patient positioning, focus-film distance, and exposure) and technical factors (portable units, survey system). In this paper, a special emphasis is put on a survey system consisting in double differentiated screens and double film, which allows the acquisition of a normo-exposed radiograph of the parenchyma and of one of the mediastinum with a single exposure. Besides these technical and methodological elements, the radiologist must pay attention to the diagnostic-therapeutical means (such as tubes, small probes, and catheters) used on most patients in intensive care units. Their exact positioning must always be checked, and possible incorrect positioning and complications must be detected promptly. All these factors, as well as their scrupulous and constant application, contribute to markedly improve the dialogue between clinician and radiologist, by allowing a rapid evaluation of the cause of the clinical case under examination and its adequate treatment.
Humans↗
[Thoracic radiography. Comparison of asymmetric screen-film, technic of mechanical homogenization, and conventional technics].
This study was aimed at comparing three different systems, i.e., asymmetric screen-film, mechanical homogenized and conventional techniques, in standing frontal and lateral plain radiographs of the chest. Two hundred consecutive patients with normal posteroanterior (PA) and lateral films were randomly subdivided into 4 groups. Each group was submitted to chest radiographs with a different technique: asymmetric screen-film systems (InSight HC and High Light GCA), mechanical homogenized (Tau-Gil Homogenized) and conventional high-kilovoltage techniques. The exposure values for frontal projections ranged 110 kV (InSight HC) to 141 kV (Tau-Gil), while for lateral projections they ranged 123 kV (conventional technique) to 143 kV (Tau-Gil). Statistically significant differences were observed between the two asymmetric systems as regards exposure values, High Light exhibiting higher mean values in the frontal projection (t-test p < 0.05). Image quality was studied jointly by 3 experienced chest radiologists. The observers were asked to grade, on a 3-point ordinal scale, the conspicuity of mediastinal borders, of pulmonary vessels and of selected areas of lung parenchyma (i.e., retrocardiac, retrosternal and apical regions), as well as overall image quality on the frontal projection. The statistical analysis of paired differences was performed with the Mann-Whitney U-test. The asymmetric and the mechanical homogenized techniques were much better than the conventional technique in depicting tracheobronchial tree, retrocardiac parenchyma, azygos-esophageal recess and thoracic spine (p < 0.05). The mechanical homogenized system provided best overall image quality on frontal films, being superior to both InSight HC and conventional techniques, but not to the High Light GCA system; only the frontal projection obtained with the homogenized technique was compared, no filter being available for the lateral projection. When the two asymmetric systems were compared, the High Light system better depicted vascular structures on frontal films (p < 0.05), while apical areas were better demonstrated with the InSight system, namely with lateral films (p < 0.05).
Female↗
Pulmonary aspergillosis in patients with hematologic malignancies: clinicoradiologic correlation.
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Adolescent↗
Diagnostic imaging of HIV-related respiratory disease.
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AIDS-Related Opportunistic Infections↗
Combined radiation and chemotherapy in lung cancer: preliminary results.
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Adult↗
[Xeroradiography and digital luminescence radiography in the study of the technics of manufacturing ancient ceramics. The advantages and limits].
This paper reports on the cooperative work of the Department of Radiology of the Catholic University, Rome, and of the Italian Institute for Middle and Far East. The study was aimed at using xeroradiography and digital luminescence radiography for the archeometric evaluation of ancient ceramics and at assessing the imaging potentials of the two techniques. Some manufacturing techniques are reported which were used in the ancient world and societies for pottery making--i.e., coil building (the superimposition of clay rings), paddle and anvil beating and throwing of the wheel. Such techniques leave, on the vessel's wall, clear traces which can be detected by X-ray imaging. After discussing the main semiologic features, we present 4 case studies from the project archive. Each vase underwent xeroradiography and digital luminescence radiography. The former technique was useful in detailing minor phase transitions--e.g., pores and inclusions--while the latter, thanks to both its wide dynamic range and its image processing potentials, was optimal in defining very gradual thickness transitions due to the different techniques used to join the clay parts. By combining the two techniques, the manufacturing technology of the artifacts could be defined. The interactive processing of radiographic images at the system console was seen to be of major importance: it allowed the best results to be obtained thanks to the integration of the radiologists' and archeologists' know-how during the actual analytical stages.
Archaeology↗
[The diagnosis of lung inflammation in AIDS patients. The use of 99mTc-labelled human polyclonal immunoglobulins and a comparison with 67Ga citrate and high-resolution computed tomography].
Technetium-99m (99mTc) labelled polyclonal human immunoglobulin (HIG) is a new agent for the localization of active inflammatory diseases. The results obtained with HIG in 29 AIDS patients referred for suspected lung infections are reported (Table I). The patients also underwent Gallium-67 citrate scanning (GS), chest radiography (Rx), high-resolution thin-layer computed tomography (HRCT) and broncho-alveolar lavage (BAL). The study population was classified as follows: 12 patients (Table II) were studied before treatment for suspected Pneumocystis carinii pneumonia (PCP), 7 patients (Table III) had known PCP and were studied during medical therapy, and 10 patients (Table IV) had lung infections other than PCP. In all PCP patients studied before treatment, positive agreement was observed between HIG, Rx and HRCT findings. In 4 patients with final clinical diagnosis of no lung conditions, both nuclear and radiologic imaging were negative. 99mTc-HIG results in the PCP patients studied during therapy were consistent with clinical and radiologic improvement; there was disagreement with 67Ga findings in one case (no. 9). In lung infections other than PCP, HIG studies were often negative (always negative in mycobacteriosis), while they were positive in 3 pyogenic abscesses. In conclusion, as for PCP and abscesses, the results obtained with 99mTc-HIG are usually in agreement with GS findings, while HIG scans seem to be negative in mycobacterial infections. Moreover, HIG scintigraphy seems to be suitable for the evaluation of treatment results in PCP (this subject deserves further research). To assess respiratory impairment a semiquantitative index (ISQ) of 99mTc-HIG lung uptake is suggested, which showed a significant linear correlation with arterial pO2.
AIDS-Related Opportunistic Infections↗
Chest radiograph in pulmonary embolism.
Chest radiograph plays a major role in patients with suspected pulmonary embolism because it frequently allows the visualization of the radiologic signs of pulmonary embolism without or with infarct while at the same time the presence of other diseases which mimic it, can be detected. Combined with other investigations this finding allows the precise diagnosis of a higher number of diseases while other diagnostic exams can be selected. Numerous radiologic signs are visualized. They involve the vascularization, the parenchyma, the pleura and diaphragms. They allow to distinguish between embolism with infarct from embolism without infarct. They require a global interpretation to attribute a diagnostic role to chest radiograph. This should be carefully performed to represent a valid support to the diagnostic approach.
Humans↗
Multidisciplinary approach to venous thromboembolism.
Venous thromboembolism shows a high incidence and a significant mortality. Even if valid methods are available, thromboembolism is underdiagnosed. There are a number of diagnostic difficulties. They concern the time of the diagnostic suspicion, the patient selection for the various procedures and their combination. These difficulties may be overcome by team work where specialists of different disciplines (surgeons, internists, experts in nuclear medicine, radiologists) integrate their competence to attain the established objectives. The integration results in "synergism", namely an added value greater than the sum of competences of the team components. Thus, an operational unit active 24 hours over 24 must be formed to diagnose and treat the largest number of cases of thromboembolism. To establish the clinical suspicion of thromboembolism is the first indispensable step for patient selection. Thromboembolism should be investigated in all patients with chest pain, dyspnea and tachypnea in the absence of preexisting cardiorespiratory disease. The team should evaluate the impact of signs and symptoms to establish a definitive clinical probability which can direct towards the suitable, least invasive imaging procedure. Perfusion scanning, when highly suggestive or normal, is conclusive. However in 70% of cases it is indeterminate. Thus it should be combined with other procedures and with the clinical assessment. In practice, many dubious cases remain unsolved. The team work represents an organizational response to this diagnostic and therapeutic inadequacy. The real change in strategy which has revolutionized the diagnosis of thromboembolism was the widespread use of color Doppler US in the diagnosis of deep vein thrombosis. Since pulmonary embolism as well as deep vein thrombosis are treated with the same therapy, it is adequate to document the thrombosis also in the absence of a definitive demonstration of embolism. The old-fashioned approach should be reversed and the investigation should be centered on the assessment of deep vein thrombosis: site, emboligenic potential, floating extremity and extension. The integration of the clinical assessment, scanning finding and color Doppler US lowers by about 20% the number of indeterminate cases and indicates the patients for whom pulmonary spiral CT or pulmonary angiography is required. In all patients with cardiorespiratory insufficiency still unsolved after the combination of noninvasive exams, pulmonary angiography or spiral CT is mandatory because of the high risk for death. The remaining ones can be followed with serial color Doppler US exams. The cost/benefit ratio shows that the noninvasive strategy is the least expensive, the least hazardous and the most effective. At present, effective therapies are available for thromboembolism. Standard heparin and low molecular weight heparin fractions, fibrinolytic agents, surgery and recently caval filters are playing a major role in secondary prophylaxis of pulmonary embolism. The therapeutic approach is conditioned by various factors: the features of thrombosis, the presence and entity of pulmonary embolism, the patient cardiorespiratory condition, possible contraindications for anticoagulant and fibrinolytic agents. The presence of such a number of variables makes the use of a therapeutic algorithm, difficult. In this phase, based on our experience we believe that the present solution lies in the activity of an operational team of experts who establish the treatment to be performed.
Cost-Benefit Analysis↗
High resolution computed tomography (HRCT) and new perspectives in functional radiology of the lung.
Computed Tomography (CT) with the advent of new techniques as high resolution computed tomography (HRTC) and spiral CT with 3D reconstructions (3D CT) allows a new morphologic-qualitative as well as functional-quantitative evaluation of pulmonary perfusion and ventilation. HRCT allows the identification of secondary lobule and a detailed morphologic and comparative analysis of minute distal anatomical structures with combined densitometric evaluation of lung parenchyma on perfusion. In particular, a new, more specific significance could be attributed to changes in density of lung parenchyma (mosaic pattern) with associated assessment of the vessel number, caliber and distribution, and a comparative evaluation of vessels and density between healthy and impaired areas. The "optical" HRCT evaluation on serial axial scans in inspiration and expiration allows the functional assessment of compartments which require spirometry and tests of respiratory function. Spiral CT allows volumetric acquisitions in a single breath which can be reconstructed and processed according to single requirements. 3D tailored reconstruction of spiral CT exam in maximum inspiration and expiration with a dedicated densitometric window (-1024/+ 100 HU) allows the calculation of total lung volume (TLV), of both lungs, of a single lung or selected sections. With the "air" densitometric window (-1024/-400 HU) the total lung capacity (TLC) and residual volume (RV) are calculated. The ratio between these values and the corresponding TLV represents the lung aeration index (LAI). 3D reconstruction with fixed densitometric value corresponding to median air density (peak of histogram) allows the scintigraphic-like "alveolographic" reconstruction of lung ventilation. Combined 3D CT and HRCT evaluation possibly from a single spiral CT exam, is used in the morphologic-functional diagnosis of respiratory pathophysiology.
Lung↗
Diagnostic imaging of pulmonary tuberculosis.
Pulmonary tuberculosis in its primary and postprimary form is a widespread disease. Radiologic and CT findings in the acute phase of the disease, its many different aspects, as well as the alterations observed following the outcomes of tuberculosis at the parenchymal and pleural level, are examined.
AIDS-Related Opportunistic Infections↗
Automated scheduling of radiologic procedures.
The dramatic advances in radiology have increased the number and type of machines and of daily performed exams. Consequently, workload and management organization problems have also markedly increased. Automated, computerized scheduling of radiologic exams is certainly a step forward in a modern rational management of a Diagnostic Imaging service: the relationship with the patient is improved with the optimization of care delivered and of the radiologist's work, who with the new technology is able to rapidly consult the previous exams as well as the list of exams to be performed. The advances in health care information technology imply communications at a distance. From each ward of the hospital, requests for radiologic exams can be automatically scheduled or kept on a dynamic waiting list for automated input in future work shifts. Via the same system, reports (and also radiologic images) can by rapidly transmitted to the wards. At the "Università Cattolica del S. Cuore" from several years, an integrated information system has been implemented for management of patient data, exams and care delivered. Radiology represents one of major departmental systems of the network for the number of machines installed and the amount of information supplied. The system will be soon able to store images from all digital and nondigital machines, and visualize on dedicated workstations the images of ongoing exams or stored previous ones.
Appointments and Schedules↗
Planning and scheduling radiologic exams.
Planning and scheduling of radiologic exams represent one of the crucial aspects in the performance of Diagnostic Imaging service, whose optimal management should lead to optimal efficiency and exploitation of technological and professional resources. A Diagnostic Imaging service with agreed and scheduled exams for customers achieves a more adequate, precise planning of the activity with optimum productivity of radiology rooms and anticipated workload assessment.
Appointments and Schedules↗
Excellence in diagnostic imaging service management.
The identification of promoting factors of excellence improvement in radiology service management means to clearly assess how the different aspects of the service are managed. The key elements for intervention are sharply differentiated according to the service managerial level. The approach to continuous improvement should be a useful tool of assessment even when all its potentialities have been exhausted and new promoting factors are necessary to move to the subsequent stage.
Delivery of Health Care, Integrated↗
Radiology room productivity.
Radiology has a significant impact on all health care processes at the "Policlinico A. Gemelli". The performance of Radiology rooms was thus analyzed within the overall performance of health care processes (e.g. medical wards, emergency service, day hospital). In this context, in the assessment phase of the reengineering project the Radiology room productivity has been analyzed. From outcomes of this analysis it appears that there is a high potential for increasing the Radiology room productivity (except for TC and MRI rooms). It has been observed that a better ward/service communication, together with a better use and planning of Radiology rooms and resources would allow a more efficient performance of the service. The reengineering project has led to a reorganization of the communication between Radiology rooms and wards/day hospital, a better inpatient transfer system from wards to Radiology rooms and the planning of the requests for exams. At present, a team is working in order to introduce a medium term budget of exams for all the wards associated to the provision of care for those diseases for which patient admission can be planned based on available Radiology rooms.
Appointments and Schedules↗