OBJECTIVE: The present study was aimed at evaluating the performance of residents trained in the reading of conventional and digital mammography images with a specific computational tool. MATERIALS AND METHODS: The training was accomplished in the Laboratory of Medical Images Qualification (QualIM - Laboratório de Qualificação de Imagens Médicas). Residents in radiology performed approximately 1,000 readings of a set of 60 images acquired from a statistical phantom (Alvim®) presenting microcalcifications and fibers with different sizes. The analysis of the residents' performance in the detection of these structures was based on statistical parameters. RESULTS: Values for detection probability were respectively 0.789 and 0.818 for conventional and digital systems. False-positive rates were 8% and 6%, and true-positive rates, 66% and 70% respectively. The total kappa value was 0.553 for readings on the negatoscope (hard-copy readings), and 0.615 on the monitor (soft-copy readings). The area under the ROC curve was 0.716 for hard-copy readings and 0.810 for soft-copy readings. CONCLUSION: The training has showed to be effective, with a positive impact on the residents' performance, representing an interesting educational tool. The results of the present study suggest that this method of training based on the reading of images from phantoms can improve the practitioners' performance in the interpretation of mammographic images.

Keywords: Digital image, Teaching & learning, Mammography, Educational tool, Soft-copy reading, Hard-copy reading

OBJECTIVE: To compare the time required for generation and typing of radiology reports by means of an electronic system based on the technology of voice over internet protocol (VoIP) and the traditional system, in which the report is handwritten by the radiologist. MATERIALS AND METHODS: It was necessary to model, build and deploy the proposed electronic system, capable of recording the reports in a digital audio format and comparing it with the traditional method. Radiologists and transcriptionists recorded the reports generation and typing times for both systems, using appropriate forms. RESULTS: When the mean times between both systems were compared, those from the electronic system presented a reduction of 20% (p = 0.0410) in the report generation time as compared with the traditional method. On the other hand, the traditional method was more efficient with respect to typing time, as the mean typing time with the electronic system was three times longer (p < 0.0001). CONCLUSION: The results demonstrated a statistically significant difference between the compared systems, with the electronic system being more efficient than the traditional one with respect to report generation time, while the traditional method presented better results with respect to typing time.

Keywords: Radiology information systems, Medical records, Analog-digital conversion

OBJECTIVE: A software called QualIM® - Qualificação de Imagens Médicas was developed for training of practitioners in the interpretation of digital mammograms classified according to BI-RADS® categories, utilizing images manipulation tools on state-of-the-art displays. MATERIALS ANDMETHODS: A Delphi 7-based system stores data resulting from mammographic findings interpretation during the training, comparing them with a golden-standard data set. The database includes computed radiography, direct radiography and digitized images. The software converts computed radiography and direct radiography images into TIFF format, preserving their original spatial and contrast resolution. During the training, the images are manipulated with the aid of the software tools (zoom, inversion, digital rulers and others). Depending on the image complexity, up to eight mammographic views, six ultrasonography images and two anatomopathological images can be displayed. RESULTS: The training was initiated in 2007 and is currently included in the radiology residency program. Based on data entered by the practitioner, the software automatically generates a BI-RADS compliant text that is compared with a database. CONCLUSION: The QualIM software is a digital educational tool aimed at assisting practitioners in the recognition of visual patterns on mammographic images as well as in the interpretation of mammograms based on the BI-RADS classification.

Keywords: Training, Digital mammography, Displays

In digital mammography, imaging acquisition, display and storage processes are separated and individually optimized. Radiation transmitted through the breast is absorbed by an electronic detector with an accurate response over a wide range of intensities. Once these data are stored, they can be displayed by means of computer image-processing techniques to allow arbitrary settings of image brightness, contrast and magnification, without the need for further radiological exposure of the patient. In this article, the current state of the art in technology for digital mammography and clinical trials data supporting the use of this technology are reviewed. In addition, several potentially useful applications, currently under development with digital mammography, are described.

Keywords: Mammography, Breast cancer, Digital radiography, Full-field digital mammography

OBJECTIVE: To observe digital sucking or hand sucking habits in fetuses using ultrasound, to identify pregnancy related factors that influence its appearance and to evaluate the persistence of digital sucking after delivery. MATERIALS AND METHODS: Two ultrasound examinations were performed in 55 pregnant women with 20-24 and 25-32 weeks of pregnancy. Questionnaires were used to evaluate the factors related to pregnancy. In order to verify the persistence of digital sucking, visits to the newborns were performed one week after delivery. RESULTS: Digital sucking was detected in 35 of the 55 fetus studied. Digital sucking in fetuses was not associated with the health status of the pregnant women and the level of pregnancy acceptance. The Q Cochran test showed no relationship between the observation of digital sucking in the fetuses and the development of sucking habit in the newborns. CONCLUSION: Ultrasound is an effective method to observe digital sucking in the fetus. There is no association between prenatal digital sucking and the development of sucking habits after delivery.

Keywords: Fetal ultrasound, Obstetric ultrasound, Oral habits, Digital sucking, Malocclusion

OBJECTIVE: To make a software available for training professionals in the interpretation of mammography images on digital systems. MATERIALS AND METHODS: The software was developed in Delphi and linked to a Interbase database to store mammographic images in association with the BI-RADS® category results. Images were previously qualified and digitized using a Lumiscan 75 laser scanner. Training is done on 18 × 24 cm images displayed on a 17² commercial monitor. The software allows displaying of each breast view individually, medial-lateral oblique and cranial-caudal views, or four images simultaneously. The user selects an exam from the database and makes a diagnosis classifying the image into BI-RADS® categories. At the end of the process, the software compares the user's interpretation with the data stored in the database and than yields scores. RESULTS: The user becomes familiar with digital systems, images interpretation using BI-RADS® categories and with the quality of the image generating process regarding the detection of fibers and microcalcifications. CONCLUSION: The software is available at "Universidade Federal de São Paulo", São Paulo, Brazil, intranet and is a valuable tool for training professionals interested in digital systems.

Keywords: Data base, Mammography, Digital, Quality control

The authors report a case of primary hypertrophic osteoarthropathy in a 29-year-old male with swollen joints. Physical examination revealed also digital clubbing and convexity of the nails. All other causes of secondary forms of hypertrophic osteoarthropathy were excluded. The main radiological abnormalities found were bone cortical hypertrophy and periosteal proliferation. Abnormalities of the joint spaces were not observed.

Keywords: Hypertrophic osteoarthropathy, Pachydermoperiostosis, Digital clubbing

Several technological developments are contributing to increase the use of imaging techniques in biomedical research and clinical medicine. Many investigators have attempted to develop computerized routines for automated detection and quantitative analysis of abnormalities in radiological images. These routines have been referred to as computer-aided diagnosis. In this paper we discuss the basic concepts of computer-aided diagnosis and review the literature.

Keywords: Computer-aided diagnosis, Digital radiography, Image processing, Computer vision, Artificial intelligence

This paper describes the implementation of a mini-PACS (picture archiving and communication system) at a university hospital ("Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo"), as a component of a project for a filmless radiology facility.

Keywords: Digital radiology. Picture archiving and communication system. PACS. Filmless radiology.

Objective: To propose a reproducible, user friendly and low cost method for digitization of radiographic films of all the standard sizes, focusing efforts on chest X-ray films. Materials and Methods: The focus on low cost have dictated the use of an A4 scanner with transparency adapter, as well as an optimized image stitching software that takes advantage of the scanner geometry and constant capture area, besides the knowledge of the standard X-ray film sizes. Results: The end result of the proposed method is a high resolution image with good contrast and no perceptible stitching artifacts. Conclusion: The proposed digitization method with an A4 scanner allows reproducibility, excellent image quality and high degree of certainty in the identification of lesions.

Keywords: Digital radiology; Teleradiology; Image stitching.

Objetivo: A principal utilidade da tomografia por emissão de pósitrons com 18-fluordeoxiglicose (FDG-PET) está no estadiamento do câncer de pulmão. Porém, ela também pode ser utilizada para diferenciar lesões pulmonares indeterminadas, mas seu impacto na ressecção cirúrgica de lesões benignas é desconhecido. O objetivo deste estudo foi comparar a prevalência de lesões benignas em toracotomias feitas por suspeição de câncer de pulmão, antes e após a introdução do FDG-PET, em um centro de referência de cirurgia torácica. Materiais e Métodos: Os autores analisaram, prospectivamente, uma base de dados cirúrgicos de todos os pacientes consecutivos submetidos a toracotomia por câncer de pulmão suspeito ou comprovado e compararam a prevalência de lesões benignas em dois grupos ao longo de dois anos consecutivos, respectivamente antes (grupo I) e depois (grupo II) da introdução da FDG-PET. Resultados: Ressecção cirúrgica foi feita em 1.233 pacientes durante o período do estudo. A prevalência de lesões benignas na cirurgia nos grupos I e II foi similar (44/626 e 41/607, ambas correspondendo a 7%), e também no grupo II, entre aqueles submetidos a FDG-PET e os restantes (21/301 e 20/306 respectivamente, ambos correspondendo a 7%). No grupo II, dos 21 pacientes com lesões benignas submetidos a FDG-PET, 19 tiveram um estudo falso-positivo (valor médio padrão de captação 5.3 [faixa 2.6–12.7]). Desses, respectivamente 13 e 4 pacientes tiveram broncoscopia não diagnóstica e biópsia transtorácica percutânea de pulmão antes da toracotomia. Não houve diferença na proporção de lesões benignas diferentes ressecadas entre o grupo I e aqueles submetidos a FDG-PET no grupo II. Conclusão: A introdução da FDG-PET não alterou a proporção de pacientes submetidos a toracotomia por lesões benignas, principalmente devido à avidez pelo isótopo de algumas lesões não malignas. Tais resultados falsos-positivos devem ser considerados nos casos em que se contempla a possibilidade de ressecção cirúrgica em pacientes com câncer de pulmão não confirmado.

Keywords: Tomografia por emissão de pósitrons; Tomografia computadorizada; Pulmão – lesões benignas ou congênitas; Câncer de pulmão – diagnóstico e estadiamento; Câncer de pulmão – cirurgia.

OBJETIVO: Avaliar a completude das fissuras, resposta radiológica ao tratamento e análise quantitativa por TC (AQTC) em população de pacientes com enfisema grave submetidos ao implante de valvas endobrônquicas (VEB). MATERIAIS E MÉTODOS: Foram estudados exames de TC multidetectores de 29 pacientes, realizados com protocolo de baixo dose, cortes finos, sem contraste. Dois radiologistas revisaram, retrospectivamente, os exames em consenso. A completude das fissuras foi estimada em escala de 5% e a resposta radiológica (atelectasia/perda volumétrica do lobo alvo) foi avaliada. AQTC foi realizada nos exames pré e pós-tratamento utilizando programa completamente automático. RESULTADOS: Resposta radiológica positiva foi vista em 16/29 pacientes. Os 13 pacientes sem resposta à TC apresentavam fissuras incompletas e completude média das fissuras obliquas de 72,8%, contra 88,3% no outro grupo. Os resultados mais significativos da AQTC mostraram redução do volume pulmonar (VP) total (média de 542 ml), VP tratado (700 ml) e volume de enfisema (331,4 ml) no grupo com resposta positiva, que também apresentou melhora nos testes funcionais. CONCLUSÃO: O benefício das VEB é maior em pacientes com fissuras completas e que desenvolvem atelectasia lobar. Nos pacientes sem resposta radiológica encontramos maior prevalência de fissuras incompletas e grau de incompletude das fissuras. Nossa AQTC automática detectou as alterações pós-tratamento, principalmente considerado a análise do pulmão tratado.

Keywords: Enfisema; Terapia de colapso pulmonar; Tomografia computadorizada.

OBJECTIVE: To evaluate suspicious amorphous calcifications diagnosed on full-field digital mammography (FFDM) and establish correlations with histopathology findings. MATERIALS AND METHODS: This was a retrospective study of 78 suspicious amorphous calcifications (all classified as BI-RADS^® 4) detected on FFDM. Vacuum-assisted breast biopsy (VABB) was performed. The histopathological classification of VABB core samples was as follows: pB2 (benign); pB3 (uncertain malignant potential); pB4 (suspicion of malignancy); and pB5 (malignant). Treatment was recommended for pB5 lesions. To rule out malignancy, surgical excision was recommended for pB3 and pB4 lesions. Patients not submitted to surgery were followed for at least 6 months. RESULTS: Among the 78 amorphous calcifications evaluated, the histopathological analysis indicated that 8 (10.3%) were malignant/suspicious (6 classified as pB5 and 2 classified as pB4) and 36 (46.2%) were benign (classified as pB2). The remaining 34 lesions (43.6%) were classified as pB3: 33.3% were precursor lesions (atypical ductal hyperplasia, lobular neoplasia, or flat epithelial atypia) and 10.3% were high-risk lesions. For the pB3 lesions, the underestimation rate was zero. CONCLUSION: The diagnosis of precursor lesions (excluding atypical ductal hyperplasia, which can be pB4 depending on the severity and extent of the lesion) should not necessarily be considered indicative of underestimation of malignancy. Suspicious amorphous calcifications correlated more often with precursor lesions than with malignant lesions, at a ratio of 3:1.

Keywords: Breast stereotaxis biopsy; Calcification; Diagnosis; Amorphous morphology; Digital mammography; Breast cancer.

OBJETIVO: Avaliar os padrões tomográficos relacionados aos agentes etiológicos da pneumonia em pacientes durante o primeiro ano após transplante renal. MATERIAIS E MÉTODOS: Foram analisados dados de prontuários de 956 pacientes submetidos a transplante renal, no período de 2013 a 2018, em um centro transplantador renal do nordeste do Brasil. Nos pacientes que desenvolveram pneumonia, os agentes etiológicos foram classificados em bactérias piogênicas, micobactérias, fungos, vírus e pneumonia polimicrobiana, enquanto os padrões tomográficos foram classificados em consolidação, broncopneumonia, pneumonia intersticial e nódulos e massas. Para verificar associação estatística entre micro-organismos e padrões tomográficos, foi utilizado o teste exato de Fisher, com p < 0,001. RESULTADOS: Foram encontrados 101 casos de pneumonia, dos quais 60 (59,4%) tiveram agente etiológico identificado, sendo as bactérias piogênicas as mais frequentes, detectadas em 22 (36,7%) dos casos. Entre os pacientes com agente causal identificado, o padrão tomográfico predominante foi o de nódulos e massas, identificado em 25 (41,7%) casos. Foi observada associação entre bactérias piogênicas e o padrão de consolidação, fungos com nódulos e massas, bem como entre agentes virais e padrão intersticial. CONCLUSÃO: Foi demonstrada associação estatística entre micro-organismos causadores de pneumonia e padrões tomográficos, informação que pode contribuir para o planejamento da terapia de pacientes transplantados renais.

Keywords: Pneumonia; Transplante de rim; Tomografia computadorizada.