RESUMO
Lung cancer is the leading cause of cancer death and second most common cancer among both men and women, but most of them are detected when patients become symptomatic and in late-stage. Chest radiography (CR) is a basic technique for the investigation of lung cancer and has the benefit of convenience and low radiation dose, but detection of malignancy is often difficult. The introduction of computed tomography (CT) for screening has increased the proportion of lung cancer detected but with higher exposure dose and higher costs. Digital chest tomosynthesis (DCT), a tomographic technique, may offer an alternative to CT. DCT uses a conventional radiograph tube, a flat-panel detector, a computer-controlled tube mover and reconstruction algorithms to produce section images. It shows promise in the detection of potentially malignant lung nodules, with higher sensibility than CR, and is emerging as a low-dose and low-cost alternative to CT to improve treatment decisions. In fact, an increasing number of researchers are showing that tomosynthesis could have a role in the detection of lung cancer, in addition to its present role in breast screening. However, DCT offers some limitations, such as limited depth resolution, which may explain the difficulty in detecting pathologies in the subpleural region and the occurrence of artefacts from medical devices. Once solved these limitations and once more studies supporting its use will be available, DCT could become the first-line lung cancer screening tool among patients at considerable risk of lung cancer.
RESUMO
Aortic impedance data of infants, children and adults (age range 0.8-54 yr), previously reported by others, were interpreted by means of three alternative four-element windkessel models: W4P, W4S, and IVW. The W4P and W4S are derived from the three-element windkessel (W3) by connecting an inertance (L) in parallel or in series, respectively, with the aortic characteristic resistance (Rc). In the IVW, L is connected in series with a viscoelastic windkessel (VW). The W4S and IVW (same input impedance) fit the data best. The W4S, however, suffers from the assumption that Rc is part of total peripheral resistance (Rp). The IVW model offers a new paradigm for interpretation of resistive properties in terms of viscous (Rd) properties of vessel wall motion, distinguished from Rp. Results indicated that rapid reduction of Rd/Rp during early development is functional to modulation of decay time constant (taud) of pressure in diastole, such that normalization over heart period (taud/T) is independent of body size. Estimates of total arterial compliance (C) vs. age were fitted by a bell-shaped curve with a maximum at 33 yr. With body weight (BW) factored out by normalization, the C/BW data scattered about a bell-shaped curve centered at 66 mmHg. Inertance was significantly higher in pediatric patients than in adults, in accordance with a lower cross-sectional area of the vasculature, commensurate to a lower aortic flow. Changes of arterial properties appear functional to control the ratio of pulsatile power to active power and keep arterial efficiency as high as 97% in infants and children.
