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Portal venous aneurysm is a rare and potential dangerous vascular pathology, which can result in thrombosis or rupture. It may be congenital or acquired. Acquired form can be related mainly to portal hypertension, chronic hepatic disease, and trauma. We present a peculiar case of a congenital aneurysm involving the hepatic portal system in nearly all its extra-hepatic components: the main portal trunk, the spleno-porto-mesenteric confluence and the distal segment of splenic, superior, and inferior mesenteric veins, in a 20-year-old male patient. The aneurysm was complicated by massive thrombosis in absence of further predisposing factors.

We present a case of a middle-age male who presented in emergency room with nonspecific abdominal pain. A contrast-enhanced computer tomography (ceCT) scan showed a reduced perfusion of both adrenal glands. The clinical examinations and the laboratory tests were negative for an adrenal pathological process. To reassess the adrenal ischemia, a second ceCT scan was performed 5 days later showing an acute bilateral adrenal hemorrhage. These findings demonstrated that the previous adrenal hypoperfusion represented the prodromal manifestation of a hemorrhagic intraglandular process. This case suggests that adrenal hypoperfusion detected on tomographic imaging dictates a prompt clinical management finalized to strictly monitor the potential evolution towards a more aggressive pathological condition and confirms the pivotal role of imaging in the diagnosis of such uncommon disorder.

The approach presented in this paper provides effective protection of critical business processes by applying advanced SIEM technology in a rigorous fashion, based on the results of accurate risk assessment. The proposed SIEM tool advances the State of The Art of the technology along two axes, specifically: privacy and integrity. The advancements are achieved via combined use of two of the most promising technologies for trusted computing, namely: Trusted Execution Environment (TTE) and Homomorphic Encryption (HE). The approach is validated with respect to a real use case of a Smart Hospital (i.e., one where IT is massively used), with challenging security requirements. The use case is contributed by one of the major public hospitals in Italy. Experiments demonstrate that, by relying on continuous monitoring of security relevant events and advanced correlation techniques, the SIEM solution proposed in this work effectively protects the critical workflows of the hospital business processes from cyber-attacks with high impact (specifically: serious harm to or even death of the patient).

Medical and biomedical research fields are paying even closer attention to the health-related quality of life (HRQoL). Furthermore, having a precise snapshot of a subject’s daily life and of the related vital parameters (heart rate, ECG pattern, movement, sleeping habits, etc.) helps medical and social structures having a precise scenario of the elders. HRQoL is largely assessed by means of patient-reported outcomes (PROs), a flawed methodology if used for quality of life evaluation. Several kinds of biometrical parameters have been demonstrated to be significant in the evaluation of the HRQoL alongside with the PROs. It has also been shown that individual quality of life is tightly related to the patient frailty status (PFS). Pre-frail elders need a constant monitoring to catch any drift in their frailty markers for foretelling a possible shift in their PFS. A scalable hardware/software architecture has been realized with the aim of gathering vital parameters keeping low cumbersomeness. Systems should be able to gather, post-process and analyze monitored person’s vital parameters but, at the same time, patient therapies’ effectiveness can be constantly monitored and examined in deep. In the next future, the widely spreading of these systems will produce an huge quantity of structured, semi- or quasi-structured data. In order to reduce the complexity and manage such data, new storage techniques and new processing algorithms are desirable. Aim of this paper is to describe a novel architecture and an example of the algorithm to reduce the complexity of the non-structured data like a single-channel ECG.

The work presented in this paper aims to improve the security of Smart Hospitals, by proposing a practical approach and developing effective protection mechanisms and tools for cyber protection, with respect to the most critical asset categories in Smart Hospitals and focusing on the cyber-related issues most relevant for Smart Hospitals, and for the health care domain in general: system failures and human errors, insecurity of medical devices (including IoT) and their communications, employee-owned mobile devices (BYOD), and identity theft. The approach aims at mitigating threats against both active and passive medical devices, both large (e.g. radiotherapy and imagery) and small (wearable devices and sensors). The approach is presented with respect to a challenging use case, contributed by one of the major public hospitals of a European country. By relying on continuous monitoring of security relevant events, the proposed risk-containment approach supports Smart Hospitals in understanding the risks they are up against and in prioritizing them based on detailed context information. This results in an increased level of security across valuable assets as well as with respect to data exchange. It further supports Smart Hospitals in the management of the residual risk, by enabling them to estimate it and thus to negotiate with insurance companies additional coverage for it.

The last decade has witnessed an exponential increase in older adult population suffering from chronic life-long diseases and needing healthcare. This situation has highlighted a need to revolutionize healthcare and provide innovative, efficient, and affordable solutions to patients at any time and from anywhere in an economic and friendly manner. The recent developments in sensing, mobile, and embedded devices have attracted considerable attention toward mobile health monitoring applications. However, existing architectures aimed at facilitating the realization of these mobile applications have shown to be not suitable to address all these challenging issues: (i) the seamless integration of heterogeneous devices; (ii) the estimation of vital parameters not measurable directly or measurable with a low accuracy; (iii) the extraction of context information pertaining to the patient’s activity to be used for the interpretation of vital parameters; (iv) the correlation of physiological and contextual information to detect suspicious anomalies and supply alerts; (v) the notification of anomalies to doctors and caregivers only when their detection is accurate and appropriate. In light of the above, this paper presents a smart mobile, self-configuring, context-aware architecture devised to enable the rapid prototyping of personal health monitoring applications for different scenarios, by exploiting commercial wearable sensors and mobile devices as well as knowledge-based technologies. This architecture is organized as a composition of four tiers that operate on a layered fashion and it exploits an ontology-based data model to ensure intercommunication among these tiers and the monitoring applications built on the top of them. The proposed architecture has been implemented for mobile devices equipped with the Android platform and evaluated with respect to its modifiability by employing the ALMA (Architecture Level Modifiability Analysis) method, highlighting its capability of being rapidly customized, personalized or eventually modified by software developers in order to prototype, with a reduced effort, novel health monitoring applications on the top of its components. Finally, it has been employed to build, as case study, a mobile application aimed at monitoring and managing cardiac arrhythmias, such as bradycardia and tachycardia, confirming its effectiveness with respect to a real scenario.

PURPOSE: To assess the relationship between coronary atherosclerotic burden and vascular function in diabetic and nondiabetic patients after balancing for coronary risk factors. METHODS: We studied 672 patients without overt coronary artery disease and normal myocardial perfusion on stress 82Rb PET/CT imaging. To account for differences in baseline characteristics between diabetic patients and nondiabetic patients, we created a propensity score-matched cohort considering clinical variables and coronary risk factors. RESULTS: Before matching, diabetic patients had higher coronary artery calcium (CAC) scores (p

Recent improvements in image segmentation techniques enabled the (semi)automatic extraction of biostructures surfaces from 3D medical imaging data. The diffusion of 3D printing technologies promoted their introduction in the medical field, giving rise to several applications, such as the development of 3D-printed anatomical imaging phantoms. These devices provide controlled experimental environments for the improvement of medical imaging techniques, as they mimic the morphological and physiological features of different body parts. However, to obtain a 3D printable model from medical imaging data, different post-processing steps are needed, which require a considerable effort. Supports generation is often a critical task, as it requires to find the minimum amount of support structures necessary to hold a part in place during the printing process. This is particularly difficult for complex anthropomorphic models, for which a high printing level of detail, along with a reasonable number of internal supports, is usually needed. In this paper, an automatic method for the design of efficient support structures is proposed, which is suitable for 3D printing of complex anatomical phantoms, even with non-professional FDM 3D printers. A custom design software was developed, which places paraboloid-shaped shells to support all and only the critical points of the 3D model. This provided different advantages over support generation by means of common slicing software, allowing a reduction of material waste and printing times, along with an easier and faster dissolution of soluble supports for the clean-up of phantoms empty volumes.

Background Tasting is a complex process involving chemosensory perception and cognitive evaluation. Different experimental designs and solution delivery approaches may in part explain the variability reported in literature. These technical aspects certainly limit the development of taste-related brain computer interface devices. New Method We propose a novel modular, scalable and low-cost device for rapid injection of small volumes of taste solutions during fMRI experiments that gathers the possibility to flexibly increase the number of channels, allowing complex multi-dimensional taste experiments. We provide the full description of the hardware and software architecture and illustrate the application of the working prototype in single-subject event-related fMRI experiments by showing the BOLD responses to basic taste qualities and to five intensities of tastes during the course of perception. Results The device is shown to be effective in activating multiple clusters within the gustatory pathway and a precise time-resolved event-related analysis is shown to be possible by the impulsive nature of the induced perception. Comparison with Existing Method(s) This gustometer represents the first implementation of a low-cost, easily replicable and portable device that is suitable for all kinds of fMRI taste experiments. Its scalability will boost the experimental design of more complex multi-dimensional fMRI studies of the human taste pathway. Conclusions The gustometer represents a valid open-architecture alternative to other available devices and its spread and development may contribute to an increased standardization of experimental designs in human fMRI studies of taste perception and pave the way to the development of novel taste-related BCIs.

Patient monitoring outside the medical structure has been a challenge of great importance for the research community. Continuous monitoring is performed by means of massive machinery, requiring complex installation at the patient's premises, or cumbersome portable devices. Combining noninvasive wearable monitoring devices, based on patient's criticality, it is possible to obtain qualitative data to evaluate the patient's quality of life variation. In clinical environment it is possible to talk of Health Related Quality of Life (HRQoL). It can be defined as the physical, mental and social outcome of medical treatment and chronic disease. These effects can be measured not only through the patient's perception but also with objective evaluations on patient's physical status. Aim of this paper is to introduce a simple and pervasive methodology to monitor the QoL variation by means of two portable devices already available on the market: a Bluetooth Low Energy Activity Tracker (BLE-ACT) and a Bluetooth Loop and Event Recorder (BT-LER). Using objective qualitative measurements obtained via such devices that follow the Pervasive Computing Paradigm (Ubicomp), it is possible to Estimate the QoL variation.

Background Right insular cortex is involved in taste discrimination, but its functional organization is still poorly known. In general, sensory cortices represent the spatial prevalence of relevant features for each sensory modality (visual, auditory, somatosensory) in an ordered way across the cortical space. Following this analogy, we hypothesized that primary taste cortex is organized in similar ordered way in response to six tastes with known receptorial mechanisms (sweet, bitter, sour, salt, umami, CO2). Design Ten normal subjects were enrolled in a pilot study. We used functional magnetic resonance imaging (fMRI), a high resolution cortical registration method, and specialized procedures of feature prevalence localization, to map fMRI responses within the right insular cortex, to water solutions of quinine hydrochloride (bitter), Acesulfamate K (sweet), sodium chloride (salt), mono potassium glutamate + inosine 5' mono phosphate (Umami), citric acid (sour) and carbonated water (CO2). During an fMRI scan delivery of the solutions was applied in pseudo-random order interleaved with cleaning water. Results Two subjects were discarded due to excessive head movements. In the remaining subjects, statistically significant activations were detected in the fMRI responses to all tastes in the right insular cortex (p

PURPOSE: To evaluate the prognostic value of coronary atherosclerotic burden, assessed by coronary artery calcium (CAC) score, and coronary vascular function, assessed by coronary flow reserve (CFR) in patients with suspected coronary artery disease (CAD). METHODS: We studied 436 patients undergoing hybrid 82Rb positron emission tomography/computed tomography imaging. CAC score was measured according to the Agatston method, and patients were categorized into three groups (0

The prevalence and severity of obesity have increased over recent decades, reaching worldwide epidemics. Obesity is associated to coronary artery disease and other risk factors, including hypertension, heart failure and atrial fibrillation, which are all increased in the setting of obesity. Several noninvasive cardiac imaging modalities, such as echocardiography, cardiac computed tomography, magnetic resonance and cardiac gated single-photon emission computed tomography, are available in assessing coronary artery disease and myocardial dysfunction. Yet, in patients with excess adiposity the diagnostic accuracy of these techniques may be limited due to some issues. In this review, we analyze challenges and possibilities to find the optimal cardiac imaging approach to obese population.

The costs of healthcare administrations are continuously increasing and techniques able of reducing costs and optimizing systems are necessary. The use of information and communications technology (ICT), such as Bluetooth (BT) Activity Tracker (ACT) devices, can expand and improve the capabilities of the management structures. We propose to extend the application of this widespread technology even in the medical environment The aim of our work is to apply BT-ACTs for workflow management and patients' performance monitoring in a Radiation Oncology Department. Indeed, in such medical department working on outpatients based regimen, workflow and clinical control may be complex. Our preliminary experience in using ACT in a Radiation Oncology Department of an Academic Institution is described. The integration of ACT with a novel electronic medical record archiving and retrieving system is implemented. We show that using BT-ACT is possible to successfully monitor patient workflow and biometric data during radiation treatment.

To evaluate the tomographic features in differentiating benign from malignant splenic diseases, 54 patients with a cytohistological examination and a contrast-enhanced multidetector computed tomography (ce-MDCT) and/or positron emission tomography/computed tomography (PET/CT) were retrospectively selected. Significant associations were observed between ce-MDCT Pattern 3 (focal hyperdense lesion) and Pattern 4 (infarcts/cysts) as well as PET/CT Pattern 3 (focal photopenia/diffuse uptakeliver) and benign pathologies, and between ce-MDCT Pattern 1 (splenomegaly without focal lesions) and Pattern 2 (focal hypodense lesion) as well as PET/CT Pattern 1 (diffuse uptake ≥ liver) and Pattern 2 (focal increased uptake) and malignant diseases. No significant association between benign or malignant diseases and spleen volumes and maximum standardized uptake value (SUV(max)) as well as lesion characteristics was observed. The metabolic data do not improve the performance of morphological patterns.

AIM: To evaluate whether FDG-positron emission tomography (PET)/computed tomography (CT) may be an accurate technique in the assessment of the T stage in patients with colorectal cancer. METHODS: Thirty four consecutive patients (20 men and 14 women; mean age: 63 years) with a histologically proven diagnosis of colorectal adenocarcinoma and scheduled for surgery in our hospital were enrolled in this study. All patients underwent FDG-PET/CT preoperatively. The primary tumor site and extent were evaluated on PET/CT images. Colorectal wall invasion was analysed according to a modified T classification that considers only three stages (≤ T2, T3, T4). Assessment of accuracy was carried out using 95% confidence intervals for T. RESULTS: Thirty five/37 (94.6%) adenocarcinomas were identified and correctly located on PET/CT images. PET/CT correctly staged the T of 33/35 lesions identified showing an accuracy of 94.3% (95% CI: 87%-100%). All T1, T3 and T4 lesions were correctly staged, while two T2 neoplasms were overstated as T3. CONCLUSION: Our data suggest that FDG-PET/CT may be an accurate modality for identifying primary tumor and defining its local extent in patients with colorectal cancer.

Purpose: A prospective study was undertaken to evaluate radiotherapy techniques for Hodgkin's lymphoma, particularly focusing on dose homogeneity in the target and normal tissue sparing capability of manual forward planning methods using MLC- optimized field-in-field technique. Methods and materials: 10 patients with Hodgkin's lymphoma were evaluated. Two plans were imulated for each patient using 6 MV X-rays: a conventional multi-leaf (MLC) parallel-opposed (AP-PA) plan , and the same plan with additional MLC subfields (field-in-field technique, FIF). For plan comparison, the minimum, the maximum and the mean dose in the PTV and in critical organs (lungs, spinal cord, heart and thyroid) were evaluated. The Inhomogeneity Coefficient (IC), the normal tissue complication probability (NTCP) and toxicity parameters were also determined. Results: the PTV coverage resulted significantly improved with the FIF technique compared to the conventional one (mean ICFIF =0.31 vs mean ICap-pa = 0.40 , p

The paper aims to describe i) tracking patients in a radiology department using RFID technology ii) integrating location information with data stored in the Radiological Information System (RIS) in order to have a complete set of information about patients. The integration of medical information (such as reports) with images or other data, waiting time and queues, used drugs and so on, enables to optimize the department services and the management of the patient workflow. According to the Human-Centered Computing Paradigm, the RFID technology has been used as an integrated network of sensors that detect when a patient enters or leaves a department room, supporting the medical personnel in the diagnostic work and the hospital management in the department organization. Using data wharehouse techniques, the system can monitor and control patient flow in controlled area where radiofarmaceuticals are used.

The PACS is not a simple storage system dedicated to the radiology department but, in a wider point of view, it can be considered as a stone of a more complex structure consisting in a complete integration of the databases of the hospital. All systems must be designed to become a piece of a complete system, that connects together more hospitals and organizations and allows, to each member, sharing exam and information after, of course, the digital authoring process. In our hospital, there is a complex situation because, as what usually happens in reality in most healthcare facilities, PACS systems are installed in an environment where RIS and HIS are produced by different vendors and are based on different technologies. In order to realize an architecture to distribute information in a web environment, RIS, HIS and PACS need to be strictly interconnected. For this reason it was decided to design a flexible “Gateway Software” that we called “RadGate”, to interface PACS to preexisting systems and realize a seamless architecture to distribute images and information in a web environment.

Processing of Synthetic Aperture Radar (SAR) data can be implemented either in space domain or in transformed (spatial) frequency domain. The latter is the usual technique, due to availability of Fast Fourier Transform codes. However, for one bit coded signals direct space domain processing may be a very convenient alternative. It is noted that one bit coding does not impair amplitude and phase information, it the signal to noise ratio is small; and that processing of one bit coded sequences can be conveniently implemented by simple digital integrated circuits. A processor for one-bit coded SAR data has been designed for real-time operations: simulation and expected performance of this processor is presented.