OBJECTIVE: To identify the most frequent aspects of spontaneous cerebral intraparenchymatous hematoma found at computed tomography examinations. MATERIALS AND METHODS: We reviewed, retrospectively, the computed tomography studies of 250 patients with spontaneous intracerebral hemorrhage carried out in three hospitals in Rio de Janeiro, Brazil. RESULTS: Deep intracerebral hematomas showed the highest incidence and were observed in 54.4% of the cases (136 patients) followed by lobar hemorrhage in 34.8% of the cases (87 patients). Cerebelar hemorrhage and brainstem bleeding were more rarely observed, occurring in 8.4% (21 patients) and 2.4% (six patients) of the cases, respectively. CONCLUSION: Chronic headache was the most frequent symptom whereas hypertension was observed in the majority of the cases. Blood draining into the ventricular system occurred more frequently in patients with deep hematomas.

Keywords: Intracerebral hemorrhage, Computed tomography scan, Hypertension, Headache

OBJECTIVE: To review the computed tomography findings in patients with nasal cavity tumors. MATERIALS AND METHODS: Eighteen patients - ten male and eight female - with nasal cavity tumors were studied using computed tomography. RESULTS: Histological types of the tumors included six epidermoid carcinoma, three malignant melanoma, two adenoid cystic carcinoma, and one case of each of the following: adenocarcinoma, undifferentiated carcinoma, neuroendocrine carcinoma, non-Hodgkin lymphoma, rhabdomyosarcoma, fusiform cell sarcoma, and stesioneuroblastoma. The lesions were more frequent on the left side and middle level of the nasal cavity (p > 0.05). CONCLUSION: Epidermoid carcimomas showed a close relationship between the lesion volume and the degree of destruction of adjacent structures. Septum involvement was different depending on the histological type of the lesion.

Keywords: Tumors, Cancer, Nasal cavities, Computed tomography

OBJECTIVE: To develop an acceptance testing protocol for magnetic resonance imaging systems and to show which and how phantoms could be used to collect data. MATERIALS AND METHODS: The definition, procedure, analysis and the acceptation criteria were created for each of 15 selected tests. RESULTS: These tests allow the evaluation of technical specifications stated on the manufacturer's sales proposal and to establish reference values to be used in subsequent constancy tests. CONCLUSION: Future quality assurance programs in magnetic resonance imaging should consider employing tests similar or equal to the ones described in this paper.

Keywords: Magnetic resonance imaging, Quality control

OBJECTIVE: To evaluate the biosafety aspects and the working conditions of radiology department professionals and to make recommendations with respect to necessary modifications to be implemented in these departments in order to comply with national regulations. MATERIALS AND METHODS: Interviews with the professionals were carried out as well as observation of their activities in the working premises including processing of radiographic films inside the dark rooms, average time inside the dark rooms, preparation of chemical solutions for automatic processors and the type of help given to patients during radiographic examinations. The efficiency of the exhausting systems in the dark rooms was also measured. The ergonomic adequacy of the accessories inside the dark rooms was analyzed. With respect to electrical safety, the location and number of fire extinguishers as well as the grounding of the electrical equipment was evaluated to check if they were in accordance with the Brazilian legislation. RESULTS: The exhaustion systems were insufficient, professionals did not wear protective clothes/devices when preparing the chemical solutions, the ergonomic aspects were not in accordance with national recommendations, and the workers presented related stress. CONCLUSION: Based on these results, risk maps were drawn for each sector of the radiology department to be used in the implementation of improvements in each sector.

Keywords: Ergonomics, Biosafety, Map risks, Stress, Protective devices

OBJECTIVE: With the aim of reducing and preventing environmental damages, handling and disposing practices of chemical effluents from radiology departments were investigated and a service management model was created in order to obtain financial resources for the department. MATERIALS AND METHODS: The proposed model, based on the evaluation of chemical effluents from automatic processors of radiographic films, showed that fixer reprocessing can be an adequate choice to solve environmental and financial problems in these departments. This model also emphasizes that compliance with management guidelines should be observed, i.e. other effluents (developer and water) must be chemically treated before disposal in the natural environment. The economical analysis has confirmed that the income originated from commercializing the silver (of which concentration ranges from 3.5 to 10.2 g/l), recovered from the used fixer, in addition to the income from the reuse of the fixer (after its recovery), is in the worst scenario (when the silver concentration is 3.5 g/l) enough to cover all the expenses with the implementation of the project. CONCLUSION: The proposed model can be a good choice for solution of environmental and financial problems. Moreover, it is ecologically correct, a potential source of financial resources to radiology departments, and can be applied to other institutions due to the similarity of problems and resources.

Keywords: X-ray film processing, Developer, Fixer, Silver, Natural environment

Pancreatic cystic lesions, particularly small lesions, are more easily diagnosed nowadays with the use of imaging methods. In some cases, the diagnosis represents a challenge to establish the treatment, as it can range from inflammatory pseudocysts to primary or metastatic cystic neoplasms. In order to choose the treatment, it is necessary to determine if the lesion is benign, borderline, or malignant. Currently, echoendoscopy is considered the gold standard procedure for pancreatic evaluation as it clearly shows the morphology of the lesion, and also allows the acquisition of pancreatic material for cytological and tumor markers studies using fine needle aspiration biopsy. This procedure is considered safe and efficient with high rates of sensibility and specificity and low rates of complications and morbidity. The presence of septa, mural nodules and irregularities in the parenchyma are the most significant predictive factors for the differential diagnosis of mucinous pancreatic-cystic lesions for which sensibility, specificity and accuracy rates are 94%, 85% and 88%, respectively. The aim of the authors in this study is to review the major primary-cystic-pancreatic neoplasms with emphasis in the application of echoendoscopy for the definite diagnosis of these lesions.

Keywords: Echoendoscopy, Endoscopic ultrasound, Endosonography, Pancreatic cystic neoplasm

A computerized system to manage quality control testing and general X-ray equipment maintenance was developed in accordance with the requirements of Brazilian legislation (Ministerial Order No. 453/98). Quality control tests are part of a quality assurance program that should be implemented in all medical and odontological radiodiagnosis institutions. A Microsoft Access® database was developed to allow a direct link with the maintenance system that is being implemented at the "Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro", Rio de Janeiro, Brazil.

Keywords: Database management systems, Quality control, Radiography

The main objective of this study is to implement an impartial and efficient inspection method for a correct and secure use of ionizing radiation in nuclear medicine. The radiological protection model was tested in 113 nuclear medicine services (NMS) all over Brazil, following a biannual analysis schedule (1996, 1998, 2000 and 2002). In the analytical process, we adopted the methodology of assigning different importance levels to each of 82 features, based on the risk factors established by the "Comissão Nacional de Energia Nuclear" (CNEN) and on the International Atomic Energy Agency (IAEA) recommendations. A feature was considered a radioprotection fault when in nonconformity with the rules mentioned above, and was imparted a grade. The sum of those grades, classified the NMS in one of the three different ranges, as follows: operating without restriction - 100 points and below; operating with restriction - between 100 and 300 points; temporary shutdown - above 300 points. Permission for the second group to carry on operation should be attached to a defined and restricted period of time (6 to 12 months), considered enough for the NMS to solve the problems and submit to a new evaluation. The NMS's classified in the third group are supposed to go back into operation only after compliance with all the pending radioprotection requirements. Until the next regular evaluation, a multiplication factor 2n was applied to the recalcitrant NMS's, where n is the number of unwilling occurrences. The previous establishment of those items of radioprotection, with their respective grades, excluded subjective and personal values in the judgement and technical evaluation of the institutions.

Keywords: Nuclear medicine, Radiation protection, Rules, Inspection

Quality control tests, according to "Portaria 453/98" of the Brazilian Health Ministry, were applied in seven public hospitals of Rio de Janeiro including 29 X-ray tubes, 30 cassettes and 20 individual protection garments. These tests evaluate mainly the X-ray generator and system geometry. Other tests in the accessories were also performed, such as: cassettes, screens, viewing boxes, darkrooms and clear rooms. In the kVp tests, 55% of the equipments were disapproved in exactitude and 15% in reproducibility. Time exactitude and reproducibility were not approved in 53% and 31% of the equipments, respectively. The percentages of disapprovement were: for the HVL (half-value layer) 30%, for beam alignment 18%, for field coincidence 30%, for exposure linearity 40% and for focal spot 64%. It has also been observed that frequently the lead aprons were not kept in appropriate hangers and this procedure may cause damage to these accessories. The results of the test suggest the need of implementation of quality assurance tests in these services. The cost benefit analysis of the results reinforces the importance of the implementation of the recommendations contained in this paper.

Keywords: Quality assurance, Quality control, Radiodiagnostic

The dose area product was evaluated and the entrance skin dose was subsequently estimated by means of suitable calculations for pediatric examinations. Results showed values around 100% above the reference levels (0.070 mGy). The technical parameters of the X-ray tubes were periodically checked since a routine quality assurance program is implemented in the hospital. Results showed a good performance of the equipment complying with recommended limits according to Brazilian legislation. Therefore, the high doses can be attributed to the low kV techniques and the lack of appropriate training of the radiographers to perform pediatric examinations. Measurements of scattered radiation were performed in the gonads with the use of thermoluminescent dosimeters which proved to be inadequate for these measurements. Therefore an ionization chamber was used instead and the values obtained showed that the doses were far below the values that can cause permanent or transient sterility.

Keywords: Radiation doses, Pediatric radiology, Image quality

OBJECTIVE: To reduce radiation dose and increase x-ray tube life in computed tomography. MATERIALS AND METHODS: Head, upper abdomen and chest scans were evaluated. We assessed the techniques employed and if these could be changed, suggested new protocols and compared the quality of the images, the radiation dose and the x-ray tube heating. RESULTS: A mAs reduction could be done without interfering with the diagnostic quality, allowing a decrease of up to 20% in the average dose for adults' head exams and up to 45% for 0 to 6 years old children; patients with less than 50 kg had a reduction of 37% on the upper abdomen radiation average dose; for chest routine scans the reduction was 54%. The decrease in the heating of the x-ray tube for head, upper abdomen and chest scans was approximately 13%, 23% and 41%, respectively. CONCLUSION: A change on the described protocols will produce a significant reduction on the radiation dose and an increasing in x-ray tube life without loss of diagnostic quality.

Keywords: X-ray computed tomography, Radiation exposure, Radiation dosage, Radiation protection

An occupational monitoring program in diagnostic radiology was implemented at the "Hospital Universitário Clementino Fraga Filho - UFRJ", Rio de Janeiro, Brazil, in accordance with the Brazilian legislation. Previously, a survey of all personnel involved with ionizing radiation was performed. Many problems were observed: the great majority of the workers were not properly monitored; only three departments of the hospital kept an independent survey of the occupational doses; there was not a follow-up control of the high doses. With the implementation of the program, a new laboratory was chosen to read the dosemeters and this initiative resulted in reduction of the hospital costs. The inclusion of seven more departments in the program represented an increase of 60% in the number of monitored workers. The program also provided a system to control the high doses, especially in the Hemodynamics department, which presented the highest mean dose value (0.32 mSv/month). An area survey program was performed during different periods in places considered of high risk for the workers and for the public as well. At the same time, a software was used to build a database with the aim of controlling all personnel data. The implementation of the program provided all personnel involved a better knowledge of the risks associated with ionizing radiation and of radioprotection, and also awareness of the need of correct use of the personal dose monitors.

Keywords: Radiological protection, Occupational exposure, Quality control, Radiation dosimetry, Radiology

We developed a management model for maintenance of hospital radiological X-ray equipment. The model was implemented in several steps including visits to other hospitals where equipment management is also done, collaboration work with "Fundação Oswaldo Cruz" for the realization of courses and a training program for the hospital electronic technicians, organization of a small library with the schemes of the radiological equipment in use at "Hospital Universitário Clementino Fraga Filho", Rio de Janeiro, Brazil, development of a management software using a database from Access (Microsoft Windows) and evaluation of the performance of the radiological equipment. The implementation of a new routine for equipment maintenance fulfils the need for reducing repair delay and costs, improving image quality in radiodiagnosis services, and complying with resolution 453/98 of the Brazilian Ministry of Health.

Keywords: Equipment maintenance, Radiography, Database management system

The authors report a case of osteopoikilosis in a woman with HIV infection and pulmonary tuberculosis, and bone abnormalities suggestive of osteopoikilosis. The diagnosis of osteopoikilosis was incidental. Plain films and computed tomography images as well as a review of the literature are presented. To our knowledge this is the first report of association of these diseases.

Keywords: Osteopoikilosis, HIV, Radiology

Quality control of automatic processors is an important issue in the implementation of quality assurance programs in diagnostic radiology. A pilot program of quality control for automatic processors using the sensitometric method was implemented in the Radiodiagnosis Service of a University Hospital in Rio de Janeiro, RJ, Brazil. An initial survey of the darkrooms showed that they had high temperature and humidity and several light leaks; fog levels were excessively high requiring an increase in mAs of up to 24% to compensate for contrast loss; dry to dry processing time was out of control with errors of up to 56%; developer temperature was as high as 39°C (4°C higher than the recommended by the manufacturers); replenishment rates presented values as high as 417% above manufacturer's recommendations; and rejection rates of radiographic films were of the order of 21% in the mammography service. Sensitometric measurements performed before the implementation of the quality control showed values of base + fog as high as 0.24 optical density and speed and contrast outside recommended limits. The radiographic films presented several artifacts that resulted in low quality images. The pilot program consisted of the implementation of the quality control in the mammography service. Several initiatives were taken including training of the technicians, improvement of maintenance of the processors and increase in the number of patients/day from 7 to 12. This procedure allowed replenishment rates to be lowered to acceptable levels. The implementation of the quality control maintained chemical products stable keeping the sensitometric parameters under control. However, the most significant result of the program was better image quality, free from artifacts, a significant reduction in costs to the hospital and especially lower doses imparted to the patients due to the reduction in rejection rates to 7.7%.

Keywords: Quality control, Automatic processors, Sensitometric method

Tumors and cysts of the heart and pericardium are rare. The aim of this paper is to present a case of a patient with a pericardial cyst of unusual x-ray appearance which was diagnosed by transthoracic echocardiography. The patient presented mild pain in the right hemithorax and the plain films showed a mass lesion contiguous to the heart, in the cardiophrenic angle. The authors also briefly review the literature on pericardial cysts.

Keywords: Pericardial cyst. Radiology.