OBJECTIVE: The present study was aimed at: a) evaluating radiographic procedures and estimating entrance surface air kerma in preterm neonates submitted to chest and abdominal radiography at the unit of neonatology in a public hospital of Belo Horizonte, MG, Brazil; b) estimating the dose to organs and respective risks for cancer as a result from radiation exposure. MATERIALS AND METHODS: Records of patients admitted to the unit of neonatology of this hospital in the period between May and September 2004 were reviewed. Anthropometric data, admission/discharge dates and radiographic studies performed were recorded for each of the patients. The calculation of the entrance surface air kerma was based on the x-ray tube output and irradiation parameters adopted for examinations. Dose to organs was calculated with the aid of the software PCXMC, and the lifetime risk for cancer, with the software IREP. RESULTS: Mean entrance surface air kerma per examination was below the diagnostic reference levels recommended by the European Community. In the most severely irradiated patients, liver, breast and stomach were the organs at highest risk for cancer, with maximum excess relative risk of respectively 3.4%, 2.3%, and 1.7%. CONCLUSION: The present study demonstrated the need for optimization of radiographic procedures in order to reduce the risks for neonates that, in spite of being considered to be low as compared with the benefits, should be reduced to values as low as reasonably achievable.

Keywords: Patient dosimetry, Radiological protection, Pediatric radiology, Cancer risk

OBJECTIVE: To evaluate radiological findings in patients submitted to surgical treatment for medullary breast cancer at Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil, correlating them with histological results. MATERIALS AND METHODS: A retrospective descriptive study was developed with patients submitted to surgery at INCA, in the period from January 1997 to December 2006, for identifying the presence of medullary breast carcinoma and analyzing radiological findings. RESULTS: Among 21,287 patients diagnosed with carcinoma, 76 (0.357%) had typical medullary breast carcinoma. The age range of these patients was 32-81 years (mean = 59.1 years). Mammography demonstrated lesions in 19 of these patients, 17 (89.5%) of them with masses, and 2 with focal asymmetry. Among the patients with masses, 15 (88.1%) presented with high density and 2 (11.9%) with isodensity. Twelve patients presented sonographic findings, 11 (91.6%) of them with hypoechoic masses, and one with an anechoic mass with areas of cystic degeneration. CONCLUSION: Nodular mass was the predominant radiological finding (89.5%), 88.1% of them corresponding to masses with high density and circumscribed margins. Despite the radiological characteristics of benignity, a solid, fast-growing, highly dense mass with circumscribed margins should be further investigated to confirm the diagnosis.

Keywords: Medullary breast cancer, Radiological findings, Diagnosis

Necrotizing enterocolitis is one of the most frequent and severe gastrointestinal emergencies occurring in the neonatal period. Once necrotizing enterocolitis is suspected a simple abdominal x-ray is a routine examination and this film will play an essential role in the diagnosis of the disease and the follow-up care of the patient, as well as in the detection of complications. In the present study we reviewed the pertinent literature and described the radiological findings, illustrated with cases from our institution. We concluded that the radiological diagnosis of necrotizing enterocolitis done at all stages contributes for an immediate therapeutic management, reducing the complications and improving the patient's survival.

Keywords: Necrotizing enterocolitis, Newborn, Radiological diagnosis

OBJECTIVE: The critical analysis of the methodology for evaluating the x-ray beam half-value layer was based on technical standards for radiological protection and quality control in medical and dental diagnoses. MATERIALS AND METHODS: Exposure parameters, experimental set-up, scattering materials, instrumentation, size of radiation field and methodology of data analysis have been taken into consideration for measurements of half-value layer. RESULTS: The half-value layer, in good geometry, measured 2.44 ± 0.02 mmAl. A maximum deviation of 4.1% was found under other geometry conditions. A 98.8% deviation was observed with a different ionization chamber, and scattering material, and 29.5% with another type of detector. CONCLUSION: Results showed that no relevant variation is observed in the half-value layer for different radiation field sizes. On the other hand, the influence of the radiation scattering on the half-value layer overestimation was clearly observed, as well as the half-value layer reduction in the presence of lead used as scattering material. The practical methodology adopted for half-value layer evaluation has shown to be quite reliable, besides evidencing remarkable discrepancies resulting from the adoption of inappropriate methodologies, emphasizing the necessity of establishing a standard procedure for measuring the half-value layer.

Keywords: Half value layer, HVL, Quality control, Diagnostic radiology

OBJECTIVE: To obtain information on diagnostic imaging equipment and radiological examinations in the State of São Paulo, Brazil. MATERIALS AND METHODS: The overall information was obtained through the Department of Computer Science of SUS - "Sistema Único de Saúde" (National Health System). The distribution of equipments and the annual frequency of examinations were analyzed considering the various health care State regions and their respective population. RESULTS: The results indicated significant regional differences, both regarding equipment distribution and frequency of examinations. Comparison with data available from other countries show that part of the population may require access to other imaging methods, particularly mammography, although access to these services have improved in the last years. CONCLUSION: This type of study show the importance of disclosure of information from the National Health System, which allows systematic and objective analysis of specific health issues, and may be used as a reference for future works.

Keywords: Diagnostic equipment, Medical examination, Radiology information systems, Radiology, SUS

In 2003, the National Committee of Medical Residency established new criteria for the accreditation of Radiology and Imaging Diagnosis Residency programs. Although these rules represent an advance to the resident's training, other specific abilities and skills should be developed in order to keep up with the technical and scientific advances and with the new requirements of the career. The authors' present the must important competencies and skills that complement the radiologist's education and suggest a change in current programs so that the resident can acquire these competencies and skills.

Keywords: Medical residency, Radiology, Image diagnostic, Resident; Education

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

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.

OBJECTIVE: To present a data analysis toolkit that may be utilized with the purpose of radiation protection of hospital inpatients and workers in areas where mobile apparatuses are used. MATERIALS AND METHODS: An Excel^® ActiveSheet was utilized to develop a computational toolkit with exposure measurements to generate a database of shape factors and to calculate the air kerma around hospital beds. The initial database included data collected with three mobile apparatuses. A non-anthropomorphic phantom was utilized and exposure measurements were performed on a (4.2 × 4.2) m² mesh-grid at 0.3 m steps. RESULTS: The toolkit calculates the air kerma (associated with patients' radiation exposure and with ambient equivalent dose) under secondary radiation. For distances lower than 60.0 cm, values above the maximum ambient equivalent dose threshold defined for radiation free areas (0.5 mSv/year) were verified. Data collected at 2.1 m have always presented values lower than 12% of that threshold. CONCLUSION: The toolkit can aid in the radiological protection of patients and workers, provided it is combined with appropriate data collection, since it allows the determination of radiation free areas around beds in rooms where mobile X-ray apparatuses are utilized.

Keywords: Radiology; Radiological protection; Software toolkit.

OBJECTIVE: To investigate the learning about management of the technology (efficient use, acquisition and maintenance of imaging diagnosis equipment) in the radiology residency program of Escola Paulista de Medicina - Universidade Federal de São Paulo, with a view to improving the education of radiologists. MATERIALS AND METHODS: Exploratory research where residents, faculty staff and tutors of the program were quantitative and qualitatively approached with Likert scale questionnaires (46), and deepening with recorded interviews (18) and categorization based upon meaning units (thematic analysis). RESULTS: Among the participants, 66% agreed that they had the opportunity of learning about the use of radiological equipment; for 61% the program should include knowledge on the importance of acquiring equipment; and 72% emphasized the lack of learning about equipment management and maintenance. CONCLUSION: As the major moment in the education of specialists, the medical residency program provides residents with a favorable environment to the learning of the skills required to the future of their professional practice, but with limited emphasis on the management of the technology: efficient use, acquisition and mainly maintenance of equipment, still poorly explored. Both the investigated program and the medical residency in radiology should incorporate, whenever possible, the commitment with the training in supplementary skills related to equipment management, developing the competence of the future radiologists.

Keywords: Medical education; Medical residency; Health management; Radiologic technology; Radiology; Imaging diagnosis.

OBJECTIVE: To describe the radiological findings of pulmonary tuberculosis in indigenous patients from the city of Dourados, MS, Brazil, according to age and sex. MATERIALS AND METHODS: Chest radiographic images of 81 patients with pulmonary tuberculosis, acquired in the period from 2007 to 2010, were retrospectively analyzed by two radiologists in consensus for the presence or absence of changes. The findings in abnormal radiographs were classified according to the changes observed and they were correlated to age and sex. The data were submitted to statistical analysis. RESULTS: The individuals' ages ranged from 1 to 97 years (mean: 36 years). Heterogeneous consolidations, nodules, pleural involvement and cavities were the most frequent imaging findings. Most patients (55/81 or 67.9%) were male, and upper lung and right lung were the most affected regions. Fibrosis, heterogeneous consolidations and involvement of the left lung apex were significantly more frequent in males (p < 0.05). Presence of a single type of finding at radiography was most frequent in children (p < 0.05). CONCLUSION: Based on the hypothesis that indigenous patients represent a population without genetically determined resistance to tuberculosis, the present study may enhance the knowledge about how the pulmonary form of this disease manifests in susceptible individuals.

Keywords: Radiology; Tuberculosis; Chest; Radiological findings; Indigenous population.

OBJECTIVE: To show the morphometric patterns of lymph nodes of the head and neck, evaluating their number, shape, dimensions, hilum, and cortex, through the use of ultrasound examination of the neck. MATERIALS AND METHODS: We analyzed 400 right and left lymph nodes in a group of 20 healthy young and middle-aged individuals of both genders. RESULTS: In the ultrasound examination, we observed the following lymph nodes: mastoid; parotid (superficial, extraglandular, and intraglandular); submandibular (preglandular, retroglandular, and intracapsular); submental; and cervical (anterior and posterior). Although some individuals had up to seven lymph nodes in the same region, most had only two to three per region. The smallest lymph node diameter observed was 0.4 cm, and the largest was 2.7 cm. Most lymph nodes showed an elongated or oval shape. Most of the lymph node hila were echogenic, although a few were hyperechoic. However, the cortex was clearly hypoechoic in all of the lymph nodes evaluated. CONCLUSION: Ultrasound examination of healthy individuals allowed the characteristics of the lymph nodes of the head and neck to be observed clearly, which could provide a basis for the analysis of patients with diseases of these lymph nodes.

Keywords: Lymph nodes/anatomy & histology; Radiology; Diagnostic imaging.

Historically, radiology has developed in a way that has increasingly distanced the radiologist from the patient. Currently, diagnostic imaging results are predominantly communicated through written reports. Written communication is not considered sufficient, verbal communication being essential for the performance of the modern radiologist to be considered satisfactory. However, a lack of preparation on the part of the radiologist when communicating the diagnosis, especially when it is not favorable (as is often the case in a cancer hospital), makes that conversation quite challenging. Studies conducted in other countries have demonstrated that there are a variety of opinions on the part of requesting physicians and patients regarding radiologist-patient communication, which can be explained by cultural differences. Although there is no rule regarding the best way to accomplish such communication, there are definitely incorrect ways. To bridge the gap between radiologists and patients and improve radiologist-patient communication, preparation of radiologists during their medical residency is fundamental. Therefore, it is important to address this question in Brazil. The objective of this study was to identify deeper discussions about the topic in the scientific literature. This analysis could help us map those involved and plan strategies to improve the ethical behavior of radiologists toward their patients.

Keywords: Radiology; Physician-patient relations; Diagnostic imaging; Ethics.

Primary bone lymphoma is a rare neoplasm that can initially present as local pain, a palpable mass, and pathologic fracture. It can also be discovered as an incidental finding on an imaging examination. It is defined as a bone marrow tumor with no involvement of other sites, lasting at least six months. The diagnosis is confirmed by biopsy and immunohistochemical analysis. Although the imaging characteristics are nonspecific, there are certain findings that, when correlated with clinical and epidemiological aspects, can increase the level of suspicion of primary bone lymphoma. The classic imaging aspect is a bone lesion with a soft-tissue component that preserves the cortical layer more than would be expected given the invasive nature of the lesion. Magnetic resonance imaging is the best imaging method to evaluate the extent of involvement of adjacent compartments, whereas computed tomography depicts the cortical layer in greater detail, as well as being an important tool for biopsy guidance. Other imaging modalities are also discussed, such as X-ray, ultrasound, bone scintigraphy, and positron emission tomography/computed tomography. The aim of this paper is to describe the most common findings obtained with the various imaging methods used in patients with a confirmed diagnosis of primary bone lymphoma.

Keywords: Bone neoplasms/diagnostic imaging; Lymphoma/pathology; Radiology; Magnetic resonance imaging.

Os nervos cranianos representam extensões das estruturas funcionais do cérebro que cruzam a cabeça e o pescoço. Eles estão ligados a diferentes estruturas cranianas e se relacionam com diversas doenças. Uma compreensão profunda de sua complexa anatomia e aparência normal de imagem permite ao examinador identificar e caracterizar com mais precisão as anormalidades. A ressonância magnética com contraste é uma importante ferramenta para avaliar essas estruturas, especialmente as sequências tridimensionais de precessão livre de estado estacionário, que proporcionam alta resolução espacial e de partes moles, apesar da fina espessura dos nervos cranianos. Na maioria dos casos, os achados de imagem são inespecíficos, e uma anamnese completa, exame físico dirigido e testes laboratoriais são necessários para estreitar o diagnóstico diferencial. Este ensaio iconográfico ilustra e discute doenças congênitas, traumáticas e vasculares dos nervos cranianos, mostrando imagens em uma abordagem fisiopatológica.

Keywords: Neuroimagem/métodos; Radiologia/métodos; Ressonância magnética/métodos; Nervos cranianos/diagnóstico por imagem.