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  1. Article ; Online: Reply to Letter to Editor: Abdominal CT: a radiologist-driven adjustment of the dose of iodinated contrast agent approaches a calculation per lean body weight.

    Zanardo, Moreno / Di Leo, Giovanni

    European radiology experimental

    2020  Volume 4, Issue 1, Page(s) 46

    Language English
    Publishing date 2020-09-22
    Publishing country England
    Document type Letter ; Comment
    ISSN 2509-9280
    ISSN (online) 2509-9280
    DOI 10.1186/s41747-020-00179-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: The environmental impact of energy consumption and carbon emissions in radiology departments: a systematic review.

    Roletto, Andrea / Zanardo, Moreno / Bonfitto, Giuseppe Roberto / Catania, Diego / Sardanelli, Francesco / Zanoni, Simone

    European radiology experimental

    2024  Volume 8, Issue 1, Page(s) 35

    Abstract: Objectives: Energy consumption and carbon emissions from medical equipment like CT/MRI scanners and workstations contribute to the environmental impact of healthcare facilities. The aim of this systematic review was to identify all strategies to reduce ... ...

    Abstract Objectives: Energy consumption and carbon emissions from medical equipment like CT/MRI scanners and workstations contribute to the environmental impact of healthcare facilities. The aim of this systematic review was to identify all strategies to reduce energy use and carbon emissions in radiology.
    Methods: In June 2023, a systematic review (Medline/Embase/Web of Science) was performed to search original articles on environmental sustainability in radiology. The extracted data include environmental sustainability topics (e.g., energy consumption, carbon footprint) and radiological devices involved. Sustainable actions and environmental impact in radiology settings were analyzed. Study quality was assessed using the QualSyst tool.
    Results: From 918 retrieved articles, 16 met the inclusion criteria. Among them, main topics were energy consumption (10/16, 62.5%), life-cycle assessment (4/16, 25.0%), and carbon footprint (2/16, 12.5%). Eleven studies reported that 40-91% of the energy consumed by radiological devices can be defined as "nonproductive" (devices "on" but not working). Turning-off devices during idle periods 9/16 (56.2%) and implementing workflow informatic tools (2/16, 12.5%) were the sustainable actions identified. Energy-saving strategies were reported in 8/16 articles (50%), estimating annual savings of thousand kilowatt-hours (14,180-171,000 kWh). Cost-savings were identified in 7/16 (43.7%) articles, ranging from US $9,225 to 14,328 per device. Study quality was over or equal the 80% of high-quality level in 14/16 (87.5%) articles.
    Conclusion: Energy consumption and environmental sustainability in radiology received attention in literature. Sustainable actions include turning-off radiological devices during idle periods, favoring the most energy-efficient imaging devices, and educating radiological staff on energy-saving practices, without compromising service quality.
    Relevance statement: A non-negligible number of articles - mainly coming from North America and Europe - highlighted the need for energy-saving strategies, attention to equipment life-cycle assessment, and carbon footprint reduction in radiology, with a potential for cost-saving outcome.
    Key points: • Energy consumption and environmental sustainability in radiology received attention in the literature (16 articles published from 2010 to 2023). • A substantial portion (40-91%) of the energy consumed by radiological devices was classified as "non-productive" (devices "on" but not working). • Sustainable action such as shutting down devices during idle periods was identified, with potential annual energy savings ranging from 14,180 to 171,000 kWh.
    MeSH term(s) Humans ; Carbon Footprint ; Radiology ; Tomography Scanners, X-Ray Computed ; Magnetic Resonance Imaging ; Europe
    Language English
    Publishing date 2024-02-29
    Publishing country England
    Document type Systematic Review ; Journal Article ; Review
    ISSN 2509-9280
    ISSN (online) 2509-9280
    DOI 10.1186/s41747-024-00424-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Reply to Letter to Editor

    Moreno Zanardo / Giovanni Di Leo

    European Radiology Experimental, Vol 4, Iss 1, Pp 1-

    Abdominal CT: a radiologist-driven adjustment of the dose of iodinated contrast agent approaches a calculation per lean body weight

    2020  Volume 2

    Keywords Abdomen ; Body composition ; Body weight ; Contrast media ; Tomography (x-ray computed) ; Medical physics. Medical radiology. Nuclear medicine ; R895-920
    Language English
    Publishing date 2020-09-01T00:00:00Z
    Publisher SpringerOpen
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article: Dual Energy X-ray Absorptiometry: Radiographer'S Role in Assessing Fracture Risk Assessment Tool (FRAX) Questionnaire Variables.

    Zanardo, Moreno / Mennini, Cinzia / Glielmo, Pierluigi / Fusco, Stefano / Albano, Domenico / Messina, Carmelo

    Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry

    2023  Volume 27, Issue 1, Page(s) 101458

    Abstract: Background: The FRAX® algorithm is a tool used to calculate the 10-year probability of fracture in patients with osteoporosis and is based the assessment of several risk factors. We assessed the performance and accuracy of the completion of the FRAX® ... ...

    Abstract Background: The FRAX® algorithm is a tool used to calculate the 10-year probability of fracture in patients with osteoporosis and is based the assessment of several risk factors. We assessed the performance and accuracy of the completion of the FRAX® anamnestic questionnaire by the radiographer without impact on the clinical workflow.
    Methodology: We evaluated the accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm before and after specific training. A total of 100 women were enrolled in the study. The radiographer preliminarily administered the FRAX® questionnaire to all subjects before the execution of the DXA examination. After the end of the examination, a radiologist administered the questionnaire to the patient. Women were divided into two groups: group A (pre-training) and group B (post-training). The radiographer in group A completed the FRAX® questionnaire for the patients before training. For group B, the same radiographer completed the FRAX® questionnaire after training. The results of the FRAX® questionnaire completed by radiographer were compared with that completed by the referring physician.
    Results: Before training, radiographer's accuracy ranged from 92% (question 7, alcohol consumption) to 36% (question 6, secondary osteoporosis). After training, accuracy values improved substantially, ranging from 100% to 92%. Analysis of the absolute values of FRAX® showed that in the pre-training group data tended to be overestimated by the radiographer, with both major and fractures probabilities being significantly higher when assessed by the radiographer (12% and 5.8%, respectively). After the training, there was a marked decrease in the variation between the FRAX® data calculated by the radiographer and the radiologist.
    Conclusions: The accuracy of fracture risk calculation by the radiographer using the FRAX® algorithm is significantly improved after a specific training period. This study demonstrates the importance of dedicated training radiographers on the FRAX® algorithm.
    MeSH term(s) Humans ; Female ; Absorptiometry, Photon ; Bone Density ; Risk Assessment/methods ; Osteoporosis/complications ; Fractures, Bone ; Risk Factors ; Surveys and Questionnaires ; Osteoporotic Fractures/diagnostic imaging ; Osteoporotic Fractures/etiology
    Language English
    Publishing date 2023-12-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2040951-5
    ISSN 1094-6950
    ISSN 1094-6950
    DOI 10.1016/j.jocd.2023.101458
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Bringing radiology to patient's home using mobile equipment: A weapon to fight COVID-19 pandemic.

    Zanardo, Moreno / Schiaffino, Simone / Sardanelli, Francesco

    Clinical imaging

    2020  Volume 68, Page(s) 99–101

    Abstract: Because of coronavirus disease 2019 (COVID-19) high contagiousness, it is crucial to identify and promptly isolate COVID-19 patients. In this context, chest imaging examinations, in particular chest x-ray (CXR), can play a pivotal role in different ... ...

    Abstract Because of coronavirus disease 2019 (COVID-19) high contagiousness, it is crucial to identify and promptly isolate COVID-19 patients. In this context, chest imaging examinations, in particular chest x-ray (CXR), can play a pivotal role in different settings, to triage in case of unavailability, delay of or first negative result of reverse transcriptase-polymerase chain reaction (RT-PCR), and to stratify disease severity. Considering the need to reduce, as much as possible, hospital admission of patients with suspected or confirmed infection, the use of mobile x-ray equipment could represent a safe approach. We picture a potential sequence of events, involving a team composed by a radiographer and a nurse, going to patient's home to perform CXR, nasopharyngeal swab (and, if needed, also a blood sample), with fast radiologist tele-reporting, and resulting patient management approach (home isolation or emergency room admission, when needed). This approach brings healthcare to patient's home, reducing the risk of infected subjects referring to family doctors' office or emergency departments, and strengthening community medicine while maintaining a strong connection with radiology departments.
    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus ; Coronavirus Infections ; House Calls ; Humans ; Pandemics ; Pneumonia, Viral ; Radiography, Thoracic/methods ; SARS-CoV-2 ; Telemedicine
    Keywords covid19
    Language English
    Publishing date 2020-06-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1028123-x
    ISSN 1873-4499 ; 0899-7071
    ISSN (online) 1873-4499
    ISSN 0899-7071
    DOI 10.1016/j.clinimag.2020.06.031
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Contrast-enhanced Mammography: A Systematic Review and Meta-Analysis of Diagnostic Performance.

    Cozzi, Andrea / Magni, Veronica / Zanardo, Moreno / Schiaffino, Simone / Sardanelli, Francesco

    Radiology

    2021  Volume 302, Issue 3, Page(s) 568–581

    Abstract: Background Contrast-enhanced mammography (CEM) is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. Purpose To perform a systematic review and meta-analysis of CEM diagnostic ... ...

    Abstract Background Contrast-enhanced mammography (CEM) is a promising technique for breast cancer detection, but conflicting results have been reported in previous meta-analyses. Purpose To perform a systematic review and meta-analysis of CEM diagnostic performance considering different interpretation methods and clinical settings. Materials and Methods The MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were systematically searched up to July 15, 2021. Prospective and retrospective studies evaluating CEM diagnostic performance with histopathology and/or follow-up as the reference standard were included. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Summary diagnostic odds ratio and area under the receiver operating characteristic curve were estimated with the hierarchical summary receiver operating characteristic (HSROC) model. Summary estimates of sensitivity and specificity were obtained with the hierarchical bivariate model, pooling studies with the same image interpretation approach or focused on the same findings. Heterogeneity was investigated through meta-regression and subgroup analysis. Results Sixty studies (67 study parts, 11 049 CEM examinations in 10 605 patients) were included. The overall area under the HSROC curve was 0.94 (95% CI: 0.91, 0.96). Pooled diagnostic odds ratio was 55.7 (95% CI: 42.7, 72.7) with high heterogeneity (τ
    MeSH term(s) Breast Neoplasms/diagnostic imaging ; Contrast Media ; Female ; Humans ; Mammography/methods
    Chemical Substances Contrast Media
    Language English
    Publishing date 2021-12-14
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Systematic Review
    ZDB-ID 80324-8
    ISSN 1527-1315 ; 0033-8419
    ISSN (online) 1527-1315
    ISSN 0033-8419
    DOI 10.1148/radiol.211412
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Reducing contrast agent residuals in hospital wastewater: the GREENWATER study protocol.

    Zanardo, Moreno / Cozzi, Andrea / Cardani, Rosanna / Renna, Laura Valentina / Pomati, Francesco / Asmundo, Luigi / Di Leo, Giovanni / Sardanelli, Francesco

    European radiology experimental

    2023  Volume 7, Issue 1, Page(s) 27

    Abstract: The potential enviromental impact of iodinated (ICAs) and gadolinium-based contrast agents (GBCAs) have recently come under scrutiny, considering the current nonselective wastewater treatment. However, their rapid excretion after intravenous ... ...

    Abstract The potential enviromental impact of iodinated (ICAs) and gadolinium-based contrast agents (GBCAs) have recently come under scrutiny, considering the current nonselective wastewater treatment. However, their rapid excretion after intravenous administration could allow their potential recovery by targeting hospital sewage. The GREENWATER study aims to appraise the effective quantities of ICAs and GBCAs retrievable from patients' urine collected after computed tomography (CT) and magnetic resonance imaging (MRI) exams, selecting ICA/GBCA per-patient urinary excretion and patients' acceptance rate as study endpoints. Within a prospective, observational, single-centre, 1-year framework, we will enrol outpatients aged ≥ 18 years, scheduled to perform contrast-enhanced CT or MRI, willing to collect post-examination urine in dedicated canisters by prolonging their hospital stay to 1 h after injection. Collected urine will be processed and partially stored in the institutional biobank. Patient-based analysis will be performed for the first 100 CT and 100 MRI patients, and then, all analyses will be conducted on the pooled urinary sample. Quantification of urinary iodine and gadolinium will be performed with spectroscopy after oxidative digestion. The evaluation of the acceptance rate will assess the "environmental awareness" of patients and will aid to model how procedures to reduce ICA/GBCA enviromental impact could be adapted in different settings. Key points • Enviromental impact of iodinated and gadolinium-based contrast agents represents a growing point of attention.• Current wastewater treatment is unable to retrieve and recycle contrast agents.• Prolonging hospital stay may allow contrast agents retrieval from patients' urine.• The GREENWATER study will assess the effectively retrievable contrast agents' quantities.• The enrolment acceptance rate will allow to evaluate patients' "green sensitivity".
    MeSH term(s) Humans ; Contrast Media ; Gadolinium/urine ; Hospitals ; Prospective Studies ; Reducing Agents ; Wastewater ; Observational Studies as Topic
    Chemical Substances Contrast Media ; Gadolinium (AU0V1LM3JT) ; Reducing Agents ; Wastewater
    Language English
    Publishing date 2023-05-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2509-9280
    ISSN (online) 2509-9280
    DOI 10.1186/s41747-023-00337-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The predictive role of right ventricular late gadolinium enhancement in patients with tetralogy of Fallot undergoing pulmonary valve replacement.

    Monti, Caterina Beatrice / Zanardo, Moreno / Capra, Davide / Lastella, Giulia / Guarnieri, Gianluca / Giambersio, Emilia / Pasqualin, Giulia / Sardanelli, Francesco / Secchi, Francesco

    European radiology experimental

    2023  Volume 7, Issue 1, Page(s) 9

    Abstract: Background: Our purpose was to evaluate the correlations between right ventricular (RV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in patients with tetralogy of Fallot (ToF) scheduled for pulmonary valve replacement (PVR) and ... ...

    Abstract Background: Our purpose was to evaluate the correlations between right ventricular (RV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) in patients with tetralogy of Fallot (ToF) scheduled for pulmonary valve replacement (PVR) and post-PVR functional data.
    Methods: We retrospectively reviewed ToF patients scheduled for PVR who underwent two CMR examinations at our institution, one before the procedure (CMR-0), including contrast-enhanced sequences, and one after the procedure (CMR-1). Functional left and RV data were obtained by segmenting short-axis stacks on both CMR examinations, and normalised variations were calculated by dividing differences between CMR-1 and CMR-0 by the intercurring time interval, whereas the RV scar burden was assessed on CMR-0 LGE sequences both semiquantitatively and quantitatively. Data were reported as median and interquartile range, differences were appraised with the Mann-Whitney U test, while correlations were assessed with Spearman's ρ.
    Results: Fifteen patients with a median age of 25 years (16-29), including 9 (60%) males, with a median time interval between CMR-0 and CMR-1 of 17 months (12-23), were retrospectively reviewed. The semiquantitative LGE score at CMR-0 was 7 (6-9), and LGE volume was 4.49 mL (3.70-5.78), covering 5.63% (4.92-7.00) of the RV. RV LGE score showed a moderate positive correlation with the normalised variation of RV stroke volume (ρ = 0.662, p = 0.007) and a borderline moderate positive correlation with the normalised variation of RV end-diastolic indexed volume (ρ = 0.513, p = 0.050).
    Conclusions: The assessment of RV LGE before PVR may provide insights on post-PVR functional data, potentially facilitating a patient-tailored treatment pathway.
    MeSH term(s) Male ; Humans ; Adolescent ; Young Adult ; Adult ; Female ; Tetralogy of Fallot/surgery ; Pulmonary Valve/surgery ; Contrast Media ; Gadolinium ; Retrospective Studies
    Chemical Substances Contrast Media ; Gadolinium (AU0V1LM3JT)
    Language English
    Publishing date 2023-02-24
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2509-9280
    ISSN (online) 2509-9280
    DOI 10.1186/s41747-023-00322-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Myocardial extracellular volume assessment at CT in hospitalized COVID-19 patients with regards to pulmonary embolism.

    Monti, Caterina Beatrice / Zanardo, Moreno / Capra, Davide / Folco, Gianluca / Silletta, Francesco / Secchi, Francesco / Sardanelli, Francesco

    European journal of radiology

    2023  Volume 163, Page(s) 110809

    Abstract: Purpose: To evaluate myocardial status through the assessment of extracellular volume (ECV) calculated at computed tomography (CT) in patients hospitalized for novel coronavirus disease (COVID-19), with regards to the presence of pulmonary embolism (PE) ...

    Abstract Purpose: To evaluate myocardial status through the assessment of extracellular volume (ECV) calculated at computed tomography (CT) in patients hospitalized for novel coronavirus disease (COVID-19), with regards to the presence of pulmonary embolism (PE) as a risk factor for cardiac dysfunction.
    Method: Hospitalized patients with COVID-19 who underwent contrast-enhanced CT at our institution were retrospectively included in this study and grouped with regards to the presence of PE. Unenhanced and portal venous phase scans were used to calculate ECV by placing regions of interest in the myocardial septum and left ventricular blood pool. ECV values were compared between patients with and without PE, and correlations between ECV values and clinical or technical variables were subsequently appraised.
    Results: Ninety-four patients were included, 63/94 of whom males (67%), with a median age of 70 (IQR 56-76 years); 28/94 (30%) patients presented with PE. Patients with PE had a higher myocardial ECV than those without (33.5%, IQR 29.4-37.5% versus 29.8%, IQR 25.1-34.0%; p = 0.010). There were no correlations between ECV and patients' age (p = 0.870) or sex (p = 0.122), unenhanced scan voltage (p = 0.822), portal phase scan voltage (p = 0.631), overall radiation dose (p = 0.569), portal phase scan timing (p = 0.460), and contrast agent dose (p = 0.563).
    Conclusions: CT-derived ECV could help identify COVID-19 patients at higher risk of cardiac dysfunction, especially when related to PE, to potentially plan a dedicated, patient-tailored clinical approach.
    MeSH term(s) Male ; Humans ; Middle Aged ; Aged ; Retrospective Studies ; COVID-19 ; Myocardium ; Tomography, X-Ray Computed/methods ; Heart Diseases ; Pulmonary Embolism/diagnostic imaging
    Language English
    Publishing date 2023-04-07
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 138815-0
    ISSN 1872-7727 ; 0720-048X
    ISSN (online) 1872-7727
    ISSN 0720-048X
    DOI 10.1016/j.ejrad.2023.110809
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: MRI-derived extracellular volume as a biomarker of cancer therapy cardiotoxicity: systematic review and meta-analysis.

    Folco, Gianluca / Monti, Caterina B / Zanardo, Moreno / Silletta, Francesco / Capra, Davide / Secchi, Francesco / Sardanelli, Francesco

    European radiology

    2023  Volume 34, Issue 4, Page(s) 2699–2710

    Abstract: Objectives: MRI-derived extracellular volume (ECV) allows characterization of myocardial changes before the onset of overt pathology, which may be caused by cancer therapy cardiotoxicity. Our purpose was to review studies exploring the role of MRI- ... ...

    Abstract Objectives: MRI-derived extracellular volume (ECV) allows characterization of myocardial changes before the onset of overt pathology, which may be caused by cancer therapy cardiotoxicity. Our purpose was to review studies exploring the role of MRI-derived ECV as an early cardiotoxicity biomarker to guide timely intervention.
    Materials and methods: In April 2022, we performed a systematic search on EMBASE and PubMed for articles on MRI-derived ECV as a biomarker of cancer therapy cardiotoxicity. Two blinded researchers screened the retrieved articles, including those reporting ECV values at least 3 months from cardiotoxic treatment. Data extraction was performed for each article, including clinical and technical data, and ECV values. Pooled ECV was calculated using the random effects model and compared among different treatment regimens and among those who did or did not experience overt cardiac dysfunction. Meta-regression analyses were conducted to appraise which clinical or technical variables yielded a significant impact on ECV.
    Results: Overall, 19 studies were included. Study populations ranged from 9 to 236 patients, for a total of 1123 individuals, with an average age ranging from 12.5 to 74 years. Most studies included patients with breast or esophageal cancer, treated with anthracyclines and chest radiotherapy. Pooled ECV was 28.44% (95% confidence interval, CI, 26.85-30.03%) among subjects who had undergone cardiotoxic cancer therapy, versus 25.23% (95%CI 23.31-27.14%) among those who had not (p = .003).
    Conclusion: A higher ECV in patients who underwent cardiotoxic treatment could imply subclinical changes in the myocardium, present even before overt cardiac pathology is detectable.
    Clinical relevance statement: The ability to detect subclinical changes in the myocardium displayed by ECV suggests its use as an early biomarker of cancer therapy-related cardiotoxicity.
    Key points: • Cardiotoxicity is a common adverse effect of cancer therapy; therefore, its prompt detection could improve patient outcomes. • Pooled MRI-derived myocardial extracellular volume was higher in patients who underwent cardiotoxic cancer therapy than in those who did not (28.44% versus 25.23%, p = .003). • MRI-derived myocardial extracellular volume represents a potential early biomarker of cancer therapy cardiotoxicity.
    MeSH term(s) Humans ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Cardiotoxicity/diagnostic imaging ; Cardiotoxicity/etiology ; Cardiotoxicity/pathology ; Magnetic Resonance Imaging ; Myocardium/pathology ; Biomarkers ; Neoplasms/diagnostic imaging ; Neoplasms/drug therapy ; Neoplasms/pathology ; Magnetic Resonance Imaging, Cine ; Predictive Value of Tests
    Chemical Substances Biomarkers
    Language English
    Publishing date 2023-10-12
    Publishing country Germany
    Document type Meta-Analysis ; Systematic Review ; Journal Article
    ZDB-ID 1085366-2
    ISSN 1432-1084 ; 0938-7994 ; 1613-3749
    ISSN (online) 1432-1084
    ISSN 0938-7994 ; 1613-3749
    DOI 10.1007/s00330-023-10260-8
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