Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography. / Incidencia de nefropatía por contraste en pacientes sometidos a tomografía computarizada: ¿qué factores la condicionan?

OBJECTIVE: To analyze the incidence of contrast-induced nephropathy in a cohort of patients undergoing computed tomography (CT) with intravenous iodinated contrast material. To evaluate the efficacy of N-acetylcysteine in preventing contrast-induced nephropathy. PATIENTS AND METHODS: This prospective observational study was carried out in the months comprising March 2016 through July 2016. We selected the first five patients scheduled to undergo CT examination each day who agreed to participate and signed the informed consent form. We recorded patients' cardiovascular histories, chronic treatments, and indications for the CT examination. We measured blood levels of creatinine and urea before and after the CT examination. We used the Modification of Diet in Renal Disease (MDRD-4) equation to estimate the glomerular filtration rate. We analyzed the type and dose of contrast material. We recorded whether N-acetylcysteine was administered before the CT examination. We used SPSS 15.0® to compare means and proportions. Statistical significance was set at p < 0.05. RESULTS: No incidents of contrast-induced nephropathy were detected in any of the 202 patients included [mean age, 63.92 ± 12 years (range 22-87); 57.4% male; 21.8% diabetic; 39.6% hypertensive; 87.1% had MDRD4 ≥ 60 ml/min/1.73 m2 (89.45 ± 14, range 62.36-134.14) and 12.9% had MDRD4 < 60 ml/min/1.73 m2 (45.38 ± 11, range 9.16-58.90)]. The most common indication for CT examinations was oncologic (81.2%). The only contrast agent administered was iopamidol; the mean dose was 107.83 ± 11 ml (range 70-140). The mean interval between pre-CT and post-CT laboratory tests was 4.06 ± 1 days. Only 13 patients received N-acetylcysteine; 9 of these had MDRD < 60 ml/min/1.73 m2 and 4 had MDRD4 ≥ 60 ml/min/1.73 m2 (p = 0.000). CONCLUSIONS: The incidence of contrast-induced nephropathy was not significant in patients with glomerular filtration rates greater than 30 ml/min/1.73 m2: these favorable results might be due to analyzing only scheduled examinations and to using relatively low doses of a "nonionic" iodinated contrast agent.

El radiólogo invisible. Respuesta de los autores / The invisible radiologist. Response of the authors

No disponible

Detectores radiográficos digitales inalámbricos en una sala de radiología de urgencias. Una solución eficaz / Wireless digital radiography detectors in the emergency area: an efficacious solution

Objetivos. Evaluar la implantación de un sistema digital de pantalla plana (flat panel digital radiography [DR]) con tecnología WiFi, en una sala de radiología de urgencias que previamente estaba trabajado con un sistema de radiología computarizada (computed radiography [CR]). Se analizaron aspectos de calidad de imagen, reducción de dosis, flujo de trabajo y ergonomía. Material y métodos. Se estudiaron los resultados obtenidos con sistemas CR y DR-WiFi, relacionados con la calidad de imagen analizada en imágenes obtenidas en maniquí y tras la valoración de imágenes radiológicas por radiólogos, también se analizaron tiempos y flujo de trabajo en la realización de los estudios con ambos métodos y especialmente se estudiaron datos de reducción de dosis en grupos de pacientes antes y después de la instalación del nuevo equipamiento. Resultados. La calidad de imagen mejoró tanto en las pruebas realizadas sobre maniquí como en la evaluación por radiólogos, que aumentó de 3 a 4,5 en una escala máxima de 5; los tiempos de estudio disminuyeron un promedio de 25 segundos por cada imagen; se comprobó que se requiere utilizar menos radiación con el panel plano en prácticamente todas las técnicas llevadas a cabo con exposimetría automática, aunque el estudio solo ha mostrado diferencias estadísticamente significativas en algunas de las técnicas (tórax, columna dorsal y lumbar). Conclusiones. La instalación del sistema DR-WiFi ha sido beneficiosa. Se ha producido un incremento en la calidad de imagen con una reducción de la dosis en los pacientes, junto a ventajas en términos de funcionalidad, ergonomía y rendimiento (AU)

Objectives. To evaluate the implementation of a flat panel digital radiolography (DR) system with WiFi technology in an emergency radiology area in which a computed radiography (CR) system was previously used. We analyzed aspects related to image quality, radiation dose, workflow, and ergonomics. Material and methods. We analyzed the results obtained with the CR and WiFi DR systems related with the quality of images analyzed in images obtained using a phantom and after radiologists’ evaluation of radiological images obtained in real patients. We also analyzed the time required for image acquisition and the workflow with the two technological systems. Finally, we analyzed the data related to the dose of radiation in patients before and after the implementation of the new equipment. Results. Image quality improved in both the tests carried out with a phantom and in radiological images obtained in patients, which increased from 3 to 4.5 on a 5-point scale. The average time required for image acquisition decreased by 25seconds per image. The flat panel required less radiation to be delivered in practically all the techniques carried out using automatic dosimetry, although statistically significant differences were found in only some of the techniques (chest, thoracic spine, and lumbar spine). Conclusions. Implementing the WiFi DR system has brought benefits. Image quality has improved and the dose of radiation to patients has decreased. The new system also has advantages in terms of functionality, ergonomics, and performance (AU)

[Wireless digital radiography detectors in the emergency area: an efficacious solution]. / Detectores radiográficos digitales inalámbricos en una sala de radiología de urgencias. Una solución eficaz.

OBJECTIVES: To evaluate the implementation of a flat panel digital radiolography (DR) system with WiFi technology in an emergency radiology area in which a computed radiography (CR) system was previously used. We analyzed aspects related to image quality, radiation dose, workflow, and ergonomics. MATERIAL AND METHODS: We analyzed the results obtained with the CR and WiFi DR systems related with the quality of images analyzed in images obtained using a phantom and after radiologists' evaluation of radiological images obtained in real patients. We also analyzed the time required for image acquisition and the workflow with the two technological systems. Finally, we analyzed the data related to the dose of radiation in patients before and after the implementation of the new equipment. RESULTS: Image quality improved in both the tests carried out with a phantom and in radiological images obtained in patients, which increased from 3 to 4.5 on a 5-point scale. The average time required for image acquisition decreased by 25 seconds per image. The flat panel required less radiation to be delivered in practically all the techniques carried out using automatic dosimetry, although statistically significant differences were found in only some of the techniques (chest, thoracic spine, and lumbar spine). CONCLUSIONS: Implementing the WiFi DR system has brought benefits. Image quality has improved and the dose of radiation to patients has decreased. The new system also has advantages in terms of functionality, ergonomics, and performance.

Osteopatía estriada con esclerosis craneal / Osteopathia striata with cranial sclerosis

La osteopatía estriada con esclerosis craneal es una rara enfermedad con menos de 100 casos descritos en la literatura médica. Presenta unos hallazgos radiológicos característicos que una vez identificados llevan al diagnóstico. Las estriaciones escleróticas longitudinales en huesos largos y la osteoesclerosis de los huesos faciales y del cráneo deben hacer pensar en esta entidad. No se trata de una enfermedad grave, aunque frecuentemente se asocia a otro tipo de trastornos y malformaciones extraesqueléticas que con frecuencia condicionan el pronóstico. La afectación de los huesos craneales y faciales puede producir deformación facial y discapacidad funcional marcada al afectar a los nervios craneales. Se presenta un caso de esta enfermedad descubierto de forma casual en una paciente joven estudiada en una consulta de medicina por manifestaciones clínicas en principio ajenas a esta dolencia (AU)

Osteopathia striata with cranial sclerosis is a rare disease: fewer than 100 cases have been reported. The radiologic findings of osteopathia striata are characteristic, and once they are identified, they lead to the correct diagnosis. Longitudinal sclerotic striation in long bones and osteosclerosis in facial bones should raise suspicion of osteopathia striata with cranial sclerosis. This is not a serious disease, although it is often associated with other kinds of disorders and extraskeletal malformations that can affect the prognosis. Involvement of cranial and facial bones can lead to facial deformity and marked functional incapacity when the cranial nerves are affected. We present a case of osteopathia striata with cranial sclerosis discovered incidentally in a young woman studied for clinical manifestations unrelated to this disease (AU)

[Teleradiology in the emergency department: opportunity and danger]. / Telerradiología en la urgencia, oportunidad y amenaza.

Teleradiology is an established fact in developed countries. It has been the subject of intense professional and even legal debate in recent years because the quality of care and the role of the radiologist as a medical specialist are at stake. The opportunities and the dangers involved in teleradiology are discussed in this article. The use of teleradiology in certain circumstances in the emergency department can result in significant benefits when done right; however, it is evident that poorly implemented teleradiology services can lead to significant decreases in the quality of care (for example when the aim is to provide a low cost reporting service through outsourcing). Radiologists must use their knowledge and collaboration to ensure that they have the main role in the design, management, and performance of teleradiology services. The stance of our scientific societies together with the legal and regulatory frameworks must be the pillars that support teleradiology as a medical act.

Telerradiología en la urgencia, oportunidad y amenaza / Teleradiology in the emergency department: opportunity and danger

La telerradiología es una realidad implantada en los países desarrollados, y ha suscitado un debate profesional e incluso legal intenso en los últimos años, ya que están en juego la calidad asistencial y el papel del radiólogo como especialista médico. La oportunidad y la amenaza que suponen la telerradiología son los aspectos que desarrollamos en este artículo: su utilización en determinadas circunstancias en las urgencias puede aportar importantes beneficios cuando se realiza adecuadamente; pero es evidente que mal implantada puede suponer una importante merma de la calidad asistencial, por ejemplo cuando su objetivo es dar un servicio de informes a bajo precio recurriendo a la externalización. El radiólogo, desde el conocimiento y la colaboración, debe mantener un papel protagonista en su diseño, dirección y realización. El posicionamiento de nuestras sociedades científicas, el marco normativo y legal deben ser los pilares para la realización de la telerradiología como un acto médico (AU)

Teleradiology is an established fact in developed countries. It has been the subject of intense professional and even legal debate in recent years because the quality of care and the role of the radiologist as a medical specialist are at stake. The opportunities and the dangers involved in teleradiology are discussed in this article. The use of teleradiology in certain circumstances in the emergency department can result in significant benefits when done right; however, it is evident that poorly implemented teleradiology services can lead to significant decreases in the quality of care (for example when the aim is to provide a low cost reporting service through outsourcing). Radiologists must use their knowledge and collaboration to ensure that they have the main role in the design, management, and performance of teleradiology services. The stance of our scientific societies together with the legal and regulatory frameworks must be the pillars that support teleradiology as a medical act (AU)

[Osteopathia striata with cranial sclerosis]. / Osteopatía estriada con esclerosis craneal.

Osteopathia striata with cranial sclerosis is a rare disease: fewer than 100 cases have been reported. The radiologic findings of osteopathia striata are characteristic, and once they are identified, they lead to the correct diagnosis. Longitudinal sclerotic striation in long bones and osteosclerosis in facial bones should raise suspicion of osteopathia striata with cranial sclerosis. This is not a serious disease, although it is often associated with other kinds of disorders and extraskeletal malformations that can affect the prognosis. Involvement of cranial and facial bones can lead to facial deformity and marked functional incapacity when the cranial nerves are affected. We present a case of osteopathia striata with cranial sclerosis discovered incidentally in a young woman studied for clinical manifestations unrelated to this disease.

[Intracranial haemorrhage secondary to a lightning strike: a case report]. / Hemorragia intracraneal secundaria a fulguración por rayo: presentación de un caso.

INTRODUCTION: The damage caused to the central nervous system by lightning can be immediate or delayed. Cerebrovascular accidents are usually an infrequent complication of lightning strikes. CASE REPORT: We report the case of a patient who was hit by lightning and then developed an acute bilateral intraparenchymatous haemorrhage in the basal ganglia and the left internal capsule. DISCUSSION: Few cases of intracranial haemorrhages secondary to lightning strikes have been reported. We carry out a review and analysis of the literature currently available on the subject. A number of theories have been put forward that attempt to explain the mechanism behind these haemorrhages in patients who have been hit by lightning. The reason why there is a predilection for the basal ganglia is unknown, although it could be linked to the particular features of the vascularisation of the area.