Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas / Atualização na avaliação por imagens dos sarcomas ósseos e das partes moles

Abstract The evolution in imaging evaluation of musculoskeletal sarcomas contributed to a significant improvement in the prognosis and survival of patients with these neoplasms. The precise characterization of these lesions, using the most appropriate imaging modalities to each clinical condition presented, is of paramount importance in the design of the therapeutic approach to be instituted, with a direct impact on clinical outcomes. The present article seeks to update the reader regarding imaging methodologies in the context of local and systemic evaluation of bone sarcomas and soft tissues.

Resumo A evolução na avaliação por imagens dos sarcomas musculoesqueléticos contribuiu para melhora significativa no prognóstico e na sobrevida dos portadores destas neoplasias. A caracterização precisa destas lesões, mediante utilização das modalidades de imagem mais adequadas a cada condição clínica apresentada, é de suma importância no delineamento da abordagem terapêutica a ser instituída, com impacto direto sobre os desfechos clínicos. O presente artigo busca atualizar o leitor a propósito das metodologias de imagem no contexto da avaliação local e sistêmica dos sarcomas ósseos e das partes moles.

Prevalence of soft tissue calcifications in the maxillofacial region: a radiographic study

Aim: To evaluate the prevalence of soft tissue calcifications in orofacial region and their panoramic radiographic characteristics using digital panoramic radiographs among patients reporting to a tertiary dental hospital. Methods: 1,578 digital panoramic radiographs were retrieved from the archives and scrutinized for the presence of calcifications. Soft tissue calcifications were recorded according to age, gender, site (left or right). Data were analysed using Chi-square and Fisher's exact test using SPSS software and a p < 0.05 was considered statistically significant. Results: Among the total number of radiographs, calcified carotid artery (34.3%), calcified stylohyoid ligament (21%), tonsillolith (10.3%), phlebolith (17.6%), antrolith (6.3%), sialolith (5.9%), rhinolith (2.5%) and calcified lymph nodes (1.9%) were identified. The most commonly observed calcifications were calcification of carotid artery and stylohyoid ligament and the least commonly observed calcifications were rhinolith and calcified lymph node. A statistically significant association of the presence of calcifications of carotid artery and stylohyoid ligament on the left and right side was observed in females and tonsillolith on the right side in males (p-value < 0.05). Considering the gender and age group, the occurrence of antrolith among males and rhinolith among females of young-adult population, tonsillolith among the males, calcified carotid artery and stylohyoid ligament among the females of middle-aged population was found to be significant. Conclusion: Soft tissue calcifications are often encountered in dental panoramic radiographs. Our study revealed that the soft tissue calcifications in orofacial region were more common in women and were found to be increased above 40 years of age

Avaliação por imagem de medidas esplênicas e tímicas como biomarcadores de resposta em pacientes com câncer tratados com imunoterapia / Imaging evaluation of thymic and splenic measurements as response biomarkers in cancer patients treated with immunotherapy

INTRODUÇÃO: Em menos de duas décadas, a imunoterapia consolidou-se como um dos pilares do tratamento do câncer. Apesar da sua potencial elevada eficácia e resposta duradoura, a proporção de pacientes que apresentam resposta objetiva é relativamente baixa e existem poucos biomarcadores para selecionar os pacientes com maior potencial de resposta. OBJETIVO: Nossa hipótese era de que era possível avaliar globalmente o sistema imune do paciente através da mensuração por imagem do timo e do baço e usar essas métricas como fator prognóstico e preditivo de resposta a bloqueadores de checkpoint. RESULTADOS: Os principais resultados foram: 1) As medidas tímicas não se correlacionam com a sobrevida em pacientes tratados com imunoterapia; 2) Há aumento do volume esplênico após o uso de imunoterapia na maior parte dos pacientes, mas o grau de aumento não se correlaciona com resposta à terapia; 3) Maior volume esplênico está associado a pior sobrevida livre de progressão em pacientes com melanoma tratados com imunoterapia, mas essa correlação não pôde ser replicada em outros tipos tumorais. CONCLUSÃO: a espessura tímica não se correlaciona com desfechos clínicos em pacientes oncológicos tratados com imunoterapia. Menor volume esplênico antes de iniciar imunoterapia está relacionada a melhor prognóstico em pacientes com melanoma, mas não em outros tipos tumorais.

INTRODUCTION: In less than two decades, immunotherapy has established itself as one of the pillars of cancer treatment. Despite its potentially high efficacy and long-lasting response, the proportion of patients who have an objective response is relatively low and there are few biomarkers to select patients with the greatest response potential. OBJECTIVE: Our hypothesis was that it was possible to assess the patient's immune system globally by measuring the thymus and spleen by imaging and using these metrics as a prognostic and predictive factor of response to immune checkpoint inhibitors. RESULTS: The main results were: 1) Thymic measurements do not correlate with survival in patients treated with immunotherapy; 2) There is an increase in splenic volume after the use of immunotherapy in most patients, but the degree of increase does not correlate with response to therapy; 3) Greater splenic volume is associated with worse progression free survival in patients with melanoma treated with immunotherapy, but this correlation could not be replicated in other tumor types. CONCLUSION: thymic thickness does not correlate with clinical outcomes in cancer patients treated with immunotherapy. Smaller splenic volume before starting immunotherapy is associated with better prognosis in patients with melanoma, but not other tumor types

Clinical photographic and radiological correlation in patients with scoliosis / Correlação clínica fotográfica e radiológica em pacientes com escoliose / Correlación clínica fotográfica y radiológica em pacientes com escoliosis

ABSTRACT Objective: The study correlates angular radiographic measurements and measurements from photographs of the trunk of patients with adolescent idiopathic scoliosis. Methods: a cross-sectional study of 10 patients with adolescent idiopathic scoliosis and indication for surgical treatment in follow-up in the spine sector of HCRFMRP-USP. They were evaluated through measurements taken from clinical photographs of the patient's torso and angles on panoramic radiographs of the spine. Results: only the correlation between the axilla angle (AHA) and the proximal thoracic curve and main thoracic curve was observed in the sample studied. No correlation was observed between the other compared variables. The study was carried out in a sample with a small number of patients, whose objective was to carry out a pilot study to explore this topic. Conclusion: the analysis of deformities should consider the aesthetic aspect and radiographic evaluation; however, in this study, no statistical correlation was observed between these parameters. Level of Evidence IV; Case Series Study.

RESUMO: Objetivo: O estudo correlaciona as mensurações radiográficas angulares e as mensurações oriundas das fotografias do tronco de pacientes com escoliose idiopática do adolescente. Métodos: estudo transversal de 10 pacientes com escoliose idiopática do adolescente e com indicação de tratamento cirúrgico, em seguimento no setor de coluna vertebral do HCRFMRP-USP. Foram avaliados por meio de mensurações das fotografias clínicas do tronco dos pacientes e mensurações dos ângulos nas radiografias panorâmicas da coluna. Resultados: na amostra estudada foi observada somente a correlação entre o ângulo axila (AHA) e a curva torácica proximal e curva torácica principal. Não foi observado correlação entre as demais variáveis comparadas. O estudo foi realizado em amostra com pequeno número de pacientes, cujo objetivo era a realização de estudo piloto para explorar esse tópico. Conclusão: a análise das deformidades deve considerar o aspecto estético e avaliação radiográfica, porem neste estudo não foi observado correlação estatística entre estes parâmetros. Nível de Evidência IV; Estudo de Série de Casos.

RESUMEN: Objetivo: El estudio correlaciona medidas radiográficas angulares y medidas de fotografías del tronco de pacientes con escoliosis idiopática del adolescente. Métodos: estudio transversal de 10 pacientes con escoliosis idiopática del adolescente y con indicación de tratamiento quirúrgico, en seguimiento en el sector de columna del HCRFMRP-USP. Se evaluaron mediante medidas tomadas de fotografías clínicas del torso de los pacientes y medidas de ángulos en radiografías panorámicas de la columna vertebral. Resultados: en la muestra estudiada solo se observó la correlación entre el ángulo axilar (AHA) y la curva torácica proximal y torácica principal. No se observó correlación entre las otras variables comparadas. El estudio se realizó en una muestra con un número reducido de pacientes, cuyo objetivo fue realizar un estudio piloto para explorar este tema. Conclusión: el análisis de las deformidades debe considerar el aspecto estético y la evaluación radiográfica, sin embargo, en este estudio no se observó correlación estadística entre estos parámetros. Nivel de Evidencia IV; Estudio de Serie de Casos.

How is the use of digital dental radiology in a developing country? An overview of Brazil / ¿Cómo es el uso de la radiología dental digital en un país en vías de desarrollo? Una visión general de Brasil

Abstract The aim of this study was to assess the use of digital dental radiology in Brazil, by focusing on the use of image receptors, imaging exams and digital image enhancement tools, also assessing the methods of professional image transfer. Questionnaires were distributed in person on dental meetings and digitally via messaging (WhatsApp®) and mailings list. The sample of this cross-sectional study consisted of 478 questionnaires. Most participants were woman (n=315, 65.9%), with average age of 33.8±9.2 years. Descriptive and frequency analysis was performed. Chi-square and Fisher's exact tests were used (α=0.05). Most dentists worked at shared dental clinics (34.7%) and use digital image receptors (51.1%), but a representative percentage (48.9%) still exclusively use radiographic films. Photostimulable phosphor plate is the most used digital image receptor. Among extraoral exams, panoramic radiography (PAN) is the most used. Regarding dental specialties, oral radiologists and oral and maxillofacial surgeons mostly use cone-beam computed tomography (p<0.001). Most dentists who use digital systems make use of digital image enhancement tools (87.8%), mainly contrast, zoom, brightness and measurements. The most common method of professional image transfer (professional-professional and professional-patiens) is by email, with few dentists using online app and social media (26%). Therefore, while most Brazilian dentists use digital imaging systems, a significant percentage still exclusively use radiographic films. The most extraoral imaging exams used is PAN. Regarding image enhancement tools, brightness and contrast adjustments, zoom and measurements are the most applied. Finally, dentists generally use email for professional image transfer.

Resumen El objetivo de este estudio fue evaluar uso de la radiología dental digital en Brasil, centrándose en uso de receptores de imagen, exámenes de imágenes y herramientas de mejora de imagen digital, evaluando también los métodos de transferencia de imagen profesional. Cuestionarios se distribuyeron de forma presencial en reuniones odontológicas y de forma digital a través de mensajería (WhatsApp®) y lista de correo. Muestra de este estudio transversal estuvo compuesta por 478 cuestionarios. Mayoría de los participantes eran mujeres (n=315, 65,9%), con edad promedio de 33,8±9,2 años. Se realizó un análisis descriptivo y de frecuencias. Se utilizaron las pruebas Chi-cuadrado y exacta de Fisher (α=0,05). La mayoría de los odontólogos trabajaban en clínicas dentales compartidas (34,7%) y utilizan receptores de imágenes digitales (51,1%), pero un porcentaje representativo (48,9%) todavía utiliza exclusivamente películas radiográficas. Placa de fósforo fotoestimulable es el receptor de imagen digital más utilizado. Entre los exámenes extraorales, la radiografía panorámica (PAN) es la más utilizada. En cuanto a las especialidades odontológicas, los radiólogos orales y los cirujanos orales y maxilofaciales utilizan mayoritariamente la tomografía computarizada de haz cónico (p<0,001). Mayoría de los odontólogos que utilizan sistemas digitales utilizan herramientas de mejora de imagen digital (87,8%), principalmente contraste, zoom, brillo y medidas. Método más común de transferencia de imágenes profesionales (profesional-profesional y profesional-pacientes) es por correo electrónico, con pocos dentistas que utilizan aplicaciones en línea y redes sociales (26%). Por lo tanto, mientras que la mayoría de dentistas brasileños utilizan sistemas de imágenes digitales, un porcentaje significativo aún utiliza exclusivamente películas radiográficas. Examen de imagen extraoral más utilizado es el PAN. En cuanto a las herramientas de mejora de imagen, los ajustes de brillo y contraste, el zoom y las medidas son las más aplicadas. Finalmente, los dentistas generalmente usan el correo electrónico para la transferencia de imágenes profesionales.

Vascular Spectrum of Imaging Findings in COVID-19: Ischemic, Hemorrhagic, and Thromboembolic Complications

Abstract Ischemic strokes secondary to occlusion of large vessels have been described in patients with COVID-19. Also, venous thrombosis and pulmonary thromboembolism have been related to the disease. Vascular occlusion may be associated with a prothrombotic state due to COVID-19-related coagulopathy and endotheliopathy. Intracranial hemorrhagic lesions can additionally be seen in these patients. The causative mechanism of hemorrhage could be associated with anticoagulant therapy or factors such as coagulopathy and endotheliopathy. We report on cases of ischemic, thrombotic, and hemorrhagic complications in six patients diagnosed with SARS-CoV-2 infection. Chest computed tomography (CT) showed typical SARS-CoV-2 pneumonia findings in all the cases, which were all confirmed by either serology or reverse transcription polymerase chain reaction (RT-PCR) tests.

Traumatismo de grandes vasos del tórax: tratamiento quirúrgico con soporte de circulación extracorpórea / Injury of the great vessels of the chest: surgical treatment with cardiopulmonary bypass support: clinical cases

Resumen Objetivo: Presentar dos casos en que se empleó como soporte la circulación extracorpórea (CEC) durante cirugía por traumatismo torácico con lesión de grandes vasos del tórax (TTLGV). Materiales y Método: Se presentan dos casos con TTLGV en que se empleó cirugía con CEC. Resultados: Caso 1; hombre de 31 años con TTLGV por cuerpo extraño (tubo pleural) intracavitario del tronco de la arteria pulmonar izquierda, con entrada a través de parénquima pulmonar, en que se realizó cirugía abierta para retiro de cuerpo extraño más toractotomía pulmonar utilizando CEC como soporte. Caso 2; hombre de 21 años con TTLGV contuso y lesión de aorta en unión sino tubular, en que se realizó cirugía abierta y reemplazo de aorta ascendente con prótesis y uso CEC como soporte. Discusión: El uso de CEC como soporte es una alternativa para sustituir la función cardíaca y/o pulmonar durante cirugías excepcionales de reparación de TTLGV. Conclusión: El uso de técnicas de asistencia circulatoria como soporte durante la cirugía de reparación de TTLGV ocurre en casos muy seleccionados, siendo una alternativa ante lesiones particularmente complejas.

Aim: To present two cases of thoracic trauma with great vessel injury (TTGVI) surgeries where extracorporeal circulation (ECC) was employed. Materials and Method: Two TTGVI cases are presented and ECC during surgery was used in both. Results: Case 1; 31-year-old man with TTGVI due to an intracavitary foreign body (pleural tube) in the left pulmonary artery trunk, which entered through lung parenchyma. An open surgery was performed to remove the foreign body with pulmonary tractotomy using ECC as support. Case 2; 21-year-old man with blunt TTGVI and aortic injury at sinotubular junction. An open surgery with ascending aorta prosthesis replacement was performed, using ECC as support. Discussion: The use of ECC as support is an alternative to replace cardiac and/or pulmonary function during exceptional TTGVI reparation surgeries. Conclusión: The use of circulation assist techniques as support during TTGVI repair surgery occurs in highly selected cases, being an alternative to face very complex injuries.

Reflexiones sobre los valores éticos de la protección radiológica para los profesionales tecnólogos médicos de imagenología / Reflections on the ethical values of radiation protection for the professional medical technologists in imaging

Las radiaciones ionizantes tienen el potencial de generar efectos adversos a la salud de las personas. Para hacer un uso más seguro y eficiente de estas radiaciones, la Comisión Internacional de Protección Radiológica fundamentalmente ha implementado un sistema de protección radiológica (SPR) que se basa en tres principios: justificación, optimización y límites. A su vez, estos principios se sustentan en cuatro valores éticos (beneficencia, prudencia, justicia y dignidad). Se sabe que en Chile el profesional que esta mandatado para realizar la toma de los exámenes que utilizan radiaciones ionizantes es el/la Tecnólogo Médico en Imagenología. Por lo tanto, resulta interesante valorar el grado de conocimiento adquirido y posteriormente aplicado en torno a los valores éticos del SPR por parte de dichos profesionales. De esta manera el objetivo del este artículo de tipo Punto de Vista fue realizar una serie de reflexiones en torno a esta temática. Cuando se realiza un procedimientos médico u odontológico con radiaciones ionizantes, el/la Tecnólogo Médico en Imagenología participa esencialmente en la realización del mismo, por lo que no debería ser su responsabilidad el cautelar que se cumplan los 4 valores éticos descritos dentro del SPR. A juicio nuestro, el principio de optimización, sería el único principio o pilar del SPR donde tiene real obligación de participar, utilizando las restricciones a las exposiciones individuales y los niveles de referencia para diagnóstico para reducir las desigualdades en la distribución de las exposiciones entre los grupos expuestos. Finalmente, resulta vital investigar si en su formación de especialidad se tocan estas temáticas

Ionizing radiation has the potential to generate adverse effects on people's health. To make safer and more efficient use of these radiations, the International Commission on Radiological Protection has fundamentally implemented a radiological protection system (RPS) based on three principles: justification, optimization and limits. In turn, these principles are based on four ethical values (beneficence, prudence, justice and dignity). It is known that in Chile the professional who is mandated to perform the exams that use ionizing radiation is the Medical Imaging Technologist. Therefore, it is interesting to assess the degree of knowledge acquired and subsequently applied around the ethical values of the RPS by these professionals. In this way, the objective of this Point of View article was to make a series of reflections on this subject. When a medical or dental procedure is performed with ionizing radiation, the Medical Imaging Technologist essentially participates in its performance, so it should not be their responsibility to ensure that the 4 ethical values described in the RPS are met. In our opinion, the principle of optimization would be the only principle or pillar of the RPS where it has a real obligation to participate, using the restrictions on individual exposures and the diagnostic reference levels to reduce inequalities in the distribution of exposures between exposed groups. Finally, it is vital to investigate whether these topics are addressed in his specialty training.

Signo de Chilaiditi, diagnóstico tomográfico / Chilaiditi Sign, Tomographic Diagnosis / Sinal de Chilaiditi, diagnóstico tomográfico

Figura 1. Tomografía Computarizada de tórax (corte coronal). Se observan ambos campos pulmonares y las cavidades cardiacas. La flecha roja señala el área hipodensa ovalada correspondiente al aire dentro de un asa de colon interpuesta entre el hemidiafragma derecho (línea hiperdensa arriba) y el borde superior del hígado (abajo), causando una depresión del borde superior del hígado. Fuente: tomada de la historia clínica, previa autorización del paciente.

Figure 1. Chest Computed Tomography Scan (coronal plane) Both lung fields and cardiac chambers are observed. The red arrow indicates the oval hypodense area corresponding to the air inside the loop of colon interposed between the right hemidiaphragm (hyperdense line up) and superior border of the liver (down), causing a depression of the superior border of the liver. Source: taken with authorization from the patient's medical record.

Figura 1. Tomografia Computadorizada de tórax (corte coronal). Observam-se ambos os campos pulmonares e as cavidades cardíacas. A seta vermelha aponta para a área hipodensa oval correspondente ao ar dentro de uma alça do cólon interposta entre o hemidiafragma direito (linha hiperdensa acima) e a borda superior do fígado (abaixo), causando uma depressão da borda superior do fígado. Fonte: obtida com permissão do histórico clínico do paciente.

Impact of dental cone-beam computed tomography on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning / Impacto de la tomografía computarizada de haz cónico en el diagnóstico y plan detratamiento preimplantologico de senos maxilares

Objective: To determine the impact of CBCT on diagnostic evaluation and treatment plan for the maxillary sinus in dental implant planning. Material and Methods: Diagnostic evaluation and treatment plan for the maxillary sinus were evaluated by eight specialists experienced in dental implant placement. Eight panoramic radiographs (PAN) and CBCT examinations were obtained from five adult patients with a specific clinical need for dental implants. Evaluation was performed first on PAN then, at least 2 weeks later, on CBCT. Residual alveolar ridge height, mucosal thickening, radiographic findings and treatment plan were recorded. The confidence level was evaluated for both diagnostic evaluation and treatment plan. The kappa statistic for intra-observer reproducibility and McNemar test were performed. Results: In the diagnostic evaluation, CBCT showed significant impact on the diagnosis of radiographic findings. Availability of CBCT significantly changed the treatment plan, for less invasive treatment, or no treatment need. Observers had significantly greater confidence when using CBCT than PAN, when indicating presence of mucosal thickening and radiographic findings in the maxillary sinus. In addition, CBCT increased confidence in the treatment plan. Conclusion: The present study suggests that CBCT has an impact on the diagnostic evaluation of radiographic findings in the maxillary sinus and on the decision to place implants, owing to misdiagnosis of pathology and planning of more invasive treatments when using PAN. Availability of CBCT also improves clinician confidence. Further studies at higher levels of diagnostic efficacy should be performed, to justify the use of CBCT, by evaluating the actual treatment performed and its outcome.

Objetivo: Determinar el impacto de la tomografía computarizada de haz cónico (CBCT) en la evaluación diagnóstica y el plan de tratamiento del seno maxilar en la planificación de implantes dentales. Material y Métodos: La evaluación diagnóstica y el plan de tratamiento del seno maxilar fueron evaluados por ocho especialistas con experiencia en la colocación de implantes dentales. Se obtuvieron ocho radiografías panorámicas (PAN) y exámenes CBCT de cinco pacientes adultos con una necesidad clínica específica de implantes dentales. La evaluación se realizó primero en PAN y luego, al menos dos semanas después, en CBCT. Se registraron la altura del reborde alveolar residual, el engrosamiento de la mucosa, los hallazgos radiográficos y el plan de tratamiento. Se evaluó el nivel de confianza tanto para la evaluación diagnóstica como para el plan de tratamiento. Se realizó el estadístico kappa para la reproducibilidad intraobservador y la prueba de McNemar. Resultados: En la evaluación diagnóstica, CBCT mostró un impacto significativo en el diagnóstico de los hallazgos radiográficos. La disponibilidad de CBCT cambió significativamente el plan de tratamiento, para un tratamiento menos invasivo o sin necesidad de tratamiento. Los observadores tuvieron una confianza significativamente mayor al usar CBCT que PAN, al indicar la presencia de engrosamiento de la mucosa y hallazgos radiográficos en el seno maxilar. Además, CBCT aumentó la confianza en el plan de tratamiento. Conclusión: El presente estudio sugiere que la CBCT tiene un impacto en la evaluación diagnóstica de los hallazgos radiográficos en el seno maxilar y en la decisión de colocar implantes, debido al diagnóstico erróneo de la patología y la planificación de tratamientos más invasivos al usar PAN. La disponibilidad de CBCT también mejora la confianza del clínico. Se deben realizar más estudios a niveles más altos de eficacia diagnóstica para justificar el uso de CBCT, evaluando el tratamiento real realizado y su resultado.

Quiste inflamatorio con tejido calcificado: presentación de un caso clínico / Inflammatory cyst with calcified tissue: presentation of a clinical case

Objetivo: Describir un caso de quiste odontogénico in- flamatorio cuya presentación imagenológica no es la habitual. Caso clínico: Acude a la clínica profesional de Pato- logía Oral de la Universidad Andrés Bello una paciente de género femenino de 13 años, sin antecedentes mórbidos, con un hallazgo radiográfico de lesión mixta ubicada entre los premolares inferiores derechos. Es derivada al posgrado de cirugía oral y maxilofacial para que le realicen una biopsia excisional de la lesión con una hipótesis diagnóstica de tumor odontogénico adenomatoide. Una vez realizado el estudio histopatológico, se define la lesión como quiste odontogénico inflamatorio, que por las características clínicas-radiográficas podría corresponder con un quiste residual de un diente tem- poral. Debido a la variabilidad en la presentación clínica e ima- genológica de las lesiones quísticas maxilofaciales, el estudio anatomopatológico es imprescindible para un correcto diag- nóstico y tratamiento (AU)

Aim: To present a case of inflammatory odontogenic cyst with unusual imaging presentation. Clinical case: A 13-year-old female patient, with no history of morbidity, with a radiographic finding of a mixed lesion located between the lower right premolars. The patient visited the professional Oral Pathology clinic of the Andrés Bello University and was referred to postgraduate oral and maxillofacial surgery for an excisional biopsy of the lesion, with a diagnostic hypothesis of adenomatoid odontogenic tu- mor. After the histopathological study, the lesion was defined as an inflammatory odontogenic cyst, which, based on clini- cal-radiographic characteristics, could be a residual cyst of a primary tooth. Due to the variability in the clinical and imaging pres- entation of maxillofacial cystic lesions, anatomopathological study is essential for correct diagnosis and treatment (AU)

Reflexiones sobre el primer programa de magister en física médica en diagnóstico por imagen de Chile / Reflections on the first master's degree on physics in diagnostic imaging from Chile

El objetivo del presente artículo de actualización será dar a conocer el nuevo programa de postgrado desarrollado denominado Magíster en Física Médica en diagnóstico por imagen, describiendo sus principales características y proponiendo algunas reflexiones. Este programa tiene la particularidad de permitir el acceso a diferentes Licenciados provenientes de las áreas de la Salud, Ingenierías o Ciencias. El plan de trabajo para este programa es de dos años, contempla cuatro semestres, con 91 créditos transferibles (SCT) por concepto de cursos y 27 SCT dedicados a la tesis. Dando un total de 118 SCT. Los Físicos Médicos son profesionales con formación académica de postgrado y entrenamiento clínico, que forman parte del grupo multidisciplinario profesional responsable del diagnóstico y tratamiento de pacientes, garantizando la calidad de los aspectos técnicos que intervienen en los procesos, la efectividad y la seguridad de los mismos, reduciendo así la probabilidad de accidentes. El programa de Magíster en Física Médica en diagnóstico por imagen de la Universidad de Tarapacá abre sus puertas para profesionales que se interesen a recibir esta formación única en Chile y ayudar en la tarea de hacer cada día del diagnóstico por imagen, una actividad más segura para los pacientes, profesionales y el público en general.

The main objective of this updating article is to present the latest Post-graduated developed program named " Master in Medical Physics in image diagnosting", describing its main characteristics and proposing some reflections about it. This program is focused on different graduates from the Health, Engineering or Science field. The study plan for this program is two years, including four semesters with 91 transferable credits for courses and 27 SCT dedicated to the thesis with a total of 118 SCT. Medical Physicists are professionals with postgraduate academic and clinical training, which is part of the professional multidisciplinary group that is responsible for the diagnosis and treatment of patients, guaranteeing the quality of the technical areas involved in the processes, the effectiveness and safety, and reducing the probability of accidents. This program of "Universidad de Tarapaca" is open to professionals that are interested in receiving unique training in Chile and in helping to provide accurate and safe imaging diagnosis to patients on a daily basis.

Avaliação da relação entre a espessura da camada de fibras nervosas e variação da pressão intraocular em suspeitos de glaucoma e em pacientes com glaucoma primário de ângulo aberto / Evaluation of the relationship between nerve fiber layer thickness and intraocular pressure variation in glaucoma suspects and in patients with primary open-angle glaucoma

Introdução: Glaucoma é uma neuropatia óptica caracterizada pela perda irreversível das células ganglionares retinianas, sendo a pressão intraocular (Po) o principal fator de risco para a doença. Grandes variações da pressão intraocular durante um determinado período de tempo têm atraído a atenção como um potencial fator de risco para o desenvolvimento e progressão do glaucoma. Objetivo: Avaliar a relação entre a flutuação de 24 horas da pressão intraocular (∆Po) e a espessura da camada de fibras nervosas da retina (CFNR) medida por tomografia de coerência óptica de domínio espectral (TCO-DE). Método: O estudo incluiu 125 olhos de 65 pacientes. Sessenta e três olhos (50,4%) tiveram o diagnóstico de glaucoma primário de ângulo aberto (GPAA) e 62 (49,6%) foram considerados suspeitos de glaucoma (SG). Todos os olhos foram submetidos a imagens usando TCO-DE, juntamente com medição da Po de 24 horas e perimetria computadorizada acromática. Apenas pacientes com ∆Po anormal (>6 mmHg) foram incluídos. Correlação e modelos mistos lineares generalizados foram usados para investigar a relação entre ∆Po e a espessura da CFNR ajustando para potenciais fatores de confusão, como idade, diagnóstico de glaucoma, espessura da córnea, Po média durante 24 horas e gravidade da doença. Resultados: A idade média foi semelhante entre os grupos SG e GPAA (62,2 ± 15,6 vs. 64,6 ± 12,0, P = 0,50), enquanto o desvio médio do campo visual apresentou diferença entre SG e GPAA (0,41 ± 1,33 vs. -3,09 ± 3,23, P <0,001). A Po média também foi semelhante entre os grupos SG e GPAA (15,6 ± 3,47 vs. 15,6 ± 2,83 mmHg, P = 0,90), assim como o pico da Po às 6h (21,7 ± 3,85 vs. 21,3 ± 3,80 mmHg, P = 0,68). Correlações negativas estatisticamente significativas foram encontradas no grupo GPAA entre a Po às 6h e a espessura da CFNR global (rs = 0,543; P < 0,001), quadrantes inferior (rs = -0,540; P < 0,001), superior (rs = -0,405; P = 0,009) e nasal (rs = −0,561; P < 0,001). Correlações negativas também foram encontradas entre ∆Po e a espessura da CFNR global (rs = −0,591; P < 0,001), e todos os demais setores (P < 0,05). No SG a Po às 6h correlacionou-se apenas com a espessura da CFNR no quadrante inferior (rs = −0,307; P = 0,047). Cada 1 mmHg maior na ∆Po foi associado à afilamento de -1,44 µm na espessura global da CFNR (IC 95%: -2,77 a -0,11, P = 0,03). Além disso, cada incremento de 10 anos na idade foi associado à afilamento de -3,56 µm na espessura global da CFNR (IC 95%: -6,06 a -1,05, P = 0,006). O GPAA teve uma afilamento média de -10,91 µm na CFNR global em relação aos SG (IC 95%: -20,21 a -1,62, P = 0,02). A Po média não foi associada à espessura global da CFNR (IC 95%: -1,37 a 0,91, P = 0,69). Conclusão: Maior ∆Po foi associado à menor espessura global da CFNR medida pelo TCO-DE, em pacientes com ∆Po >6 mmHg. Esse achado corrobora um papel potencial da flutuação da Po como fator de risco para perda estrutural no glaucoma.

Introduction: Glaucoma is an optic neuropathy characterized by irreversible loss of retinal ganglion cells, with intraocular pressure (IOP) being the main risk factor for the disease. Large variations in IOP over a period of time have attracted attention as a potential risk factor for the development and progression of glaucoma. Purpose: To evaluate the relationship between 24-hour fluctuation of intraocular pressure (∆IOP) and retinal nerve fiber layer (RNFL) thickness measured by spectraldomain optical coherence tomography (SD-OCT). Material and Methods: The study included 125 eyes of 65 patients. Sixty-three eyes (50.4%) had a diagnosis of primary open angle glaucoma (POAG) and 62 (49.6%) were considered glaucoma suspects (GS). All eyes underwent imaging using SDOCT, along with 24-hour IOP measurement and standard automated perimetry. Only patients with abnormal ∆IOP (>6 mmHg) were included. Correlation and generalized linear mixed models were used to investigate the relationship between ∆IOP and RNFL thickness adjusting for potential confounding factors such as age, glaucoma diagnosis, corneal thickness, mean IOP during 24 hours, and disease severity. Results: Mean age was similar between the SG and POAG groups (62.2 ± 15.6 vs. 64.6 ± 12.0, P = 0.50), while the mean deviation of visual field showed a difference between SG and POAG (0.41 ± 1.33 vs. -3.09 ± 3.23, P < 0.001). The mean Po was also similar between GS and POAG groups (15.6 ± 3.47 vs 15.6 ± 2.83 mmHg, P = 0.90) as was IOP peak at 6 AM (21.7 ± 3.85 vs. 21.3 ± 3.80 mmHg, P = 0.68). Statistically significant negative correlations were found in POAG group between IOP at 6 AM and RNFL thickness in global (rs = −0.543; P < 0.001), inferior (rs = −0.540; P < 0.001), superior (rs = −0.405; P = 0.009), and nasal quadrants (rs = −0.561; P < 0.001). Negative correlations were also found between ∆IOP and RNFL thickness in global (rs = −0.591; P < 0.001), and all other sectors (P < 0.05). In GS IOP at 6 AM correlated only with RNFL thickness in the inferior quadrant (rs = −0.307; P = 0.047). Each 1 mmHg higher in ∆IOP was associated with thinning of -1.44 µm in global RNFL thickness (95% CI: -2.77 to -0.11, P = 0.03). Also, each 10-years increment in age was associated with thinning of -3.56 µm in global RNFL thickness (95% CI: 6.06 to -1.05, P = 0.006). POAG had on average -10.91 µm thinning in global RNFL than glaucoma suspects (95% CI: -20.21 to -1.62, P = 0.02). Mean IOP was not associated with global RNFL thickness (95% CI: -1.37 to 0.91, P = 0.69). Conclusion: Higher ∆IOP was associated with lower global RNFL thickness measured by SD-OCT, in patients with ∆IOP > 6 mmHg. This finding corroborates a potential role for IOP fluctuation as a risk factor for structural loss in glaucoma.

Infrared Imaging Meibomian Gland Segmentation System Based on Deep Learning / 中国医疗器械杂志

In order to better assist doctors in the diagnosis of dry eye and improve the ability of ophthalmologists to recognize the condition of meibomian gland, a meibomian gland image segmentation and enhancement method based on Mobile-U-Net network was proposed. Firstly, Mobile-Net is used as the coding part of U-Net for down sampling, and then features are extracted and fused with the features in decoder to guide image segmentation. Secondly, the segmentation of meibomian gland region is enhanced to assist doctors to judge the condition. Thirdly, a large number of meibomian gland images are collected to train and verify the semantic segmentation network, and the clarity evaluation index is used to verify the meibomian gland enhancement effect. The experimental results show that the similarity coefficient of the proposed method is stable at 92.71%, and the image clarity index is better than the similar dry eye detection instruments on the market.

An optical parameter imaging system with profile information fusion / 生物医学工程学杂志

There is a shared problem in current optical imaging technologies of how to obtain the optical parameters of biological tissues with complex profiles. In this work, an imaging system for obtaining the optical parameters of biological tissues with complex profile was presented. Firstly, Fourier transformation profilometry was used for obtaining the profile information of biological tissues, and then the difference of incident light intensity at different positions on biological tissue surface was corrected with the laws of illumination, and lastly the optical parameters of biological tissues were achieved with the spatial frequency domain imaging technique. Experimental results indicated the proposed imaging system could obtain the profile information and the optical parameters of biological tissues accurately and quickly. For the slab phantoms with height variation less than 30 mm and angle variation less than 40º, the maximum relative errors of the profile uncorrected optical parameters were 46.27% and 72.18%, while the maximum relative errors of the profile corrected optical parameters were 6.89% and 10.26%. Imaging experiments of a face-like phantom and a human's prefrontal lobe were performed respectively, which demonstrated the proposed imaging system possesses clinical application value for the achievement of the optical parameters of biological tissues with complex profiles. Besides, the proposed profile corrected method can be used to combine with the current optical imaging technologies to reduce the influence of the profile information of biological tissues on imaging quality.

Neurotoxoplasmosis con presentación imagenológica atípica / Atypical imaging presentation of neurotoxoplasmosis

La toxoplasmosis cerebral o neurotoxoplasmosis es una de las infecciones por agentes oportunistas más frecuentes en pacientes infectados por virus de inmunodeficiencia humana (VIH) y se relaciona con inmunodeficiencia severa. En estos pacientes causa lesiones neurológicas de alto grado e incluso la muerte. Suele aparecer como múltiples focos de lesión de predominio gangliobasal y con realce anular. Se presenta un caso clínico de neurotoxoplasmosis en paciente VIH con un patrón radiológico poco frecuente.

Cerebral toxoplasmosis or neurotoxoplasmosis is one of the most frequent infections by opportunistic agents in HIV-infected patients and is associated with severe immunodeficiency. In these patients, it causes high-grade neurological lesions and even death. It usually appears as multiple foci of lesions with gangliobasal predominance and annular enhancement. We present a clinical case of neurotoxoplasmosis in a HIV patient with an unusual radiological pattern.

Métodos diagnósticos para tuberculose: uma revisão integrativa / Diagnostic methods for tuberculosis: an integrative review

A tuberculose é doença muito prevalente, com 5,8 milhões de casos ao ano, podendo apresentar padrão multissistêmico de acometimento, sendo mais comum a forma pulmonar. Objetivo: Revisão de literatura acerca dos métodos existentes de diagnóstico da tuberculose, focada em suas eficácias. Método: Foi realizada revisão integrativa por meio de publicações de 2016 a 2022 obtidas na base de dados PubMed e Scielo. Foram usados os descritores: Mycobacterium tuberculosis AND diagnosis. Foram obtidos 14 artigos que satisfizeram os critérios de inclusão. Resultado: Das formas de diagnóstico existem exames de imagem (Raio-X e tomografia computadorizada), baciloscopia, cultura e moleculares. Conclusão: Os métodos por imagem têm relevância quando seus achados são correlacionados com a clínica e podem auxiliar no diagnóstico. Nos métodos bacteriológicos, o sistema do GeneXpert Ultra apresenta maior custo-benefício, com valores de sensibilidade e especificidade altos - acima de 90% - superior à baciloscopia, e com menor tempo para realização em comparação com a cultura

nd may present a multisystem pattern of involvement, with the pulmonary form being the most common. Objective: Literature review on existing methods used to diagnose tuberculosis. Method: An integrative review was carried out through publications from 2016 to 2022 in the PubMed and Scielo publication database. The descriptors were used: Mycobacterium tuberculosis AND diagnosis. Fourteen articles that met the inclusion criteria were obtained. Result: Among the ways of diagnosing tuberculosis, there are imaging tests (X-ray and computed tomography), bacilloscopy, culture and molecular tests. Conclusion: Imaging methods have their findings correlated and can aid in the diagnosis. In bacteriological methods, the GeneXpert Ultra system is cost-effective, with high sensitivity and specificity values - above 90% -, superior to bacilloscopy, with a shorter time to perform compared to culture

Axial view of the shoulder. Description of a technique / Proyección axial de hombro. Descripción de una técnica

Shoulder fracture is one of the most frequently treated injuries in trauma centers, with an overall incidence that appears to have increased in recent years, ranging from 219 to 419 cases per 100 000 person-years. In clinical terms, shoulder girdle injury is difficult to diagnose due to the close relationship between the shoulder and the chest, and imaging identification of the different types of injuries can be challenging. In this context, X-rays are the most appropriate method and the cornerstone of the initial approach to shoulder trauma, and at least 3 views are recommended: true anteroposterior view (AP), axial or axillary projection or modified axial projection (Velpeau view), and lateral scapula shoulder or Y view. However, patient positioning is often problematic due to the additional pain associated with limb mobilization in order to achieve the proper position for radiographic projection. The following is the description of a technique for performing an axial shoulder projection that is free of these complications, easy to standardize, and applicable to any traumatic or degenerative disease of the proximal humerus or glenohumeral joint, which, to the best of the authors' knowledge, has not been previously published.

El trauma de hombro es una de las patologías más frecuentemente vista en los centros de trauma con una incidencia global que aparentemente ha aumentado en los últimos años y que se ha reportado entre 219 a 419 casos por 100000 personas-año. El diagnóstico del trauma de la cintura escapular no es fácil clínicamente por la íntima relación entre el hombro y el tórax, y la identificación imagenológica de las distintas lesiones puede ser desafiante. Las radiografías son el método más apropiado y piedra angular del estudio inicial en el trauma de hombro, el set de trauma tiene al menos 3 planos: la vista Anteroposterior (AP) verdadera, una proyección axial o axilar o su modificación descrita por Velpeau. Y una proyección Y de escápula. Sin embargo, el posicionamiento del paciente muchas veces no es fácil por el dolor adicional que puede generar la movilización de la extremidad para lograr la posición adecuada para la proyección radiográfica. Describimos una técnica para realizar una proyección axial de hombro sin estas dificultades, fácilmente estandarizable para cualquier patología traumática o degenerativa del húmero proximal o de la articulación gleno-humeral y que creemos no ha sido publicada previamente.