Lineamientos técnicos de radiología e imágenes en el Primer Nivel de Atención / Technical guidelines for radiology and images in the First Level of Care

Los presentes lineamientos técnicos contienen las directrices para la regulación y estandarización de los procesos de atención en la realización de estudios radiológicos con base en las especificaciones técnicas de los equipos de rayos X portátiles, adquiridos para los establecimientos del Primer Nivel de Atención, incluye además los aspectos relacionados con la calidad, seguridad y eficacia, indicaciones, contraindicaciones y el flujograma de atención para la toma de imágenes

These technical guidelines contain the guidelines for the regulation and standardization of care processes in the performance of radiological studies based on the technical specifications of portable X-ray equipment, acquired for First Level Care establishments, and also includes the aspects related to quality, safety and efficacy, indications, contraindications and the care flow chart for image taking

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.

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.

Sarcoma folicular de células dendríticas mediastinal: primer reporte de caso en Costa Rica / Mediastinal Follicular Dendritic Cell Sarcoma: First Case Report in Costa Rica

El sarcoma folicular de células dendríticas (SFCD) es una neoplasia maligna rara derivada de las células dendríticas foliculares. Ha sido clasificado, dadas sus características inmunohistoquímicas, como parte del grupo de los sarcomas, donde representa un porcentaje menor al 1%. Actualmente, existen menos de 1.000 reportes en la literatura a nivel mundial, lo cual plantea una dificultad no sólo diagnóstica, siendo confundido frecuentemente con neoplasias de tipo linfoide; sino también terapéutica al no existir un claro consenso sobre su manejo definitivo. Esta revisión de caso clínico describe el primer caso reportado de SFCD en Costa Rica.

Follicular dendritic cell sarcoma (SFCD) is a rare malignant neoplasm derived from follicular dendritic cells, which has been classified, given its immunohistochemical characteristics, as part of the group of sarcomas, where it represents less than 1%. Currently, there are less than 1000 reports in the literature worldwide, which generates a difficulty not only in diagnosis, being frequently confused with lymphoid type neoplasms; but also, as therapeutic as there is no clear consensus on its definitive management. This clinical case review describes the first reported case of SFCD in Costa Rica.

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)

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.

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.

Estratégias pedagógicas de ensino de diagnóstico por imagem nas escolas médicas brasileiras: uma revisão sistemática / Pedagogical strategies for teaching diagnostic imaging in Brazilian medical schools: a systematic review

RESUMO Introdução: A competência dos profissionais de saúde em radiologia não apenas desempenha um papel fundamental no controle de custos, mas também na prevenção de erros médicos decorrentes da inexperiência durante a prática clínica. Objetivo: Este estudo realiza uma revisão sistemática com o objetivo de investigar as estratégias pedagógicas empregadas no ensino de diagnóstico por imagem nas instituições médicas brasileiras, bem como analisar o nível de conhecimento adquirido pelos estudantes de Medicina ao longo de sua graduação. Método: A revisão sistemática da literatura seguiu as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) e abrangeu as bases de dados PubMed, LILACS/BVS, Scopus, Web of Science, Embase e ScienceDirect. A busca visou identificar artigos que abordassem metodologias e estratégias de disseminação do conhecimento em imagiologia médica. A avaliação do nível de evidência foi conduzida utilizando a abordagem GRADE. Resultado: Dos 152 artigos inicialmente identificados, 13 foram selecionados após a remoção de duplicatas e análise de títulos e resumos. Durante a leitura completa, excluíram-se oito artigos por causa de metodologias inadequadas ou desalinhamento com os objetivos da pesquisa. Os estudos elegíveis envolveram 461 alunos de Medicina em 49 instituições brasileiras, principalmente privadas, caracterizadas por um sistema híbrido de ensino e uma ênfase particular em módulos de radiologia médica. Salas de aula foram destacadas como os principais ambientes de ensino. No contexto do ensino de diagnóstico por imagens, muitos alunos ainda enfrentam dificuldades na avaliação de exames, independentemente do período letivo. O estudo aponta para a falta de uniformidade nos benefícios das políticas governamentais, resultando em segregação regional e financeira no acesso ao ensino. Conclusão: A despadronização do ensino contribui para uma formação deficiente em radiologia, deixando os profissionais despreparados para a interpretação adequada de exames. Diante da escassez de estudos e das disparidades identificadas, torna-se imperativo estabelecer parâmetros mínimos para os currículos em radiologia médica, proporcionando uma base estruturada para as instituições de ensino nacionais e visando à melhoria da qualidade do ensino e da formação profissional.

ABSTRACT Introduction: The competence of healthcare professionals in radiology not only plays a fundamental role in cost control but also in preventing medical errors resulting from inexperience during clinical practice. Objective: This study conducts a systematic review aiming to investigate the pedagogical strategies employed in teaching imaging diagnostics at Brazilian medical institutions, as well as to analyze the level of knowledge acquired by medical students throughout their education. Method: The systematic literature review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and covered the databases PubMed, LILACS/BVS, Scopus, Web of Science, Embase, and ScienceDirect. The search aimed to identify articles that addressed methodologies and strategies for disseminating knowledge in medical imaging. The evaluation of the level of evidence was conducted using the GRADE approach. Results: Of the 152 articles initially identified, 13 were selected after the removal of duplicates and analysis of titles and abstracts. During the full reading, eight articles were excluded due to inadequate methodologies or misalignment with the research objectives. The eligible studies involved 461 medical students across 49 Brazilian institutions, primarily private, characterized by a hybrid teaching system and a particular emphasis on medical radiology modules. Classrooms were highlighted as the main teaching environments. In the context of teaching imaging diagnostics, many students still face difficulties in evaluating exams, regardless of the academic term. The study points to the lack of uniformity in the benefits of government policies, resulting in regional and financial segregation in access to education. Conclusion: The lack of standardization in education contributes to inadequate training in radiology, leaving professionals unprepared for the proper interpretation of exams. Given the scarcity of studies and the identified disparities, it becomes imperative to establish minimum standards for medical radiology curricula, providing a structured foundation for national educational institutions and aiming to improve the quality of education and professional training.

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.

Aplicaciones de la inteligencia artificial en el diagnóstico dentomaxilofacial / Applications of Artificial Intelligence in Dentomaxillofacial Diagnosis

SUMMARY Introduction: The introduction of applications driven by artificial intelligence is revolutionizing dentomaxillofacial imaging. Objectives: Describe the current state of the applications of artificial intelligence in dentomaxillofacial diagnosis, evaluate its impact, and identify future directions for research and implementation. Method : A narrative review was carried out using systematic searches in databases such as PubMed, Google Scholar, IEEE Xplore, among others. The study focused on articles published from 2010 to the present. Research that applies artificial intelligence technologies in dentomaxillofacial diagnosis was included and its quality and relevance were evaluated using established tools. Results: Artificial intelligence, especially deep learning, has shown significant improvements in image segmentation, disease detection, and treatment planning in dentomaxillofacial imaging. Artificial intelligence techniques have allowed the automation of image analysis tasks, improving efficiency and diagnostic accuracy. Conclusions: Artificial intelligence has significant potential to revolutionize dentomaxillofacial imaging, as it offers improvements in diagnostic accuracy, efficiency in image interpretation, and treatment planning. Further research is needed to overcome technical, ethical, and privacy challenges and validate the clinical applicability of these technologies(AU)

Introducción: La introducción de aplicaciones impulsadas por la inteligencia artificial está revolucionando la imagenología dentomaxilofacial. Objetivos: Describir el estado actual de las aplicaciones de la inteligencia artificial en el diagnóstico dentomaxilofacial; evaluar su impacto e identificar direcciones futuras para la investigación y la implementación. Método : Se realizó una revisión narrativa, utilizando búsquedas sistemáticas en bases de datos como PubMed, Google Scholar, IEEE Xplore, entre otras; el estudio se enfocó en artículos publicados desde 2010 hasta la actualidad. Se incluyeron investigaciones que aplican tecnologías de la inteligencia artificial en el diagnóstico dentomaxilofacial; se evaluó su calidad y relevancia mediante las herramientas establecidas. Resultados: La inteligencia artificial, especialmente el aprendizaje profundo, ha mostrado mejoras significativas en la segmentación de imágenes, la detección de enfermedades y la planificación del tratamiento en imagenología dentomaxilofacial. Las técnicas de inteligencia artificial han permitido la automatización de tareas de análisis de imágenes, mejorado la eficiencia y la precisión diagnóstica. Conclusiones: La inteligencia artificial posee un potencial significativo para revolucionar la imagenología dentomaxilofacial, pues ofrece mejoras en la precisión diagnóstica, eficiencia en la interpretación de imágenes y en la planificación del tratamiento. Se necesitan más investigaciones para superar desafíos técnicos, éticos y de privacidad y validar la aplicabilidad clínica de estas tecnologías(AU)

Hitos poco conocidos en la historia de la radiología en Cuba

Introducción: A pesar de su trascendencia, algunos hechos, apenas conocidos en la actualidad, favorecieron el crecimiento de la radiología en Cuba. La documentación sobre ellos es sumamente escasa y se encuentra muy dispersa, lo que dificulta sobremanera el acceso a ella. El rescate de esa información contribuye al conocimiento de la historia de la radiología en Cuba. Objetivo: Identificar cronológicamente hechos significativos, aunque poco conocidos, que influyeron en el progreso y reconocimiento de la radiología cubana y que obligan a reevaluar su historia. Métodos: Se utilizaron los métodos analítico-sintético, deductivo-inductivo, así como los submétodos cronológico y geográfico. Resultados: Fueron recogidos ―con una caracterización sintética― quince sucesos notables, poco conocidos, más algunos apuntes sobre la docencia de la radiología en estomatología. Conclusiones: Entre los hechos identificados destacan los que deben ser considerados como los primeros acercamientos a los rayos X en Cuba, que obligan a reescribir lo actualmente aceptado a ese respecto. Además de los revisados aquí, otros eventos significativos en la edificación de la historia de la radiología en Cuba deben ser abordados en futuras investigaciones.

Introduction: Despite their significance, some facts, barely known today, favored the growth of radiology in Cuba. The documentation about them is extremely scarce and is widely dispersed, which makes access to it extremely difficult. The rescue of this information contributes to the knowledge of the history of radiology in Cuba. Objective: To chronologically identify significant events, although little-known, that influenced the progress and recognition of Cuban radiology and that force us to reevaluate its history. Methods: Analytical-synthetic, deductive-inductive methods were used, as well as chronological and geographical sub-methods. Results: Fifteen notable, little-known events―with a synthetic characterization―were collected, plus some notes on the teaching of radiology in stomatology. Conclusions: Among the facts identified are those that should be considered the first approaches to X-rays in Cuba which force us to rewrite what is currently accepted in this regard. In addition to those reviewed here, other significant events in the construction of the history of radiology in Cuba should be studied in future research.

Radiologia odontológica: percepção e segurança de dentistas de centros de especialidades odontológicas e serviços de apoio diagnóstico públicos / Dental radiology: perception and safety of dentists from dental specialty centers and public diagnostic support services

Objetivo: Avaliar a percepção e segurança dos cirurgiões-dentistas servidores municipais de Porto Alegre - RS que realizam radiografias intrabucais em relação à conteúdos da radiologia odontológica. Materiais e métodos: Todos os 26 dentistas que atuam no Centro de Especialidades Odontológicas e Serviço de Apoio Terapêutico da Secretaria Municipal de Saúde foram convidados a participar de 15 horas do Projeto de Extensão em Radiologia Odontológica da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul, onde alunos de graduação atendem pacientes encaminhados pelas unidades básicas de saúde. Foi aplicado um questionário online de 19 questões relacionado a sua segurança e rotina na Radiologia. Os dados coletados foram submetidos à análise descritiva. Dez profissionais participaram do projeto, e oito responderam ao questionário (n=8). Resultados: Realização de técnicas e processamentos radiográficos, a maioria dos participantes mostrou-se segura, assim como os aspectos de radioproteção. Relataram maior dificuldade em realizar exames radiográficos em criança, molares e caninos superiores, além de preferirem, o método manual visual de processamento radiográfico. Foi identificada menor compreensão sobre biossegurança e efeitos biológicos determinísticos. Discussão: Conhecer esses servidores, suas rotinas e vivências com a radiologia, permitiu aprimorar o atendimento aos pacientes e a integração da Faculdade ao programa de educação permanente. Observa-se que princípios teóricos, não estão sedimentados o que pode interferir tanto na sua saúde como na do paciente. Conclusão: Os profissionais estudados sentem-se seguros em relação à prática e compreendem suas lacunas de conhecimento sobre efeitos biológicos e biossegurança na área da Radiologia.

Aim: To evaluate the perception and confidence of dental surgeons working in Porto Alegre - RS who perform intraoral radiographs in relation to the contents of dental radiology. Materials and methods: All 26 dentists who work at the Center for Dental Specialties and Therapeutic Support Service of the Municipal Health Department were invited to participate in 15 hours of the Extension Project in Dental Radiology at the School of Dentistry at the Federal University of Rio Grande do Sul, where students Undergraduate courses assist patients referred by basic health units. An online questionnaire of 19 questions related to your safety and routine in Radiology was applied. The collected data were submitted to descriptive analysis. Ten professionals participated in the project, and eight answered the questionnaire (n=8). Results: Performing radiographic techniques and processing, most participants proved to be safe, as well as radioprotection aspects. They reported greater difficulty in performing radiographic examinations in children, molars and upper canines, in addition to preferring the visual manual method of radiographic processing. Less understanding of biosafety and deterministic biological effects was identified. Discussion: Getting to know these public servants, their routines and experiences with radiology, made it possible to improve patient care and integrate the Faculty into the permanent education program. It is observed that theoretical principles are not settled, which can interfere with both your health and that of the patient. Conclusion: The professionals studied feel safe and understand their knowledge gaps such as biological effects and biosafety in the field of Radiology.

Primeros pasos en el intervencionismo. Lecciones de la práctica diaria / First steps in interventionism. Lessons from daily practice

Resumen Las características del paciente y la localización de la lesión diana pueden hacer más complejo un procedimiento intervencionista. Una adecuada formación basada en el conocimiento de los instrumentos, manejo de técnicas alternativas y complementos hacen que estos procedimientos sean efectivos y seguros. Destacaremos la planificación anticipada, los enfoques seguros, el papel de la integración y la discusión interdisciplinaria. Los elementos descritos aquí y la bibliografía adjunta pueden tomarse como una guía para comenzar una carrera en radiología intervencionista.

Abstract The characteristics of the patient and the location of the target lesion can make an interventional procedure more complex. An adequate training based on the knowledge of instruments, handling of alternative techniques and supplementary tools make these procedures effective and safe. We will emphasize advanced planning, safe approaches, the role of integration, and interdisciplinary discussion. The items described here and the accompanying bibliography can be taken as a guide to starting a career in interventional radiology.

Are we ready to stratify BI-RADS 4 lesions observed on magnetic resonance imaging? A real-world noninferiority/equivalence analysis / Estamos prontos para estratificar lesões BI-RADS 4 na ressonância magnética? Uma análise de não inferioridade/equivalência do mundo real

Abstract Objective: To demonstrate that positive predictive values (PPVs) for suspicious (category 4) magnetic resonance imaging (MRI) findings that have been stratified are equivalent to those stipulated in the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography and ultrasound. Materials and Methods: This retrospective analysis of electronic medical records generated between January 4, 2016 and December 29, 2021 provided 365 patients in which 419 suspicious (BI-RADS category 4) findings were subcategorized as BI-RADS 4A, 4B or 4C. Malignant and nonmalignant outcomes were determined by pathologic analyses, follow-up, or both. For each subcategory, the level 2 PPV (PPV2) was calculated and tested for equivalence/noninferiority against the established benchmarks. Results: Of the 419 findings evaluated, 168 (40.1%) were categorized as malignant and 251 (59.9%) were categorized as nonmalignant. The PPV2 for subcategory 4A was 14.2% (95% CI: 9.3-20.4%), whereas it was 41.2% (95% CI: 32.8-49.9%) for subcategory 4B and 77.2% (95% CI: 68.4-84.5%) for subcategory 4C. Multivariate analysis showed a significantly different cancer yield for each subcategory (p < 0.001). Conclusion: We found that stratification of suspicious findings by MRI criteria is feasible, and malignancy probabilities for sub-categories 4B and 4C are equivalent to the values established for the other imaging methods in the BI-RADS. Nevertheless, low suspicion (4A) findings might show slightly higher malignancy rates.

Resumo Objetivo: Demonstrar que os valores preditivos positivos (VPPs) para lesões suspeitas (categoria 4) identificadas por ressonância magnética (RM) são equivalentes aos estipulados no ACR BI-RADS para mamografia e ultrassonografia. Materiais e Métodos: Análise retrospectiva de dados em prontuário eletrônico, entre 4 de janeiro de 2016 e 29 de dezembro de 2021, resultou em 365 pacientes elegíveis, com 419 lesões classificadas como BI-RADS 4A, 4B ou 4C. Desfechos malignos e não malignos foram determinados por estudo patológico e/ou acompanhamento. Realizamos o cálculo do VPP nível 2 (VPP2) para cada subcategoria e testamos para não inferioridade/equivalência em relação aos valores de referência. Resultados: Dos 419 achados, 168 (40,1%) foram malignos e 251 (59,9%), não malignos. O VPP2 para subcategoria 4A foi 14,2% (IC 95%: 9,3-20,4%), para 4B foi 41,2% (IC 95%:, 32,8-49,9%) e para 4C foi 77,2% (IC 95%: 68,4-84,5%). Análise multivariada demonstrou diferenças estatisticamente significantes entre as subcategorias (p < 0,001). Conclusão: A estratificação de achados suspeitos por RM é factível, sendo que a probabilidade de malignidade das subcategorias 4B e 4C é equivalente à estabelecida para outros métodos de imagem pelo BI-RADS. Contudo, lesões de baixa suspeição (4A) podem apresentar taxas mais altas de malignidade.

Disección carotídea espontánea: Presentación de un caso clínico con revisión de la literatura / Carotid Artery Dissection. Case Report and Literature Review

Resumen Introducción: La disección carotídea consiste en el desgarro de la pared del vaso. Es una patología infrecuente, pero es la causa más común de enfermedad vascular cerebral (EVC) isquémica en personas menores de 45 años. Las manifestaciones clínicas son muy variables. Método: Utilizamos las recomendaciones CARE para el reporte de casos clínicos. Caso clínico: Hombre de 45 años previamente sano, con debilidad aguda de la extremidad torácica derecha sin causa aparente. La tomografía simple de cráneo no evidenció alteraciones. La resonancia magnética mostró una oclusión completa de la arteria carótida interna en todos sus segmentos y disminución del flujo de la arteria cerebral media izquierda. La evolución clínica fue desfavorable. Conclusión: La disección carotídea debe sospecharse en personas con EVC sin factores de riesgo cardiovascular.

Abstract Introduction: Carotid dissection consists of a tear in the vessel wall. It is a rare pathology, but it is the most common cause of ischemic cerebral vascular disease (CVD) in people under 45 years of age. The clinical manifestations are very variable. Method: We used CARE recommendations for reporting clinical cases. Clinical case: Previously, a healthy 45-year-old man with acute weakness of the right thoracic extremity without apparent cause. The simple skull tomography did not show any alterations. MRI showed complete occlusion of the internal carotid artery in all its segments and decreased flow of the left middle cerebral artery. The clinical evolution was unfavorable. Conclusion: Carotid dissection should be suspected in people with CVD without cardiovascular risk factors.

Gastrointestinal Foreign Bodies: 14 Years of Experience in a University Clinic

Introduction: Ingesting foreign bodies is a common medical problem, especially in the emergency department. Some small studies describe experiences in this regard. Materials and methods: A descriptive retrospective study included patients with suspected ingestion of foreign bodies admitted to the gastroenterology and GI endoscopy service of the Clínica Universitaria Colombia between January 2007 and August 2020. Results: The age of occurrence of the event was 18 to 95 years, and the average age was 45 years. The foreign bodies ingested and found were variable. The most frequent was fish bones, representing 64.11% of the cases, followed by chicken bones and dietary impaction. Thirty-eight percent of patients required foreign body removal; the most frequently used tool was the foreign body forceps. The primary location was the esophagus in 12.53% of cases, followed by the cricopharynx in 11.18% and the hypopharynx in 10%. Conclusions: The Clínica Universitaria Colombia is a referral site for many gastroenterology emergencies due to its high technological level and extensive human resources. This paper probably describes the largest number of patients with this reason for consultation, which is why this retrospective descriptive study was designed. It shows the demographic characteristics, foreign body types, radiological and endoscopic findings, and associated complications, which help to provide a more accurate knowledge of this pathology.

Introducción: La ingesta de cuerpos extraños es un problema médico frecuente, especialmente en el servicio de urgencias. Existen algunos estudios pequeños que describen las experiencias al respecto. Materiales y métodos: Estudio descriptivo, retrospectivo, en el cual se incluyó a pacientes con sospecha de ingesta de cuerpos extraños, ingresados al servicio de gastroenterología y endoscopia digestiva de La Clínica Universitaria Colombia, entre enero de 2007 y agosto de 2020. Resultados: La edad de ocurrencia del evento se presentó en pacientes desde los 18 hasta los 95 años, y la edad promedio fue de 45 años. Los cuerpos extraños ingeridos y encontrados fueron variables; los más frecuentes fueron la ingesta de espinas de pescado, que representó el 64,11% de los casos, seguido por la ingesta de huesos de pollo y la impactación alimentaria. Un 38% de los pacientes requirieron la extracción de cuerpo extraño y la herramienta usada con mayor frecuencia fue la pinza de cuerpo extraño. La localización principal fue el esófago, en el 12,53% de los casos, seguido por la cricofaringe, en el 11,18%, y la hipofaringe, en el 10%. Conclusiones: La Clínica Universitaria Colombia es un sitio de referencia de una gran cantidad de urgencias en gastroenterología debido a su alto nivel tecnológico y al gran recurso humano que requieren. Este trabajo representa probablemente la cantidad más grande de pacientes con este motivo de consulta, razón por la que se diseñó este estudio descriptivo retrospectivo, que muestra las características demográficas, los tipos de cuerpo extraño, los hallazgos radiológicos y endoscópicos y las complicaciones asociadas, que son de utilidad para tener un conocimiento más real de esta patología.

El renacimiento tecnológico de la Radiología: la revolución open source y la inteligencia artificial

El campo de la radiología ha experimentado avances notables en las últimas décadas, con desarrollos que van desde la mejora de la calidad y digitalización de las imágenes hasta la detección asistida por computadora. Particularmente, la aparición de técnicas de Inteligencia Artificial basadas en Deep Learning y Visión Computacional han promovido soluciones innovadoras en el diagnóstico y el análisis radiológico. Se explora la relevancia de los desarrollos y modelos open source en el progreso de estas técnicas, resaltando el impacto que la colaboración y el acceso abierto han tenido en el avance científico del campo. La investigación tiene un enfoque cualitativo, con alcance descriptivo y retrospectivo, de corte longitudinal. Se realizó un análisis documental de la evolución y el impacto del open source en la Radiología, poniendo de relieve la colaboración multidisciplinar. Se examinaron casos de uso, ventajas, desafíos y consideraciones éticas en relación con la implementación de soluciones basadas en Inteligencia Artificial en Radiología. El enfoque open source ha mostrado ser una influencia positiva en la Radiología, con potencial para influir en la atención médica, ofreciendo soluciones más precisas y accesibles. No obstante, se presentan desafíos éticos y técnicos que requieren atención.

The field of radiology has seen notable advances in recent decades, with developments ranging from image quality improvement and digitization to computer-aided detection. Particularly, the emergence of Artificial Intelligence techniques based on Deep Learning and Computer Vision have promoted innovative solutions in diagnosis and radiological analysis. This article explores the relevance of open source developments and models in the progress of these techniques, highlighting the impact that collaboration and open access have had on the scientific advancement in this field. This research has a qualitative approach, with a descriptive, retrospective, longitudinal scope. A documentary analysis of the evolution and impact of open source in Radiology was carried out, highlighting multidisciplinary collaboration. Use cases, advantages, challenges and ethical considerations were also examined in relation to the implementation of AI-based solutions in Radiology. The Open Source approach has been shown to be a positive influence in Radiology, with the potential to influence medical care, offering more precise and accessible solutions. However, there are ethical and technical challenges that require attention.