KEYWORDSUltrasonography; Chest; Radiograph; Computed tomography.Abstract Diagnosis of acute lung disease is a daily challenge for radiologists working in acutecare areas. It is generally based on the results of chest radiography performed under technically unfavorable conditions. Computed tomography (CT) is undoubtedly more accurate in these cases, but it cannot always be performed on critically ill patients who need continuous care. The use of thoracic ultrasonography (US) has recently been proposed for the study of acute lung disease. It can be carried out rapidly at the bedside and does not require any particularly sophisticated equipment. This report analyzes our experience with chest sonography as a supplement to chest radiography in an Emergency Radiology Unit. We performed chest sonography e as an adjunct to chest radiography e on 168 patients with acute chest pathology. Static and dynamic US signs were analyzed in light of radiographic findings and, when possible, CT. The use of chest US improved the authors' ability to provide confident diagnoses of acute disease of the chest and lungs.Sommario La patologia polmonare acuta rappresenta una sfida quotidiana per il Radiologo d'Urgenza, al quale è richiesto di porre una diagnosi sulla base di un radiogramma del torace, eseguito spesso in condizioni tecniche precarie. La Tomografia Computerizzata (TC), pur essendo uno strumento decisivo per ovviare alla scarsa accuratezza del radiogramma del torace, non sempre è eseguibile in questi pazienti che necessitano di assistenza continua. Recentemente è stato proposto l'impiego dell'ecografia toracica per lo studio della patologia acuta. L'esame è eseguito rapidamente al letto del paziente e non necessita di apparecchiature particolari. In 168 pazienti con patologia toracica acuta è stato eseguito uno studio ecografico del torace a completamento dell'esame radiologico. Sono stati valutati i segni statici e dinamici correlandoli ai quadri radiografici e, quando possibile, di TC. Nell'esperienza riportata l'impiego dell'ecografia del torace ha permesso di migliorare la confidenza diagnostica degli autori nella diagnosi radiologica delle patologie acute del distretto toraco-polmonare. ª

In projection radiography, two types of digital imaging systems are currently available, computed radiography (CR) and direct radiography (DR): a difference between them can be stated in terms of dose and image quality. In the Radiology Emergency Department of our hospital, a flat-panel DR equipment (Siemens Axiom Aristos FX) and two CR systems (Kodak CR-850) are employed. In 2006, five standard radiographic examinations (abdomen, chest, lumbar spine, pelvis, skull) were considered: doses delivered to patients in terms of both entrance skin dose (ESD) and effective dose (E) were calculated and compared in order to study the dosimetric discrepancies between CR and DR. Assessment of image quality is undertaken by Consultant Radiologists to ensure that the quality criteria for diagnostic radiographic images of the European guidelines were met. Results showed that both ESD and E in DR are lower than that in CR; all images met the criteria in the European Guidelines for both modalities and were used for reporting by the radiologists. Since the operators are the same and the image quality is comparable in both modalities, this study shows that in the considered examinations, DR can perform better than CR from a dosimetric point of view.

New flat-panel direct digital radiography equipment has recently been installed in our Accident and Emergency Department; its characteristics and versatility are well suited to the work undertaken in this environment. The aim of this study was to compare radiation doses to patients undergoing standard radiographic examinations using conventional screen-film radiography, computed radiography and direct digital radiography; entrance surface dose and effective dose were calculated for six standard examinations (a total of 10 projections) using standard patient exposure parameters for the three imaging modalities. It was found that doses for computed radiography (all examinations) were higher than the doses for the other two modalities; effective doses for direct digital radiography were approximately 29% and approximately 43% lower than those for screen-film radiography and computed radiography, respectively. The image quality met the criteria in the European guidelines for all modalities.

Generally, lowering tube potentials in chest examinations seems to allow better image quality/effective dose ratio when using digital equipment.

KEYWORDSProstate; Ultrasonography; Contrast media.Abstract Purpose: To evaluate the diagnostic performance of ultrasonography using secondgeneration contrast agent in the study of patients with focal prostate lesions and increased serum prostate-specific antigen (PSA) level. Materials and methods: Six consecutive patients (age range: 72e87 years) with increased PSA (4 ng/ml) underwent transrectal ultrasonography (TRUS) followed by contrast-enhanced ultrasonography (CEUS) with injection of second-generation contrast agent. All patients showed areas of abnormal echostructure suspicious for neoplastic lesions. On the basis of CEUS, a time/intensity curve of the suspected area was compared to that of a normalappearing distant area of the gland and to the results of biopsy of the hypoechoic area. Results: At CEUS two different patterns of enhancement were identified and considered to be significant: pattern 1 characterized by a rapid rise in the time/intensity curve of the suspected area compared with the normal gland. Two out of six patients had this pattern and biopsy showed cancer in the biopsied area. Pattern 2 was characterized by a similar rise in the time/intensity curve of the suspected area compared with the normal gland. Four out of six patients had this pattern and biopsy showed prostatitis in the biopsied area. Conclusions: CEUS using second-generation contrast agent can on the basis of time/intensity curves show differences in vascularization in normal and pathological tissue. Evaluation of the two patterns seems to be useful for identifying areas requiring biopsy, particularly when peripheral hypoechoic areas are observed at TRUS. Our data need to be confirmed in a larger patient population.Sommario Scopo: Determinare la performance diagnostica dell'ecografia con mezzo di contrasto di seconda generazione nello studio delle lesioni focali della prostata nei pazienti con elevati valori sierologici di antigene prostatico specifico. Materiali e metodi: Sei pazienti consecutivi (età 72e87 anni) con elevati valori di antigene prostatico specifico (4 ng/ml) sono stati sottoposti a ecografia transrettale tradizionale seguita da ecografia con mezzo di contrasto. In ogni paziente sono state identificate le aree periferiche di alterata ecostruttura sospette per lesione neoplastica. Queste aree sono state valutate con ecografia con mezzo di contrasto mediante curve di intensità/tempo. I dati ottenuti sono stati confrontati con la biopsia dell'area sospetta. Risultati: L'ecografia con mezzo di contrasto ha consentito di identificare due pattern distinti: pattern 1 caratterizzato da rapida elevazione della curva calcolata a livello della lesione rispetto all'intensità di impregnazione del parenchima adiacente. Due dei sei pazienti con questo pattern hanno dimostrato presenza di lesione neoplastica nell'area sottoposta a biopsia. Pattern 2 caratterizzato da scarsa elevazione della curva rispetto all'intensità dell'impregnazione del parenchima adiacente. I rimanenti 4 dei 6 pazienti esaminati avevano questo pattern e l...