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

Hypopituitarism can be caused by radiation therapy, even when it is not directly applied on the hypothalamic-pituitary axis, and can lead to anterior pituitary deficiency mainly due to hypothalamic damage. The progressive loss of the anterior pituitary hormones usually occurs in the following order: growth hormone, gonadotropin hormones, adrenocorticotropic hormone and thyroid-stimulating hormone. Although there are several different tests available to confirm anterior pituitary deficiency, this paper will focus on the gold standard tests for patients submitted to radiation therapy. We emphasize that the decline of anterior pituitary function is time- and dose-dependent with some variability among the different axes. Therefore, awareness of the need of a joint management by endocrinologists and oncologists is essential to improve treatment and quality of life of the patients.

Keywords: Radiotherapy, Hypopituitarism, Anterior pituitary, Diagnosis, Quality of life

Ten patients treated with Ilizarov external fixator for limb lengthening were monitored with radiographs and sonography examinations between March, 2001 and March, 2002. Most of the patients were children and adolescents who were submitted to surgery for correction of congenital deformities (six cases). In three patients shortening was secondary to post-traumatic osteomielitis and in one patient due to tumor resection. The femur was affected in 60%, tibia in 30% and fibula in 10% of the cases. The main radiographic findings of bone regeneration during the normal process of limb lengthening were lucent areas, linear ossification, periosteal reaction, soft tissue abnormalities and complete consolidation. Sonographic findings of new bone formation included anechoic areas, sparse echogenic foci within the distraction site, linear longitudinally oriented echogenic foci, amorphous and coarse echogenic foci and complete calcification. There were 15 complications in six patients: fluid collection at the distraction site (five cases), pin site infection (four cases), soft tissue collection (three cases), premature consolidation (two cases) and delayed consolidation (one case).

Keywords: Ilizarov, Limb lengthening, Radiography, Sonography

A database of radiographic images was created in order to protect data from time deterioration and to allow easy access to information. This database was designed to store clinical data of each patient and the corresponding digitalized images. The different parts of the software were organized according to the orientation of the professors of the Radiology Department of "Universidade Federal do Rio de Janeiro", Rio de Janeiro, Brazil. This system is of low cost and easy manipulation.

Keywords: Image digitalization, Database, Teaching, Radiology

In view of the great importance of quality control in radiotherapy services, this paper aimed primarily to evaluate the tests recommended by international protocols TG40 and ARCAL XXX for teletherapic equipments (cobalt, linear accelerator and simulator). A second objective was to evaluate the tests currently used in some radiotherapy services in Brazil and Latin America and to compare these tests with the ones recommended by the international protocols. Our results suggest that ARCAL is more complete than TG40, although the latter includes all the essential basic tests. We concluded that radiotherapy services should implement all basic quality control tests and that all other complementary tests should be implemented according to the need of each service. Finally, suggestions of protocols are presented, elaborated from the official and routine protocols used.

Keywords: Teletherapy, Protocols, Quality control

OBJECTIVE: To evaluate the use of transjugular intrahepatic portosystemic shunt (TIPS) and suprahepatic venous stenting in the management of Budd-Chiari syndrome, emphasizing the indications, technical aspects and the advantages of the procedure. MATERIALS AND METHODS: Nine patients with Budd-Chiari syndrome were referred to the Hemodynamics Service of "Hospital São Lucas", Porto Alegre, RS, Brazil, for percutaneous procedure. Suprahepatic venous occlusion was detected in all cases using Doppler sonography. In the TIPS procedure, a snare loop was identified in the inferior vena cava just below the right atrium at the site of expected outflow of the occluded hepatic vein. After sonographic and fluoroscopic localization of the portal bifurcation, the needle was advanced into the portal vein and a stiff guide wire was introduced. Venography was performed and a stent was implanted. Follow-up color Doppler examinations were obtained in all cases at different intervals. RESULTS: Prominent hepatic venous stenosis was detected in three patients that were treated with suprahepatic stent implantation. Two of these patients required TIPS due to thrombosis of the stent. In the other six patients a TIPS creation was done. During follow-up, shunt dysfunction occurred in three of eight patients, requiring repeat intervention and insertion of another endoprostheses in two patients, mechanical thrombectomy and balloon dilatation in one and coil embolization of ectatic collaterals in another patient. CONCLUSION: TIPS is a safe and effective procedure for the treatment of portal hypertension caused by Budd-Chiari syndrome, allowing clinical and hemodynamic improvement and avoiding invasive approaches.

Keywords: Budd-Chiari syndrome, Transjugular intrahepatic portosystemic shunt (TIPS), Suprahepatic occlusion

Gaucher's disease has a genetic background and is characterized by the deficiency of enzyme glucocerebrosidase, resulting in secondary accumulation of glucocerebrosides in the reticuloendothelial organs. The objective of the present study is to evaluate the x-ray findings in the skeleton of a group of 32 male and female patients of different ages, with biochemical diagnosis of Gaucher's disease. The following bone lesions were observed: diffuse osteopenia (100% of the patients), "Erlenmeyer flask" deformities (93.7% of the patients), abnormalities of the joints (40.6% of the patients), necrosis of the femoral head (28.1% of the patients), lytic lesions (28.1% of the patients), pathological fractures (9.3% of the patients) and necrosis of the humeral head (6.2% of the patients). These results are concordant with the literature, and demonstrate the importance of conventional x-ray as a complementary method in the diagnosis of Gaucher's disease.

Keywords: Gaucher's disease. Radiology. Osseous abnormalities.

Lunotriquetral coalition and ulnar impaction syndrome are among the spectrum of pathology encountered at the medial wrist. The co-existence of these entities in the same wrist is rare. The purpose of this pictorial essay is to present the etiology, clinical course, imaging findings, and treatment of lunotriquetral coalition and ulnar impaction syndrome, and co-existing disease.

Keywords: Lunotriquetral coalition; Ulnar impaction syndrome; Wrist.

In recent decades, high-resolution ultrasound (HRUS) has revolutionized the morphological and structural evaluation of peripheral nerves and muscles, revealing details of the internal structure of the neural fascicles and muscle architecture. Applications range from diagnostics to interventional procedures. The anatomy of the forearm region is complex, with several muscles and an extensive network of vessels and nerves. To guarantee the success of the evaluation by HRUS, knowledge of the normal anatomy of the region is essential. The aim of these two companion articles is to present the normal anatomy of the nerves and compartments of the forearm, as revealed by HRUS, as well as the relationships between the main vessels and nerves of the region. Part 1 aims to review the overall structure of nerves, muscles and tendons, as seen on HRUS, and that of the forearm compartments. We present a practical approach, with general guidelines and tips on how best to perform the study. Part 2 is a pictorial essay about compartment vascularization and cutaneous innervation. Knowledge of the normal anatomy of the forearm improves the technical quality of the examinations, contributing to better diagnoses, as well as improving the performance and safety of interventional procedures.

Keywords: Ultrasonography/methods; Forearm/anatomy & histology; Radial nerve/anatomy & histology; Median nerve/anatomy & histology; Ulnar nerve/anatomy & histology.

In recent decades, high-resolution ultrasound (HRUS) has revolutionized the morphological and structural evaluation of peripheral nerves and muscles, revealing details of the internal structure of the neural fascicles and muscle architecture. Applications range from diagnostics to interventional procedures. The anatomy of the forearm region is complex, with several muscles and an extensive network of vessels and nerves. To guarantee the success of the evaluation by HRUS, knowledge of the normal anatomy of the region is essential. The aim of these two companion articles is to present the normal anatomy of the nerves and compartments of the forearm, as revealed by HRUS, as well as the relationships between the main vessels and nerves of the region. Part 1 aims to review the overall structure of nerves, muscles and tendons, as seen on HRUS, and that of the forearm compartments. We present a practical approach, with general guidelines and tips on how best to perform the study. Part 2 is a pictorial essay about compartment vascularization and cutaneous innervation. The relationships between arteries, satellite veins and nerves, as well as the relationship between cutaneous nerves and superficial veins, are demonstrated. Knowledge of the normal anatomy of the forearm improves the technical quality of the examinations, contributing to better diagnoses, as well as improving the performance and safety of interventional procedures.

Keywords: Ultrasonography/methods; Radial artery/anatomy & histology; Ulnar artery/anatomy & histology; Skin/innervation; Forearm/anatomy & histology.