Journals
2026 EN
Jochems Sylvia H. J. · Vilahur Nadia · Tongeren Martie
+15 more
Occupational exposure to cancer‐causing agents is a major, yet preventable, contributor to cancer in Europe and globally. In the European Union (EU), cancer is responsible for nearly half of all work‐related deaths, underscoring the critical need for prevention measures. Effective strategies typically involve regulatory and workplace measures aimed at reducing or eliminating exposure risks. Raising awareness of hazardous workplace exposures is essential to empower individuals, foster a culture of prevention, and support effective regulation. The 5th edition of the European Code Against Cancer (ECAC5) includes a recommendation on how individuals can minimize their cancer risk and highlights the shared responsibilities of workers and employers for occupational safety and health: ‘Inform yourself about cancer‐causing factors at work and call on your employer to protect you against them. Always follow health and safety instructions at your workplace’. Key to ECAC5 is the addition of policy pointers at the governance level to support employers in taking preventive action and improving worker awareness. Strengthening regulatory frameworks and increasing awareness are crucial steps toward reducing the burden of occupational cancer.
Journals
2026 EN
Ringborg Ulrik · Braun Joachim · Celis Julio
+41 more
The cancer problem is expanding, particularly in low‐ and middle‐income countries (LMICs). Preventive measures can reduce the incidence by 40–50%, and cure rates have increased during the past decades in a number of cancers. However, optimizing prevention programmes and increasing cure rates of cancer remain significant research challenges. The main focus of the conference was on P4 Cancer Medicine (Predictive, Preventive, Personalized and Participatory), a comprehensive strategy encompassing Health‐Related Quality of Life (HRQoL) research, aiming to enhance the well‐being of patients and individuals at risk. Addressing the cancer problem requires two key elements: translational cancer research and the development of relevant infrastructures. A Comprehensive Cancer Centre (CCC) acts as an innovation hub by integrating high‐quality, multidisciplinary therapy and care, with healthcare‐dependent prevention, research, and education. The United States has been at the forefront, providing quality‐assured CCCs and the Cancer Moonshot for strategic cancer research. The EU has followed with the European Research Council for basic research, the European Innovation Council to boost disruptive innovation, and two EU initiatives on cancer, Europe's Beating Cancer Plan (EBCP) and the Mission on Cancer. The increasing complexity of cancer biology and technologies presents both a research challenge and a healthcare demand. For most patients, a CCC is not available. A critical discussion focused on quality assurance of healthcare outside the catchment area of a CCC and involving patients in clinical research. The strategic deployment of resources to support collective healthcare efforts and research aimed at reducing the cancer problem was discussed with representatives from the United States, EU, Africa, China, India and Taiwan. Analyses of translational cancer research have revealed important gaps in implementing innovations, assessment of clinical effectiveness, HRQoL, outcome and health economics research. The increased release of new anticancer agents over the last 25 years, accompanied by insufficient information on clinical benefits, presents both an economic and ethical problem. Direct healthcare costs have increased due to expenses for anticancer agents for the treatment of patients with incurable diseases. Evidence‐based treatment based on HRQoL research is an unmet need. Basic/preclinical research aimed at increasing the cure rate should identify new, broader targets for therapy and develop extended diagnostic technologies for stratifying patients, to inform innovative clinical trials. Present research strategies convert cancer to a chronic disease, a growing burden for the healthcare systems. The increasing complexity of cancer biology and technology, the growing need for translational cancer research, and the demand for supporting infrastructures underscore the importance of international collaborations between CCCs. However, funding for cancer research is not currently aligned to reduce the cancer problem. While public funding for cancer research doubled between 2005 and 2024, the pharmaceutical industry's spending on cancer research increased tenfold. Increasing funding by public and non‐profit funding organizations is mandatory. Education is another significant need, but it is currently fragmented and underfunded. The last session of the conference summarized the strategies in a Statement with a strong emphasis on global collaboration addressing the growing cancer burden and pronounced inequalities. Expanding partnerships and fostering innovative, multidisciplinary approaches to cancer prevention, therapeutics/care, as well as research, are not just urgent but essential steps towards reducing incidence, increasing cure rates and enhancing the well‐being of cancer patients. Data‐driven cancer medicine is currently under development, and modern communication technologies for diagnostics may facilitate interactions across geographical distances. A global cancer research agenda can become a model of solidarity, sustainability, and ethical responsibility.
Journals
2026 EN
Hoek Gerard · Tongeren Martie · Röösli Martin
+15 more
Most European Union (EU) residents live in areas where outdoor air pollution levels exceed the 2021 World Health Organization (WHO) air quality guidelines for fine particles and nitrogen dioxide. Outdoor air pollution is classified as carcinogenic to humans, and both outdoor and indoor air contain established human carcinogens, including diesel exhaust particulates, benzo(a)pyrene [B(A)P] and benzene. The European Code Against Cancer, 5th edition (ECAC5), incorporates recommendations for individuals and policymakers aimed at reducing the cancer burden from both outdoor and indoor air pollution. A critical step is aligning EU air quality limit values with the more stringent 2021 WHO guidelines. This should be complemented by integrated policy measures, including stricter regulation of combustion emissions, promotion of active and environmentally friendly transportation, incentives for cleaner energy sources for heating and cooking, and harmonization with broader EU climate initiatives. At the individual level, emissions and exposure may be reduced by limiting car use, avoiding second‐hand smoke, and refraining from burning wood or coal indoors or outdoors. Further exposure reduction may be achieved by limiting walking or cycling along heavily trafficked routes.
Journals
2026 EN
SánchezArtuñedo David · NavarroPalomas Paula · HermidaLópez Marcelino
+2 more
Abstract Purpose To determine the gamma criteria that maximize the sensitivity and specificity of the transit dosimetry software PerFRACTION (Sun Nuclear Corporation) under five possible failure modes in external beam radiotherapy. Methods We simulated five failure modes that potentially introduce large changes in the absorbed dose distribution: (1) Linac hardware incidents. In a VMAT head and neck treatment plan, erroneous plans were created, introducing known errors in the MLC aperture, the collimator angle, and the monitor units. (2) Breathing management protocol incidents. Based on a 4D‐CT of a lung treatment, we created expiration and inspiration CT images. A treatment plan was created using each CT and recalculated in the alternate CT. (3) Patient identification incidents. The treatment plan of one breast patient was recalculated on another patient, and vice versa. (4) Selection of the planning CT incidents. A lung patient had two planning CTs with the presence/absence of lung fluid. A treatment plan was generated for each CT and recalculated for the other. (5) Bolus positioning incidents. An erroneous treatment plan for a breast plan was created without the bolus. For the five failure modes, the transit images were compared using seven gamma criteria, both global and local. Receiver‐operating characteristic (ROC) curves were generated based on the change in the PTV mean dose: > 5%, > 10%, and > 20%. The area under the curve (AUC) and optimal passing rate were calculated. Results The global gamma criterion γ(10%/1 mm) maximizes PerFRACTION sensitivity and specificity to detect failure modes that introduce a change in the PTV mean dose exceeding 10%. The standard global gamma criterion, as γ(3%/3 mm), maximizes PerFRACTION sensitivity and specificity to detect deviations in the PTV mean dose above 5%. Conclusions A 10%, 1 mm global gamma parameter value produces the needed sensitivity and specificity to identify erroneous deliveries at a level of dose differences of 10% or greater.
Journals
2026 EN
Walker Christopher M. · Maldonado Maria G. · Jacobsen Megan C.
+9 more
Abstract Background As medical imaging demand grows, there is increasing stress on the currently available workforce to deliver consistent, high‐quality imaging studies while ensuring rapid study turnaround times and round‐the‐clock radiology coverage. Advances in remote access technology facilitating remote scan assistance and control are now commercially available to address these pressing clinical needs. Methods This work evaluated an early clinical application of a virtual scanner operations system (syngo Virtual Cockpit (VA13A, Siemens Healthineers, Erlangen, Germany) for remote magnetic resonance imaging (MRI) monitoring and scan control at three geographically distant outpatient sites associated with our primary institution. Results The system facilitated execution of technically complex oncologic MRI exams at these geographically distant clinics with no measurable impact on acquisition time compared to MR imaging performed at our primary hospital location. Additional operational improvements were realized with the use of the system, including remote staff training, technical assistance, and scanning during staff shortages. This early iteration of remote scanning had some limitations including limited utility for additional assistance in the scanning of those protocols that require complex physical setup. Moreover, connectivity issues were noted to be a limiting factor that contributed to operational delays. It was still necessary to have an onsite MRI technologist at the scanner console to interface with the patient and ensure safe operation. Conclusion Despite these limitations, our initial experience demonstrates that the use of remote MRI scanning support facilitates staffing flexibility while providing expanded patient access to oncology MRI services.
Journals
2026 EN
Yang Yunjie · Lim Seng Boh · Das Indra
+6 more
Abstract Background Accurate in vivo dosimetry is crucial for dose monitoring of cardiac implantable electronic devices (CIED) and for dose verification for special procedures such as total body irradiation (TBI) and total skin electron therapy (TSET). Purpose A new near real‐time in vivo dosimetry system using radiochromic films (RCF) is investigated for clinical use in megavoltage external beam radiotherapy. Methods The Pnt‐Dos™ in vivo dosimetry system comprises of a new type of RCF and a dedicated software module. Each Pnt‐Dos device is a small piece of RCF individually packed with a unique QR code for identification and record keeping. Different from the traditional film dosimetry workflow, where a film developing time of at least 16 hours is recommended, a near real‐time dose readout can be achieved with the Pnt‐Dos system using a novel calibration procedure. This involves an automated scanning process at user‐specified time intervals, utilizing auto‐region of interest (ROI) detection and triple‐channel calibration to capture the time‐resolved post‐irradiation growth. Two standard Epson scanner models (V600/13000XL) were used to cross‐validate readouts and accommodate users who may prefer to utilize existing 13000XL scanners rather than acquire an additional V600 for in vivo dosimetry. The dosimetric accuracy was evaluated over a range of 15–400 cGy. Angular dependence was studied in 45° increments over 360°, normalized to the response at 0°, at 250 cGy using a cylindrical phantom. Energy dependence was evaluated for four photon energies (6 MV, 6 MV FFF, 10 MV FFF, 15 MV) and five electron energies (6 MeV, 9 MeV, 12 MeV, 16 MeV, and 20 MeV). Long‐term reproducibility/stability were assessed with nine devices with different doses under identical conditions, alongside daily scans of quality control (QC) devices over three months. Results The system provides accurate dose measurements across high‐ and low‐dose ranges. All readings were within specification: accuracy was < ± 5 cGy for doses ≤ 80 cGy doses (max discrepancy 6.0 cGy), and < ± 5% for doses > 80 cGy on average (max discrepancy 5.1%). Angular dependence showed a maximum variation of 2.6% ± 2.1% when the beam passed through the posterior oblique side of the device. Daily QC/reproducibility tests confirmed system constancy of 0.1% average day‐to‐day variation. Energy dependence analysis revealed deviations of up to 4.9% ± 2.3% for all photon and electron energies compared to 6 MV photons, indicating the need for energy correction during commissioning. Film readings were compared with ion chamber measurements at 10 × 10 cm 2 , d max , 100 cm SAD (photons) or 100 cm SSD (electrons). Both scanners provided comparable readouts, within 1.3 cGy for doses ≤ 80 cGy and 0.6% for doses > 80 cGy. Based on these findings, user guidelines were established to ensure optimal performance and accuracy. Conclusion The new film‐based in vivo dosimetry system provides an automated workflow that enables consistent, time‐independent, and near real‐time readout with a user‐friendly design that simplifies handling and analysis, thereby streamlining in vivo dosimetry measurements. It also provides a traceable record of the patient dosimetry.
Journals
2026 EN
De Bartolo Maria Ilenia · Belvisi Daniele · Costanzo Matteo
+11 more
ABSTRACT Objectives In our previous study, we investigated in de novo PD patients salivary biomarkers targeting different molecular pathways, including alpha‐synuclein (a‐syn), tau pathology, autophagy (MAPLC3beta), and inflammation (TNFalpha). Here, we aimed to investigate longitudinal changes in these salivary biomarkers with the goal of assessing their dynamic changes over time and their predictive value for clinical progression. Methods A clinical and molecular 4‐year follow‐up (T1) was conducted on 43 PD patients of our previously molecularly characterized cohort of de novo PD patients (T0). Salivary levels of oligomeric and total a‐syn, pS199‐tau, total‐tau, activated MAP‐LC3beta, and TNFalpha were quantified using ELISA. Clinical assessments included motor and non‐motor symptom scales. The Wilcoxon test was used to verify molecular and clinical variations from T0 to T1; regression analysis to determine whether salivary biomarkers at T0 could predict clinical progression and Spearman's correlations to explore correlations between changes in molecular biomarkers and clinical scores. Results Oligomeric a‐syn and MAPLC3beta dramatically decrease, while total a‐syn, phosphorylated‐tau, total‐tau, and TNFalpha exhibited significantly higher levels from T0 to T1. Oligomeric and total a‐syn, phosphorylated and total‐tau at baseline predicted motor progression, while TNFalpha predicted non‐motor worsening. Significant correlations were found for MAPLC3beta, phosphorylated tau, and TNFalpha with motor and non‐motor scores, while no correlations emerged between a‐syn species and clinical scores both at T0 and T1. Interpretation Salivary biomarkers dynamically reflect PD progression and predict long‐term clinical outcomes. These findings support the use of saliva as a noninvasive, accessible source for predicting and monitoring disease progression in PD.
Journals
2026 EN
Franceschini Alessandro · Preziosa Paolo · Valsasina Paola
+5 more
ABSTRACT Objective Cognitive impairment, fatigue, and depression are common in multiple sclerosis (MS), potentially due to disruption of regional functional connectivity caused by white matter (WM) lesions. We explored whether WM lesions functionally connected to specific brain regions contribute to these MS‐related manifestations. Methods A total of 596 MS patients underwent 3T brain MRI acquisition, neurologic assessment, and neuropsychological evaluation (Brief Repeatable Battery, Modified Fatigue Impact Scale [MFIS], and Montgomery‐Åsberg Depression Rating Scale [MADRS]). Voxel‐wise lesion probability maps were compared between subgroups based on cognition, fatigue, or depression. Lesion distributions were linked to a brain functional connectivity atlas to map lesion network associations. Lesion network maps (LNMs) were then compared among subgroups ( p < 0.05, FWE‐corrected). Results One hundred twenty‐six (27.2%) MS patients were cognitively impaired and showed significantly more widespread WM lesions, more strongly functionally connected to bilateral hippocampi, thalami, cerebellum, and occipital cortices (corrected‐ p < 0.05) than cognitively preserved patients. Lesion networks were similar for impaired processing speed/attention. Verbal memory deficits were associated with WM lesions connected to parahippocampi, temporal pole, and cerebellum (corrected‐ p ≤ 0.05), while verbal fluency deficits involved connections to thalami, putamen, caudate nuclei, anterior cingulate cortex, and cerebellum (corrected‐ p ≤ 0.05). No significant lesion distribution or network connectivity differences were found in patients with visual memory deficits, fatigue (MFIS ≥ 38, 184/493 [37.3%]) or depression (MADRS > 9, 192/495 [38.8%]). Interpretation Regional WM lesions disrupting connections to the hippocampus, thalamus, cerebellum, and temporo‐occipital cortices contribute to cognitive impairment, but not fatigue or depression. LNM may clarify mechanisms underlying cognitive deficits in MS.
Journals
2026 EN
AmundsenHuffmaster Sommer L. · Chung Jae Woo · LinnEvans Maria E.
+9 more
ABSTRACT Objective People with Parkinson's disease (PD) and rapid eye movement (REM) sleep without atonia (RSWA) often have more severe gait disturbances compared to PD without RSWA. The association between the presence and expression of RSWA and the rate of progression of gait impairment in PD is unknown. This study examined the changes in spatiotemporal gait metrics over 3 years in people with mild‐to‐moderate PD (median 1.5 years since diagnosis at baseline) with (PD+RSWA, n = 16) and without RSWA (PD‐RSWA, n = 14), and matched controls ( n = 16). Methods Steady‐state gait metrics were obtained using a pressure‐sensitive walkway at baseline and 3‐year follow‐up. RSWA scores were measured from electromyographic recordings during video‐based polysomnography at baseline. Linear mixed models tested for the effects of visit, group, side (less vs. more affected), and their interactions. In people with PD, Spearman's correlations examined the relationship between baseline RSWA scores and the change in gait metrics. Results Stride velocity variability was larger in PD+RSWA, compared to PD‐RSWA and controls. Spatial and temporal measures of gait significantly worsened in both PD groups over 3 years. The PD+RSWA group showed a significantly larger decrement in step length ( p < 0.05; mean = 7.9%) compared to PD‐RSWA (2.6%) and controls (2.3%). Variability measures did not change significantly. In PD, the change in stride length correlated with chin RSWA scores at baseline. Interpretation RWSA in early PD may be a harbinger of a more rapid progression in gait impairment, characterized primarily by a shortening of steps.
Journals
2026 EN
Salih Hadi · Samadzadeh Sara · Bereuter Charlotte
+37 more
ABSTRACT Introduction Optical coherence tomography (OCT)‐derived retina measurements are markers for neuroaxonal visual pathway status. High‐quality OCT scans are essential for reliable measurements, but their acquisition is particularly challenging in eyes with severe visual impairment, as often observed in neuromyelitis optica spectrum disorders (NMOSD). Objective To investigate OCT quality issues in real‐world data from the international Collaborative Retrospective Study on Retinal OCT in Neuromyelitis Optica (CROCTINO). Methods We evaluated the quality of peripapillary and macular OCT scans, using Heidelberg Spectralis SD‐OCT, Carl Zeiss Cirrus HD‐OCT, or Topcon SD‐OCT across 22 centers. Experienced graders applied OSCAR‐IB criteria for OCT quality. Eyes were classified as severely visually impaired or not based on a 1.0 logMAR cut‐off. Quality outcomes were compared using the Chi‐square test. Results A total of 3075 OCT scans (1630 peripapillary, 1445 macular) from 539 people with NMOSD and related conditions were evaluated. Macular scans were rejected more often than peripapillary scans due to quality issues (20.1% vs. 14.5%, p < 0.001). Rejection rates were higher in eyes with severe visual impairment (peripapillary: 28.9%, macular: 41.6%) compared to eyes without severe visual impairment (peripapillary: 10.7%, p < 0.001; macular: 14.6%, p < 0.001). Conclusion Our study revealed that approximately one in six scans was rejected due to low quality, with higher rejection rates in eyes with severe visual impairment. As scan quality can bias quantitative outcomes and artificial intelligence applications, these findings emphasize the unmet need for standardized OCT practices tailored to NMOSD and other conditions involving severe visual impairment.