OBJECTIVE: The objective of the present study is to analyze the optimization of fluoroscopic image quality and patient entrance surface air kerma rate in interventional radiology procedures, utilizing a phantom adapted for fluoroscopy. MATERIALS AND METHODS: The authors utilized a phantom developed for evaluating conventional radiological images adapted for fluoroscopy through the addition of two catheters with different diameters, both of them utilized in interventional radiology. The patient entrance surface air kerma rate was determined with the aid of this phantom. RESULTS: The evaluation of technical parameters for different exposure modes of a digital fluoroscopic imaging system has allowed the determination of the air kerma rate, enabling the optimization of the image quality in interventional procedures. The decrease in the patient entrance surface air kerma rate may achieve 67%. CONCLUSION: The optimization of fluoroscopic image quality achieved with a phantom allows reducing the patient entrance surface air kerma with no significant loss of diagnostic performance.

Keywords: Images optimization, Fluoroscopy, Phantom, Dose reduction

OBJECTIVE: To implement a protocol for correction of images acquired by videofluoroscopy based on the mathematical model described by Baltzopoulos (1995) and to evaluate the magnitude of error in the linear and non-linear calibration methods. MATERIALS AND METHODS: The images were acquired using a Axion Siemens Iconos R100 videofluoroscope from one individual during knee extension exercise. A non-linear calibration pattern was used for the correction of the images. Data was processed using a Silicon Graphics 320 capture plate and subsequently analyzed using the Matlab software. RESULTS: In order to demonstrate the method's applicability, the deformation of the patellar ligament was evaluated. The use of a linear calibration pattern produced a maximum error of 0.086 mm, while the non-linear calibration pattern reached a maximum value of 0.019 mm. According to the mean error, the linear calibration was 0.024 mm, and the non-linear presented a value of 0.007 mm. CONCLUSION: The results show the need to use a non-linear calibration procedure.

Keywords: Videofluoroscopy, Images calibration, Patellar ligament, Knee

We present the preliminary results of testing and acceptance of a method for displaying medical images that employs simple computer freewares that can be run in unsophisticated computational platforms, which are commonly underutilized. This method allows easy and accessible visualization, printing, documenting, archiving, consulting and electronic transmission of a wide range of medical images without the need of expensive, complex and difficult to learn softwares.

Keywords: Medical images, Freeware, Ultrasound

OBJECTIVE: To present the process of implementation of toolkits for visualization of medical images using DICOM and to review the basis and characteristics of this protocol. In this paper we present a VDTApplication for visualization of local and remote images, and a VDTApplet that allows the visualization of images on a web browser. MATERIALS AND METHODS: The toolkits were implemented using Java programming language. For the development of this toolkit we considered the different version of the DICOM protocol, creating a generic system capable of reading and opening images generated by different modalities of different manufacturers. The tools were evaluated qualitatively by doctors taking into account the system's interface, image quality and image adjustment. RESULTS: The evaluation score ranged from 1 (very poor ) to 5 (very good) for each item, with the following results: 5 for system interface, 4 for image quality and 3 for the image adjustment. Based on the scores obtained we concluded that the tools can be considered good. CONCLUSION: These results allowed us to conclude that these tools are practical, user friendly and should be added to the PACS (picture archiving and communication system) of "Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo", Ribeirão Preto, SP, Brazil.

Keywords: Medical images, DICOM, Filmless radiology, Medical images visualization

The purpose of this work was to evaluate the action of the vitamin E as a radioprotective agent in the process of tissue reparation in rats submitted to a surgical procedure, which consisted of a wound done in the fore dorsal area. The animals were divided into five groups: group C (controls) - wound; group VE - previous treatment with vitamin E (90 UI); group IR - wound and irradiation of the borders three days after surgery; group VEIR - previous treatment with 90 UI of the vitamin E and irradiation of the borders three days after the surgery; group OIR - previous treatment with olive oil and irradiation of the borders three days after surgery. The radioprotective effect of the vitamin E was evaluated using hematoxylin-eosin stained specimens in order to identify granulation tissue, at 4, 7, 14 and 21 days after the surgical procedures. The results showed that 6 Gy of electron irradiation with a beam of 6 MeV caused retardation of the tissue repairing process and that vitamin E was effective as a radioprotective agent.

Keywords: Vitamin E, Radioprotective, Free radicals, Ionizing radiation, Tissue reparation

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

We present the results of a study for the development of a computational program for the evaluation and control of medium size medical radiological facilities in agreement with the recent guidelines of radiological protection of the Brazilian Ministry of Health. The routine procedures of the Radiology Department of Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil, were analyzed and a computer program was developed using Windows tools. The program named "Sistema Radiológico" (Radiological System) was implemented and tested with data and measurements. The results proved that the methodology employed allows fulfillment of the requirements of the Directive nº 453 of the Brazilian Ministry of Health, and moreover, increases the efficiency of several other activities in the radiology department.

Keywords: Radiology, Quality control, Software

Technetium-99m labeled radiopharmaceuticals are currently the main diagnostic agents used in nuclear medicine. Radiopharmaceuticals are prepared locally through a reaction between a complexant agent (pharmaceutical) and technetium-99m. These reactions may generate impurities resulting into the production of radiopharmaceuticals with substandard quality or with different characteristics from those considered ideal. In this article we discuss some of the factors that may interfere with the preparation of radiopharmaceuticals and the quality control tests that can be used to ensure the quality of the agents.

Keywords: Radiopharmaceuticals. Generators. Technetium-99m. Quality controls.

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 percepção de médicos residentes em radiologia de 4º ano sobre as melhores modalidades de imagem na investigação de neoplasias e trauma. Materiais e Métodos: Vinte e sete médicos residentes de 4º ano de quatro programas de residência em radiologia americanos participaram do estudo. Aos participantes foi perguntado sobre a melhor modalidade de imagem para se avaliar o cérebro e a coluna vertebral, pulmões, abdome e o sistema musculoesquelético. As modalidades de imagem disponíveis foram: RM, TC, ultrassonografia, PET e radiografia simples. Todos os achados foram comparados com os Critérios de Adequação de Exames de Imagem e Radioterapia do ACR. Resultados: A RM foi escolhida como melhor modalidade de imagem para se avaliar neoplasias encefálicas, espinhais, abdominais e musculoesqueléticas por 96,3%, 100%, 70,4% e 63% dos residentes, respectivamente. A TC foi escolhida por 88,9% dos residentes para avaliar neoplasias pulmonares. A modalidade de imagem ótima para se avaliar trauma foi a TC para lesões encefálicas (100%), espinhais (92,6%), pulmonares (96,3%), abdominais (92,6%) e grandes lesões traumáticas musculoesqueléticas (74,1%); a RM foi escolhida para lesões esportivas (96,3%). Observou-se concordância com os critérios de adequação do ACR. Conclusão: Houve concordância entre a percepção dos residentes sobre as melhores modalidades de imagem para avaliação de neoplasias e trauma e os critérios de adequação do ACR.

Keywords: Formação de residentes; Educação médica; Modalidades de imagem.

OBJECTIVE: To evaluate the quality of primary and secondary displays of conventional radiography systems based on luminance measurements. The level of ambient lighting within the rooms was also measured. MATERIALS AND METHODS: Luminance measurements were performed with an Unfors Xi Light Detector in 23 primary and 22 secondary displays (six of them utilized in emergency departments) at five different institutions, and according to the method described on the American Association of Physicists in Medicine (AAPM) TG18 report. The level of ambient lighting was measured with Delta Ohm HD 9221 lux meter. RESULTS: In general, both the primary and secondary the displays were compliant with the AAPM guidelines. As regards ambient lighting, the primary workstation rooms were slightly above the recommended levels. As far as The Royal College of Radiologists (RCR) recommendations are concerned, the number of compliant displays corresponded to a minority, with no significant difference, though. CONCLUSION: Although most of the displays could not meet the strict RCR guidelines, in general, the results were satisfactory. The level of agreement between primary and secondary displays should be as high as possible in order to guarantee the image quality. Considering the key role played by diagnostic imaging systems, medical imaging displays must be regularly evaluated to assure that the quality of the imaging system is maintained.

Keywords: Quality control; Luminance; Illuminance.

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.

The aim of this article is to provide a comprehensive guide to image quality assessment in diagnostic radiology, emphasizing practical methodologies for radiologists. The goal is to improve diagnostic accuracy and patient care on the basis of the understanding and application of quantitative and qualitative metrics in clinical practice and research. We conducted a review of the literature in the PubMed, Scopus, Web of Science, and Embase databases. The search terms included “image quality in radiology”, “quantitative and qualitative assessment”, “modulation transfer function”, “signal-to-noise ratio”, “contrast-to-noise ratio”, “radiation dose optimization”, and “artificial intelligence in image quality assessment”. The review identified the main methodologies for image quality assessment. We analyzed these metrics for their applicability in clinical settings, highlighting their benefits and limitations. In addition, we discuss qualitative methods such as visual assessment, the assessment of contrast/density, and peer review. This guide fills a gap in the literature by providing accessible, practical knowledge for general radiologists. Ongoing research, education, and technological development are essential to advance the field and ensure high standards in radiology practice.

Keywords: Quality control; Image processing, computer-assisted; Radiology; Diagnostic imaging; Practice guideline.

In May 2025, the World Health Assembly adopted Resolution WHA78.13, formally recognizing medical imaging as a fundamental pillar of universal health coverage. Brazil, as a co-sponsor of the Resolution, plays a decisive role in promoting equitable access to imaging services throughout Latin America. This article explores the implications of the resolution for Brazil, highlighting its leadership and the need to address regional disparities in imaging infrastructure and workforce distribution. On the basis of data from the 2025 Atlas of Radiology in Brazil, the article highlights the unequal distribution of radiologists and imaging equipment, especially in underserved areas. Strategic priorities for regional action are outlined, including workforce development, infrastructure investments, and public policy integration. The Brazilian College of Radiology and Diagnostic Imaging is positioned to participate in national efforts, advocating for medical imaging as a public health priority. By aligning national initiatives with global strategies and embracing innovation, Brazil and Latin America can transform diagnostic equity and improve health outcomes.

Keywords: Diagnostic imaging; Delivery of health care/organization & administration; Health personnel/organization & administration; Global health; Health policy; World Health Organization; Radiology/statistics & numerical data; Brazil.

OBJECTIVE: To critically analyze evidence-based alternatives to sedation in patients with radiology-related phobias, focusing on clinical efficacy, feasibility, and implementation challenges.
METHODS: This is a narrative review of the scientific literature published between 1985 and 2025, based on indexed databases (PubMed, Scopus, Embase, Scientific Electronic Library Online, and PsycINFO) and clinical guidelines. We included observational studies, clinical trials, systematic reviews, and expert consensus statements.
RESULTS: Effective nonpharmacological interventions include mock scanner training, cognitive-behavioral therapy, virtual reality exposure, breathing/relaxation techniques, environmental modifications, and therapeutic communication. These approaches significantly reduce the need for sedation, particularly in pediatric, geriatric, and neurodivergent populations. However, implementation remains limited by structural, economic, and cultural barriers.
CONCLUSION: Nonpharmacological strategies are clinically effective and ethically desirable for managing patient anxiety and phobias in the setting of magnetic resonance imaging. Their systematic incorporation requires institutional restructuring, interdisciplinary training, and investment in supportive technology.

Keywords: Magnetic resonance imaging; Phobic disorders; Hypnotics and sedatives/adverse effects; Anxiety/prevention & control.