OBJECTIVE: To evaluate and measure the scapular positioning, and establishing its correlation with functional postural analysis and degree of upper extremities disability in sonographers. MATERIALS AND METHODS: Eighteen physicians divided into two groups - symptomatic individuals with pain for more than six months, and asymptomatic individuals - were interviewed and submitted to physical assessment with application of the Brazilian version of the DASH questionnaire. Functional measurements of scapular inclination angles and upper limbs positioning were obtained during the ultrasound scanning. The Mann-Whitney U test was utilized for analyzing the disability questionnaires; the t-Student test, for upper limbs positioning; ANOVA, for scapular inclination angles, and the Spearman's test for correlation between the functional upper limbs positioning and disability degree. RESULTS: A significant difference between symptomatic and asymptomatic groups was observed in the first 30 items of the DASH questionnaire as well as in the four study-related questions. Measurements of scapular positioning presented significant differences between the groups in the frontal plane at 90° and 120°. No significant difference was found for the analysis of functional upper limbs positioning. CONCLUSION: Changes in the scapular positioning may result in upper limbs dysfunction, and the application of the DASH questionnaire can indicate the level of pain and disability of an individual.

Keywords: Biomechanics, Shoulder joint complex, Scapular positioning, Scapulohumeral rhythm, Sonographer

OBJECTIVE: The present study was aimed at evaluating the frequency and types of anatomical variants of the ostiomeatal complex. MATERIALS AND METHODS: Computed tomography studies of 200 patients evaluated for clinical suspicion of sinusopathy were reviewed. RESULTS: Two or more types of anatomical variants were observed in 83.5% of the patients. The most frequent anatomical variants involved the middle turbinate (84%) and the nasal septum (34%). Other common variants found were the presence of pneumatized agger nasi cells and infraorbital ethmoid cells (Haller cells). CONCLUSION: The prevalence of anatomical variants in the ostiomeatal complex is high, the most frequent ones involving the middle turbinate and the nasal septum.

Keywords: Computed tomography, Ostiomeatal complex, Paranasal cavities, Anatomy, Drainage

OBJECTIVE: To develop of a software tool for evaluation and control of sensitometric curves. MATERIALS AND METHODS: A method was developed for obtaining high- and low-contrast films sensitometric values, with no need to define wedge steps. RESULTS: The software named Sensito was implemented and tested utilizing data of sensitometric strips from conventional radiology, hemodynamics, and mammography departments. The feasibility of analyzing sensitometric curves from these areas remained evidenced with no need of user-dependent adjustments, and with no deviation in the evaluated sensitometric parameters and variations. CONCLUSION: The software allows the creation of a database including sensitometric curves from different processors in a same institution, easily generating gamma curves of a register and constant charts of the evaluated sensitometric characteristics, constituting an important tool for sensitometric control.

Keywords: Automatic processor, Sensitometric curve, Sensitometry

We report a case of a 40-year-old female patient presenting with dysphagia and retrosternal chest pain for three years caused by a retroesophageal aberrant left subclavian artery originating from an aneurysmatic dilatation (Kommerell's diverticulum). The aortic arch and descending thoracic aorta were right-sided. Diagnosis was established by esophagogram, computed tomography and magnetic resonance angiography. The patient was very responsive to clinical treatment and she is presently being followed-up in the outpatient clinic for over one year.

Keywords: Right aortic arch, Aberrant left subclavian artery, Kommerell's diverticulum, Radiology

Sonographic presentation of bile duct hamartomas is variable. It is important to recognize their different forms of presentation in order to be included in the differential diagnosis of multiple focal hepatic lesions. Herein the authors report a case of bile duct hamartomas that was identified as multiple diffuse hyperechogenic liver nodules with the largest measuring 1.6 cm, without posterior acoustic reverberation.

Keywords: Liver, Bile duct hamartomas, von Meyenburg complex, Ultrasonography

The evaluation of film processing using the STEP test (sensitometric test for the evaluation of processing) is based on the identification of significant deviations in the processor-chemicals-film system. Ideal processing conditions are established for this type of evaluation. A standard film is processed according to the manufacturer's recommendations, i.e. standard processing at 100. The film is exposed to the light of a calibrated sensitometer and the sensitometric steps are read with the use of a densitometer. A standard curve (OD × STEP) is therefore obtained. The percentual deviation should be lower than 20% compared to the standard curve. This method is useful to identify processing problems. We tested processors from several public/university hospitals and found that approximately 33% of the equipments had inadequate processing conditions.

Keywords: Automatic processors, Radiographic films, Sensitometry, STEP test

The recognition and identification of benign liver tumors is important since most of these tumors do not require any intervention. The authors report the ultrasonography findings in 16 patients with bile duct hamartomas (von Meyenburg complex) that were evaluated prospectively by an active search of eight years. Multiple lesions with size equal or less than 0.8 cm were identified in 14 patients. Two other patients had only two lesions measuring 0.4 cm to 1.3 cm. The most common ultrasonographic pattern was that of multiple small hyperechogenic lesions (with or without posterior acoustic reverberation) with irregular margins (14 patients). A less common finding (two patients with two lesions each) was the "target" pattern with echogenic center and well defined limits.

Keywords: Liver, Bile duct hamartomas, von Meyenburg complex, Ultrasonography, Intraoperative ultrasonography

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

Objective: To evaluate endothelial function in patients with risk factors for atherosclerosis by measuring brachial artery flow-mediated dilatation (BAFMD) and intima-media thickness (IMT) of carotid and brachial arteries. Materials and methods: A cross-sectional, case-control study in which endothelial function was evaluated by measurement of BAFMD and IMT of carotid and brachial arteries and presence or absence of risk factors in 112 patients distributed as follows: women with risk factors (n = 49), women control group (n = 24), men with risk factors (n = 21), men control group (n = 18). Results: BAFMD was significantly compromised in the group with risk factors as compared with the control group, regardless of sex: in women, 15.2 Χ 25.3 (p < 0.01); in men, 11.8 Χ 16.8 (p < 0.02). On the other hand, IMT was not significant both for the carotid and brachial arteries, regardless of sex: brachial artery in women, 0.3 Χ 0.3 (p < 0.06); brachial artery in men, 0.36 Χ 0.23 (p < 0.07); carotid artery in women, 0.6 Χ 0.4 (p < 0.07); carotid artery in men, 0.85 Χ 0.38 (p < 0.08). The significance level was set at 5% (p < 0.05). Conclusion: Measurement of BAFMD was effective for detecting endothelial impairment in a population with risk factors for atherosclerosis.

Keywords: Atherosclerosis; Endothelial dysfunction; Brachial artery flow-mediated dilatation; Intima-media complex of the carotid and brachial arteries.

OBJECTIVE: To evaluate immediate and mid-term outcomes in a series of patients submitted to endovascular repair of infrarenal abdominal aortic aneurysm in a reference center for cardiovascular medicine. MATERIALS AND METHODS: The present retrospective study included a series of patients treated in the period from January 2009 to July 2010, and evaluated demographic characteristics, technical success, therapeutic success, morbimortality, immediate complications and perioperative reintervention rate in a one-year follow-up. RESULTS: The authors evaluated 102 consecutive patients with a mean age of 72 ± 9 years (79% were men). Technical success was observed in 97.1% of cases, and therapeutic success, in 81%. Perioperative mortality was 0.9% and one-year mortality rate was 7.8%. Reintervention was necessary in 18.8% of the patients during follow-up. CONCLUSION: The outcomes observed in the present study justify performing such a procedure in patients with suitable anatomy.

Keywords: Aneurysm; Vascular graft; Atherosclerosis.

OBJECTIVE: To analyze treatment outcomes in a consecutive series of patients submitted to endovascular treatment of thoracic aortic disease. Technical success, therapeutic success, morbimortality, rate of perioperative complications and reinterventions were taken into consideration. MATERIALS AND METHODS: The present retrospective study was developed in a reference center in the period from January 2010 to July 2011, involving patients submitted to endovascular treatment of thoracic aortic disease. The study population was divided into two groups: group 1 (G1) - true thoracic aortic aneurysms, aortic ulcer and pseudoaneurysm; group 2 (G2) - chronic type B aortic dissection. RESULTS: Out of a total of 55 patients, 29 belonged to the G1 and 26 to the G2 group. Mean ages were 66.8 ± 10 and 56.4 ± 7 years, respectively. The technical and therapeutic success reached respectively 86.3% and 68.6% in G1 and 100% and 74% in G2. The perioperative mortality rate was 10.3% in G1 and 19.3% in G2. The reintervention rate was 10.3% in G1 and 15.3% in G2. CONCLUSION: In the present study, the endovascular treatment of thoracic aortic disease proved to be a feasible method associated with acceptable rate of complications.

Keywords: Aneurysm; Vascular graft; Atherosclerosis.

OBJECTIVE: To evaluate the accuracy in the detection of abdominal aortic calcification by densitometry as compared with lateral spine radiography. MATERIALS AND METHODS: Study comprising 80 individuals, 50 of them with abdominal aortic calcification and 30 without calcification. Densitometry was performed once for each participant, with the patient in right lateral decubitus position. RESULTS:Both groups were similar in terms of age range and body mass index - mean age of 74.56 ± 10.55 years and 68.40 ± 10.80 years and mean body mass index of 28.94 ± 6.06 kg/m², and 26.84 ± 4.11 kg/m², respectively for the individuals with abdominal aortic calcification and for the individuals without calcification. A statistical comparison between densitometry and radiography demonstrates similar performances of the two methods in the detection of abdominal aortic calcification, with 100% specificity and positive predictive value, 94% sensitivity, 90.9% negative predictive value, and 96.3% accuracy. Qualitative equivalence in diagnosis was demonstrated by kappa correlation index of 0.922. CONCLUSION: The results obtained by radiography and densitometry were statistically equivalent, which endorses the indication of densitometry for investigating abdominal aortic calcification.

Keywords: Atherosclerosis; Abdominal aorta; Densitometry.

Superior vena cava syndrome is defined by a set of signs and symptoms secondary to superior vena cava obstruction caused principally by malignant diseases. The present report describes the case of an unusual clinical manifestation of this syndrome with bilateral breast swelling, and emphasizes the relevance of knowledge on mammographic signs of systemic diseases.

Keywords: Mammography; Superior vena cava syndrome; Subclavian vein thrombosis.

OBJECTIVE: To compare automatic and manual measurements of intima-media complex (IMC) in common carotid, common femoral and right subclavian arteries of HIV-infected patients in relation to a control group, taking into consideration the classical risk factors for atherosclerosis. MATERIALS AND METHODS: The study sample comprised 70 HIV-infected patients and 70 non-HIV-infected controls paired according sex and age. Automatic (gold standard) and manual measurements of IMC were performed in the carotid arteries. Manual measurements were also performed in common femoral and right subclavian arteries. Bland-Altman graphs were utilized in the comparison and the adopted level significance was 5%. RESULTS: Intima-media complex alterations were not observed in any of the individuals as the mean automatic measurement in the right common carotid (RCC) artery was considered as the gold standard. As the gold standard was compared with the manual measurements (mean, maximum and minimum), no clinically significant alteration was observed. As the gold standard was compared with other sites, the difference was statistically and clinically significant at the origin of right subclavian artery (RCC: 0.51 mm vs. 0.91 mm) (p < 0.001). CONCLUSION: HIV-infected individuals are not at higher risk for atherosclerosis than the control population.

Keywords: Atherosclerosis; Intima-media complex; Automatic; Subclavian; Femoral.

Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease.

Keywords: Computed tomography; Thoracic aorta; Aortic diseases; Atherosclerosis; Cardiovascular surgery.