Indices of agreement between neurosurgeons and a radiologist in interpreting tomography scans in an emergency department / Índice de concordância entre neurocirurgiões e radiologistas na interpretação de tomografias de crânio na emergência

The power of interpretation in the analysis of cranial computed tomography (CCT) among neurosurgeons and radiologists has rarely been studied. This study aimed to assess the rate of agreement in the interpretation of CCTs between neurosurgeons and a radiologist in an emergency department. Method 227 CCT were independently analyzed by two neurosurgeons (NS1 and NS2) and a radiologist (RAD). The level of agreement in interpreting the examination was studied. Results The Kappa values obtained between NS1 and NS2 and RAD were considered nearly perfect and substantial agreement. The highest levels of agreement when evaluating abnormalities were observed in the identification of tumors, hydrocephalus and intracranial hematomas. The worst levels of agreement were observed for leukoaraiosis and reduced brain volume. Conclusions For diseases in which the emergency room procedure must be determined, agreement in the interpretation of CCTs between the radiologist and neurosurgeons was satisfactory. .

O poder de interpretação na análise de tomografias de crânio (TCC) entre neurocirurgiões e radiologistas tem sido pouco estudada. O objetivo deste estudo é avaliar as taxas de concordância na interpretação de TCCs entre neurocirugiões e radiologista em um departamento de emergência. Método 227 TCCs foram independentemente analizadas por 2 neurocirugiões (NC1 e NC2) e um radiologista(RAD). O índice de concordância nas análises foi estudada posteriormente. Resultados O valor de Kappa obtido entre os NC1 e NC 2 e entre estes e RAD foram quase perfeitos e substancial respectivamente. O maiores índices de concordância quando avaliadas anormalidades foram observados na identificação de tumores, hidrocefalia e hematomas intracranianos. O piores índices foram observados com relação a leucaraiose e redução volumétrica. Conclusão Para doenças apresentadas em um departamento emergência que demandam tratamento mais agressivo o índice de concordância na interpretação de TCCs entre RAD e NC foi satisfatório. .

Famílias de idosos na Estratégia de Saúde no Sul do Brasil / Familias de edad avanzada en la Estrategia de Salud en el sur de Brasil / Elderly families of South of Brazil in the Health Strategy

RESUMOObjetivo:caracterizar as famílias e situação de saúde de idosos na Estratégia de Saúde da Família e verificar a associação da composição familiar com as características sociodemográficas e de saúde dos idosos.Método:estudo de base populacional, com 215 famílias e 266 idosos, adscritos à Estratégia da Saúde da Família, de um município do Rio Grande do Sul.Resultados:predomínio da composição familiar nuclear, considerada como a principal fonte de apoio informal, de famílias de idosos do sexo feminino e agravos cardiovasculares. A estrutura parental nuclear teve associação bruta significativa com o sexo feminino e o consumo do tabaco.Conclusão:os resultados reforçam a necessidade de manutenção de uma rede de apoio formal e informal ao idoso e sua família para preservar a independência ou postergar o declínio da capacidade funcional.

RESUMENObjetivo:la caracterización de las familias y de la situación de salud de ancianos en la Estrategia de Salud de la Familia y, además, la verifi cación de la asociación de la composición familiar con las características sociodemográfi cas y de salud de los mayores.Método:estudio de base poblacional, con 215 familias y 266 ancianos, adscritos a la Estrategia de Salud de la Familia, de un municipio del Rio Grande del Sur. Prevaleció la composición familiar nuclear, considerada como la principal fuente de apoyo informal y de familias de ancianos del sexo femenino (62,6%).Resultados:los resultados de la asociación bruta de las variables en el estudio con la composición parental nuclear ha demostrado asociación signifi cativa (p<0,05) con el sexo femenino (RP=0,77; p=0,025) y el consumo de tabaco (RP=1,35; p=0,009).Conclusión:estos resultados refuerzan la necesidad de manutención de una red de apoyo formal e informal al anciano y a su familia para preservar la independencia o postergar el descenso de la capacidad funcional.

ABSTRACTObjective:to characterize families and health status of the elderly in the Family Health Strategy and to verify the association of family composition with sociodemographic characteristics and health of the elderly.Method:population-based study with 215 families and 266 elderly, linked to the Family Health Strategy from a city of Rio Grande do Sul state.Results:there was predominance of nuclear family composition, considered as the main source of informal support, families of female elderly (62.6%) and cardiovascular complication. The nuclear structure was signifi cantly associated with female gender (PR = 0.77; p = 0.025) and smoking (PR = 1.35; p = 0.009).Conclusion:the results reinforce the need to maintain a network of formal and informal support to the elderly and their families to preserve the independence or to postpone the decline in functional capacity.

Reduction of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation

PURPOSE: To evaluate the changes of contractility and reactivity in isolated lymphatics from hemorrhagic shock rats with resuscitation. METHODS: Six rats in the shock group suffered hypotension for 90 min by hemorrhage, and resuscitation with shed blood and equal ringer's solution. Then, the contractility of lymphatics, obtained from thoracic ducts in rats of the shock and sham groups, were evaluated with an isolated lymphatic perfusion system using the indices of contractile frequency (CF), tonic index (TI), contractile amplitude (CA) and fractional pump flow (FPF). The lymphatic reactivity to substance P (SP) was evaluated with the different volume of CF, CA, TI and FPF between pre- and post-treatment of SP at different concentrations. RESULTS: The CF, FPF, and TI of lymphatics obtained from the shocked rats were significantly decreased than that of the sham group. After SP stimulation, the ∆CF (1×10-8, 3×10-8, 1×10-7, 3×10-7 mol/L), ∆FPF (1×10-8, 3×10-8, 1×10-7 mol/L), and ∆TI (1×10-8 mol/L) of lymphatics in the shock group were also obviously lower compared with the sham group. In addition, there were no statistical differences in CA and ∆CA between two groups. CONCLUSION: Lymphatic contractility and reactivity to substance P appears reduction following hemorrhagic shock with resuscitation. .

Comparison between Greulich-Pyle and Girdany-Golden methods for estimating skeletal age of children in Pakistan

To compare Greulich-Pyle [GP] and Girdany-Golden [GG] methods for estimation of Skeletal Age [SA] in children referred to a tertiary care hospital in Karachi, Pakistan. Cross-sectional study. Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan, from July 2010 to June 2012. Children up to the age of 18 years, who had undergone X-ray for the evaluation of trauma were included. Each X-ray was interpreted using both methods by two consultant paediatric radiologists having at least 10 years experience, who were blinded to the actual Chronologic Age [CA] of children. A total of 283 children were included. No significant difference was noted in mean SA estimated by GP method and mean CA for female children [p=0.695]. However, a significant difference was noted between mean CA and mean SA by GG method for females [p=0.011]. For males, there was a significant difference between mean CA and mean SA estimated by both GP and GG methods. A stronger correlation was found between CA and SA estimated by GP method [r=0.943 for girls, r=0.915 for boys] as compared to GG method [r=0.909 for girls, r=0.865 for boys] respectively. Bland- Altman analysis also revealed that the two methods cannot be used interchangeably. Excellent correlation was seen between the two readers for both GP and GG methods. There was no additional benefit of using GP and GG methods simultaneously over using GP method alone. Moreover, although GP was reliable in estimating SA in girls, it was unable to accurately assess SA in boys. Therefore, it would be ideal to develop indigenous standards of bone age estimation based on a representative sample of healthy native children

Bevacizumab in combination with gemcitabine and carboplatin in recurrent ovarian cancer: a critical consideration / 부인종양

No abstract available.

Melhoria da proteção radiológica mediante um ciclo de avaliação interna da qualidade / Enhancement of radiological protection through an internal quality assessment cycle

OBJETIVO: Determinar o nível de qualidade da proteção radiológica para os pacientes durante a realização de exames radiológicos e avaliar a efetividade de uma intervenção dirigida a melhorar a qualidade. MATERIAIS E MÉTODOS: Realizou-se um ciclo de melhoria em um serviço de radiologia da Administração Geral de Saúde do Algarve, Portugal. Utilizando seis critérios de qualidade, foram efetivadas uma avaliação, uma intervenção focada nos critérios mais problemáticos (durante oito meses) e uma reavaliação. As amostras foram aleatórias (n = 60), possibilitando a inferência sobre as estimativas pontuais e intervalos de confiança do cumprimento de cada critério, assim como o cálculo da significância estatística da melhoria identificada, através do teste Z. RESULTADOS: Na avaliação inicial, todos os critérios de qualidade apresentaram falhas. Após a intervenção, a melhoria relativa mínima foi de 33% em cinco dos seis critérios, sendo significativa (p < 0,05) em dois deles. A frequência absoluta de não conformidades diminuiu de 38 (primeira avaliação) para 21 (segunda avaliação), que corresponde a uma melhoria de 44,7%. CONCLUSÃO: O início do ciclo de avaliação institucional revelou uma margem de melhoria que antes parecia incipiente, porém, a intervenção implementada foi efetiva para estimular boas práticas e aumentar o nível de proteção radiológica para os pacientes.

OBJECTIVE: To determine the level of quality in radiation protection of patients during radiological examination, evaluating the effectiveness of an intervention aimed at enhancing the quality of such a protection. MATERIALS AND METHODS: A quality improvement cycle was implemented in a radiology service of the Regional Health Administration, in Algarve, Portugal. Based on six quality criteria, an initial evaluation was performed and followed by an intervention focused on the most problematic points (over an eight-month period) and a subsequent quality reassessment. A random sampling (n = 60) has allowed the authors to infer the point estimates and confidence intervals for each criterion, as well as calculating the statistical significance of the results by means of the Z-test. RESULTS: Initially, deficiencies were observed in relation to all the quality criteria. After the intervention, a minimum relative improvement of 33% was observed in five of the six criteria, with statistical significance (p < 0.05) in two of them. The absolute frequency of non-compliance decreased from 38 (first evaluation) to 21 (second evaluation), corresponding to a 44.7% improvement. CONCLUSION: The first institutional evaluation cycle showed a seemingly incipient improvement margin. However, the implemented intervention was effective in stimulating good practices and improving the level of radiological protection of patients.

Controle de qualidade de monitores de diagnóstico por imagem e iluminância nos espaços de pós-processamento em serviços de imagiologia / Display quality control based on luminance measurements in post-processing units at imaging diagnosis centers

OBJETIVO: Avaliar a qualidade dos monitores de diagnóstico e tratamento de imagem digital em radiologia convencional (raios X) com base nos níveis de luminância. Fez-se a medição da iluminância dos postos de trabalho onde estavam os monitores. MATERIAIS E MÉTODOS: A medição da luminância foi realizada usando-se um detector Unfors Xi Light em cinco instituições, com 23 monitores primários e 22 secundários, sendo 6 usados em urgência, seguindo o método descrito no relatório TG18 da American Association of Physicists in Medicine (AAPM). O instrumento de medida utilizado foi o Delta Ohm HD 9221 luximeter. RESULTADOS: Para as recomendações da AAPM, tanto monitores primários como secundários cumpriram, no geral, os níveis de tolerância. No caso dos níveis de iluminância, nos locais de trabalho dos monitores primários encontravam-se ligeiramente acima do intervalo recomendado. Quanto às recomendações do The Royal College of Radiologists (RCR), os monitores que respeitaram os níveis recomendados estavam em minoria, embora as diferenças não fossem significativas. CONCLUSÃO: Em geral, os resultados foram satisfatórios, embora os monitores não fossem adequados para atingir as recomendações exigentes do RCR. Os níveis de referência entre os monitores primários e secundários deveriam aproximar-se, de modo a garantir a qualidade de imagem. Os monitores para visualização e diagnóstico de imagens médicas devem ser regularmente avaliados para manter um sistema com a qualidade exigida, dada a função que desempenham.

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

Imaging-Based Tumor Treatment Response Evaluation: Review of Conventional, New, and Emerging Concepts

Tumor response may be assessed readily by the use of Response Evaluation Criteria in Solid Tumor version 1.1. However, the criteria mainly depend on tumor size changes. These criteria do not reflect other morphologic (tumor necrosis, hemorrhage, and cavitation), functional, or metabolic changes that may occur with targeted chemotherapy or even with conventional chemotherapy. The state-of-the-art multidetector CT is still playing an important role, by showing high-quality, high-resolution images that are appropriate enough to measure tumor size and its changes. Additional imaging biomarker devices such as dual energy CT, positron emission tomography, MRI including diffusion-weighted MRI shall be more frequently used for tumor response evaluation, because they provide detailed anatomic, and functional or metabolic change information during tumor treatment, particularly during targeted chemotherapy. This review elucidates morphologic and functional or metabolic approaches, and new concepts in the evaluation of tumor response in the era of personalized medicine (targeted chemotherapy).

Controle de infecções cruzadas em radiologia odontológica digital: proposta de um protocolo

É grande a importância da radiologia na obtenção de diagnósticos e para definição da estratégia de tratamento a ser adotada pelo dentista. Entretanto, para execução destes procedimentos é necessário que o profissional responsável pela radiografia manipule o filme na boca do paciente, ocasionando o contato da saliva com o equipamento e com o profissional também, que pode vir gerar infecção cruzada nos pacientes e demais membros da equipe...

Conceptos actuales en la radiología basada en evidencias: revisión / A review of current concepts in evidence-based radiology

La medicina basada en evidencias (MBE) se fundamenta en un descubrimiento sistemático, evaluación crítica y utilización de la investigación actual publicada en la literatura médica, para la toma de decisiones referentes al cuidado de un paciente individual o políticas de salud. En la radiología (incluyendo sus ramas diagnóstica y terapéutica), los principios y práctica de una MBE han recibido atención limitada. En esta breve revisión, presentamos algunos conceptos básicos de cómo implementar una radiología basada en evidencias y los conceptos y etapas de la MBE y el metaanálisis con enfoque en la radiología basada en evidencias. Se identifican las aplicaciones de ésta en la práctica, la educación y la investigación, y las habilidades requeridas. La aplicación de los principios de la MBE en el diagnóstico por imagen facilita la interpretación de los estudios y sustenta una evaluación bien dirigida. Esta revisión será útil para radiólogos en cualquier etapa de su entrenamiento o desarrollo profesional, con el fin de estimular una práctica radiológica basada en evidencias, especialmente en países en desarrollo.

It has been noted that "Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough." Evidence-based medicine (EBM) is defined as the process of systematically finding, critically appraising, and using contemporary research published in the medical literature as a basis to make decisions regarding individual patient care and health care policy. In radiology, including its diagnostic and interventional aspects, the principles and practice of EBM have not been thoroughly studied. In this brief review article, we describe key aspects of evidence-based radiology (EBR), concepts and steps followed in EBM and meta-analysis. The skills required to practice EBR are identified, and the roles of EBR in radiologic practice, education, and research are discussed. The application of EBM principles to diagnostic imaging facilitates the interpretation of imaging studies and produces a sound and comprehensive radiologic evaluation. This review could be useful for radiologists and clinicians at any stage of their training or career. It encourages the practice of EBM and EBR especially in developing countries.

Influência da metodologia de avaliação da camada semi-redutora em radiologia diagnóstica / The methodology for evaluating half-value layer and its influence on the diagnostic radiology

OBJETIVO: A análise crítica da metodologia de medida da camada semi-redutora em feixes de raios X teve como base o regulamento técnico para proteção radiológica e controle de qualidade em radiodiagnóstico médico e odontológico. MATERIAIS E MÉTODOS: Na medida da camada semi-redutora, a técnica radiográfica, o arranjo experimental, os meios espalhadores, a instrumentação, o tamanho de campo de radiação e a metodologia de análise dos dados foram considerados. RESULTADOS: A camada semi-redutora obtida em condições de boa geometria, para a técnica escolhida, foi de 2,44 ± 0,02 mmAl. Em relação a este valor, observaram-se desvios máximos na camada semi-redutora de 4,1 por cento na variação da geometria, de 98,8 por cento na variação da câmara de ionização e do meio espalhador, e de até 29,5 por cento com outro tipo de detector. CONCLUSÃO: Os resultados mostraram que não ocorre variação significante na camada semi-redutora para diferentes tamanhos de campo de radiação, mas foram evidentes a influência do espalhamento na superestimação da camada semi-redutora e a redução desta na presença de blocos de chumbo como meio espalhador. O procedimento prático adotado mostrou-se bastante confiável e evidenciou a grande discrepância decorrente da adoção de metodologias impróprias, enfatizando a necessidade de estabelecer um procedimento padrão para a medida da camada semi-redutora.

OBJECTIVE: The critical analysis of the methodology for evaluating the x-ray beam half-value layer was based on technical standards for radiological protection and quality control in medical and dental diagnoses. MATERIALS AND METHODS: Exposure parameters, experimental set-up, scattering materials, instrumentation, size of radiation field and methodology of data analysis have been taken into consideration for measurements of half-value layer. RESULTS: The half-value layer, in good geometry, measured 2.44 ± 0.02 mmAl. A maximum deviation of 4.1 percent was found under other geometry conditions. A 98.8 percent deviation was observed with a different ionization chamber, and scattering material, and 29.5 percent with another type of detector. CONCLUSION: Results showed that no relevant variation is observed in the half-value layer for different radiation field sizes. On the other hand, the influence of the radiation scattering on the half-value layer overestimation was clearly observed, as well as the half-value layer reduction in the presence of lead used as scattering material. The practical methodology adopted for half-value layer evaluation has shown to be quite reliable, besides evidencing remarkable discrepancies resulting from the adoption of inappropriate methodologies, emphasizing the necessity of establishing a standard procedure for measuring the half-value layer.

Evaluation of technical, protective and technological operation of radiologists in hospitals of Mazandaran medical science universities

Radiology unit has an important role in the diagnosis of many disorders, along with providing suitable and high quality pictures. A good picture is provided using a correct technical criteria and suitable circumstance of patient. Finally, operation and knowledge of radiology personnels directly has a primary role in the determination of radiography quality. This study was done in order to determine personnel operation in the units of hospitals radiologist, related to Universities of Mazandaran Medical Science. Data collection tools, made a researcher check list that was used after getting suitable letter and validity indices. All of the 73 personnels of the radiology unit related to Mazandaran Medical Science were studied. 35 operations [in technical, protective and technological fields], in any of personnel in three distinct shifts were observed and recorded. All of them were tested about these three fields with 40 questions. The total obtained scores from personnels in technical pad in the morning, evening and night shift were 66.4, 53.9 and 60.2 percents. Received scores from personnels in protective fields were 68.1, 59.5 and 60.2 percents, while received scores from personnels in Technological operation fields were 47.8, 39.95 and 43.65 percents. Comparison of these three scores in technical, protective and Technological operation fields showed a meaningful difference [p<0.05]. The total quality of personnels operations were nearly desirable and in need of continuous education, supervision and evaluation. Emphasizing protection to beams, accessibility of necessary tools and continuous supervision regarding usage of these equipments and respecting other security points have important role in reducing patients absorbed doses

La calidad de los servicios de radiología en cinco países latinoamericanos / The quality of radiology services in five Latin American countries

OBJETIVO: Determinar la correlación entre ciertos indicadores de calidad para los servicios de imaginología y la certeza en la interpretación de los exámenes radiológicos para cuatro quejas frecuentes: las masas de la mama, el malestar del aparato digestivo, el dolor de espalda y los síntomas de la tuberculosis. MÉTODOS: Se evaluaron veintiséis servicios de radiología en Argentina, Bolivia, Colombia, Cuba y México. Se evaluaron los equipos de mamografía y de radiografía/fluoroscopia convencional usados en los servicios seleccionados utilizando protocolos comunes, hojas de especificaciones técnicas, instrumen-tos de prueba, maniquíes y sistemas de dosimetría calibrados. Los estudios se realizaron en establecimientos de complejidad media. Se obtuvo el consentimiento informado de todos los pacientes estudiados, y se garantizó la confidencialidad de los resultados. Se evaluaron y documentaron los siguientes parámetros: el tipo de establecimiento (público o privado); la población cubierta; el número de pacientes y exámenes; los equipos radiológicos, los de procesamiento de imágenes y los suministros; la educación y la capacitación del personal profesional y técnico; los programas de la garantía de la calidad y del mantenimiento preventivo, y la adherencia a las normas de seguridad radiológica. Se determinaron el funcionamiento de los equipos de rayos X, los receptores de la imagen y las procesadoras; las condiciones del cuarto oscuro y de la visualización de las imágenes; las dosis recibidas por los pacientes y la calidad de la imagen, usando parámetros uniformados en todos los casos. Los paneles independientes de radiólogos, reconocidos como expertos por la sociedad radiológica local, evaluaron la calidad de las imágenes clínicas obtenidas y realizaron una interpretación radiológica para cada paciente usando las mismas películas e historia clínica a disposición de los médicos especialistas en imaginología de la institución. El acuerdo entre...

OBJECTIVE: To determine the correlation between certain quality indicators for imaging services and the accurate interpretation of radiological exams for four frequent complaints: breast lumps, gastrointestinal discomfort, back pain, and symptoms of tuberculosis. METHODS: Twenty-six radiology services in Argentina, Bolivia, Colombia, Cuba, and Mexico were assessed. The mammography and conventional radiographic/fluoroscopic equipment used in selected services were evaluated utilizing common protocols, data sheets, testing instruments, phantoms, and calibrated dosimetry systems. The studies were performed in medium-complexity facilities. Informed consent was obtained from all patients studied, and the confidentiality of results was guaranteed. The following parameters were documented: type of facility (public vs. private); population covered; patient workload; radiological and image-processing equipment and supplies; education and training of professional and technical staff; quality assurance and preventive maintenance programs, and adherence to radiation safety standards. The performance of x-ray units, image receptors and processors; darkroom and image viewing conditions; patient doses and image quality, were determined using standardized parameters in all cases. Independent panels of radiologists, recognized as experts by the local radiological society, assessed the quality of the clinical images obtained and performed a radiological interpretation for each patient using the same films and clinical history available to the institution's imaging physicians. The agreement between the panel of expert's reports and those of local radiologists was taken as an indicator of the radiological diagnostic accuracy. RESULTS: Analyses were carried out of 366 mammograms, 343 radiological procedures for gastrointestinal complaints, 319 X-rays of the spinal column, and 157 chest radiographs. The agreement between the radiological interpretation of...

Uso y abuso del estudio radiológico de esófago, estómago y duodeno en pacientes pediátricos: necesidad de una adecuada normativa y de una estandarización del exámen / Use and abuse of upper gastrointestinal radiography study in pediatric patients: need of an adequate normative and standardization

Introducción: El rol de la radiografía de esófago, estómago y duodeno (RxEED) en el estudio del niño con vómitos y en especial, en la pesquisa del reflujo gastroesofágico (RGE), en nuestro medio, es confuso. El RGE es una condición generalmente fisiológica que se manifiesta como regurgitación habitual en el lactante menor. La academia Americana de Pediatría considera la RxEED como un procedimiento útil para la evaluación de anormalidades anatómicas y reitera que en los lactantes con vómitos y regurgitación, la historia clínica y el examen físico son suficientes para formular diagnóstico, reconocer complicaciones e iniciar tratamiento. Los radiólogos estamos efectuando exámenes muchas veces innecesarios y molestos para los niños, cuyos resultados no son adecuadamente interpretados, ya sea por desconocimiento de los médicos solicitantes o por una errada normativa legal en cuanto a la extensión de licencia maternal. Se debe agregar que estamos haciendo uso inadecuado de radiación ionizante. Objetivos: Este trabajo persigue analizar la confusión sobre la utilidad e indicaciones de la RxEED en el estudio del niño con vómitos o regurgitación, la inadecuada indicación médica de este y la errada normativa vigente que obliga a los niños a ser sometidos a este estudio para extender una licencia postnatal de las madres. Se propone además, un intento para estandarizar la técnica de examen y establecer un consenso en cuanto a sus indicaciones e interpretación. Pacientes y Método: En forma prospectiva, se incluyó en este estudio a 190 niños, menores de 1 año, estudiados en forma consecutiva con RxEED en nuestro Hospital Clínico, desde el 1° de Abril hasta el 30 de Septiembre del 2004. En cada caso se consignó numerosos antecedentes, incluyendo la técnica del examen, el cuadro clínico, el motivo del examen y un cuestionario a los padres. Resultados:Este estudio reveló que la mayor parte de los niños referidos para RxEED, eran lactantes que solamente presentaban regurgitació.

Radiología basada en la evidencia: estrategia conceptual focalizada para la práctica de la imagenología / Evidence-based radiology: focused conceptual strategy for practice of the imaging

La radiología basada en la evidencia (RBE) para algunos calza con un abordaje humanístico en su práctica que da cuenta de la responsabilidad del radiólogo hacia el paciente y la comunidad. La RBE incentiva utilizar los resultados de la investigación clínica sistemática en la práctica de una disciplina de mayor complejidad en que coexisten numerosas alternativas como herramientas en el diagnóstico. Por otra parte su práctica desincentiva el usar, solamente, la experiencia clínico radiológica no sistemática, la racionalidad de la patología radiológica y la intuición como recursos únicos para tomar decisiones en la selección e interpretación de las diferentes imágenes diagnósticas. Este abordaje otorga herramientas que nos permiten con un proceso de varios pasos que incluye el convertir la necesidad de información en una pregunta factible de responder, la identificación de la mejor evidencia disponible, la apreciación crítica de la literatura respecto a la evidencia y su posterior integración a las circunstancias clínicas, ir desde la validez de la evidencia anecdótica, analógica o empírica resumidas como evidencias de un experto en una disciplina y desplazarnos hacia el uso de información obtenida por investigación sistemática relevante obtenida por ensayos clínicos y/o revisiones sistemáticas de estudios particulares de sus usos en órganos y sistemas. Este artículo entrega conceptos básicos esenciales para comenzar a comprender su práctica y focaliza algunos puntos que se pueden explorar en la literatura de referencia.

Anatomía del error en radiología / Anatomy of error in radiology

La actividad médica, por su naturaleza, se desarrolla en un ambiente de incertidumbre, ya que sus resultados no son constantes en respuesta a actos médicos iguales, y por ello es una función de alto riesgo, siendo necesarias medidas y acciones para disminuirlo y aumentar la seguridad de la atención médica. Esto implica un conocimiento adecuado del error en el área médica en que nos desempeñamos, una cuantificación lo más ajustada posible de éste y la adopción de medidas preventivas y correctivas sobre personas, sistemas en los que estas trabajan e instituciones.

Comunicación en el departamento de radiología: radiológos y pacientes / Communication in the radiology department: radiologist and patients

El buen y efectivo ejercicio de la medicina requiere interacciones positivas y efectivas entre médicos y pacientes o parientes. El proceso de comunicación con ellos, que es una vía que corre en ambos sentidos, implica responsabilidades y deberes por ambas partes. Una relación médico paciente exitosa depende en una gran medida de las capacidades comunicacionales y de la sensibilidad del médico a las necesidades de los pacientes. Los radiólogos, con excepciones, no interactúan en forma directa con la mayoría de sus pacientes, pero en ocasiones se producen importantes contactos. A mayor abundamiento, es imperativo entregar destrezas comunicacionales efectivas a todo el personal que tiene contacto con los pacientes radiológicos, para su adecuada aplicación.