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OBJECTIVES: To audit whether using magnification of images by use of a large viewing screen using digital matrix magnification which enlarges the image by 33% without using the X-ray machine zoom magnification protocols on a Siemens Artis Zee X-ray machine in a cardiac catheter laboratory results in a reduction of kerma-area product (KAP) for both diagnostic and interventional procedures. This reduction was predicted in an in vitro study in our laboratory, which has previously shown a 20.4% reduction in KAP. METHODS: A retrospective analysis was conducted of the radiation exposure to compare the measured KAP recorded during the period when conventional magnification with automatic brightness and dose control was used on a Siemens Artis Zee X-ray machine with a flat panel detector and when magnification settings were avoided by using a large screen to enlarge and project a non-magnified image by digital magnification. The analysis was carried out for patients having a diagnostic coronary angiogram and those having an interventional coronary procedure. RESULTS: For diagnostic coronary angiograms the median KAP per procedure in the period using conventional magnification was 2124.5 µGy.m2 compared to 1401 µGy.m2 when image matrix magnification was used, a 34% reduction (p < 0.0001). For interventional coronary procedures, the median KAP per procedure in the period using conventional magnification was 3791 µGy.m2 compared to 2568.5 µGy.m2 when image matrix magnification was used, a 32% reduction (p < 0.0001). CONCLUSION: Avoiding using conventional magnification in the cardiac catheter laboratory and using a large screen to magnify images was associated with a statistically significant greater than 30% reduction in KAP. ADVANCES IN KNOWLEDGE: This paper is the proof in clinical practice of a theoretical conclusion that radiation dose (KAP) is reduced by use of Image matrix magnification using a large viewing screen without the need to use X-ray tube magnification without significant loss of image resolution in interventional cardiology. The same approach will be useful in interventional radiology.
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Cateterismo Cardíaco , Doses de Radiação , Ampliação Radiográfica/instrumentação , Ampliação Radiográfica/métodos , Radiografia Intervencionista/instrumentação , Radiografia Intervencionista/métodos , Idoso , Feminino , Humanos , Masculino , Imagens de Fantasmas , Estudos RetrospectivosRESUMO
BACKGROUND: For diagnosing gastric cancer, differences in the diagnostic performance between endocytoscopy with narrow-band imaging and magnifying endoscopy with narrow-band imaging have not been reported. We aimed to clarify these differences by analyzing diagnoses made by endoscopists in Japan. METHODS: This single-center retrospective cohort study used 106 cancerous and 106 non-cancerous images obtained via both modalities (total, 424 images) for diagnosis. Sixty-one endoscopists with varying experience levels from 45 institutions were included. Diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated to determine the diagnostic performance of each modality and compared using the Mann-Whitney U test. RESULTS: Among all endoscopists, diagnostic accuracy, sensitivity, positive predictive value, and negative predictive value were higher with endocytoscopy with narrow-band imaging than with magnifying endoscopy with narrow-band imaging (percentage [95% confidence interval]: 78.8% [76.4-83.0%] versus 72.2% [69.3-73.6%], p < 0.0001; 82.1% [78.3-85.9%] versus 64.2% [60.4-69.8%], p < 0.0001; 88.7% [82.6-90.7%] versus 78.5% [75.4-85.1%], p = 0.0023; 79.0% [75.3-80.5%] versus 68.5% [66.4-71.6%], p < 0.0001, respectively). In the magnifying endoscopy with narrow-band imaging-trained group, these values were also higher with endocytoscopy with narrow-band imaging than with magnifying endoscopy with narrow-band imaging (p < 0.0001, p = 0.0001, p = 0.0143, and p < 0.0001, respectively). Diagnostic accuracy, sensitivity, and negative predictive value were higher with endocytoscopy with narrow-band imaging than with magnifying endoscopy with narrow-band imaging in the magnifying endoscopy with narrow-band imaging-untrained group (p = 0.0041, p = 0.0049, and p = 0.0098, respectively). CONCLUSIONS: Diagnostic performance was higher using endocytoscopy with narrow-band imaging than using magnifying endoscopy with narrow-band imaging. Our results may help change the technique used to diagnose gastric cancer.
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Detecção Precoce de Câncer/estatística & dados numéricos , Endoscopia Gastrointestinal/estatística & dados numéricos , Imagem de Banda Estreita/estatística & dados numéricos , Ampliação Radiográfica/estatística & dados numéricos , Neoplasias Gástricas/diagnóstico , Estudos de Casos e Controles , Competência Clínica , Detecção Precoce de Câncer/métodos , Endoscopia Gastrointestinal/métodos , Humanos , Japão , Imagem de Banda Estreita/métodos , Valor Preditivo dos Testes , Ampliação Radiográfica/métodos , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Reducing radiation exposure is a very important issue in interventional cardiology techniques such as percutaneous coronary intervention. Although novel techniques to reduce radiation exposure are valuable, we should also reconsider older techniques. Digital zoom has been available in Japan from 2005. Digital zoom enlarges an 8-inch field of view (FOV) by 1.2 times, allowing visualization of a 6.7-inch FOV without FOV switching. We identified 2101 suitable cases of percutaneous intervention (PCI) and divided them into two groups according to the use of digital zoom; 1195 patients were included in the digital zoom group and 906 patients in the conventional group. We collected data regarding the reference air kerma (RAK) and dose-area product (DAP). We calculated RAK and DAP per minute fluoroscope time (RAK/min, DAP/min, respectively). There were intergroup differences in RAK, DAP, RAK/min, and DAP/min (digital zoom group vs conventional group; RAK, 1590 mGy [990-2410] vs 1850 [1220-2720], p < 0.01, RAK/min; 54.7 mGy/min [38.5-73.2] vs 71.2 [51.5-93.0], p < 0.01; DAP, 16,000 cGy × cm2 [10,300-24,400] vs 20,700 [13,400-29,500], p < 0.001; DAP/min, 557 cGy × cm2/min [392-737] vs 782 [571-1010], p < 0.01, respectively). Because of baseline differences between the two groups, we performed propensity score matching. Even after score matching, there were intergroup differences in DAP, DAP/min, RAK, and RAK/min. Furthermore, the least squares method showed that digital zoom is a significant predictor of RAK (ß = 0.14, p < 0.01) and DAP (ß = 0.20, p < 0.01). Digital zoom is an older cost-effective technique that can significantly reduce radiation exposure in PCI.
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Intervenção Coronária Percutânea/métodos , Doses de Radiação , Exposição à Radiação/prevenção & controle , Ampliação Radiográfica/métodos , Idoso , Angiografia Coronária/métodos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Ampliação Radiográfica/economia , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Early detection of early gastric cancer (EGC) allows for less invasive cancer treatment. However, differentiating EGC from gastritis remains challenging. Although magnifying endoscopy with narrow band imaging (ME-NBI) is useful for differentiating EGC from gastritis, this skill takes substantial effort. Since the development of the ability to convolve the image while maintaining the characteristics of the input image (convolution neural network: CNN), allowing the classification of the input image (CNN system), the image recognition ability of CNN has dramatically improved. AIMS: To explore the diagnostic ability of the CNN system with ME-NBI for differentiating between EGC and gastritis. METHODS: A 22-layer CNN system was pre-trained using 1492 EGC and 1078 gastritis images from ME-NBI. A separate test data set (151 EGC and 107 gastritis images based on ME-NBI) was used to evaluate the diagnostic ability [accuracy, sensitivity, positive predictive value (PPV), and negative predictive value (NPV)] of the CNN system. RESULTS: The accuracy of the CNN system with ME-NBI images was 85.3%, with 220 of the 258 images being correctly diagnosed. The method's sensitivity, specificity, PPV, and NPV were 95.4%, 71.0%, 82.3%, and 91.7%, respectively. Seven of the 151 EGC images were recognized as gastritis, whereas 31 of the 107 gastritis images were recognized as EGC. The overall test speed was 51.83 images/s (0.02 s/image). CONCLUSIONS: The CNN system with ME-NBI can differentiate between EGC and gastritis in a short time with high sensitivity and NPV. Thus, the CNN system may complement current clinical practice of diagnosis with ME-NBI.
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Gastrite/diagnóstico por imagem , Gastroscopia/métodos , Imagem de Banda Estreita/métodos , Redes Neurais de Computação , Ampliação Radiográfica/métodos , Neoplasias Gástricas/diagnóstico por imagem , Diagnóstico Diferencial , Detecção Precoce de Câncer/métodos , Reações Falso-Positivas , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Background and Objectives: The most common complications after conventional thyroid surgery in adult patients are recurrent laryngeal nerve (RLN) injury and hypocalcemia. Magnification techniques (surgical loupes or surgical microscope) are used for identification of RLN and parathyroid glands to diminish these complications although more evidence is necessary to assess their safety and efficacy in comparison with direct vision. Methods and Materials: Electronic databases (Pubmed, Cochrane Library, Scopus) as well as gray literature sources were searched for randomized controlled trials (RCTs) comparing the frequency of transient/permanent RLN injury and hypocalcemia after thyroid surgery by using magnification techniques and direct vision for identification of RLN and parathyroid glands until October 17, 2019. The main outcomes were transient/permanent RLN injury and hypocalcemia. For all outcomes, 95% confidence intervals (95% CI) were used. Statistical analysis was performed with RevMan 5.3. Results: Systematic review and meta-analysis included 3 RCTs with 437 patients overall. Magnification techniques did not significantly affect the risk of occurrence of transient RLN injury (OR = 0.38, 95% CI (0.11-1.35), I2 = 0%) and transient hypocalcemia (OR = 0.31, 95% CI (0.09-1.09), I2 = 23%) compared with direct vision. Included RCTs demonstrated only two patients with permanent hypocalcemia and another one with permanent RLN injury, who belonged to the direct vision group. Conclusion: The use of magnification techniques for identification of RLN and parathyroid glands seems to be as safe as direct vision. However, they do not decrease the risk of RLN injury and transient hypocalcemia after thyroid surgery compared with direct vision. Finally, further prospective research should be conducted as the sample among the studies was small.
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Ampliação Radiográfica/normas , Procedimentos Cirúrgicos Operatórios/normas , Glândula Tireoide/cirurgia , Humanos , Ampliação Radiográfica/métodos , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
Predicting Helicobacter pylori (Hp) status by endoscopic finding would be useful in recent clinical condition that the use of proton-pump inhibitors, anti-platelet, and anti-coagulant have become widespread. We aimed to elucidate the diagnostic accuracy of magnifying narrow-band imaging (M-NBI) endoscopy in distinguishing Hp status in patients with or without history of successful Hp eradication and compare this accuracy to the diagnostic accuracy of conventional white light (WL) endoscopy.Two hundred seven endoscopic examinations before and after Hp eradication were performed in prospective 163 patients. Endoscopic images by using the M-NBI and conventional WL were stored electronically and randomly allocated to 2 readers for evaluation. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were assessed by reference to Hp status assessed by conventional clinical test.Sensitivity, specificity, PPV, NPV, and accuracy for predicting Hp status for the conventional WL was 72.2%, 75.5%, 72.2%, 75.5%, and 73.9% for the first reader; 86.6%, 57.3%, 64.1%, 82.9%, and 71.0% for the second reader. On the other hand, sensitivity, specificity, PPV, NPV, and accuracy for predicting Hp status for the M-NBI was 96.9%, 93.6%, 93.1%, 97.1%, and 95.2% for the first reader; 92.8%, 93.6%, 92.8%, 93.6%, and 93.2% for the second reader, respectively. The diagnostic accuracy of M-NBI was significantly higher than that of WL (Pâ<â.0001 for both readers). Inter-observer agreement of M-NBI (kâ=â0.83) was also better than that of WL (kâ=â0.53).M-NBI was capable of distinguishing Hp status before and after eradication therapy.
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Endoscopia do Sistema Digestório/estatística & dados numéricos , Gastrite/diagnóstico por imagem , Infecções por Helicobacter/diagnóstico por imagem , Helicobacter pylori , Imagem de Banda Estreita/estatística & dados numéricos , Ampliação Radiográfica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia do Sistema Digestório/métodos , Feminino , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/microbiologia , Humanos , Luz , Masculino , Pessoa de Meia-Idade , Imagem de Banda Estreita/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Ampliação Radiográfica/métodos , Sensibilidade e Especificidade , Adulto JovemRESUMO
The use of a marker ball in digital templating for hip arthroplasty is a well-established method of preoperative planning and is used to overcome the inherent magnification in plain film radiographs. Our hospital policy is to place a marker ball in all anteroposterior pelvic films taken in the emergency department (ED) which have been requested for suspected neck of femur fractures. We carried out a baseline measurement followed by three Plan-Do-Study-Act cycles for all pelvic films taken in ED during July 2016, November 2016, February 2017 and November 2017. Interventions between the baseline measurement and cycle 1 were to educate the lead radiographer and publish the results in the radiology newsletter, and between cycles 1 and 2 was to run a teaching session for radiographers, display posters in the X-ray department and place an electronic prompt on the X-ray machine to alert them of the need to place a marker ball in the X-ray field. Cycle 3 looked to see if improvements were sustained. 16/81 (20%) radiographs complied with the policy in our baseline measurement; 25/51 (46%, p=0.002) in cycle 1; 40/54 (74%, p=0.0056) in cycle 2; and 48/63 (76%) in cycle 3. Our quality improvement project led to large improvements in clinical practice through straightforward, small, but appropriately targeted interventions. Stakeholder management is key to successfully implementing change. The next step is to switch from the VoyantMark to the KingMark marker ball, as it has greater accuracy of templating and is also easier to place within the field of an X-ray.
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Ampliação Radiográfica/efeitos adversos , Radiografia/métodos , Radiografia/normas , Fraturas do Colo Femoral/diagnóstico por imagem , Humanos , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Cuidados Pré-Operatórios/estatística & dados numéricos , Ampliação Radiográfica/métodos , Radiografia/estatística & dados numéricos , Participação dos InteressadosRESUMO
INTRODUCTION: Digital templating for total joint replacement is the current standard. For image calibration, external calibration markers (ECM) are used. However, there are concerns regarding the precision of the method. This study aimed to identify the direct influence of calibration errors on digital templating. PATIENTS AND METHODS: A retrospective analysis of 100 post-operative radiographs with unilateral total hip arthroplasty was performed. The magnification factor of the ECM and of the internal prosthetic femoral head (ICM) as a reference value was calculated for each radiograph. Two blinded observers performed templating of the contralateral hip using a randomized list for all radiographs and both markers. The component size templated by the ECM magnification was compared to the reference by the ICM magnification. RESULTS: Mean magnification factors of ICM and ECM differed significantly (p = 0.006). The absolute difference was 5.2% (range 0.0-23.3%, SD 4.8%). Templating of the acetabular or the femoral component showed no significant differences (p = 0.120, p = 0.599). Differences of more than one size were found in 26% of the acetabular components and 14% of the femoral components and differences over two sizes in 10% respectively 3%. Correlation coefficients for magnification error and size differences of acetabular components were - 0.645 (p < 0.001) and for the femoral component - 0.607 (p < 0.001). INTERPRETATION: The calibration error of external calibration markers in digital templating for hip replacement influences component sizes significantly. Thus, correct positioning of ECM is of utmost importance.
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Artroplastia de Quadril/métodos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Prótese de Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Calibragem , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Ampliação Radiográfica/métodos , Distribuição Aleatória , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
BACKGROUND: Currently available smartphones are equipped with optic systems allowing even 10x magnifi-ca-tion, which makes it possible to use them as magnifying devices for microsurgery training. The objective of this study was to assess the usefulness of smartphones for basic microsurgery training. MATERIAL AND METHODS: Two students began experimental microsurgical training using a smartphone as a magni-fy-ing device. Both students had acquired microsurgical skills following training under the microscope. For the expe-riment, the time of completion of a "6 stitches" test was measured and compared for each student using a smartphone and a microscope, after 1 and 6 hours of training using only a smartphone. RESULTS: After one hour of training, the first student completed the "6 stitches" test within 7:52 min. under the mi-croscope and within 16:35 min. using a smartphone, while the respective scores of the second student were 12:31 and 20:12 min.. In both cases the time required to complete the test was longer when working with a smartphone. The test was repeated after 6 hours of practice with a telephone, and the results now were as follows: first student 7:10 min. with the microscope and 12:50 min. with a smartphone, second student 8:54 min. with the microscope and 12:01 min. with a smartphone. CONCLUSIONS: 1. The microsurgical skills of both trainees improved gradually when they were using a smartphone (by 3:8 min. and 8:1 min) and the microscope (by 0:4 min. and 3:8 min). 2. Two drawbacks of the smartphone were noticed: lack of three-dimensional vision, deteriorating vertical orientation in the operating field and worse vision quality compared to the microscope. 3. Advantages of this tool include the availability of training at home, low cost and possibility of analysis of images recorded in the smartphone memory.
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Microcirurgia/educação , Microcirurgia/instrumentação , Microcirurgia/métodos , Ampliação Radiográfica/métodos , Smartphone , Adulto , Competência Clínica , Feminino , Humanos , Masculino , Adulto JovemRESUMO
BACKGROUND: We undertook this prospective, randomized, surgeon-blinded study to compare the accuracy of using of a magnification marker on preoperative radiographs for templating vs using a standard 21% magnification. METHODS: One hundred consecutive total hip arthroplasties were randomized to preoperative templating using a 25-mm magnification marker (50 patients) or a standard 21% magnification (50 patients). Intraoperative data were collected regarding the actual and predicted size of the femoral and acetabular components. RESULTS: The 2 groups were found to be comparable with respect to body mass index (28.9 vs 27.9, P = .26) and gender (P = .69). In the magnification marker group, we predicted the femoral size within 1 size in 80% of the cases and the acetabular component in 94%. In the group of a standard 21% magnification, we predicted the femoral size within 1 size in 90% of the cases and the acetabular component in 96%. These proportions did not statistically differ (femur: χ2P = .16, odds ratio = 2.3, 95% confidence interval = 0.7-7.1; acetabulum: χ2P = .65, odds ratio = 1.5, 95% confidence interval = 0.3-9.6). CONCLUSION: We did not detect a statistically significant difference in accuracy by using one method over the other when comparing the accuracy of component size selection. As the use of the magnification marker adds to the time and expense of preoperative radiographic acquisition, we feel using a standard 21% magnification is an equally accurate technique.
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Artroplastia de Quadril/métodos , Ampliação Radiográfica/métodos , Acetábulo/cirurgia , Feminino , Fêmur/cirurgia , Articulação do Quadril/cirurgia , Prótese de Quadril , Humanos , Masculino , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Radiografia , CirurgiõesRESUMO
BACKGROUND AND AIM: In Western countries, endoscopic removal of all adenomas during colonoscopy is recommended. The present study evaluates the usefulness of magnifying colonoscopy without removal of diminutive (≤5 mm) colorectal polyps. METHODS: Patients with diminutive polyps who were observed for over 5 years using magnification at Hiroshima University Hospital were selected retrospectively. Lesions ≥6 mm in size, depressed lesions, and lesions with type V pit pattern were indications for endoscopic resection. We investigated the characteristics of lesions indicated for endoscopic resection detected on surveillance colonoscopy and the risk factors for the incidence of lesions indicated for endoscopic resection. RESULTS: A total of 706 consecutive patients were enrolled. Sixty-eight lesions indicated for endoscopic resection were detected, averaging 9.0 ± 4.8 mm, and 33 (49%) lesions were located in the right colon. Pathological diagnoses were adenoma, Tis carcinoma, and T1 carcinoma in 58 (85%), eight (12%), and two (3%) lesions, respectively. Five lesions were considered to grow from previously detected diminutive polyps. Relative risks for the incidence of a lesion indicated for endoscopic resection were 1.76 (95% confidence interval [CI], 1.004-3.23) for males compared with females, 3.76 (95% CI, 2.03-7.50) for more than three polyps at initial colonoscopy compared with one polyp, and 2.84 (95% CI, 1.43-5.24) for patients with carcinoma at initial colonoscopy compared with patients with no lesion indicated for endoscopic resection. Nine carcinomas were resected endoscopically. CONCLUSION: Diminutive low-grade adenomas detected by using magnifying colonoscopy may not necessarily require removal.
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Adenoma/cirurgia , Neoplasias do Colo/cirurgia , Pólipos do Colo/cirurgia , Colonoscopia/métodos , Detecção Precoce de Câncer/métodos , Adenoma/diagnóstico , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Neoplasias do Colo/diagnóstico , Pólipos do Colo/diagnóstico , Colonoscopia/efeitos adversos , Feminino , Seguimentos , Hospitais Universitários , Humanos , Japão , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Ampliação Radiográfica/métodos , Estudos Retrospectivos , Medição de Risco , Fatores SexuaisRESUMO
OBJECTIVE: The purpose of this study was to assess the influence of magnification and superimposition of structures on CBCT-generated lateral cephalometric radiographs (LCR) using different segments of the cranium. METHODS: CBCT scans of 10 patients were selected. Four LCR were generated using Dolphin Imaging(r) software: full-face, right side, left side and center of the head. A total of 40 images were imported into Radiocef Studio 2(r), and the angles of the most common cephalometric analyses were traced by the same observer twice and within a 10-day interval. Statistical analyses included intraexaminer agreement and comparison between methods by means of intraclass correlation coefficient (ICC) and Bland-Altman agreement tests. RESULTS: Intraexaminer agreement of the angles assessed by ICC was excellent (> 0.90) for 83% of measurements, good (between 0.75 and 0.90) for 15%, and moderate (between 0.50 and 0.75) for 2% of measurements. The comparison between methods by ICC was excellent for 68% of measurements, good for 26%, and moderate for 6%. Variables presenting wider confidence intervals (> 6o) in the Bland-Altman tests, in intraexaminer assessment, were: mandibular incisor angle, maxillary incisor angle, and occlusal plane angle. And in comparison methods the variables with wider confidence interval were: mandibular incisor, maxillary incisor, GoGn, occlusal plane angle, Frankfort horizontal plane (FHP), and CoA. CONCLUSION: Superimposition of structures seemed to influence the results more than magnification, and neither one of them significantly influenced the measurements. Considerable individual variability may occur, especially for mandibular and maxillary incisors, FHP and occlusal plane.
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Cefalometria/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Ampliação Radiográfica/métodos , Adolescente , Criança , Queixo/diagnóstico por imagem , Oclusão Dentária , Meato Acústico Externo/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Incisivo/diagnóstico por imagem , Masculino , Mandíbula/diagnóstico por imagem , Maxila/diagnóstico por imagem , Dente Molar/diagnóstico por imagem , Variações Dependentes do Observador , Órbita/diagnóstico por imagemRESUMO
Endocytoscopy (ECS) is a novel endoscopic technique that allows detailed diagnostic examination of the gastrointestinal tract at the cellular level. We previously reported that use of ECS at ×380 magnification (GIF-Y0002) allowed a pathologist to diagnose esophageal squamous cell carcinoma (ESCC) with high sensitivity (94.9%) but considerably low specificity (46.7%) because this low magnification did not reveal information about nuclear abnormality. In the present study, we used the same magnifying endoscope to observe various esophageal lesions, but employed digital 1.6-fold magnification to achieve an effective magnification of ×600, and evaluated whether this improved the diagnostic accuracy in distinguishing neoplastic from non-neoplastic lesions.We examined the morphology of surface cells using vital staining with toluidine blue and compared the histological features of 40 cases, including 19 case of ESCC and 21 non-neoplastic esophageal lesions (18 cases of esophagitis, 1 case of glycogenic acanthosis, 1 case of leiomyoma, and 1 case of normal squamous epithelium). One endoscopist classified the lesions using the type classification, and we consulted one pathologist for judgment of the ECS images as 'neoplastic', 'borderline', or 'non-neoplastic'. At ×600 magnification, the pathologist confirmed that nuclear abnormality became evident, in addition to the information about nuclear density provided by observation at ×380. The overall sensitivity and specificity with which the endoscopist was able to predict neoplastic lesions using the type classification was 100% (19/19) and 90.5% (19/21), respectively, in comparison with values of 94.7% (18/19 cases) and 76.2% (16/21), respectively, for the pathologist using a magnification of ×600. The pathologist diagnosed two non-neoplastic lesions and one case of ESCC showing an apparent increase of nuclear density with weak nuclear abnormality as 'borderline'. Among the 21 non-cancerous lesions, two cases of esophagitis that were misdiagnosed by the endoscopist were also misinterpreted as 'neoplastic' by the pathologist. We have shown, by consultation with a pathologist, that an ECS magnification of ×600 (on a 19-inch monitor) is adequate for recognition of nuclear abnormality. We consider that it is feasible to diagnose esophageal neoplasms on the basis of ECS images, and that biopsy histology can be omitted if a combination of increased nuclear density and nuclear abnormality is observed.
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Carcinoma de Células Escamosas/ultraestrutura , Endoscopia/métodos , Neoplasias Esofágicas/ultraestrutura , Microscopia Nuclear/métodos , Ampliação Radiográfica/métodos , Erros de Diagnóstico , Neoplasias Esofágicas/classificação , Carcinoma de Células Escamosas do Esôfago , Esofagite/patologia , Esofagoscopia/métodos , Esôfago/ultraestrutura , Humanos , Sensibilidade e Especificidade , Coloração e Rotulagem , Cloreto de TolônioRESUMO
BACKGROUND AND GOALS: Pit pattern (PP) analysis of colorectal neoplasms using magnification chromoendoscopy with crystal violet (CV-MCE) is useful for predicting histologic features, but it is time consuming. Capillary pattern analysis by magnification endoscopy with narrow-band imaging (NBIME) is a useful and simpler procedure, but its diagnostic accuracy may be inferior to CV-MCE. NBIME with acetic acid enhancement (A-NBIME) is effective for rapid visualization of gastric mucosal microstructures. We performed a prospective study to compare the diagnostic reliability and feasibility of A-NBIME and CV-MCE in PP diagnosis of colorectal neoplasms. STUDY: The present study consisted of 3 protocols: Study-1 assessed 56 colorectal lesions photographed with A-NBIME and CV-MCE, and the endoscopic images were reviewed by 3 experts to compare the diagnostic concordance; study-2 assessed 202 colorectal lesions photographed with A-NBIME in 116 consecutive patients and the correlation between PP and histologic findings; study-3 randomly allocated 100 patients with colorectal lesions equally to A-NBIME and CV-MCE, and compared the procedure time and visible ratio of PP. RESULTS: The κ value for interobserver agreement for A-NBIME and CV-MCE was 0.71 (0.66 to 0.75) and 0.80 (0.75 to 0.85), respectively. Intraobserver agreement between modalities for each reviewer was 0.79 (0.70 to 0.88), 0.80 (0.71 to 0.90), and 0.74 (0.67 to 0.82). Non-neoplastic polyps and massively invasive submucosal adenocarcinomas were statistically related to type II and type VI-H/VN. The procedure time was statistically shorter with A-NBIME than with CV-MCE (31 vs. 81 s), and the visible ratio of PP was equivalent (98.9% vs. 98.3%). CONCLUSIONS: A-NBIME is comparable with CV-MCE in PP diagnosis of colorectal neoplasms and is a simpler technique.
Assuntos
Ácido Acético , Colonoscopia/métodos , Neoplasias Colorretais/patologia , Imagem de Banda Estreita/métodos , Ampliação Radiográfica/métodos , Adenocarcinoma/patologia , Idoso , Pólipos do Colo/patologia , Feminino , Humanos , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Duração da Cirurgia , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
AIMS: This study evaluated the horizontal magnification of images taken from adults and pediatrics with PM 2002 CC Planmeca analogue machine. MATERIALS AND METHODS: A series of 120 panoramic radiographs were obtained of 60 adults and 60 pediatrics. For all patients, negative impressions were used to make positive casts of the teeth. A caliper was used to measure the maximum mesiodistal length of the buccal surface of all teeth except canines on both casts and radiographs. The horizontal magnification factor was calculated for incisor, premolar, and molar regions by dividing the values obtained from the casts by the values obtained from the radiographs. STATISTICAL ANALYSIS: Independent t-test and one-way analysis of variance (ANOVA) were used. RESULTS: The results indicated that with regard to adults, maxillary and mandibular incisor regions, unlike the other two sessions, didn't show significant difference of the mean magnification of horizontal dimension (P = 0.5). In pediatrics, the comparison between mean magnification factors of all subgroups showed significant difference (P < 0.0001). Despite the adults' radiographs, the results of pediatrics' radiographs showed significantly higher magnification than the index listed by the manufacturer of the radiographic machine used. CONCLUSION: The present study results point to the fact that PM 2002 CC Proline panoramic machine makes possible precise measurements on radiographs of adults' jaws in the horizontal dimension.
Assuntos
Ampliação Radiográfica/métodos , Radiografia Panorâmica , Adulto , Criança , Feminino , Humanos , Irã (Geográfico) , Masculino , Mandíbula/diagnóstico por imagem , Maxila/diagnóstico por imagemRESUMO
La endoscopia estándar no diagnostica infección por Helicobacter pylori. Con magnificación y "Flexible Spectral Imaging Colour Enhancement" (FICE) se observan patrones de mucosa gástrica que sugieren su presencia. Diagnosticar infección por Helicobacter pylori con magnificación endoscópica y "Flexible Spectral Imaging Colour Enhancement" (FICE). Previo consentimiento se incluyeron a los individuos con indicación electiva de endoscopia digestiva superior. Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400. En ambas caras del cuerpo gástrico se realizó consecutivamente: a) alta resolución, b) magnificación, c) alta resolución, d)FICE, e)magnificación y f) biopsia en el antro y del patrón mas prevalente en cada cara del cuerpo evaluadas sin información del paciente. Todo el procedimiento se grabó, se fotografió y se guardó en JPEG en programa Power Point. Se evaluaron 60 áreas en 30 pacientes: 10 hombres y 20 mujeres con edades de 20-82 años y promedio 49,60 años. Solo magnificación y FICE identificaron los patrones de mucosa en cuerpo gástrico. En 37,03% se diagnosticó Helicobacter pylori con histología, 53,33% y 61,11% en patrón Z2 y Z3 respectivamente. La magnificación y FICE permiten identificar los patrones de mucosa gástrica que sugieren infección por Helicobacter pylori
Helicobacter pylori infection is not diagnosed with standard endoscopy. With high resolution and magnification patterns of gastric mucosa suggesting its presence are observed. Diagnose Helicobacter pylori infection with endoscopic magnification and "Flexible Spectral Imaging Colour Enhancement" (FICE). Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. Endoscopy was practiced on both sides of the gastric body consecutively with: a) high-resolution, b) magnification, c) high-resolution, d) FICE, e) magnification and g) biopsy of the antrum and the pattern more prevalent on each side of the body evaluated without patient information. The entire procedure was recorded, was photographed and was saved in JPEG in program Power Point. 60 Areas in 30 patients were evaluated: 10 men and 20 women with ages of 20-82 years and average 49.60. Only magnification and FICE identified patterns of mucosa in gastric body. Helicobacter pylori was diagnosed in 37.03% with histology and in pattern Z2 and Z3 in 53.33% and 61.11% respectively. The endoscopic magnification and Flexible Spectral Imaging Colour Enhancement (FICE) identify patterns of gastric mucosa suggesting Helicobacter pylori infection
Assuntos
Feminino , Adulto Jovem , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Endoscopia Gastrointestinal/métodos , Gastrite/diagnóstico , Gastrite/patologia , Gastrite/virologia , Helicobacter pylori/virologia , Ampliação Radiográfica/métodos , Mucosa Gástrica , Equipamentos para Diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , GastroenterologiaRESUMO
Congenital fissures of the alveolar process and hard palate are one of the severest pathologies of the teeth and jaws. Plain magnification microfocus radiography and microfocus radioimaging of the upper jaw with bite occlusion are the radiodiagnostic methods of choice for the evaluation of bone defects and regenerative processes. To study the regenerative processes, 52 patients aged 10-16 years with congenital fissures of the alveolar process and hard palate were examined after bone reparative surgery. A bone block from the mental region of the lower jaw, or cancellous iliac crest tissue or biocomponents materials were used to close maxillary alveolar process bony defect. Early and late postoperative osteoreparative processes were evaluated applying plain magnification radiography and microfocus radioimaging. The first signs of osteointegration were observed one month after surgery; the most active processes were detected in the patients in whom a mandibular bone block was employed as an autograft. The patients with a cancellous iliac autograft were found to have partial bone resorption in a number of cases at 6 and 9 months.
Assuntos
Processo Alveolar , Palato Duro , Complicações Pós-Operatórias/diagnóstico por imagem , Ampliação Radiográfica/métodos , Adolescente , Processo Alveolar/anormalidades , Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Materiais Biocompatíveis/uso terapêutico , Regeneração Óssea , Transplante Ósseo/efeitos adversos , Transplante Ósseo/instrumentação , Transplante Ósseo/métodos , Criança , Pesquisa Comparativa da Efetividade , Feminino , Humanos , Ílio/transplante , Masculino , Mandíbula/transplante , Palato Duro/anormalidades , Palato Duro/diagnóstico por imagem , Palato Duro/cirurgia , Período Pós-Operatório , Fatores de Tempo , Transplante Autólogo/métodos , Resultado do TratamentoRESUMO
This study aimed to examine the resolution effects of breast thickness and lesion location in magnification mammography by evaluating generalized modulation transfer function (GMTF) including the effect of focal spot, effective pixel size, and the scatter. Polymethyl methacrylate (PMMA) thicknesses ranging from 10 to 40 mm were placed on a standard supporting platform that was positioned to achieve magnification factors ranging from 1.2 to 2.0. As the magnification increased, the focal spot MTF degraded, while the detector MTF improved. The GMTF depended on the trade-off between the focal spot size and effective pixel size. Breast thickness and lesion location had little effect on the resolution at high frequencies. The resolution of small focal spot did improve slightly with increasing PMMA thickness for magnification factors less than 1.8. In contrast, system resolution decreased with increasing PMMA thickness for magnification factors greater than 1.8 since focal spot blur begins to dominate spatial resolution. In particular, breast thickness had a large effect on the resolution at lower frequencies. A low-frequency drop effect increased with increasing PMMA thickness because of the increase in scatter fraction. Hence, the effect of compressed breast thickness should be considered for the standard magnification factor of 1.8 that is most commonly used in clinical practice. Our results should provide insights for determining optimum magnification in clinical application of digital mammography, and our approaches can be extended to a wide diversity of radiological imaging systems.