OBJECTIVE: The present paper is aimed at introducing a software to allow a detailed analysis of the swallowing dynamics. MATERIALS AND METHODS: The sample included ten (six male and four female) stroke patients, with mean age of 57.6 years. Swallowing videofluoroscopy was performed and images were digitized for posterior analysis of the pharyngeal transit time with the aid of a chronometer and the software. RESULTS: Differences were observed in the average pharyngeal swallowing transit time as a result of measurements with chronometer and software. CONCLUSION: This software is a useful tool for the analysis of parameters such as swallowing time and speed, allowing a better understanding of the swallowing dynamics, both in the clinical approach of patients with oropharyngeal dysphagia and for scientific research purposes.

Keywords: Swallowing videofluoroscopy, Software, Quantitative analysis

OBJECTIVE: To configure an auxiliary equipment to allow videofluoroscopic study of swallowing and related disorders without the patients' active collaboration in obtaining the required positions, with reproducibility of views, postures and maneuvers needed for the examination, in spite of limitations imposed by associated diseases. MATERIALS AND METHODS: A Philips BV-22 C-Arm was utilized, with adaptation implemented to allow simultaneous images recording on both digital and analog media. Primary and secondary chairs were specially designed, built and attached to the equipment. RESULTS: Adults and children could be appropriately seated and all necessary radiographic views could be obtained without active positioning or cooperation from the volunteers. Additionally, a calibration system was developed, allowing the input of dimensional parameters for quantification of recorded phenomena. CONCLUSION: The videofluoroscopy utilization spectrum could be extended to agitated patients, and those with behavior similar to patients affected by neuromotor disorders, with greater effectiveness and consequently with lower radiation exposure time.

Keywords: Videofluoroscopy, Swallowing, Dysphagia, Neuromotor disorder, Adapted chair

OBJECTIVE: The purpose of thys study was to investigate the effect of the addition of aluminum (1 mm) and copper (0.4 mm) filters on effective radiation doses and image quality in videofluoroscopy. MATERIALS AND METHODS: An ionization chamber coupled with an electrometer was added to x-ray tube to measure the kerma area product with 65 kV and 0.7 mA technique, without and with additional filtration. Low contrast, gray scale and spatial resolution were measured utilizing Leeds test objects. Fifteen volunteers underwent pharynx study, ten without and five with aluminum and cooper filters associated, and had the kerma area product/minute compared. RESULTS: The specified filters addition, either separated or associated, allowed an expressive decrease in kerma area product besides an actual improvement in the videofluoroscopic images quality determined by a better gray tones differentiation and increased brightness contrast ratio in the gray curve. CONCLUSION: Additional aluminum and copper filters interposition, especially when associated, results in improved image quality with expressive reduction in the required radiation doses.

Keywords: Videofluoroscopy, Kerma area product, X-ray, Radiological image, Radiation dose

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

OBJECTIVE: To compare the clinical signs of swallowing abnormalities with videofluoroscopy findings in patients with cerebrovascular accident (CVA) in the subacute phase. MATERIALS AND METHODS: From a group of 37 patients with subacute CVA confirmed by imaging examinations, 26 patients (male and female; mean age of 59.69 years) were clinically and videofluoroscopically evaluated. The clinical parameters for penetration/aspiration of fluids and the confirmation by videofluoroscopy were used for the statistical analysis. RESULTS: Dysphagia was identified in 19 (73%) of the 26 patients who were submitted to videofluoroscopy; 10 (38.6%) patients presented penetration/aspiration of fluids. The results demonstrated that there was no correlation (p < 0.05) between the occurrence of dysphagia and/or dysartria and penetration/aspiration of fluids observed on videofluoroscopy. There was correlation between penetration/aspiration of liquids observed on videofluoroscopy and the following parameters: condition of the teeth (p = 0.047), face motility (p = 0.019) and sensibility (p = 0.039), and tongue motility (p = 0.012). CONCLUSION: It was not possible to determine the presence of penetration/aspiration of liquids in the airways by the epidemiological data of the CVA. Patients with bad teeth, facial and/or tongue motility abnormalities, or facial sensibility showed increased risk of penetration/aspiration of liquids. Videofluoroscopic assessment remains an important means to better evaluate dysphagia in patients with CVA.

Keywords: Dysphagia, Cerebrovascular accident, Aspiration pneumonia, Videofluoroscopy, Radiology, Rehabilitation

OBJECTIVE: To distinguish healthy from pathological tissues in pediatric patients with posterior cranial fossa tumors using calculated textural parameters from magnetic resonance images. MATERIALS AND METHODS: We evaluated 14 pediatric patients with posterior cranial fossa tumors using the software MaZda to define the texture parameters in selected regions of interest representing healthy and pathological tissues based on T2-weighted magnetic resonance images. RESULTS: There was a statistically significant difference between normal and tumoral tissues as well as between supposedly normal tissues adjacent and distant from the tumoral lesion. CONCLUSION: Magnetic resonance textural evaluation is an useful tool for determining differences among various tissues, including tissues that appear apparently normal on visual analysis.

Keywords: Magnetic resonance imaging, Textural evaluation, Posterior cranial fossa tumors, Pediatric patients, MaZda software

We analyzed the dose area product (DAP) of 12 patients submitted to videofluoroscopic swallowing studies. The aim of this study was to establish, in a preliminary manner, the values of radiation exposure for patients submitted to this type of examination. A Diamentor equipment was used to register the cumulative radiation doses emitted by the x-ray tubes. Two different rooms with identical radiological equipment were used to collect the data. The protocol used was rigorously the same and the same experienced professional performed the examinations. DAP's values for the three phases (oral, pharyngeal and esophagogastric) of the videofluoroscopic swallowing study were, for the room A (7 patients), 4,101 cGy.cm², DAP/min. = 577 cGy.cm²/min., and for the room B (5 patients), 804 cGy.cm², DAP/min = 119 cGy.cm²/min. These different results were obtained from patients of the same height and weight, using the same examination time (around 7 minutes) for all patients. We concluded that the data showing doses five times lower in room B are more reliable that those obtained for room A and that DAP and DAP/min. are good elements to inform patient doses imparted by videofluoroscopic swallowing examination. We believe that the high dose differences observed between the two groups are due to lack of calibration of the x-ray equipment, since unfortunately "quality assurance programs" are not routinely implemented.

Keywords: Dosimetry, Videofluoroscopy, Dose area product (DAP), Swallowing

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

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 evaluate the contribution of deglutition videofluoroscopy in the clinical diagnosis of dysphagia in chronic encephalopathy of childhood. MATERIALS AND METHODS: The study sample consisted of 93 children diagnosed with chronic encephalopathy, in the age range between two and five years, selected by convenience among patients referred to the authors' institution by speech therapists, neurologists and gastroenterologists in the period from March 2010 to September 2011. The data collection was made at two different moments, by different investigators who were blind to each other. RESULTS: The method presented low sensitivity for detecting aspiration with puree consistency (p = 0.04). Specificity and negative predictive value were high for clinical diagnosis of dysphagia with puree consistency. CONCLUSION: In the present study, the value for sensitivity in the clinical diagnosis of dysphagia demonstrates that this diagnostic procedure may not detect any change in the swallowing process regardless of the food consistency used during the investigation. Thus, the addition of the videofluoroscopic method can significantly contribute to the diagnosis of dysphagia.

Keywords: Swallowing disorders; Videofluoroscopy; Clinical diagnosis; Sensitivity; Specificity.

There is great optimism that artificial intelligence (AI), as it disrupts the medical world, will provide considerable improvements in all areas of health care, from diagnosis to treatment. In addition, there is considerable evidence that AI algorithms have surpassed human performance in various tasks, such as analyzing medical images, as well as correlating symptoms and biomarkers with the diagnosis and prognosis of diseases. However, the mismatch between the performance of AI-based software and its clinical usefulness is still a major obstacle to its widespread acceptance and use by the medical community. In this article, three fundamental concepts observed in the health technology industry are highlighted as possible causative factors for this gap and might serve as a starting point for further evaluation of the structure of AI companies and of the status quo.

Keywords: Artificial intelligence/supply & distribution; Industry/organization & administration; Software/trends; Delivery of health care/trends; Diagnosis, computer-assisted/trends.