GPCALMA: a Grid Approach to Mammographic Screening

The next generation of High Energy Physics experiments requires a GRID approach to a distributed computing system and the associated data management: the key concept is the "Virtual Organisation" (VO), a group of geographycally distributed users with a common goal and the will to share their resources. A similar approach is being applied to a group of Hospitals which joined the GPCALMA project (Grid Platform for Computer Assisted Library for MAmmography), which will allow common screening programs for early diagnosis of breast and, in the future, lung cancer. HEP techniques come into play in writing the application code, which makes use of neural networks for the image analysis and shows performances similar to radiologists in the diagnosis. GRID technologies will allow remote image analysis and interactive online diagnosis, with a relevant reduction of the delays presently associated to screening programs.Comment: 4 pages, 3 figures; to appear in the Proceedings of Frontier Detectors For Frontier Physics, 9th Pisa Meeting on Advanced Detectors, 25-31 May 2003, La Biodola, Isola d'Elba, Ital

Visualising accessibility: an interactive tool and two applications to empirical case studies of urban development and public engagement

While a substantial body of literature exists on the theoretical definitions and measures of accessibility, the extent to which such measures are applied into practice to assess project alternatives is less frequent (Geurs and Van Wee, 2004). Recent studies affirm that one of the main barriers to the usability of accessibility measure is the lack of visualisation quality and mapping tool for accessibility representation (te Brömmelstroet et al, 2014), while visualisation tools are commonly recognised as the most effective methodology to facilitate knowledge sharing, particularly in those processes involving public stakeholders and non-experts with different expertise. Starting form this consideration, this paper presents an application of the Interactive Visualisation Tool, named InViTo (Pensa and Masala, 2014a; 2014b; Pensa, et al., 2014; Pensa, Masala and Lami, 2013; Pensa, Masala and Marina, 2013) able to generate maps of the level of perceived accessibility (i.e. “desirability”) of different urban areas. Desirability is here computed as the perceived level of access to different urban items as transport supply (metro and rail stations, public transport stops, parking) and urban activities such as hospitals, schools, museums. In this respect, the concept of desirability encompasses a measure of accessibility to several urban facilities, and the perception that residents of the study area have of such facilities. The InViTo tool allows to build up maps of desirability interactively, by making selection of the chosen items and by giving differential weights to each items. This makes the tools powerful and very useful particularly when discussing and showing analysis results to stakeholders, who could have the opportunity to see in real time the results of different scenario alternatives and assumptions. In the paper two applications are presented. The first one to the empirical case study of Rome, presents the steps to undertake in order to apply the tool: from data gathering, maps coding, and results representation. The second application aims at exploring the potential usability of the tool in engaging public stakeholders into the assessment of different urban development options. Furthermore, the results of a workshop held in Turin, in which public and private stakeholders were interactively involved, are discussed. The paper is organised as follows. In section 2, an overview of the InViTo tool is given with a focus on its applicability formeasuring accessibility. In section 3 the results of the two InViTo applications are discussed. Conclusions are drawn in section 4, with an outlook to undergoing research issues

Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results.

Background Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. Methods The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense. Results The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. Conclusions To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications. Level of evidence III. Treatment study: Case–control study

Dietary determinants of changes in waist circumference adjusted for body mass index - a proxy measure of visceral adiposity

Background Given the recognized health effects of visceral fat, the understanding of how diet can modulate changes in the phenotype “waist circumference for a given body mass index (WCBMI)”, a proxy measure of visceral adiposity, is deemed necessary. Hence, the objective of the present study was to assess the association between dietary factors and prospective changes in visceral adiposity as measured by changes in the phenotype WCBMI. Methods and Findings We analyzed data from 48,631 men and women from 5 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Anthropometric measurements were obtained at baseline and after a median follow-up time of 5.5 years. WCBMI was defined as the residuals of waist circumference regressed on body mass index, and annual change in WCBMI (¿WCBMI, cm/y) was defined as the difference between residuals at follow-up and baseline, divided by follow-up time. The association between energy, energy density (ED), macronutrients, alcohol, glycemic index (GI), glycemic load (GL), fibre and ¿WCBMI was modelled using centre-specific adjusted linear regression, and random-effects meta-analyses to obtain pooled estimates. Men and women with higher ED and GI diets showed significant increases in their WCBMI, compared to those with lower ED and GI [1 kcal/g greater ED predicted a ¿WCBMI of 0.09 cm (95% CI 0.05 to 0.13) in men and 0.15 cm (95% CI 0.09 to 0.21) in women; 10 units greater GI predicted a ¿WCBMI of 0.07 cm (95% CI 0.03 to 0.12) in men and 0.06 cm (95% CI 0.03 to 0.10) in women]. Among women, lower fibre intake, higher GL, and higher alcohol consumption also predicted a higher ¿WCBMI. Conclusions Results of this study suggest that a diet with low GI and ED may prevent visceral adiposity, defined as the prospective changes in WCBMI. Additional effects may be obtained among women of low alcohol, low GL, and high fibre intake

Treatment of intermetatarsal Morton's neuroma with alcohol injection under US guide: 10-month follow-up

Mortons neuroma (MN) is a frequent cause of metatarsalgia. The aim of our study was to evaluate the efficacy of neuroma alcohol-sclerosing therapy (NAST) under US guide in MN after a 10-month follow-up. Forty intermetatarsal neuromas underwent alcohol-sclerosing therapy after sonographic evaluation of their dimensions and echotexture. After subcutaneous anesthesia, a sclerosing solution composed of anesthetic (carbocaine-adrenaline 70%) and ethylic alcohol (30%) was injected inside the mass under US guidance. The procedure was repeated at intervals of 15 days until the resolution of the symptoms. A total or partial symptomatic relief was obtained in 36 cases (90%). No procedure-related complications were observed. Transitory plantar pain, due to the flogistic reaction induced by the sclerosing solution, occurred in 6 cases (15%). The 10-month follow-up revealed a 20-30% mass volume reduction and an adiposus-like change in echotexture. In the 4 cases (10%) of therapeutic failure, the preliminary sonography demonstrated a hypoechoic echotexture with a strong US beam attenuation corresponding to a highly fibrous neuroma after surgical resection. The NAST is a feasible and cost-efficient procedure with high rates of therapeutic success

A Computer Aided Detection system for mammographic images implemented on a GRID infrastructure

The use of an automatic system for the analysis of mammographic images has proven to be very useful to radiologists in the investigation of breast cancer, especially in the framework of mammographic-screening programs. A breast neoplasia is often marked by the presence of microcalcification clusters and massive lesions in the mammogram: hence the need for tools able to recognize such lesions at an early stage. In the framework of the GPCALMA (GRID Platform for Computer Assisted Library for MAmmography) project, the co-working of italian physicists and radiologists built a large distributed database of digitized mammographic images (about 5500 images corresponding to 1650 patients) and developed a CAD (Computer Aided Detection) system, able to make an automatic search of massive lesions and microcalcification clusters. The CAD is implemented in the GPCALMA integrated station, which can be used also for digitization, as archive and to perform statistical analyses. Some GPCALMA integrated stations have already been implemented and are currently on clinical trial in some italian hospitals. The emerging GRID technology can been used to connect the GPCALMA integrated stations operating in different medical centers. The GRID approach will support an effective tele- and co-working between radiologists, cancer specialists and epidemiology experts by allowing remote image analysis and interactive online diagnosis.Comment: 5 pages, 5 figures, to appear in the Proceedings of the 13th IEEE-NPSS Real Time Conference 2003, Montreal, Canada, May 18-23 200

Diffusion tensor imaging and magnetic resonance spectroscopy assessment of cancellous bone quality in femoral neck of healthy, osteopenic and osteoporotic subjects at 3T: Preliminary experience.

We assessed the potential of diffusion tensor imaging (DTI) in combination with proton magnetic resonance spectroscopy ((1)H-MRS), in cancellous bone quality evaluation of the femoral neck in postmenopausal women. INTRODUCTION: DTI allows for non-invasive microarchitectural characterization of heterogeneous tissue. In this work we hypothesized that DTI parameters mean diffusivity (MD) and fractional anisotropy (FA) of bone marrow water, can provide information about microstructural changes that occur with the development of osteoporosis disease. Because osteoporosis is associated with increased bone marrow fat content, which in principal can alter DTI parameters, the goal of this study was to examine the potential of MD and FA, in combination with bone marrow fat fraction (FF), to discriminate between healthy, osteopenic and osteoporotic subjects, classified according to DXA criteria. MATERIALS AND METHODS: Forty postmenopausal women (mean age, 68.7years; range 52-81years), underwent a Dual-energy X-ray absorptiometry (DXA) examination in femoral neck, to be classified as healthy (n=12), osteopenic (n=14) and osteoporotic (n=14) subjects. (1)H-MRS and DTI (with b value=2500s/mm(2)) of femoral neck were obtained in each subject at 3T. The study protocol was approved by local Ethics Committee. MD, FA, FF and MD/FF, FA/FF were obtained and compared among the three bone-density groups. One-way ANOVA with multiple comparisons Bonferroni test and Pearson correlation analysis were applied. Receiver operating characteristic (ROC) curve analysis was also performed. RESULTS: Reproducibility of DTI measures was satisfactory. CV was approximately 2%-3% for MD and 4%-5% for FA measurements. Moreover, no significant difference was found in both MD and FA measurements between two separate sessions (median 34days apart) comprised of six healthy volunteers. FF was able to discriminate between healthy and osteoporotic subjects only. Conversely MD and FA were able to discriminate healthy from osteopenic and healthy from osteoporotic subjects, but they were not able to discriminate between osteopenic and osteoporotic patients. A significant correlation between MD and FF was observed in healthy group only. A moderate correlation was found between MD and T-score when all groups together are considered. No significant correlation was found between MD and T-score within groups. A significant positive correlation between FA and FF was found in both osteopenic and osteoporotic groups. Vice-versa no correlation between FA and FF was observed in healthy group. A high significant positive correlation was found between FA and T-score in all groups together, in healthy and in osteoporotic groups. MD/FF and FA/FF are characterized by a higher sensitivity and specificity compared to MD and FA in the discrimination between healthy, and osteoporotic subjects. MD/FF vs FA/FF graph extracted from femoral neck, identify all healthy individuals according to DXA results. CONCLUSION: DTI-(1)H-MRS protocol performed in femoral neck seems to be highly sensitive and specific in identifying healthy subjects. A MR exam is more expensive when compared to a DXA investigation. However, even though DXA BMD evaluation has been the accepted standard for osteoporosis diagnosis, DXA result has a low predictive value on patients' risk for future fractures. Thus, new approaches for examining patients at risk for developing osteoporosis would be desirable. Preliminary results showed here suggest that future studies on a larger population based on DTI assessment in the femoral neck, in combination with (1)H-MRS investigations, might allow screening of high-risk populations and the establishment of cut-off values of normality, with potential application of the method to single subjects