diagnostic imaging


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2. DIAGNOSTIC IMAGING & RADIOTHERAPY 169 DIRECTOR OF DEPARTMENT HEADS OF DIVISION AND UNITEmilio Bombardieri, MD Daniele Vergnaghi, MD phone number: +39 02 2390 2220 Radiology and Diagnostic Imaging 1 &e-mail: emilio.bombardieri@istitutotumori.mi.it Magnetic Resonance UnitThe Department of Diagnostic Imaging and Radiotherapy is made up of sevenAlfonso Marchian, MDRadiology and Diagnostic Imaging 2 & Divisions and a number special units have been established within these Divisions: theComputed Tomography Unit Magnetic Resonance Unit in Diagnostic Radiology 1, the Computed Tomography Unit and the Intralesional Treatment Unit in Diagnostic Radiology 2, the Breast Imaging UnitFrancesco Garbagnati, MD and the Diagnostic and Interventional Gastroenterology Unit in Diagnostic Radiology 3, Intralesional Treatment Unitthe Clinical PET Unit and the Radiometabolic Therapy and Silvana Bergonzi, MD Endocrinology Unit in Nuclear Medicine. The technologies inRadiology and Diagnostic Imaging 3 & the area of diagnostic imaging (diagnostic radiology and nuclear Breast Imaging Unit medicine) provide not only morphologic information but alsoGuido Cozzi, MD functional parameters. The daily activity related to cancerDiagnostic and Interventional patients is structured in different steps: diagnosis of primaryGastroenterology Unit cancer, characterization, staging and restaging, treatmentEmilio Bombardieri, MD monitoring, and posttreatment follow-up. Besides diagnosticNuclear Medicine procedures, a large part of the activity of the Department is dedicated to cancer treatment. MRI research is carried out inEttore Seregni, MDNuclear Medicine Therapy and different fields: monitoring response to therapy, investigatingEndocrinology Unit patients with a high genetic risk of cancer, and developing software for imaging elaboration and quantitation. Flavio Crippa, MDClinical PET Unit Interventional radiology is an essential component of the scientific culture of INT and several trials are dedicated toPatrizia Olmi, MD central venous catheter placement, embolization and chemoembolization for regional Radiotherapy 1 cancer treatment, and new approaches with radiofrequency ablation. A multi-Carlo Fallai, MD institutional lung cancer screening program with low-dose spiral CT has involved Radiotherapy 2 Diagnostic Radiology Division. The Breast Imaging Unit is conducting studies on the surveillance of young women who previously underwent radiation therapy and on theRenato Marchesini, Physics DMedical Physics early diagnosis of breast cancer in women with a genetic predisposition. New diagnostic modalities such as elastosonography, a novel noninvasive technique, are under evaluation. The Interventional Gastroenterology Unit performs procedures such as percutaneous gastrojejunostomy, transluminal drainage of fluid collection, balloon 3. 170 SCIENTIFIC REPORT 2008 dilatation of stenoses, and palliative stenting. The Nuclear Medicine Division contributes to research activity with high technology modalities like PET/CT to image and better characterize cancer and develop new radiopharmaceuticals (positron- emitting products and radiolabeled peptides and antibodies). These radiopharmaceuticals are selective for tumor targeting and also for delivering killer radiation energy to the tumor mass by the administration of high activities of specific radioactive bullets. Dosimetric studies are of major interest in this area since the final goal of these efforts is to provide physicians with quantitative data about the absorbed dose to healthy organs (dose sparing) and tumor lesions (dose optimization to the target). External beam radiation therapy is focused on organ and function preservation, with the aim to deliver a higher total dose to the tumor and spare normal tissues as much as possible. In the Radiation Therapy Division this is obtained by techniques like 3D-conformal stereotactic intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), and brachytherapy with low and high dose rates. The newly acquired linear accelerators permit both online and offline treatment verification, which is especially needed for sophisticated techniques like IMRT and IGRT. High dose rate brachytherapy is also used in uterine cancer, biliary tract cancer and breast cancer. Several trials are addressing pediatric tumors. Research is ongoing on patients with bone metastases and solid tumors (thyroid cancer, rectal cancer, prostate cancer, soft tissue sarcomas, head and neck cancer). The Medical Physics group carries out studies on natural fluorescence spectroscopy of human blood plasma for cancer detection, and simulation of skin and melanocytic lesions with a melanoma-like phantom, mimicking the clinical decision-making related to pigmented skin lesions and implementation of the brachytherapy facility. This summary demonstrates that multidisciplinary interests continue to stimulate clinical studies and basic research, and this is due to the heterogeneity and interaction of the many components of the Department. 4. DIAGNOSTIC IMAGING & RADIOTHERAPY 171 RADIOLOGY AND DIAGNOSTIC IMAGING 1THE DIVISION OF DIAGNOSTIC RADIOLOGY 1 (RD1) INCLUDES THE UNIT OF MAGNETIC RESONANCE IMAGING (MRI). THE DIRECTOR OF DIAGNOSTIC RADIOLOGY IS ALSO THE HEAD OF THE MRI UNIT. In 2008 RD1 carried out 10,956 MRI scans and 36,529 conventional radiologicHEAD OF DIVISION examinations (chest, general bone, contrast radiology of kidney and urinary system). Daniele Vergnaghi, MD MRI was used for the diagnosis of primary cancer, tumor staging, treatment STAFF MEMBERS monitoring, and follow-up. The following new methodologies were improved:Alberto Laffranchi, MD; Paolo - DCE-MRI (dynamic contrast-enhancement magnetic imaging)Potepan, MD; Giovanna Trecate, MD;Antonella Messina, MD; Davide - Diffusion technologyScaramuzza, MD - Perfusion technology - Spectroscopy of prostate cancer and of breast cancer RADIOLOGY TECHNICIANS - Magnetic resonance urography and magnetic resonance cholangiopancreatography Valeria Tosi, RT; Carmelina Pannone,RT; Cinzia Fossaceca, RT; Tina and new technologies were established: Mastrostefano; Antonella Laturra, - Total body imaging RT; Nicola Puler, RT; Maurizio - MRI-guided breast biopsy.Zattoni, RT; Annunziata Gaetano, RT;Luca Musumeci, RT The research activity was focused on several institutional projects on: Multicenter surveillance of women with a high genetic or familial risk of breast cancer (in collaboration with the Istituto Superiore Sanit, Rome); Prostate project on the study of patients by means of diffusion and DCE-MRI evaluation and spectroscopy performed with endocoil; DCE-MRI applied to the evaluation of tumor response to specific treatments carried out in some of the clinical Units. RD1 continued its collaboration with the Department of Biomedical Engineering of the Polytechnic of Milan aimed at developing software for image elaboration. In detail, a project to evaluate the accuracy of both DCE-MRI and diffusion MRI for the diagnosis of rectal cancer relapse was developed. The project on prostate DCE-MRI achieved a high level of development. RD1 collaborated with several clinical Units of the Institute in order to integrate diagnostic imaging with clinical information and to monitor the response of primary cancer to traditional and novel treatment strategies. The radiologists worked in close 5. 172 SCIENTIFIC REPORT 2008 cooperation with the physicians of the Soft Tissue Sarcoma Unit, Pediatric Oncology Unit, Colorectal Surgery Unit, and Head and Neck Unit. The most relevant interest of the Division lies in the area of breast disease, with more than 650 breast MRI examinations performed each year. An experience spanning nearly 20 years makes the Division a national reference center for breast cancer. Important results were obtained in patients at high genetic risk for breast cancer and in patients previously submitted to plastic and reconstructive surgery.FIGURE 1Total Body Imaginga) T1 W imageb) T2 W fat satc) Fusion image between T1morfological e diffusion images.Arrows point pathologic tissuedue a myeloma disease. 6. DIAGNOSTIC IMAGING & RADIOTHERAPY 173 RADIOLOGY AND DIAGNOSTIC IMAGING 2WITHIN THE DIVISION OF DIAGNOSTIC RADIOLOGY 2 (RD2), TWO SPECIAL UNITS FOR SPECIFIC ACTIVITIES HAVE BEEN ESTABLISHED: THE UNIT OF COMPUTED TOMOGRAPHY AND THE UNIT OF INTRALESIONAL TREATMENT WITH RADIOFREQUENCY. THE DIRECTOR OF THE RD2 DIVISION ALSO LEADS THE UNIT OF COMPUTED TOMOGRAPHY. RD2 makes use of ultrasonography (US), computed tomography (CT), multifunctionalHEAD OF DIVISION fluoroscopy and digital angiography. Diagnostic oncology and interventionally-orientedAlfonso Marchian, MD radiology represent the daily activity. Inpatients and outpatients with cancer undergo a STAFF MEMBERS diagnostic workup, including the different steps of patient management: primary Francesco Garbagnati, MD; Enrico diagnosis, staging, follow-up and monitoring after surgical, chemotherapeutic and/orCivelli, MD; Giuseppe radiotherapeutic treatment. Di Tolla, MD; Laura F. Frigerio, MD; Rodolfo Lanocita, MD; Carlo Morosi, The interventional radiology activity includes long-term central venous catheterMD; Carlo Spreafico, MD placement, infusion chemotherapy, nutritional support, and infusional support. The selection and follow-up of candidates for liver transplantation are on the way, including CONSULTANTS Bruno Damascelli, MD perioperative standby for emergency diagnostic procedures related to transplant Gianluigi Patelli, MD salvage. All kinds of percutaneous biopsies are currently carried out. During 2008, 1,133 diagnostic vascular procedures, 313 interventional vascularRADIOLOGY TECHNICIANS Pietro Basile; Marilena Barbiero; procedures, about 500 long-term central venous catheter placements, 254 nonvascular Maria Ferrarello; Roberto Gallo; interventional procedures, an


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