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We reviewed chest radiographs of 57 HIV-infected patients with pulmonary diseases in whom Streptococcus pneumoniae was the sole respiratory pathogen isolated to evaluate whether highly active antiretroviral therapy (HAART) or bacteremia modify radiographic appearance. Pneumococcal lung disease presented as lobar pneumonia in 40% of the cases, 54% of whom were on HAART; as bronchopneumonia in 42%, 58% on HAART; as interstitial infiltrates in 17%, 60% on HAART. Bacteremia was observed 38 times in 23 patients with CD4 less than 200/[mm.sup.3], and in 15 with CD4 greater than 200/[mm.sup.3] (p > 0.05). HAART does not significantly influences radiographic appearances of lung disease caused by Streptococcus pneumoniae (p > 0.05). Immunosuppression induced by HIV infection was a major risk factor for development of pneumococcal lung disease (p = 0.04) and influences radiographic appearance; bronchopneumonia (p = 0.006), in particular multifocal (p = 0.008), which was more frequent in subjects with CD4 less than 200/[mm.sup.3]. Bacteremia influences radiographic appearance of pneumococcal lung disease; lobar pneumonia was more frequent (p = 0.003), and considering CD4 cell count, was more frequent if CD4 cell count was above 200/[mm.sup.3]. An original finding of this study was the frequency of interstitial changes. This pattern of pneumonia, found in 17% of our patients, could represent a difference between HIV-seropositive and -seronegative subject in displaying pneumococcal lung disease.

Abstract Background Computer Tomography (CT) is considered the gold standard for assessing the morphological changes of lung parenchyma. Although novel CT techniques have substantially decreased the radiation dose, radiation exposure is still high. Magnetic Resonance Imaging (MRI) has been established as a radiation- free alternative to CT for several lung diseases, but its role in infectious diseases still needs to be explored further. Therefore, the purpose of our study was to compare MRI with high resolution CT (HRCT) for assessing pulmonary tuberculosis. Methods 50 patients with culture-proven pulmonary tuberculosis underwent chest HRCT as the standard of reference and were evaluated by MRI within 24 h after HRCT. Altogether we performed 60 CT and MRI examinations, because 10 patients were also examined by CT and MRI at follow- up. Pulmonary abnormalities, their characteristics, location and distribution were analyzed by two readers who were blinded to the HRCT results. Results Artifacts did not interfere with the diagnostic value of MRI. Both HRCT and MRI correctly diagnosed pulmonary tuberculosis and identified pulmonary abnormalities in all patients. There were no significant differences between the two techniques in terms of identifying the location and distribution of the lung lesions, though the higher resolution of MRI did allow for better identification of parenchymal dishomogeneity, caseosis, and pleural or nodal involvement. Conclusion Technical developments and the refinement of pulse sequences have improved the quality and speed of MRI. Our data indicate that in terms of identifying lung lesions in non-AIDS patients with non- miliary pulmonary tuberculosis, MRI achieves diagnostic performances comparable to those obtained by HRCT but with better and more rapid identification of pulmonary tissue abnormalities due to the excellent contrast resolution.

Objectives: To perform an online survey aimed at evaluating the impact of COVID-19 on Italian radiology departments. Methods: We launched a survey composed of 25 questions about how COVID-19 has changed the safety and organization of daily activity in Italian radiology units. Results: A total of 2136/10,564 (20.2%) radiologists of the Italian Society of Medical and Interventional Radiology participated. Two-thirds performed at least one diagnostic/interventional procedure on COVID-19 patients. The 88.1% reported a reduction in the elective imaging volumes, with US, mammography, and MRI having shown the greater decrease (41.1%, 23.9%, and 21.1%, respectively). In 69.6% of cases, institutions had trouble getting personal protective equipment (PPE), especially public hospitals and southern institutions. Less than 30% of participants were subjected to RT-PCR swab test, although 81.5% believed that it should be done on all health workers and 70% suggested it as the most important measure to improve safety at work. Slightly more than half of participants declared to work safely and felt to be adequately protected by their institutions. Up to 20% of northern participants were redeployed to clinical services. The first imaging examination performed by admitted COVID-19 patients was chest radiography in 76.3% of cases. Almost half of participants reported that less than 30% of health workers were infected in their radiology department, with higher rates in northern regions and public institutions. Conclusions: This snapshot of the current situation in Italian radiology departments could be used to harmonize the organization of working activity in order to safely and effectively face this pandemic. Key Points: • More than two-thirds of institutions had trouble getting PPE for health workers, with public hospitals and southern institutions that presented more procurement problems • A substantial drop of imaging volumes was observed in the vast majority of Italian radiology departments, mostly due to the decrease of ultrasound, mammography, and MRI, especially in private practice were working activity was stopped in 13.3% of institutions • RT-PCR swab to health workers was reported as the most suggested measure by Italian radiologists to improve safety at work, as more than 80% of them believed that it should be performed to all health workers, although less than 30% were subjected to this test [ABSTRACT FROM AUTHOR]

Background: Computer Tomography (CT) is considered the gold standard for assessing the morphological changes of lung parenchyma. Although novel CT techniques have substantially decreased the radiation dose, radiation exposure is still high. Magnetic Resonance Imaging (MRI) has been established as a radiation- free alternative to CT for several lung diseases, but its role in infectious diseases still needs to be explored further. Therefore, the purpose of our study was to compare MRI with high resolution CT (HRCT) for assessing pulmonary tuberculosis., Methods: 50 patients with culture-proven pulmonary tuberculosis underwent chest HRCT as the standard of reference and were evaluated by MRI within 24 h after HRCT. Altogether we performed 60 CT and MRI examinations, because 10 patients were also examined by CT and MRI at follow- up. Pulmonary abnormalities, their characteristics, location and distribution were analyzed by two readers who were blinded to the HRCT results., Results: Artifacts did not interfere with the diagnostic value of MRI. Both HRCT and MRI correctly diagnosed pulmonary tuberculosis and identified pulmonary abnormalities in all patients. There were no significant differences between the two techniques in terms of identifying the location and distribution of the lung lesions, though the higher resolution of MRI did allow for better identification of parenchymal dishomogeneity, caseosis, and pleural or nodal involvement., Conclusion: Technical developments and the refinement of pulse sequences have improved the quality and speed of MRI. Our data indicate that in terms of identifying lung lesions in non-AIDS patients with non- miliary pulmonary tuberculosis, MRI achieves diagnostic performances comparable to those obtained by HRCT but with better and more rapid identification of pulmonary tissue abnormalities due to the excellent contrast resolution.

Purpose: Different evaluation systems and indicators have recently been used to measure the activity volumes of Italian hospital departments, and in particular of Diagnostic Imaging Units. These measurements have mostly been based on more or less complex and repeatable indicators such as total accesses, accesses per imaging modality, type and number of exams. The aim of this study was to compare four models for measuring and evaluating productivity to assess their features and propose a common method for measuring activity volumes in a Diagnostic Imaging Unit. The models considered are: a) the numerical count, b) the model proposed by SNR-SAGO-SIRM, c) the model based on transfer prices in use in the Emilia Romagna Region (RER), d) the model used by the U.S. Health Care Financing Agency (HCFA-USA), based on a complex system of weights named RVUs (Relative Value Units)., Materials and Methods: The period under review considers two years of activity (2000-2001) at our Diagnostic Imaging Unit. The data were collected by grouping the radiological procedures into homogeneous groups (macroaggregates) which were then assessed with the four models. The reference parameters considered in order to produce homogeneous data were: the number of procedures per physician hour, the score per hour according to the SNR-SAGO-SIRM model, the score per hour according to the RER model, the number of work-RVUs per hour worked. With regard to the HCFA-USA system, the following indicators were used: the work component (work-RVU), the insurance component (malpractice RVU) and the technical component (practice expense-RVU), the equivalent units of physician time (FTE: Full Time Equivalent), such as the number of procedures per FTE, the difficulty index, and the number of RVUs per FTE., Results: a) The total number of procedures was 55,884, the number of procedures per hour ranged from 2.43 (August 2000) to 4.20 (March 2000); based on the numerical count conventional radiology accounted for the most of the Unit's activity (40%). b) The total score according to the SNR-SAGO-SIRM model was 147,358; the weight of each physician hour ranged from 6.37 (August 2000) to 9.80 (October 2001). The SNR-SAGO-SIRM model indicates that the most significant macroaggregate in the Unit's activity was ultrasound (42%). c) The total score according to the RER model was 4,313,047, the weight of each physician hour varied between 159 (August 2000) and 316 (April 2000). Based on the RER model, CT (42%) accounted for most of the Unit's activity. d) According to the RVU model, the total number of work-RVUs was 37,619, and the physician weight per hour ranged from 1.45 (August 2000) to 2.86 (March 2000). The predominant method was ultrasound (35%); the number of total practice expense-RVUs was 192,749; the month with the highest score was March 2000 (9,398), while the one with the lowest score was August 2000 (4,710); the total number of malpractice RVUs was 9,940, and the months with the highest scores were April 2000 (487) and March 2000 (487), while the month with the lowest score was August 2000 (243), and the modality carrying the highest insurance risks was MRI (38%). We also calculated the number of procedures per FTE (6,141), the number of work-RVUs per FTE (4,134); the difficulty index resulting from the ratio between work-RVUs and number of procedures (0.67); the number of work-RVUs per hour worked (3.06)., Conclusions: Based on the numerical count, conventional radiology and ultrasound play a predominant role (40% and 34%, respectively, total 74%). This approach therefore fails to reflect the weight of more technologically advanced procedures. The SNR-SAGO-SIRM model gives adequate importance to the combination ''number- weight of patients'' among the macroaggregates analysed. The RER model rewards the use of more expensive technologies, as it assesses the overall weight of the service and not only the weight of the radiologist's activity. The RVU model, with its distribution of weights, differentiates the different work, cost, and insurance components of the macroaggregates. It also introduces an important aspect that is new to our professional and scientific culture: evaluation of the ''insurance component'', whose role will become increasingly important in Italy. The difficulty index (work-RVUs/no. of procedures), which expresses the ratio between the number of modalities and their complexity, is particularly interesting. This index, adjusted to reflect the Italian situation, might help to assess the true technological and scientific content of the department's activity.