This study optimized the ultrasound image of carotid artery stenosis using Taguchi dynamic analysis and an indigenous water phantom. Eighteen combinations of seven essential factors of the ultrasound scan facility were organized according to Taguchi’s L₁₈ orthogonal array. The seven factors were assigned as follows: (1) angle of probe; (2) signal gain; (3) resolution vs. speed; (4) dynamic range; (5) XRES; (6) zoom; (7) time gain compensation. An indigenous water phantom was customized to satisfy the quantified need in Taguchi’s analysis. Unlike the conventional dynamic Taguchi analysis, an innovative quantified index, the figure of merit (FOM), was proposed to integrate four specific quality characteristics, namely (i) average difference between the practical scan and theoretically preset area (78.5, 50.2 and 12.6 mm²) of stenosis, (ii) standard deviation of the average, (iii) practical scan’s sensitivity β to various stenosis diameters (10, 8, and 4 mm), and (iv) correlation coefficient r² of the linear regressed sensitivity curve. The highest value (FOM = 0.413) was furnished by the optimal combination of factors on 18 groups under study, yielding high r² and low β or standard deviation values and the best quality of ultrasound images for the further clinical diagnosis. The comparison between FOM and the conventional signal-to-noise (S/N) ratio in Taguchi’s analysis revealed that FOM compiled more quality characteristics that were superior by nature to fulfill the practical need in clinical diagnosis. The alternative choice in ultrasound scan optimization can be based on stenosis diameter variation from a different perspective to be explored in the follow-up study. Full article

Gamma rays have been extensively investigated for breast imaging using collimators; however, the coded-aperture technique needs to be investigated more. In this paper, we propose an experimental study and Geant4 simulations of MURA mask breast imaging. First, we compare the experimental data against the simulation results carried out using Geant4 (version 10.4) and accreditation phantom. Second, we virtually extend our work by changing the tumor-to-background (TBR) and lesion location parameters. We used ${}^{99m}Tc$ as a radioactive source. Good agreement has been seen for the benchmark stage, especially in terms of tumor localization. Moreover, the calculated full width at half maximum (FWHM) and contrast for decoded images (having average values of 8 and 3.5 for TBR between 2 and 10) permitted us to conclude that we can accurately localize small lesions up to lower TBR values by following the decoding procedure of deducing the image of a “blank phantom” (phantom with TBR = 1) every time within a matlab-based program. Hence, this work can be considered a continuously added value to previous investigations for scintimammography imaging. Full article

Background: Aim of the study was to test the accuracy of AI-based software for detection of large vessel occlusion (LVO) with computed tomography angiography (CTA) in stroke patients using an experienced neuroradiologist’s evaluation as the reference. Methods: Consecutive patients who underwent multimodal brain CT for suspected acute ischemic stroke were retrospectively identified. The presence and site (classified as proximal and distal) of LVO were assessed in CTA by an experienced neuroradiologist as a reference and compared to readings of three medical students and AI-based software, the e-CTA. Results: One-hundred-eight participants with a mean age of 70 years (±12.6); 55 (50.9%) females were included. Neuroradiologist found LVO in 70 (64.8%) cases: 45 (41.7%) proximal, and 25 (23.1%) distal. The overall sensitivity for e-CTA was 0.67 (95%CI 0.55–0.78); 0.84 (95%CI 0.71–0.94) for proximal, and 0.36 (95%CI 0.18–0.57) for distal LVOs. Overall specificity and accuracy for e-CTA were 0.95 (95%CI 0.82–0.99) and 0.77 (95%CI 0.68–0.84), respectively. The student’s performance was similar to e-CTA. Conclusions: The tested software’s performance is acceptable for the detection of proximal LVOs, while it appears to be not accurate enough for distal LVOs. Full article

The impressive results in terms of survival brought by immune checkpoint inhibitors (ICI) in metastatic malignant melanoma and the transformation of this disease with a poor prognosis into a chronic disease even with long-term survival cases have opened horizons for a new era in cancer treatments. Later, therapy with CTLA-4 and PD-1/PD-L1 inhibitors became standard in other solid tumors, especially in relapsed and metastatic settings. The PACIFIC clinical trial revolutionized the concept of consolidation immunotherapy after the favorable response to curative chemoradiotherapy in non-small cell lung carcinoma (NSCLC). Two new effects will govern the future of the immunotherapy–radiotherapy association: the local “in situ” vaccination effect and the systemic remote “abscopal” response. Even if stereotactic body irradiation (SBRT) or stereotactic radiosurgery (SRT) seems to be more effective in generating the synergistic effect, the PACIFIC trial demonstrates the role of conventional irradiation in combination with chemotherapy in modulating the host’s immune response. Thus, the radiotherapy–chemotherapy–immunotherapy triad may become the future standard in locally advanced disease. The different mechanisms of producing immune-mediated cell death and the indirect role of augmenting the immune effect induced by radiotherapy make the old theories related to the therapeutic sequence, fractionation, doses, and target volumes as well as the protection of healthy tissues to be re-evaluated. The new concept of immuno-radiotherapy in synergistic association has as its physiopathological substrate the dual immunosuppressive and enhancement of antitumor response to irradiation, including the activation of the immune effectors in the tumor microenvironment (TME). The choice of sequential treatment, a hypofractionated irradiation regime, and the possible omission of lymph node irradiation with the limitation of lymphopenia could tilt the balance in favor of the activation and potentiation of the antitumor immune response. The selection of therapeutic targets chosen for the combination of immunotherapy and associated radiotherapy can be conducted based on the classification of tumors in the three immune phenotypes that characterize “cold” and “hot” tumors from the point of view of the response to therapy. Full article