[Medical electroradiology technicians: mediators in hospital care]. / Les manipulateurs et manipulatrices en électroradiologie médicale : médiateurs du soin à l'hôpital.

Beyond simply carrying out the medical imaging procedure, radiology technicians have an ambivalent position in radiology departments: working both with the patient and with the doctor, they act as a link between these two entities which rarely, if ever, meet. This socioprofessional category is a keystone to medical imaging services, yet it receives little recognition and its crucial role is often overlooked. The exact delimitation of its functions within the hospital is often misunderstood.

[Feasibility study: The medical imaging as a tool for therapeutic education in radiotherapy]. / Étude de faisabilité : l'utilisation de l'imagerie médicale en éducation thérapeutique en radiothérapie.

PURPOSE: Assess the feasibility of a randomized controlled trial (RCT) exploring the use of medical imaging as a therapeutic education (TPE) intervention in external radiation therapy. MATERIALS AND METHODS: Experimental feasibility trial of "RCT" type carried out in a single-center, between November 2019 and March 2020, following adult patients treated by thoracic radiotherapy. In addition to the information usually given, the experimental group benefited from an intervention consisting in the visualization of their own medical images using the open-source software "Stone of Orthanc". RESULTS: Forty-nine patients were recruited with a refusal rate of 8.16% (4/49). 20 patients were withdrawn from the study for health reasons (COVID), 10 for medical reasons. All the remaining 15 participants completed the process. Although not significant, the experimental group showed a median gain in the perception of knowledge compared to the control group (+ 1.9 (1.6 - 2.2)) vs (+ 1.4 (1.4 - 1.8)), as well as a decrease in scores related to anxiety (- 3.0 (-4.5 - (-2.0)) vs - 1.0 (-5.0 - 0.0)) and emotional distress ((- 5.0 (- 7.5 - (- 3.5)) vs (- 2.0 (- 5.0 - (- 1.0)) A significant reduction (p=0.043) is observed for the depression score ((- 2.0 (-3.0 - (-1.5)) vs (0.0 (0.0 - 0.0)). CONCLUSION: This study demonstrates the feasibility of the project, with promising preliminary results. Some adaptations in order to conduct a larger-scale RCT are highlighted.

[Artificial intelligence and medical imaging]. / Intelligence artificielle et imagerie médicale.

The use of artificial intelligence methods for image recognition is one of the most developed branches of the AI field and these technologies are now commonly used in our daily lives. In the field of medical imaging, approaches based on artificial intelligence are particularly promising, with numerous applications and a strong interest in the search for new biomarkers. Here, we will present the general methods used in these approaches as well as the potential areas of application.

[Quality of Medical Imaging examination requests in Bouaké (Cote d'Ivoire): about 3129 requests]. / Qualite des demandes d'examen d'Imagerie Medicale a Bouake (Cote d'Ivoire) : a propos de 3129 cas.

OBJECTIVE: Assess the quality of medical imaging exam requests in order to facilitate their successful completion. MATERIAL AND METHODS: This was a prospective study, carried out at the Bouaké UniversityHospital over a period of 4 months. This study covered 3129 requests for examination. The aim was to evaluate the conformity of the different requests established by the CDEI indicator. Data analysis was carried out using Epi Info 7 software. RESULTS: Requests for medical imaging exams were under-informed in 98.66% of cases by prescribers as defined by the CDEI indicator. The requests included the patient's name in 99.78% of cases, first name(s) in 98.91% of cases, age in 51.45%, and sex in 60.95% of cases. 84.79% of the reports came from the Bouaké CHU and 98.43% were dated. The patient's hospitalized status was not specified in 99.97% of the requests for analysis. The indication was included in 92.78% of the reports and diagnostic hypotheses were mentioned in only 94.76%. The imaging medium requested was specified in 99.78% with conventional radiography predominating in 80.88%. The anatomical region was mentioned in 92.49%. The identity and contact information of the prescribers represented 92% and 48% of the requestsrespectively. CONCLUSION: The quality of writing of medical imaging examination requests was unsatisfactory overall with a high rate of non-compliance. Much effort to be made by the different actors.

OBJECTIF: Evaluer la qualité des demandes d'examen en imagerie médicale pour faciliter leur bonne réalisation. MÉTHODES: Il s'agissait d'une étude prospective, réalisée au CHU de Bouaké sur une période de 4 mois. Cette étude a porté sur 3129 demandes d'examen.Il était question d'évaluer la conformité des différentes demandes établies par l'indicateur CDEI. Les données ont été analysées avec le logiciel Epi Info 7. RÉSULTATS: Les demandes d'examen d'imagerie médicale étaient insuffisamment renseignées dans 98,66% des cas par les prescripteurs selon l'indicateur CDEI. Les demandes comportaient le nom du patient dans 99,78% des cas, leur(s) prénom(s) dans 98,91% des cas, l'âge dans 51,45% des cas et le sexe dans 60,95% des cas. Les demandes d'examen provenaient du CHU de Bouaké dans 84,79% des cas et ils étaient datés dans 98,43% des cas. Le statut hospitalisé du patient n'était pas précisé dans 99,97% des cas. L'indication y figurait dans 92,78% et les hypothèses diagnostiques n'étaient pas mentionnées dans 94,76%. Le moyen d'imagerie demandé figurait dans 99,78 % avec une prédominance de la radiographie standard dans 80,88%. La région anatomique était mentionnée dans 92,49%. L'identité et les coordonnées des prescripteurs étaient indiquées respectivement dans 92% des cas et 48% des cas sur les demandes d'examen. CONCLUSION: La qualité de rédaction des demandes d'examen d'imagerie médicale était insatisfaisante d'une manière globale avec un taux élevé de non conformités. Beaucoup d'efforts restent à faire de la part des différents acteurs.

The dorsal tangent line - A new approach in the radiological analysis of metacarpal fractures.

Traditionally, the angle between the intersecting central axes (lateral projection intersecting central axes - LCA) of the proximal and distal fragments of metacarpal fractures is measured on radiographs. We recommend using the angle between the intersecting dorsal tangent lines instead (lateral projection intersecting dorsal tangent lines - LDT). We analyzed radiographs of 25 fractures of the fifth metacarpal bone shaft in three planes. Intraclass correlation coefficients (ICC) were used to estimate inter-rater and intra-rater reliability. Mean palmar tilt was 35.6° ± 12.5° according to LCA and 27.6° ± 12.0° according to LDT. There were no differences during repeated measurements. Intra-rater reliability was high: ICC (95% CI) for LDT was 0.82 (0.74-0.88) and for LCA it was 0.71 (0.51-0.83). Mean values of palmar tilt using LCA exceeded those using LDT by 8.0° ± 7.7° (p < 0.001). Only LDT measurements provided comparable results between all raters. In conclusion, we demonstrated the feasibility and reliability of intersecting dorsal tangent lines for measuring palmar tilt in fifth metacarpal fractures as an alternative to the commonly used angle between the intersecting central axes.

Le corps aux confins du soin et de l'éthique.

The body at the boundaries of care and ethics. The body is the site of a variety of explorations, from the most basic to the most sophisticated imaging examinations, to provide a diagnosis, monitor the evolution of a pathology or decide on a therapy. For the patient, the examination is an ordeal, as is the wait for the results. In their role in providing images for clinicians, medical imaging professionals must ensure that they adopt an ethical approach showing compassion towards the person whose body is undergoing investigation.

[Computational medical imaging (radiomics) and potential for immuno-oncology]. / Imagerie médicale computationnelle (radiomique) et potentiel en immuno-oncologie.

The arrival of immunotherapy has profoundly changed the management of multiple cancers, obtaining unexpected tumour responses. However, until now, the majority of patients do not respond to these new treatments. The identification of biomarkers to determine precociously responding patients is a major challenge. Computational medical imaging (also known as radiomics) is a promising and rapidly growing discipline. This new approach consists in the analysis of high-dimensional data extracted from medical imaging, to further describe tumour phenotypes. This approach has the advantages of being non-invasive, capable of evaluating the tumour and its microenvironment in their entirety, thus characterising spatial heterogeneity, and being easily repeatable over time. The end goal of radiomics is to determine imaging biomarkers as decision support tools for clinical practice and to facilitate better understanding of cancer biology, allowing the assessment of the changes throughout the evolution of the disease and the therapeutic sequence. This review will develop the process of computational imaging analysis and present its potential in immuno-oncology.

[Epidemiology and treatment of sinus mucoceles: 25 cases in Abidjan (Côte d'Ivoire)]. / Les mucoceles sinusiennes: etude epidemio-clinique et therapeutique de 25 cas colliges a Abidjan (Cote d'Ivoire).

OBJECTIVE: To determine the epidemiological, clinical and therapeutic characteristics of sinus mucoceles in Ivory Coast. MATERIALS AND METHODS: A multicenter study conducted in the three services ENT (ear, nose & throat) hospital and university centers and clinics in Abidjan from 1996 to 2012 (16 years). It involved patients who have been diagnosed clinically and radiologically with a sinus mucocele who benefited from surgical treatment. RESULTS: During the study period, 25 patients were recruited - a hospital incidence of 1.5 cases per year. A female predominance was noted with 60% of women and 40% men with a sex ratio of 0.67. Patients consulted for headache (68%), facial swelling (68%), proptosis (28%). Allergic rhinitis is the antecedent rhinologic found most commonly (32%) followed by sinusitis (12%) and nasal sinus surgery (12%). The naso-sinus CT was performed in all patients diagnosed with mucocele. Surgical excision was made by several surgical approach, the most used were the way of JACQUES and paralateronasal rhinotomy of MOURE. Pathological examination of the surgical specimen confirmed the diagnosis of sinus mucocele. The development was beset by complications such as eyelid swelling (1 case), blurred vision (1 case), unsightly surgical scar (1 case). CONCLUSION: The nasal sinus mucoceles are relatively rare benign lesions with pseudo-cystic insidious evolution. Diagnosis suspected by the clinic is confirmed by radiology. Their treatment is mainly surgical.

OBJECTIF: Déterminer les caractéristiques épidémio-cliniques et thérapeutiques des mucocèles sinusien-nes en Côte d'Ivoire. MATÉRIEL ET MÉTHODE: Il s'est agit d'une étude multicentrique menée dans les services d'ORL des trois centres hospitaliers et universitaires et les polycliniques d'Abidjan de 1996 à 2012 (16 ans). Elle a concerné les patients chez qui il a été diagnostiqué cliniquement et radiologiquement une mucocèle sinusienne et qui ont bénéficié d'une prise en charge chirurgicale. RÉSULTATS: Pendant la période d'étude, 25 patients ont été recrutés soit une incidence hospitalière de 1.5 cas par an. Il y avait une prédominance féminine avec 60% de femme et 40% d'homme soit un sex ratio de 0.67. Les patients consultaient pour des céphalées (68%), des tuméfactions faciales (68%), une exophtalmie (28%). La rhinite allergique est l'antécédent rhinologique le plus retrouvé (32%) suivi des sinusites (12%) et de la chirurgie naso-sinusienne (12%). La tomodensitométrie naso-sinusienne réalisée chez tous nos patients, a posé le diagnostic de mucocèle dans 100% des cas. L'exérèse chirurgicale a été faite par plusieurs voie d'abord dont les plus utilisées étaient la voie de JACQUES et la rhinotomie paralatéronasale de MOURE. L'examen anatomopathologique des pièces opératoires a confirmé le diagnostic de mucocèle sinusienne. L'évolution a été émaillée de complications à type de tuméfaction palpébrale (1 cas), flou visuel (1 cas), cicatrice opératoire disgracieuse (1 cas). CONCLUSION: Les mucocèles naso-sinusiennes sont des lésions bénignes pseudo-kystiques relativement rares, d'évolution insidieuse. Leur diagnostic soupçonné par la clinique est confirmé par le bilan radiologique. Leur traitement est essentiellement chirurgical.

Enjeux d'une discussion entre psychanalyse et neurosciences à propos de l'imagerie cérébrale / Challenges of a debate between psychoanalysis and neurosciences about brain imaging / Desafíos de un debate entre psicoanálisis y neurociencias a propósito de imágenes cerebrales

Cette contribution propose d'interroger, à partir de la psychanalyse, quelques interactions possibles avec les neurosciences. Il s'agit de spécifier la particularité de l'investigation psychanalytique de la technique, notamment de l'imagerie cérébrale, pour en questionner les présupposés. Ce que révèle la prise en compte de toutes les dimension du dispositif, c'est qu'une méthodologie interdisciplinaire permet de circonscrire les limites de ce qui est observé. Ce dialogue veut garder la singularité de chaque position épistémologique. La méthode biologique ne peut pas expliciter ce qui est inconscient. En effet, les chercheurs en neurosciences semble confondre les processus inconscients et préconscient. Le risque pourrait être de perdre la spécificité de ce que la psychanalyse peut apporter dans le débat interdisciplinaire Par exemple, l'hypothèse du nouvel inconscient telle que la développe Lionel Naccache (2001 e 2002) est discutée à cette occasion et mise à l'épreuve de ce qu'enseigne la clinique. L'argumentation de cet article propose l'idée que le dialogue entre psychanalyse et neurosciences apparaît particulièrement fécond si la délimitation des champs et des méthodes se cherche et se précise, sans ambiguïté.

This contribution examines some possible interactions between the neurosciences and psychoanalysis. The goal is to specify the particularities of psychoanalytic investigation of technology, specifically regarding brain imaging, and question its basic assumptions. Taking into account all the aspects of this medical procedure, we find that interdisciplinary approach enables us to define the boundaries of the field of observation. This dialogue wants to keep the singularity of each epistemological position. The biological methodology can't explicate what is unconscious. In fact researchers in Neuroscience seem confuse unconscious and preconscious processes. The risk could be to lose the specificity of what psychoanalysis can bring in interdisciplinary debate. The hypothesis of a new unconscious, as developed by Lionel Naccache, is also discussed and tested by clinical experience. The author argues that a dialogue between psychoanalysis and the neurosciences appears especially fruitful if we seek to unambiguously delimit and precise its exact field and methods.

Esta contribución analiza algunos posibles interacciones entre las neurociencias y el psicoanálisis. El objetivo es especificar las particularidades de la investigación psicoanalítica de la tecnología, específicamente en relación con las imágenes del cerebro, y cuestionar sus supuestos básicos. Teniendo en cuenta todos los aspectos de este procedimiento médico, encontramos que el enfoque interdisciplinar permite definir los límites del campo de observación. Este diálogo quiere mantener la singularidad de cada posición epistemológica. La metodología biológica no puede explicar lo que es inconsciente. De hecho los investigadores en Neurociencias parecen confundir los procesos inconscientes y preconscientes. El riesgo podría ser perder la especificidad de lo que el psicoanálisis puede aportar en el debate interdisciplinar. La hipótesis de un nuevo inconsciente, desarrollado por Lionel Naccache, también se discute y probado por la experiencia clínica. El autor sostiene que el diálogo entre el psicoanálisis y las neurociencias aparece especialmente fructífera si buscamos para delimitar de forma inequívoca y precisa su ámbito exacto y métodos.

Esta contribuição examina possíveis interações entre as neurociências e a psicanálise. O objetivo é especificar as particularidades da investigação psicanalítica sobre a tecnologia, especificamente a respeito de imagens do cérebro, e questionar suas premissas básicas. Levando-se em conta todos os aspectos deste procedimento médico, descobrimos que uma abordagem interdisciplinar nos permite definir os limites do campo de observação. Este diálogo quer manter a singularidade de cada posição epistemológica. A metodologia biológica não pode explicar o que é inconsciente. Na verdade, os pesquisadores em neurociência parecem confundir os processos inconscientes e pré-conscientes. O risco pode ser perder a especificidade do que a psicanálise pode trazer para o debate interdisciplinar. A hipótese de um novo inconsciente, desenvolvida por Lionel Naccache, também é discutida e testada pela experiência clínica. O autor argumenta que um diálogo entre a psicanálise e as neurociências parece especialmente frutífero se procurarmos delimitar de forma inequívoca e precisa seu campo e seus métodos exatos.

Imaging-Based Methods for Non-invasive Assessment of Bone Properties Influenced by Mechanical Loading.

PURPOSE: To describe the most common in vivo imaging-based research tools used to assess bone properties that are influenced by mechanical loading associated with exercise, habitual physical activity, or disease states. Bone is a complex metabolically active tissue that adapts to changes in mechanical loading by altering the amount and spatial organization of mineral. METHOD: Using a narrative review design, the authors provide an overview of bone biology and biomechanics to emphasize the importance of bone size scale, porosity, and degree of mineralization when interpreting measures acquired using quantitative ultrasound (QUS), dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), and finite element analysis (FEA). For each imaging modality, basic imaging principles, typical outcome measures associated with changes in mechanical loading, and salient features for physiotherapists are described. MAIN RESULTS: While each imaging modality has strengths and limitations, currently CT-based methods are best suited for determining the effects of mechanical loading on bone properties-particularly in the peripheral skeleton. CONCLUSIONS: Regardless of the imaging technology used, the physiotherapist must carefully consider the assumptions of the imaging-based method, the clinical context, the nature of the change in mechanical loading, and the expected time course for change in bone properties.Purpose: To describe the most common in vivo imaging-based research tools used to assess bone properties that are influenced by mechanical loading associated with exercise, habitual physical activity, or disease states. Bone is a complex metabolically active tissue that adapts to changes in mechanical loading by altering the amount and spatial organization of mineral. Method: Using a narrative review design, the authors provide an overview of bone biology and biomechanics to emphasize the importance of bone size scale, porosity, and degree of mineralization when interpreting measures acquired using quantitative ultrasound (QUS), dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), and finite element analysis (FEA). For each imaging modality, basic imaging principles, typical outcome measures associated with changes in mechanical loading, and salient features for physiotherapists are described. Main Results: While each imaging modality has strengths and limitations, currently CT-based methods are best suited for determining the effects of mechanical loading on bone properties­particularly in the peripheral skeleton. Conclusions: Regardless of the imaging technology used, the physiotherapist must carefully consider the assumptions of the imaging-based method, the clinical context, the nature of the change in mechanical loading, and the expected time course for change in bone properties.

RÉSUMÉ Objectif : Décrire les outils de recherche en imagerie in vivo les plus couramment utilisés pour l'évaluation des propriétés des os qui sont influencés par la charge mécanique associée à l'exercice, à l'activité physique habituelle ou aux problèmes de santé. Les os sont des tissus actifs complexes sur le plan métabolique, qui s'adaptent aux changements de la charge mécanique en modifiant la quantité et l'organisation spatiale des minéraux. Méthode : À l'aide d'un modèle de revue narrative, un aperçu de la biologie et de la biomécanique osseuse est produit en vue de mettre l'accent sur l'importance de l'échelle de la dimension des os, de la porosité et du degré de minéralisation au moment d'interpréter les mesures recueillies à l'aide d'ultrasons quantitatifs (QUS), d'absorptiométrie à rayons X biphotonique (DXA), de tomographie informatisée (CT), d'imagerie par résonance magnétique (IRM) et d'analyse par éléments finis (FEA). Pour chaque modalité d'imagerie, les principes d'imagerie de base, les mesures typiques de résultats associés aux changements de charge mécanique et les caractéristiques principales pour les physiothérapeutes ont été décrits. Principaux résultats : Bien que chaque modalité d'imagerie ait ses forces et ses limites, les méthodes à base de tomographie informatisée sont les mieux adaptées pour déterminer les effets de la charge mécanique sur les propriétés osseuses ­ particulièrement dans le squelette périphérique. Conclusions : Sans égard à la technologie d'imagerie utilisée, le physiothérapeute doit analyser soigneusement les hypothèses de la méthode fondée sur l'imagerie, le contexte clinique, la nature du changement de charge mécanique et le délai attendu de changement des propriétés osseuses.