Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal.

Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.

Audiovisual Content for a Radiology Fellowship Selection Process During the COVID-19 Pandemic: Pilot Web-Based Questionnaire Study.

BACKGROUND: Traditional radiology fellowships are usually 1- or 2-year clinical training programs in a specific area after completion of a 4-year residency program. OBJECTIVE: This study aimed to investigate the experience of fellowship applicants in answering radiology questions in an audiovisual format using their own smartphones after answering radiology questions in a traditional printed text format as part of the application process during the COVID-19 pandemic. We hypothesized that fellowship applicants would find that recorded audiovisual radiology content adds value to the conventional selection process, may increase engagement by using their own smartphone device, and facilitate the understanding of imaging findings of radiology-based questions, while maintaining social distancing. METHODS: One senior staff radiologist of each subspecialty prepared 4 audiovisual radiology questions for each subspecialty. We conducted a survey using web-based questionnaires for 123 fellowship applications for musculoskeletal (n=39), internal medicine (n=61), and neuroradiology (n=23) programs to evaluate the experience of using audiovisual radiology content as a substitute for the conventional text evaluation. RESULTS: Most of the applicants (n=122, 99%) answered positively (with responses of "agree" or "strongly agree") that images in digital forms are of superior quality to those printed on paper. In total, 101 (82%) applicants agreed with the statement that the presentation of cases in audiovisual format facilitates the understanding of the findings. Furthermore, 81 (65%) candidates agreed or strongly agreed that answering digital forms is more practical than conventional paper forms. CONCLUSIONS: The use of audiovisual content as part of the selection process for radiology fellowships is a new approach to evaluate the potential to enhance the applicant's experience during this process. This technology also allows for the evaluation of candidates without the need for in-person interaction. Further studies could streamline these methods to minimize work redundancy with traditional text assessments or even evaluate the acceptance of using only audiovisual content on smartphones.

Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal / Consenso de terminologia em radiologia torácica em português do Brasil e de Portugal

ABSTRACT Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.

RESUMO A comunicação eficiente entre a equipe médica é um fator importante no diagnóstico e tratamento precoce e adequado dos pacientes. A terminologia utilizada em relatórios de exames radiológicos aparece nesse contexto como um elo importante entre radiologistas e os demais integrantes da equipe médica. Portanto, a heterogeneidade no uso de termos em relatórios é importante mas ainda pouco discutida. Este artigo é resultado de uma extensa revisão da nomenclatura radiológica em radiologia torácica, englobando pela primeira vez termos utilizados em vários métodos (radiografia, TC e RM), desenvolvida por radiologistas brasileiros e portugueses. O objetivo desta revisão da terminologia médica foi criar uma linguagem padronizada para os profissionais médicos e as equipes multidisciplinares.

Evaluation of Audiovisual Reports to Enhance Traditional Emergency Musculoskeletal Radiology Reports.

Traditional radiology reports are narrative texts that include a description of imaging findings. Recent implementation of advanced reporting software allows for incorporation of annotated key images and hyperlinks directly into text reports, but these tools usually do not substitute in-person consultations with radiologists, especially in challenging cases. Use of on-demand audio/visual reports with screen capture software is an emerging technology, providing a more engaged imaging service. Our study evaluates a video reporting tool that utilizes PACS integrated screen capture software for musculoskeletal imaging studies in the emergency department. Our hypothesis is that referring orthopedic surgeons would find that recorded audio/video reports add value to conventional reports, may increase engagement with radiology staff, and also facilitate understanding of imaging findings from urgent musculoskeletal cases. Seven radiologists prepared a total of 47 audiovisual reports for 9 attending orthopedic surgeons from the emergency department. We applied two surveys to evaluate the experience of the referring physicians using audio/visual reports as a complementary material from the conventional text report. Positive responses were statistically significant in most questions including: if the clinical suspicion was answered in the video; willingness to use such technology in other cases; if the audiovisual report made the imaging findings more understandable than the traditional report; and if the audiovisual report is faster to understand than the traditional text report. Use of audiovisual reports in emergency musculoskeletal cases is a new approach to evaluate potentially challenging cases. These results support the potential of this technology to re-establish the radiologist's role as an essential member of patient care and also provide more engaging, precise, and personalized reports. Further studies could streamline these methods in order to minimize work redundancy with traditional text reporting or even evaluate acceptance of using only audiovisual radiology reports. Additionally, widespread adoption would require integration with the entire radiology workflow including non-urgent cases and other medical specialties.

Chronic pulmonary embolism: diagnosis.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of venous thromboembolic disease. Differently from other causes of pulmonary hypertension, CTEPH is potentially curable with surgery (thromboendarterectomy) or balloon pulmonary angioplasty. Imaging plays a central role in CTEPH diagnosis. The combination of techniques such as lung scintigraphy, computed tomography and magnetic resonance angiography provides non-invasive anatomic and functional information. Conventional pulmonary angiography (CPA) with right heart catheterization (RHC) is considered the gold standard method for diagnosing CTEPH. In this review, we discuss the utility of these imaging techniques in the diagnosis of CTEPH.

High-Resolution Computed Tomography in the Diagnosis of Diffuse Parenchymal Lung Diseases: Is it Possible to Improve Radiologist's Performance?

OBJECTIVE: The aims of this study were to assess the concordance between high-resolution computed tomography (HRCT) diagnostic hypotheses (DH) and final diagnosis in patients with diffuse lung disease and to evaluate whether clinical data or the radiologist's degree of certainty influence concordance. METHODS: Concordances between first and any one of radiologists' DH and final diagnosis were assessed before and after access to clinical data, with study of importance of degree of certainty in the DH formulated. RESULTS: Concordances of HRCT DH and final diagnosis were 48% and 76%, respectively, considering first or any of the DH without access to clinical data. Accessing clinical data improved concordance especially for hypersensitivity pneumonitis. Diagnostic hypotheses formulated with high degree of confidence were correct in 69% of cases. CONCLUSIONS: First HRCT DH was concordant with final diagnosis in approximately half of cases, increasing to approximately 75% when considering any 1 of the 3 DH. Radiologists' knowledge of clinical data or increased degree of certainty improved concordance of HRCT DH and the final diagnosis.

Pulmonary artery enlargement in schistosomiasis associated pulmonary arterial hypertension.

BACKGROUND: Schistosomiasis associated pulmonary arterial hypertension (Sch-PAH) might represent the most prevalent form of PAH worldwide. In Sch-PAH, the presence of aneurismal dilation of the pulmonary artery has been described, although it is still a matter of debate whether on average the pulmonary artery is more enlarged in Sc-PAH than IPAH. METHODS: We retrospectively evaluated patients with IPAH (n = 25) and Sch-PAH (n = 22) who underwent computed tomography pulmonary angiogram and right heart catheterization. RESULTS: Sch-PAH patients were older and presented less severe hemodynamic profiles. Main pulmonary artery diameter (MPAD) was greater in Sch-PAH than IPAH (4.5 ± 1.8 vs 3.7 ± 1.1 cm, p = 0.018). For the same level of mean pulmonary artery pressure, the MPAD in Sch-PAH was 0.89 cm larger than in IPAH (Covariance model p = 0.02). CONCLUSION: This study demonstrated that pulmonary artery enlargement is more pronounced in Sch-PAH than IPAH, independently of mean pulmonary artery pressure level, suggesting that this is more likely a feature of Sch-PAH.

Estudo da perfusão pulmonar por angiotomografia computadorizada em pacientes com hipertensão pulmonar / Pulmonary perfusion imaging derived from computed tomography pulmonary angiograms in patients with pulmonary hypertension

Introdução: A hipertensão arterial pulmonar (HAP) é uma doença grave da circulação pulmonar, cujo diagnóstico e cuja avaliação funcional dependem do cateterismo cardíaco direito. A tomografia de dupla energia (TCDE), por meio da técnica de decomposição de materiais, permite obter um mapa de Iodo do parênquima pulmonar, que pode ser avaliado de forma qualitativa e quantitativa, e pode ser útil na avaliação da HAP. Objetivos: Avaliar a distribuição de Iodo no parênquima pulmonar, comparando com marcadores hemodinâmicos, marcadores de gravidade e com grupo-controle normopressórico. Métodos: Pacientes com HAP, acompanhados na Unidade de Circulação Pulmonar (InCor-HCFMUSP), foram avaliados por angiotomografia das artérias pulmonares (angioTC) como parte de sua rotina diagnóstica, em modo de dupla energia. O grupo-controle foi composto por pacientes com suspeita clínica de tromboembolismo pulmonar (TEP), com angioTC negativa para TEP e com ecocardiograma normal. Foram avaliadas as concentrações de Iodo no pulmão (mg/mL) por meio de 8 regiões de interesse redondas com 1 cm2 de área, distribuídas ao longo do eixo ântero-posterior do pulmão direito, em 3 níveis predeterminados. Foram obtidas, também, as medidas do ventrículo direito (VD), ventrículo esquerdo (VE), razão VD/VE, diâmetros da aorta (AO) e artéria pulmonar (AP). O realce da artéria pulmonar por meio da TCDE (PAenh) também foi obtido. Os resultados foram comparados entre os grupos, e correlacionados no grupo HAP com parâmetros hemodinâmicos invasivos e marcadores de gravidade. Resultados: O grupo HAP foi composto por 21 pacientes, com idade média de 42 anos, 47,6% em classe funcional I/II. Houve diferença significativa nos diâmetros da AP (p<0,01), VD (p<0,01), e VE (p=0,01), entre os grupos HAP e controle. Também demonstraram diferenças significativas às relações entre os diâmetros AP/AO (p < 0,01) e VD/VE (p < 0,01)...

Background: Pulmonary arterial hypertension (PAH) is a severe disease of the pulmonary circulation. Right heart catheterization (RHC) is crucial for diagnosis and management of these patients. High-resolution computed tomography (CT) and CT angiography play a crucial role in the diagnostic work-up of pulmonary hypertension. Dual energy computed tomography (DECT) is a technique of acquisition of modern CT scanners that allows obtaining a computed tomography of the pulmonary arteries with low iodine dose, and providing an estimation of iodine distribution in the lungs. Although the search for non-invasive methods for evaluation of PAH is developing, data concerning application of DECT on PAH patients remain scarce. Objectives: To evaluate the iodine distribution in the lungs obtained by DECT in PAH patients and a control group and compare to the hemodynamic profile, and prognostic markers of PAH patients. Methods: 21 patients followed at the Pulmonary Circulation Unit (InCor-HCFMUSP) and submitted to CT angiography were evaluated by DECT. A matched control group was composed by patients routinely referred to CT angiography to rule out pulmonary embolism with negative results and also a normal echocardiogram obtained at the same day. Eight circular 1cm2 ROIs were placed along the anteroposterior axis, at the middle of the right lung and at predetermined levels to measure the Iodine concentration in the lungs. Measurements of the pulmonary artery (PA), ascending aorta (AO), right ventricle (RV) and left ventricles (LV) were obtained, as well as enhancement of the PA (PAenh). Results were compared to the control group, and correlated with hemodynamic parameters in the PAH group. Results: PAH patients averaged 42 y/o, female/male ratio of 7/1, NYA functional classes I/II. Statistically significant differences between PAH patients and controls were found regarding measurements of PA (p < 0,01), RV (p < 0,01), LV (p=0,01), PA/AO (p < 0,01) and RV/LV (p < 0,01)...

Thoracic manifestations of collagen vascular diseases.

Collagen vascular diseases are a diverse group of immunologically mediated systemic disorders that often lead to thoracic changes. The collagen vascular diseases that most commonly involve the lung are rheumatoid arthritis, progressive systemic sclerosis, systemic lupus erythematosus, polymyositis and dermatomyositis, mixed connective tissue disease, and Sjögren syndrome. Interstitial lung disease and pulmonary arterial hypertension are the main causes of mortality and morbidity among patients with collagen vascular diseases. Given the broad spectrum of possible thoracic manifestations and the varying frequency with which different interstitial lung diseases occur, the interpretation of thoracic images obtained in patients with collagen vascular diseases can be challenging. The task may be more difficult in the presence of treatment-related complications such as drug toxicity and infections, which are common in this group of patients. Although chest radiography is most often used for screening and monitoring of thoracic alterations, high-resolution computed tomography can provide additional information about lung involvement in collagen vascular diseases and may be especially helpful for differentiating specific disease patterns in the lung. General knowledge about the manifestations of thoracic involvement in collagen vascular diseases allows radiologists to provide better guidance for treatment and follow-up of these patients.

The role of imaging techniques in the assessment of pulmonary circulation.

Knowledge of the structure and function of pulmonary circulation has evolved considerably in the last few decades. The use of non-invasive imaging techniques to assess the anatomy and function of the pulmonary vessels and heart has taken on added importance with the recent advent of novel therapies. Imaging findings not only constitute a diagnostic tool but have also proven to be essential for prognosis and treatment follow-up. This article reviews the myriad of imaging methods currently available for the assessment of pulmonary circulation, from the simple chest X-ray to techniques that are more complex and promising, such as electrical impedance tomography.

O papel dos exames de imagem na avaliação da circulação pulmonar / The role of imaging techniques in the assessment of pulmonary circulation

O conhecimento sobre a estrutura e a função da circulação pulmonar evoluiu sensivelmente nas últimas décadas. A utilização de exames de imagem não invasivos para a avaliação da anatomia e da função dos vasos pulmonares e do coração ganhou ainda mais importância com o advento de tratamentos até então indisponíveis. Além do auxílio para o diagnóstico, as informações obtidas têm se mostrado fundamentais para o estabelecimento de prognósticos e como parâmetro de sucesso dos tratamentos. A presente revisão discute os diversos métodos que podem ser utilizados para a avaliação da circulação pulmonar por imagens existentes nos dias de hoje, desde técnicas amplamente disponíveis e de relativa baixa complexidade técnica, como a radiografia de tórax, até métodos complexos e promissores, como a tomografia de impedância elétrica.

Knowledge of the structure and function of pulmonary circulation has evolved considerably in the last few decades. The use of non-invasive imaging techniques to assess the anatomy and function of the pulmonary vessels and heart has taken on added importance with the recent advent of novel therapies. Imaging findings not only constitute a diagnostic tool but have also proven to be essential for prognosis and treatment follow-up. This article reviews the myriad of imaging methods currently available for the assessment of pulmonary circulation, from the simple chest X-ray to techniques that are more complex and promising, such as electrical impedance tomography.

Nonsurgical extracardiac vascular shunts in the thorax: clinical and imaging characteristics.

Extracardiac nonsurgical vascular shunts in the thorax are a group of well-recognized heterogeneous conditions, frequently symptomatic, in which there is diversion of blood flow from one vessel to another or from a vessel to a cardiac chamber. The authors describe and classify many of these nonsurgical extracardiac shunts or fistulas according to their source and endpoint (eg, systemic-to-systemic, systemic-to-pulmonic, pulmonic-to-systemic, and pulmonic-to-pulmonic) and to whether the oxygenated blood mixes with deoxygenated systemic venous flow (left-to-right shunts), deoxygenated blood bypasses the pulmonary capillary bed (right-to-left shunts), or oxygenated blood recirculates (left-to-left shunts). Clinical manifestations and imaging appearances of these conditions are highlighted.

Observer agreement in the diagnosis of interstitial lung diseases based on HRCT scans.

OBJECTIVE: To determine the interobserver and intraobserver agreement in the diagnosis of interstitial lung diseases (ILDs) based on HRCT scans and the impact of observer expertise, clinical data and confidence level on such agreement. METHODS: Two thoracic radiologists and two general radiologists independently reviewed the HRCT images of 58 patients with ILDs on two distinct occasions: prior to and after the clinical anamnesis. The radiologists selected up to three diagnostic hypotheses for each patient and defined the confidence level for these hypotheses. One of the thoracic and one of the general radiologists re-evaluated the same images up to three months after the first readings. In the coefficient analyses, the kappa statistic was used. RESULTS: The thoracic and general radiologists, respectively, agreed on at least one diagnosis for each patient in 91.4% and 82.8% of the patients. The thoracic radiologists agreed on the most likely diagnosis in 48.3% (kappa = 0.42) and 62.1% (kappa = 0.58) of the cases, respectively, prior to and after the clinical anamnesis; likewise, the general radiologists agreed on the most likely diagnosis in 37.9% (kappa = 0.32) and 36.2% (kappa = 0.30) of the cases. For the thoracic radiologist, the intraobserver agreement on the most likely diagnosis was 0.73 and 0.63 prior to and after the clinical anamnesis, respectively. That for the general radiologist was 0.38 and 0.42.The thoracic radiologists presented almost perfect agreement for the diagnostic hypotheses defined with the high confidence level. CONCLUSIONS: Interobserver and intraobserver agreement in the diagnosis of ILDs based on HRCT scans ranged from fair to almost perfect and was influenced by radiologist expertise, clinical history and confidence level.

Observer agreement in the diagnosis of interstitial lung diseases based on HRCT scans / Concordância entre observadores no diagnóstico das doenças pulmonares intersticiais por imagens de TCAR

OBJECTIVE: To determine the interobserver and intraobserver agreement in the diagnosis of interstitial lung diseases (ILDs) based on HRCT scans and the impact of observer expertise, clinical data and confidence level on such agreement. METHODS: Two thoracic radiologists and two general radiologists independently reviewed the HRCT images of 58 patients with ILDs on two distinct occasions: prior to and after the clinical anamnesis. The radiologists selected up to three diagnostic hypotheses for each patient and defined the confidence level for these hypotheses. One of the thoracic and one of the general radiologists re-evaluated the same images up to three months after the first readings. In the coefficient analyses, the kappa statistic was used. RESULTS: The thoracic and general radiologists, respectively, agreed on at least one diagnosis for each patient in 91.4 percent and 82.8 percent of the patients. The thoracic radiologists agreed on the most likely diagnosis in 48.3 percent (κ = 0.42) and 62.1 percent (κ = 0.58) of the cases, respectively, prior to and after the clinical anamnesis; likewise, the general radiologists agreed on the most likely diagnosis in 37.9 percent (κ = 0.32) and 36.2 percent (κ = 0.30) of the cases. For the thoracic radiologist, the intraobserver agreement on the most likely diagnosis was 0.73 and 0.63 prior to and after the clinical anamnesis, respectively. That for the general radiologist was 0.38 and 0.42.The thoracic radiologists presented almost perfect agreement for the diagnostic hypotheses defined with the high confidence level. CONCLUSIONS: Interobserver and intraobserver agreement in the diagnosis of ILDs based on HRCT scans ranged from fair to almost perfect and was influenced by radiologist expertise, clinical history and confidence level.

OBJETIVO: Determinar a concordância interobservador e intraobservador no diagnóstico de doenças pulmonares intersticiais (DPIs) por TCAR e o impacto da experiência dos observadores, dos dados clínicos e do grau de confiança nessas concordâncias. MÉTODOS: Dois radiologistas torácicos e dois gerais independentemente avaliaram imagens de TCAR de 58 pacientes com DPIs em dois momentos: antes e após da anamnese clínica. Os observadores selecionaram até três hipóteses diagnósticas para cada paciente e definiram o grau de confiança dessas hipóteses. Um dos radiologistas torácicos e um dos gerais reavaliaram as mesmas imagens até três meses após a primeira leitura. As análises estatísticas foram feitas utilizando o coeficiente kappa. RESULTADOS: Os radiologistas torácicos e os gerais, respectivamente, concordaram com uma ou mais hipóteses diagnósticas em 91,4 por cento e 82,8 por cento dos pacientes. Os radiologistas torácicos concordaram com o diagnóstico mais provável em 48,3 por cento (κ = 0,42) e 62,1 por cento (κ = 0,58) dos casos, respectivamente, antes e após a anamnese clínica; de forma semelhante; os radiologistas gerais concordaram com o diagnóstico mais provável em 37,9 por cento (κ = 0,32) e 36,2 por cento (κ = 0,30). A concordância intraobservador do radiologista torácico no diagnóstico mais provável foi de 0,73 e 0,63, antes e após da anamnese clínica, respectivamente; para o radiologista geral, essa foi de 0,38 e 0,42. Os radiologistas torácicos apresentaram graus de concordância quase perfeitos nas hipóteses diagnósticas definidas com o grau de confiança alto. CONCLUSÕES: A concordância interobservador e intraobservador no diagnóstico das DPIs por TCAR variaram de regular a quase perfeita, tendo sido influenciadas pela experiência do radiologista, pela história clínica e pelo grau de confiança.

Outbreak of invasive pulmonary aspergillosis among patients hospitalized in a bone marrow transplant ward: tomographic findings.

OBJECTIVE: To evaluate the main aspects on CT scans of six patients hospitalized in a bone marrow transplant ward, diagnosed with invasive pulmonary aspergillosis (IPA), during an in-hospital outbreak of the disease. METHODS: We reviewed 10 chest CT scans of six neutropenic or immunocompromised patients hospitalized in the hematology and bone marrow transplant ward of the Hospital São Paulo, in the city of São Paulo, Brazil, who were diagnosed with IPA between April of 2007 and October of 2007. The diagnosis of IPA was confirmed by anatomopathological findings (in 2 cases), culture (in 3 cases) or appropriate treatment response (in 1 case). RESULTS: We evaluated the CT scans of three male and three female patients, ranging from 22 to 58 years of age. The most common tomographic findings were nodules (5/6 cases) and areas of consolidation (2/6 cases). The nodules were more often multiple (3/5 cases), with irregular contours (4/5 cases) and accompanied by the halo sign (3/5 cases). One case presented multiple, centrally distributed areas of consolidation, and another presented an isolated, peripheral area of consolidation. Areas of ground-glass attenuation and septal thickening were found in three and two patients, respectively. Bilateral pleural effusion occurred in three cases. CONCLUSIONS: Consolidation, nodules, septal thickening, pleural effusion and ground-glass opacities were the principal tomographic findings in the six patients hospitalized in the above mentioned ward during the IPA outbreak. The nodules were often (in 67% of the cases) accompanied by the halo sign, a classically described finding in patients with IPA.

Ressonância magnética cardiovascular e tomografia computadorizada cardiovascular nas doenças não-coronárias / Role of cardiovascular magnetic resonance and computed tomography in noncoronary diseases

A tomografia computadorizada e, principalmente, a ressonância magnética cardiovascular têm se mostrado de utilidade cada vez maior para a avaliação de doenças cardiovasculares não-isquêmicas. A alta resolução tanto espacial como temporal desses métodos possibilita a aquisição de imagens com grande detalhamento anatômico, permitindo a avaliação da relação espacial entre estruturas adjacentes de forma não-invasiva. A tomografia tem particular importância para a análise vascular e é o melhor método para detecção de calcificações. No entanto, tem a desvantagem de utilizar contraste iodado e radiação ionizante, de não apresentar alta resolução de contraste entre as estruturas, e de adquirir imagens predominantemente estáticas. A ressonância magnética, por sua vez, é um método que não utiliza radiação ionizante e, por meio de diversas sequências de pulsos e técnicas de aquisição de imagens, é capaz de fornecer, além do detalhamento anatômico...