Potential of artificial intelligence to generate health research reports of decayed, missed and restored teeth / Potencial de la inteligencia artificial para generar informes de investigación sanitaria sobre dientes cariados, perdidos y restaurados

Abstract This study aims to indicate the potential of artificial intelligence (AI) in epidemiological reports of decayed, missed and restored teeth. As a proof of concept our study model used panoramic x-ray images and an AI algorithm for tooth numbering, detection of the caries and restorations with accuracy over 80% for such diagnostic tasks. The output came as the number of decayed, missed and restored teeth according to patient's age and the DMFT index (number of decayed, missing, and filled teeth) which varied from 3.6 (up to 20 years old) to 20.4 (+60 years old). Thus, it is suggested that AI is a promising method to automate health data collection through the analysis of x-rays.

Resumen Este estudio tiene como objetivo indicar el potencial de la inteligencia artificial (IA) en los informes epidemiológicos de dientes cariados, perdidos y restaurados. Como prueba de concepto, nuestro modelo de estudio utilizó imágenes panorámicas de rayos X y un algoritmo de inteligencia artificial para la numeración de dientes, la detección de caries y las restauraciones con una precisión superior al 80 % para dichas tareas de diagnóstico. El resultado fue el número de dientes cariados, perdidos y restaurados según la edad del paciente y el índice CPOD (número de dientes cariados, perdidos y obturados) que varió de 3,6 (hasta 20 años) a 20,4 (+60 años). Por tanto, se sugiere que la IA es un método prometedor para automatizar la recopilación de datos de salud mediante el análisis de rayos X.

Diagnostic approach to a rare case of anaplastic meningioma with osteosarcomatous differentiation and associated bone alterations

Anaplastic meningioma with osteosarcomatous differentiation is a very rare finding. We herewith present squash cytology, histopathology and immunohistochemistry findings of this rare case with systematic approach to diagnosis. A 38-year-old female presented with complaints of headache, vomiting, seizure with loss of consciousness and left side weakness. Radiologically, there was a heterogeneous hyperintense likely extra axial densely calcified solid lesion measuring approximately 4.2�1�5 cm along right high frontal convexity compressing the adjacent brain parenchyma. Histology sections revealed fibro collagenous tissue, devitalized bone, multiple vascular spaces lined by fibrous septa with giant cells, along with spindle cell and round proliferation at one end with vague whorl formation. High mitosis, (>20/10 hpf) along with malignant lacy osteoid closely abutting the highly pleomorphic cells were indicative of a malignant spindle cell neoplasm with osteosarcomatous differentiation. Systematic approach, immunohistochemistry with involvement of all the specialities involved led to the correct diagnosis and management of patient.

Role of multidetector computed tomography and magnetic resonance imaging in evaluation of buccal mucosal neoplasms

Background: Buccal mucosa cancers are increasingly common among younger individuals, primarily due to tobacco usage. Accurate staging is essential for effective treatment planning. This study evaluates the role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in assessing buccal mucosa neoplasms. Methods: This prospective study included 25 patients from Great Eastern medical school and hospital over a 12-month period. All patients underwent initial clinical examination followed by CT and MRI scans. CT scans were conducted using a GE 16-slice MDCT scanner, and MRI scans were performed with a 1.5-T unit. Imaging results were correlated with histopathological findings. The TNM classification system was used for disease staging. Results: CT and MRI demonstrated high sensitivity (98%) in detecting bone erosion and invasion into the infratemporal fossa. MDCT effectively identified the extent of bone involvement, while MRI provided detailed soft tissue contrast, aiding in the evaluation of surgical outcomes. Imaging accurately identified key features impacting staging and treatment, including involvement of the retromolar trigone, tongue, masticator space, bones, neurovascular bundles, lymph nodes, and distant metastases. Conclusions: MDCT and MRI are non-invasive, cost-effective tools critical for the staging and management of buccal mucosa cancer. Early and accurate imaging significantly improves treatment planning and prognostication. Both modalities play complementary roles in assessing disease extent and guiding clinical decisions.

Prevalence of the Fabella and Determination of the Fabella Index / Prevalencia de la Fabela y Determinación del Índice Fabelar

SUMMARY: The fabella is a bony anatomical variable, which in humans is located posterior to the lateral condyle of the femur, in the tendinous portion of the lateral head of the gastrocnemius muscle. Its prevalence rate has been reported in different populations, ranging from 3% to 86%. This study aimed to create an index that classifies the fabella according to its dimensions, determine the prevalence of the fabella in the Colombian population, and identify possible differences according to the fabella index (FI), sex, age, laterality, and degree of fabellar degeneration. A retrospective study used 93 lateral knee radiographs belonging to Colombian individuals. A fabella index was established to classify fabellae into longifabellar, medifabellar, and equifabellar, and radiological classification was used to identify the degree of fabellar degeneration (DFD). The prevalence of fabella was 36.30 %, and this variant was associated with the individual's sex, with male subjects having 2.66 times the probability of presenting fabella. A higher prevalence of medifabellar fabellae (57.60 %) was observed, followed by longifabellar (24.20 %) and equifabellar (18.20 %). There was a positive and moderate correlation between the DFD and age. We consider that larger fabellae can cause entrapment of the common fibular nerve, compression of the popliteal artery, and tear of the medial meniscus, so the FI becomes relevant in clinical practice, providing information on the type of fabella and its associated pathological manifestations. This study introduces a novel fabella index and investigates the frequency of fabella in the Colombian population. The findings of this study will serve as a reference for future research and contribute to the field of knee orthopedics and surgery in this population.

La fabela es una variable anatómica ósea, que en humanos se localiza posterior al cóndilo lateral del fémur, en la porción tendinosa de la cabeza lateral del músculo gastrocnemio. Su tasa de prevalencia se ha reportado en diferentes poblaciones, cuyos valores oscilan entre 3 % y 86 %. El objetivo de este estudio fue crear un índice que clasifique la fabela según sus dimensiones, determinar la prevalencia de la fabela en población colombiana, así como identificar posibles diferencias en función del índice fabelar, sexo, edad, lateralidad y grado de degeneración de la fabela. Se desarrolló un estudio retrospectivo en el que se dio uso a 93 radiografías laterales de rodilla, pertenecientes a individuos colombianos. Se estableció un índice fabelar que clasificó las fabelas en longifabelares, medifabelares y equifabelares, además utilizamos la clasificación radiológica para identificar los grados de degeneración fabelar (GDF). La prevalencia de la fabela fue del 36,30 %, se encontró asociación de esta variante al sexo del individuo, siendo los hombres quienes tuvieron 2,66 veces más probabilidades de presentar la fabela. Se observó mayor prevalencia de fabelas tipo medifabelar 57,60 %, seguido de tipo longifabelar 24,20 % y equifabelar 18,20 %. Hubo correlación positiva y moderada entre la edad y el grado de degeneración fabelar. Consideramos que las fabelas con mayores dimensiones podrían causar atrapamiento del nervio fibular común, compresión de la arteria poplítea y desgarro del menisco medial, por lo que el índice fabelar adquiere relevancia en la práctica clínica, al dar información del tipo de fabela y sus manifestaciones patológicas asociadas. El presente estudió es el primero en proponer un índice fabelar y la frecuencia de la fabela en población colombiana, por lo que servirá de referencia para futuras investigaciones, además de brindar un aporte al área traumatológica y quirúrgica de la rodilla en esta población.

Quiste paradental inflamatorio / Inflammatory paradental cyst

El quiste paradental es un quiste inflamatorio odontogénico (clasificación de la OMS, 1992), e incluye: el quiste paradental inflamatorio que ocurre en la presentación bucal o distal de un tercer molar mandibular erupcionado o parcialmente erupcionado, o de un canino erupcionado (primera descripción por Main en 1970); y el quiste bucal mandibular infectado que ocurre en la superficie bucal del segundo o primer molar mandibular en niños alrededor de 6-8 años de edad con antecedentes asociados de signos inflamatorios (Stoneman y Worth, 1983)(2). El propósito de este artículo es presentar seis casos de quistes paradentales en la zona del tercer molar inferior. Palabras claves: quistes inflamatorios, quiste paradental, quiste odontogénico, maxilar inferior, radiología (AU)

The paradental cyst is an odontogenic inflammatory cyst (WHO classification, 1992). It includes the inflammatory paradental cyst which occurs on the buccal or distal aspects of an erupted or partialy erupted third mandibular molar or of a canine (first description by Main in 1970)(1); and the mandibular infected buccal cyst which occurs on the buccal surface of the mandibular second or first molar in children around 6-8 years of age with an associated history of inflammatory signs (Stoneman and Worth, 1983)(2). The purpose of this paper is to present six cases of a paradental cyst in the third mandibular molar zone (AU)

Trauma craneoencefálico moderado y severo en un hospital del suroccidente de Colombia: factores clínico-radiológicos relacionados con la mortalidad / Moderate and severe traumatic brain injury in a hospital in southwest Colombia: Clinical radiological factors related to mortality

Resumen Introducción: El trauma craneoencefálico es una patología con altos índices de mortalidad, por lo que es de gran relevancia identificar los factores que inciden en ella. Materiales y métodos: Se elaboró un estudio analítico entre los años 2020 y 2021, donde se incluyeron pacientes con trauma craneoencefálico moderado y severo, se caracterizaron las variables más relacionadas con el pronóstico, como aspectos demográficos, clínicos y radiológicos, y se analizó la asociación entre la mortalidad y estas variables. Resultados: La mortalidad hospitalaria fue del 22,8 %, encontrando como variables relacionadas la frecuencia respiratoria, la anisocoria, el reflejo pupilar y la atención en unidad de cuidados intensivos (UCI), y como factor relacionado con supervivencia, el número de días de estancia hospitalaria. Discusión: La mortalidad por trauma craneoencefálico es más elevada en países de ingresos medianos y bajos, posiblemente en relación con una mayor cantidad de accidentes de tránsito y un acceso limitado a tratamientos. Los factores asociados en el estudio se respaldan con estudios previos y se subraya la importancia de las alteraciones pupilares en la evaluación del paciente. Conclusiones: Es fundamental un examen físico completo desde el momento del ingreso, pues hallar taquipnea, anisocoria, ausencia del reflejo pupilar o signos de choque, puede dictar el pronóstico. Aunque la literatura global se centra en la caracterización del TCE, este estudio subraya la necesidad de una mayor investigación sobre factores que permitan predecir cursos hospitalarios tórpidos con desenlaces fatales.

Abstract Introduction: Traumatic brain injury is a disease with high mortality rates, so it is highly relevant to identify the factors that affect it. Materials and methods: An analytical study was prepared between 2020 and 2021, which included patients with moderate and severe head trauma, characterized the variables most related to prognosis, such as demographic, clinical, and radiological aspects, and analyzed the association between mortality and these variables. Results: Hospital mortality was 22.8%, finding as conditions related to mortality the respiratory rate, anisocoria, pupillary reflex, ICU care and as a factor related to survival, the number of days of hospital stay. Discussion: Mortality due to traumatic brain injury is higher in low- and middle-income countries, possibly due to a higher incidence of traffic accidents and limited access to treatment. The factors identified in this study are consistent with previous research, emphasizing the importance of pupillary abnormalities in patient assessment. Conclusions: A comprehensive physical examination from the time of admission is crucial, as the presence of tachypnea, anisocoria, absence of pupillary reflex, or signs of shock can dictate prognosis. While global literature primarily focuses on characterizing traumatic brain injuries, this study underscores the need for further research on factors predicting protracted hospital courses with fatal outcomes.

Aspectos genéticos e imagenológicos de la enfermedad quística renal en pediatría: serie de casos / Genetic and radiological aspects of pediatric renal cystic disease: A case series

Las enfermedades quísticas renales son condiciones frecuentes cuya etiología puede ser muy heterogénea, por lo que se requiere un adecuado abordaje para su diagnóstico y manejo. El objetivo de este trabajo fue ilustrar parte del espectro de la enfermedad renal quística por medio de casos clínicos manejados en la Fundación Valle del Lili. Se describen 11 casos clínicos que incluyen enfermedades como displasia multiquística renal, enfermedad poliquística renal autosómica dominante y autosómica recesiva, entre otras. Las enfermedades quísticas renales varían en su presentación clínica, historia natural, hallazgos imagenológicos, bases genéticas y fisiopatológicas, por consiguiente, el enfoque diagnóstico y el manejo integral se debe realizar de forma individualizada y con un abordaje multidisciplinario.

Renal cystic diseases are common conditions whose etiology can be highly heterogeneous. They require a correct approach for adequate diagnosis and management. We aimed to illustrate part of the spectrum of renal cystic diseases through some clinical cases managed in our service. We describe 11 clinical cases including clinical entities such as renal multicystic dysplasia, and autosomal dominant and autosomal recessive polycystic renal disease, among other pathologies. Renal cystic diseases are heterogeneous in their clinical presentation, natural history, radiological findings, and genetic and pathophysiological basis. An integral clinical approach is needed to get a clear etiological diagnosis and offer adequate individualized care and follow-up for patients.

Evaluation of the root morphology of mandibular first premolars using cone-beam computed tomography in a peruvian population / Evaluación de la morfología radicular de primeros premolares mandibulares mediante tomografía computarizada de haz cónico en una población peruana

Introduction: The morphology of the root canal of the first premolars is not always the same and therefore a good knowledge of its dental anatomy is essential. Aim: To assess the morphology of roots and root canals of mandibular first premolars in a Peruvian population using cone-beam computed tomography (CBCT). Materials and Methods: This was a descriptive cross-sec-tional study. A total of 370 mandibular first premolars fulfilling the inclusion criteria were evaluated using CBCT, and the number of roots and root canals, the Vertucci's classification of root canal configuration, age, sex and side of the tooth were registered. Results: One and two roots were presented in 96.2% (n=356) and 3.8% (n=14), respectively, of the mandibular first premolars analyzed, and one canal was present in 67.6% (n=250) and two canals in 32.2% (n=119). A type I root canal configuration was found in 67.6% (n=250) of the cases followed by type V with 26.2% (n=97). A statistically significant association was found between the number of roots and canals (p<0.001) and age also had a significant influence on this variable (p=0.0043). Conclusions: The presence of one canal in mandibular first premolars is the most frequent, although there is a considerable prevalence of two in the population studied. The number of roots is associated with the number of canals, with age having a significant influence on these variables.

Introducción: La morfología del canal radicular de los primeros premolares no siempre es la misma y por ello es fundamental un buen conocimiento de su anatomía dental. Objetivo: Evaluar la morfología de las raíces y conductos radiculares de primeros premolares mandibulares en una población peruana mediante tomografía computarizada de haz cónico. Materiales y Métodos: Este fue un estudio transversal descriptivo. Se evaluaron mediante tomografías un total de 370 primeros premolares mandibulares que cumplían con los criterios de inclusión, y se registró el número de raíces y conductos radiculares, la clasificación de Vertucci de la configuración radicular, la edad, el sexo y el lado del diente. Se realizaron las pruebas de chi-cuadrado y una regresión logística binaria (p<0,05). Resultado: Se presentó una y dos raíces en el 96,2% (n=356) y 3,8% (n=14), respectivamente, de los primeros premolares mandibulares analizados, y un canal estuvo presente en el 67,6% (n=250) y dos canales en el 32,2% (n=119). Se encontró una configuración del conducto radicular tipo I en el 67,6% (n=250) de los casos seguido del tipo V con un 26,2% (n=97). Se encontró una asociación estadísticamente significativa entre el número de raíces y conductos (p<0.001) y la edad también influyó significativamente en esta variable (p=0.0043). Conclusión: La presencia de 1 canal en primeros premolares mandibulares es la más frecuente, aunque existe una prevalencia considerable de 2 en la población estudiada. El número de raíces está asociado al número de canales, teniendo la edad una influencia significativa en estas variables.

Asociación entre Calcificaciones del Complejo Estilohioideo y Síntomas Clínicos en Pacientes Atendidos en el Centro de Salud de la Universidad San Sebastián, Sede Santiago, Chile

Hoy en día es común recibir pacientes en la clínica odontológica relatando dolor uni o bilateral en la zona lateral de la cara, más específicamente en la zona de las ramas mandibulares. Este dolor puede ser muchas veces de origen dental, muscular masticatorio, de las articulaciones temporomandibulares, o incluso tonsilar. Debido a que las anteriores son patologías más frecuentes, muchas veces el clínico no considera que la causa de estos dolores podría estar asociada al síndrome de Eagle. Esta investigación se fundamentó en la necesidad de utilizar las radiografías panorámicas como herramienta para asociar dolores que no remiten a tratamientos convencionales a calcificaciones del complejo estilohioideo, muchas veces hallazgos radiográficos que no son comúnmente tomados en consideración por el clínico. El objetivo del estudio fue eterminar la asociación entre calcificaciones del complejo estilohioideo en radiografías panorámicas y sintomatología clínica dolorosa en pacientes del centro de salud de la Universidad San Sebastián, sede Santiago, Chile. Se realizó un estudio correlacional, analítico y retrospectivo en el Centro de Salud de la Universidad San Sebastián. Se tomó una muestra aleatoria de 815 radiografías y fichas clínicas asociadas, en las cuáles se analizó la presencia, tipo y ubicación de calcificaciones del complejo estilohioideo, así como, si los pacientes relataron sintomatología dolorosa asociable al Síndrome de Eagle. Posteriormente se realizó un análisis descriptivo, exploratorio e inferencial de asociación entre variables. El porcentaje de pacientes que presentó calcificaciones del complejo estilohioideo alcanzó un 85,4%, siendo la mayoría de tipo elongado (70,98%), seguida del tipo segmentado (26,72%) y muy por debajo el tipo pseudoarticulado (2,3%). Con respecto a la prevalencia de sintomatología la gran mayoría de los pacientes no presentó (96,32%), sin verse diferencias según sexo o edad. Por último, al realizar el análisis de asociación el valor de X 2 calculado fue de 3,171, menor al valor de X2 crítico tabulado de 3,841. Al obtener un X2 calculado menor a un X2 crítico tabulado se demostró que no existe una asociación entre la presencia de calcificaciones del complejo estilohioideo y sintomatología clínica asociada. Además, las prevalencias de calcificaciones y sus tipos no variaron según la edad o género, lo que no nos permitió establecer una relación causal entre las variables.

Nowadays it is very common to receive patients in the dental clinic reporting unilateral or bilateral pain in the lateral area of the face, more specifically in the mandibular rami area. The origin of this pain can often be dental, muscular, from the temporomandibular joint or even tonsillar. Because the named pathologies are more frequent, many times the clinician does not consider that the cause of this pain could be associated with Eagle syndrome. This research was based on the need to use panoramic radiographs as a tool to associate pain that does not refer to conventional treatments with calcifications of the stylohyoid complex, many times radiographic findings that are not commonly considered by the clinician. This correlational cross analytical study was carried out at San Sebastián University Health Center. A random sample of 815 radiographs and associated clinical records was taken, in which the presence, type and location of calcifications of the stylohyoid complex were analyzed, as well as whether the patients reported painful symptoms associated with Eagle syndrome. Subsequently, a descriptive, exploratory, and inferential analysis of association between variables was conducted. The percentage of patients who presented calcifications of the stylohyoid complex reached 85.4%, being the majority the elongated type (70.98%), followed by the segmented type (26.72%) and far below the pseudoarticulated type (2.3%). Regarding the prevalence of symptoms, the vast majority of patients did not present (96.32%), without seeing differences according to gender or age. Finally, when performing the association analysis, the calculated X2 value was 3.171, lower than the critical tabulated X2 value of 3.841. Obtaining a calculated X2 lower than a critical tabulated X2 showed that there is no association between the presence of calcifications of the stylohyoid complex and associated clinical symptoms. In addition, the prevalence of calcifications and their types did not vary according to age or gender, which did not allow us to establish a causal relationship between the variables.

Relationship between the Volume of the Upper Airways and the Mandibular Angle Analyzed in Computed Tomography Scans / Relação do Volume das Vias Aéreas Superiores com o Ângulo Mandibular Analisadas em Tomografias Computadorizadas

Several variables can influence the treatment and outcome of orthognathic surgery, one of which is the angle of the mandibular ramus. The objective of this study is to analyze the upper airways (UA) of patients prior to orthognathic surgery, using cone-beam computed tomography (CBCT) and to correlate their volume with the angle of the mandibular ramus. DICOM (Digital Image Communication in Medicine) images of a radiology clinic were used, with a survey of 124 full face CBCT scans, from 2015 to 2018, and the measurement of the total volume in mm³ through software. To obtain the values of the angle of the mandibular ramus, images obtained from medical reports were used, through morphological evaluation. The values were tabulated and subsequently statistical analysis was performed using the ANOVA test to assess the differences between the mean airway volumes (mm³) according to gender, age and mandibular ramus angle. However, the angle of the ramus did not influence the volume of the UA, but a greater average of UA volume was observed in male individuals and in individuals over 34 years of age. There is no evidence that it is possible to measure or predict the volume of the UA by evaluating the angle of the mandibular ramus. (AU)

Diversas as variáveis podem influenciar no tratamento e resultado de uma cirurgia ortognática, uma delas é o ângulo do ramo mandibular. O objetivo deste trabalho é analisar as vias aéreas superiores (VAS) de pacientes previamente à cirurgia ortognática, por meio de tomografia computadorizada de feixe cônico (TCFC) e correlacionar o seu volume com o ângulo do ramo mandibular. Foram utilizadas imagens DICOM (Comunicação de Imagens Digitais em Medicina) de uma clínica radiológica, com o levantamento de 124 exames de TCFC de face total, do ano de 2015 até 2018 e feita a mensuração do volume total em mm³ através de um software. Para a obtenção dos valores do ângulo do ramo mandibular foram utilizadas imagens obtidas através dos laudos médicos, mediante avaliação morfológica. Os valores foram tabulados e posteriormente feita a análise estatística com o teste ANOVA para avaliar as diferenças entre as médias de volume das vias aéreas (mm³) de acordo com o gênero, a idade e o ângulo do ramo mandibular. Contudo, o ângulo do ramo não influenciou no volume das VAS, mas uma maior média de volume de VAS foi observada nos indivíduos do gênero masculino e nos indivíduos acima de 34 anos. Não há evidências de que se é possível mensurar ou ter previsibilidade do volume de VAS, avaliando o ângulo do ramo mandibular. (AU)

La profesora Raquel Pérez González y el signo de la muela de cangrejo / Professor Raquel Pérez González and crab claw sign

La Dra. Raquel Pérez González, más conocida entre colegas, alumnos y compañeros de trabajo por "la profe Raquel", obtuvo el título de Medicina en el año 1976. Comenzó por vía directa la residencia de Radiología y obtuvo el título de especialista de primer grado en 1979. Se convirtió así, el Hospital Militar Central "Dr. Carlos J. Finlay", en la cuna de su formación profesional y en años posteriores, en la casa que la vio crecer, especialmente como maestra de numerosas generaciones de radiólogos e imagenólogos. Hoy reposan en el jardín del Departamento de Imagenología, parte de sus cenizas, custodiadas por el amor que fue capaz de cultivar. En el 2016, una paciente femenina de 60 años de edad, acudió a la consulta de gastroenterología, con dolor abdominal difuso. La radiografía de abdomen simple, anteroposterior, en posición acostado mostró, una imagen en "muela de cangrejo", visible al tomar el aire dentro del hemicolon transverso izquierdo, como contraste, el cual bordea por ese lado parcialmente, una opacidad de partes blandas, que se extiende desde el mesogastrio, hasta la fosa ilíaca derecha, donde se observa el signo del menisco. Los estudios de imágenes realizados, evidenciaron signos radiológicos típicos de invaginación por causa tumoral maligna. En varias ocasiones, la profesora Raquel utilizó la imagen de este caso, como pregunta en exámenes de promoción de residentes. La publicación de este caso constituye un homenaje a quien será siempre un paradigma de docente.

Dr. Raquel Pérez González, better known among colleagues, students and co-workers as "professor Raquel", obtained her degree in Medicine in 1976. She began her Radiology residency directly and obtained the title of first-class specialist degree in 1979. Thus, the Central Military Hospital "Dr. Carlos J. Finlay" is the cradle of her professional training and in later years, in her home where she saw her grow up, especially as a teacher to numerous generations of radiologists and imaging scientists. Today, part of her ashes rest in the garden of the Imaging Department, guarded by the love that she was able to cultivate. In 2016, a 60-year-old female patient attended the gastroenterology clinic with diffuse abdominal pain. The simple, anteroposterior abdominal x-ray, in the lying position, showed a "crab claw" image, visible when breathing into the left transverse hemicolon, as contrast, which partially borders on that side, a soft tissue opacity, which extends from the mesogastrium to the right iliac fossa, where the meniscus sign is observed. The imaging studies performed showed typical radiological signs of invagination due to malignant tumor. On several occasions, Professor Raquel used the image of this case as a question in resident promotion exams. The publication of this case constitutes a tribute to someone who will always be a paradigm of a teacher.

Orthopedic sports injuries: advanced imaging modalities, return-to-play criteria, and injury prevention

Orthopaedic sports injuries encompass a wide range of musculoskeletal conditions resulting from the physical demands of athletic activities. These injuries can vary from acute, such as sprains and fractures, to chronic overuse syndromes like tendinopathies. Prevalent due to the global enthusiasm for sports, they affect bones, muscles, tendons, ligaments, and joints. The etiology of these injuries is multifactorial, stemming from biomechanical stressors, training methods, genetics, and environmental conditions. Advanced imaging modalities like magnetic resonance imaging and Computed tomography have revolutionized the assessment and diagnosis of these injuries, aiding in treatment decisions and return-to-play criteria. Injury prevention is paramount and involves understanding intrinsic (athlete-related) and extrinsic (environmental) risk factors. Strategies include pre-participation screening, strength and conditioning programs, biomechanical analysis, neuromuscular training, proper equipment use, rule changes, education, and creating a safety-conscious culture. Effective prevention reduces the burden of these injuries. Treatment strategies range from conservative approaches to surgery, depending on the type and severity of the injury. Emerging trends in sports medicine, including biologic therapies and telemedicine, offer promising avenues for improved diagnosis and recovery. The holistic approach to orthopaedic sports injuries encompasses prevention, diagnosis, and treatment, ensuring athletes' well-being and longevity in their chosen sports.

Analysis of the trend of radiological diagnostic examination frequency and the related influencing factors / 中华放射医学与防护杂志

Objective:To investigate the trend of radiological diagnostic examination frequency and the related influencing factors in a general hospital in recent four years.Methods:The hospital information system and the radiology information system were used to collect the information on the numbers of the outpatients, the emergency patients, and the inpatients and the radiology examination information from 2019 to 2022. The examination frequency and proportion of various imaging equipment were counted by using the perspective table of data, and the examination items and the proportion of the radiological diagnostic examinations were calculated. The positive rates of the radiological examinations were measured from 2019 to 2022. The gender and age distribution of the patients were analyzed. Spearman correlation analysis was used to analyze the relationships between the numbers of the patients undergoing radiological examinations and the numbers of the outpatients, emergency patients and the inpatients.Results:The annual frequency of radiological diagnostic examinations from 2019 to 2022 were 307 306, 245 418, 317 250 and 325 625, respectively, with a total of 1 195 599. Among them, the proportions of CT, X-rays, bedside X-rays, bone density, gastrointestinal imaging and mammography were 59.74%, 38.04%, 1.39%, 0.42%, 0.21% and 0.19%, respectively. In each year, the proportion of CT in all radiological diagnostic examinations was 49.58%, 63.40%, 60.40% and 65.20%, respectively. The frequency of emergency CT and emergency chest CT was correlated with the number of emergency patients( r =0.63, 0.61, P<0.05), and the frequency of non-emergency CT was correlated with the number of outpatients and inpatients ( r =0.61, 0.66, P<0.05). The positive rates of the CT examinations were higher than 80% except the lowest of 79.95% in 2021. Conclusions:Radiological examinations especially CT examinations have increased significantly, and played an important role in the diagnosis of diseases. However, attention should be paid to the Justification of the CT examinations. Timely statistical analysis of radiological examination information can provide data supports and references for scientific management of radiological examinations.

Application of Monte Carlo simulation in radiation dose estimation and optimization for diagnostic radiology / 中华放射医学与防护杂志

The increasing frequency of radiographic diagnostic imaging and the cumulative dose to the public from radiation has raised widespread concerns. However, accurate measurement of the radiation dose received by the human body is difficult to achieve. Monte Carlo simulation, as a numerical computational method guided by probability statistics theory, has been applied to various dose assessments, imaging optimizations, and radiation protection in radiographic diagnostic imaging. We provide a comprehensive review of the principles of the Monte Carlo method, the modelling process of Monte Carlo simulation and the progress of its application to diagnostic radiological dose estimation.

Analysis of thyroid hormone indicators among interventionaland diagnostic radiologists / 预防医学

Objective@#To learn the levels of thyroid hormone indicators among interventional and diagnostic radiologists, so as to provide insights into occupational health monitoring of radiologists.@*Methods@#Demographic information, body mass index (BMI), thyroid hormone indicators and cumulative individual doses over 5 years among interventional and diagnostic radiologists were collected through the personal dosimetry monitoring database of Ningbo Center for Disease Control and Prevention and the Occupational Health Examination Center of a tertiary hospital in Ningbo City. The thyroid hormone indicators of different job types and cumulative individual doses over 5 years were analyzed, and factors affecting the thyroid hormone indicators were identified using a multivariable ordinal logistic regression model.@*Results@#There were 159 interventional and 159 diagnostic radiologists included, and the proportions of abnormal thyroid hormone indicators were 9.43% and 12.26%, respectively, with no statistically significant difference (P>0.05). The levels of triiodothyronine and free triiodothyronine in interventional radiologists were lower than those in diagnostic radiologists [(1.54±0.41) vs. (1.68±0.34) nmol/L, (5.13±1.07) vs. (5.55±0.87) pmol/L; both P<0.05]. The levels of triiodothyronine and free triiodothyronine were significantly different among radiologists with cumulative individual doses over 5 years of <1.5 mSv, 1.5-<3.0 mSv and ≥3.0 mSv [(1.69±0.31), (1.69±0.40) vs. (1.52±0.41) nmol/L, (5.60±0.83), (5.32±0.94) vs. (5.14±1.09) pmol/L; both P<0.05]. Multivariable ordinal logistic regression analysis identified BMI (<18.5 kg/m2, OR=0.111, 95%CI: 0.028-0.436) and cumulative individual doses over 5 years (<1.5 mSv, OR=6.259, 95%CI: 2.368-16.547) as the factors affecting triiodothyronine, and job types (diagnostic radiologists, OR=3.171, 95%CI: 1.529-6.574), BMI (18.5-<24.0 kg/m2, OR=0.393, 95%CI: 0.184-0.842), and gender (men, OR=3.449, 95%CI: 1.294-9.190) as the factors affecting free triiodothyronine.@*Conclusion@#Occupational exposure has a certain impact on the thyroid hormone indicators among interventional and diagnostic radiologists, and the main influencing factors include BMI, radiation dose, job type and gender.

Solutions based on three-dimensional technologies for the practice and teaching of biomedical sciences

Introduction: Three-dimensional printing is one of the technologies that promote change at an economic and social level, and one of the fundamental elements of industry 4.0. It has enormous potential for the future of medicine, establishing itself as a new paradigm. Despite its advantages, its use in our environment is incipient. Objective: To design and develop solutions based on three-dimensional technologies for the teaching and practice of biomedical sciences. Materials and methods: A technological development investigation was carried out between the Center for Assisted and Sustainable Manufacturing of the University of Matanzas and Matanzas University of Medical Sciences, between September 2019 and July 2022. The designs and fabrications were made from the acquisition of computed tomography images, or from a surface scanner, which were then processed, converted into Standard Tessellation Language format, printed, and post-processed. Virtual designs were developed using computer-aided design software. Results: Various solutions were developed including prototypes: biomodels for craniosynostosis repair and anatomical figures, custom cranial prosthesis mold, hand prosthesis, O2 line splitters, tissue scaffolds, syringe gun, face shields, breast prosthesis; autologous restoration mold and tissue expander. Conclusions: In all areas of application of this technology in medicine―except the printing of medicines, in the current context―, it is feasible to obtain solutions in the territory of Matanzas. It is therefore imperative that managers and the medical community in general, begin to acquire awareness, knowledge, and experience to ensure the optimal use of this technology.

Introducción: La impresión tridimensional es una de las tecnologías que promueve el cambio a nivel económico y social, y uno de los elementos fundamentales de la industria 4.0. Asimismo, constituye un enorme potencial para el futuro de la medicina, estableciéndose como un nuevo paradigma. A pesar de sus ventajas, su explotación en nuestro medio es incipiente. Objetivos: Diseñar y desarrollar soluciones basadas en tecnologías tridimensionales para la enseñanza y la práctica de las ciencias biomédicas. Materiales y métodos: Se realizó una investigación colaborativa, de desarrollo tecnológico entre el Centro de Fabricación Asistida y Sostenible de la Universidad de Matanzas y la Universidad de Ciencias Médicas de Matanzas, entre septiembre de 2019 y julio de 2022. Los diseños y fabricaciones se realizaron a partir de la adquisición de imágenes de tomografía computarizada, o desde un escáner de superficie, las que luego se procesaron, se convirtieron en formato Standard Tessellation Language, se imprimieron y posprocesaron. Los diseños virtuales se desarrollaron empleando un software de diseño asistido por computadora. Resultados: Se desarrollaron varias soluciones que incluyen varios prototipos: biomodelos para reparación de craneosinostosis y figuras anatómicas, molde de prótesis craneal personalizada, prótesis de mano, divisores de líneas de O2, andamios tisulares, pistola portajeringas, protectores faciales, prótesis de mama, molde para restauración autóloga y expansor tisular. Conclusiones: En todas las áreas de aplicación de esta tecnología en medicina―salvo en la impresión de medicamentos, en el contexto actual―, es factible obtener soluciones en el territorio de Matanzas. Es un imperativo, pues, que directivos y la comunidad médica en general, comiencen a adquirir conciencia, conocimientos y experiencias para garantizar la utilización óptima de esta tecnología.

Performance of ChatGPT on questions from the Brazilian College of Radiology annual resident evaluation test / Desempenho do ChatGPT nas questões da avaliação anual de residentes do Colégio Brasileiro de Radiologia

Abstract Objective: To test the performance of ChatGPT on radiology questions formulated by the Colégio Brasileiro de Radiologia (CBR, Brazilian College of Radiology), evaluating its failures and successes. Materials and Methods: 165 questions from the CBR annual resident assessment (2018, 2019, and 2022) were presented to ChatGPT. For statistical analysis, the questions were divided by the type of cognitive skills assessed (lower or higher order), by topic (physics or clinical), by subspecialty, by style (description of a clinical finding or sign, clinical management of a case, application of a concept, calculation/classification of findings, correlations between diseases, or anatomy), and by target academic year (all, second/third year, or third year only). Results: ChatGPT answered 88 (53.3%) of the questions correctly. It performed significantly better on the questions assessing lower-order cognitive skills than on those assessing higher-order cognitive skills, providing the correct answer on 38 (64.4%) of 59 questions and on only 50 (47.2%) of 106 questions, respectively (p = 0.01). The accuracy rate was significantly higher for physics questions than for clinical questions, correct answers being provided for 18 (90.0%) of 20 physics questions and for 70 (48.3%) of 145 clinical questions (p = 0.02). There was no significant difference in performance among the subspecialties or among the academic years (p > 0.05). Conclusion: Even without dedicated training in this field, ChatGPT demonstrates reasonable performance, albeit still insufficient for approval, on radiology questions formulated by the CBR.

Resumo Objetivo: Testar o desempenho do ChatGPT em questões de radiologia formuladas pelo Colégio Brasileiro de Radiologia (CBR), avaliando seus erros e acertos. Materiais e Métodos: 165 questões da avaliação anual dos residentes do CBR (2018, 2019 e 2022) foram apresentadas ao ChatGPT. Elas foram divididas, para análise estatística, em questões que avaliavam habilidades cognitivas de ordem superior ou inferior e de acordo com a subespecialidade, o tipo da questão (descrição de um achado clínico ou sinal, manejo clínico de um doente, aplicação de um conceito, cálculo ou classificação dos achados descritos, associação entre doenças ou anatomia) e o ano da residência (R1, R2 ou R3). Resultados: O ChatGPT acertou 53,3% das questões (88/165). Houve diferença estatística entre o desempenho em questões de ordem cognitiva inferior (64,4%; 38/59) e superior (47,2%; 50/106) (p = 0,01). Houve maior índice de acertos em física (90,0%; 18/20) do que em questões clínicas (48,3%; 70/145) (p = 0,02). Não houve diferença significativa de desempenho entre subespecialidades ou ano de residência (p > 0,05). Conclusão: Mesmo sem treinamento dedicado a essa área, o ChatGPT apresenta desempenho razoável, mas ainda insuficiente para aprovação, em questões de radiologia formuladas pelo CBR.

The dark side of T2: central nervous system lesions with low signal intensity on T2-weighted imaging / The dark side of T2: lesões do sistema nervoso central com baixo sinal em ponderações T2

Abstract The majority of central nervous system diseases show high signal intensity on T2-weighted magnetic resonance imaging. Diseases of the central nervous system with low signal intensity are less common, which makes it a finding that helps narrow the differential diagnosis. This was a retrospective analysis of brain and spine magnetic resonance imaging examinations in which that finding was helpful in the diagnostic investigation. We selected the cases of patients examined between 2015 and 2022. All diagnoses were confirmed on the basis of the clinical-radiological correlation or the histopathological findings. We obtained images of 14 patients with the following central nervous system diseases: arteriovenous malformation; cavernous malformation; metastasis from lymphoma; medulloblastoma; embryonal tumor; metastasis from melanoma; Rathke's cleft cyst; Erdheim-Chester disease; aspergillosis; paracoccidioidomycosis; tuberculosis; syphilis; immunoglobulin G4-related disease; and metastasis from a pulmonary neuroendocrine tumor. We described lesions of different etiologies in which the T2-weighted imaging profile helped narrow the differential diagnosis and facilitated the definitive diagnosis.

Resumo A grande maioria das doenças do sistema nervoso central apresenta alto sinal em ponderações T2 na ressonância magnética. As alterações com baixo sinal são menos comuns, de forma que essa característica permite estreitar o diagnóstico diferencial. Analisamos, retrospectivamente, pacientes com imagens de ressonância magnética de crânio e/ou coluna em que este achado foi útil na investigação diagnóstica. Os pacientes foram selecionados no período entre 2015 e 2022 e todos tiveram seus diagnósticos confirmados por estudo clinicorradiológico ou por estudo histopatológico. Obtivemos imagens de 14 pacientes com as seguintes afecções: malformação arteriovenosa, cavernoma, metástase de linfoma, meduloblastoma, tumor embrionário, metástase de melanoma, cisto da bolsa de Rathke, doença de Erdheim-Chester, aspergilose, paracoccidioidomicose, tuberculose, sífilis, doença relacionada à IgG4 e metástase de tumor neuroendócrino de pulmão. Descrevemos lesões de diversas origens etiológicas que, a partir de suas características nas imagens ponderadas em T2, foi possível reduzir o quadro de diagnósticos diferenciais e chegar mais facilmente à hipótese final.

Percepción de la inteligencia artificial en la comunidad radiológica argentina / Perception of artificial intelligence in the Argentine radiological community

Resumen Introducción: La aplicación de la inteligencia artificial (IA) en radiología se encuentra en fases iniciales y estaría influenciada por la percepción de sus usuarios. Objetivo: Valorar el grado de conocimiento, interés y expectativas acerca de la IA en la comunidad radiológica argentina. Método: Entre septiembre y noviembre de 2022 se distribuyó una encuesta online acerca del conocimiento, la actitud y las expectativas con respecto a la IA. Resultados: De un total de 161 encuestados, la mayoría eran mujeres (55,3%), tenían entre 31 y 40 años (43,4%), eran médicos de planta (42%), trabajaban en el ámbito privado (55,6%) y estaban localizados en la CABA/Buenos Aires (59%). El 52,5% no habían utilizado software de IA y el 87,7% no habían realizado cursos de IA. El 88,2% manifestaron interés en la formación en este campo. Casi la totalidad concordaba en que la IA modificaría su labor diaria en los próximos 10 años (87,6%), aunque no los reemplazaría (56,8%), ni cambiarían de carrera (69,8%). Conclusiones: Aunque el grado de conocimiento acerca de la IA en la comunidad radiológica argentina es moderado, encontramos un alto interés y expectativas, y un bajo nivel de miedo o rechazo. Las sociedades radiológicas argentinas deberían desarrollar cursos de formación en IA.

Abstract Introduction: The application of artificial intelligence (AI) in radiology is in early stages and could be influenced by the perception of its users. Objectives: To assess the degree of knowledge, interest, and expectations about AI in the Argentine radiological community. Method: Between September and November 2022, an online survey about knowledge, attitude and expectations of AI was distributed. Results: Of a total of 161 respondents, the majority were women (55.3%), had between 31 and 40 years old (43.4%), were staff physicians (42%), worked in the private sector (55.6%) and were located in CABA/Buenos Aires (59%). 52.5% had not used AI software and 87.7% had not taken any previous AI courses. 88.2% were interested in training in this field. Almost all agreed that AI would modify their daily work in the next 10 years (87.6%), although it would not replace them (56.8%), nor would they change their careers (69.8%). Conclusions: Although the degree of knowledge about AI in the Argentine radiological community is moderate, we found high interest and expectations, and low level of fear or rejection. Argentine radiological societies should develop AI training courses.