Bases de la imagen funcional II: técnicas emergentes de resonancia magnética y nuevos métodos de análisis / Fundamentals of functional imaging II: emerging MR techniques and new methods of analysis

La resonancia magnética (RM) integra en los protocolos multiparamétricos clínicos actuales información estructural, fisiológica y metabólica del cáncer. Existen técnicas emergentes, como ASL, BOLD, RM elastografía, CEST e hiperpolarización, que aportan un nuevo tipo de información y que están cerca de su integración en la clínica diaria. Además, existe un gran interés en el estudio de la heterogeneidad tumoral con imagen como factor pronóstico y de resistencia al tratamiento. Para ello, se están aplicando nuevos métodos de análisis de los protocolos multiparamétricos, y a su vez se están desarrollando nuevos biomarcadores oncológicos integrando la información de la RM con los datos clínicos, analíticos, genéticos e histológicos, gracias a la aplicación del big data y la inteligencia artificial. En esta revisión se analizan varias técnicas emergentes de RM que permiten evaluar las características fisiológicas, metabólicas y mecánicas del cáncer, así como sus principales aplicaciones clínicas. Además, se resumen los métodos de análisis más novedosos de la información radiológica funcional en oncología

Current multiparameter MRI protocols integrate structural, physiological, and metabolic information about cancer. Emerging techniques such as arterial spin-labeling (ASL), blood oxygen level dependent (BOLD), MR elastography, chemical exchange saturation transfer (CEST), and hyperpolarization provide new information and will likely be integrated into daily clinical practice in the near future. Furthermore, there is great interest in the study of tumor heterogeneity as a prognostic factor and in relation to resistance to treatment, and this interest is leading to the application of new methods of analysis of multiparametric protocols. In parallel, new oncologic biomarkers that integrate the information from MR with clinical, laboratory, genetic, and histologic findings are being developed, thanks to the application of big data and artificial intelligence. This review analyzes different emerging MR techniques that are able to evaluate the physiological, metabolic, and mechanical characteristics of cancer, as well as the main clinical applications of these techniques. In addition, it summarizes the most novel methods of analysis of functional radiologic information in oncology

Cómo integrar la información cuantitativa en el informe radiológico del paciente oncológico / How to integrate quantitative information into imaging reports for oncologic patients

En la actualidad, tanto las imágenes como los datos que generan y los informes que se emiten son digitales y constituyen una fuente de datos fiable. Los informes pueden clasificarse, en función de su contenido, formato y tipo de datos, como organizado (texto libre en lenguaje natural), predefinido (con plantillas y guías construidas con campos previamente determinados con lenguaje natural tipo BI-RADS y PI-RADS) y estructurado (con desplegables en forma de preguntas, con diversas posibles respuestas, previamente pactadas en el equipo multidisciplinario, con léxicos estandarizados y estructurado como base de datos, con información trazable y explotable mediante herramientas estadísticas y de minería de datos). Este informe estructurado, compatible con MRRT (Management of Radiology Report Templates), permite incorporar información cuantitativa relacionada con el análisis digital de los datos de las imágenes adquiridas para describir, mediante radiómica (características y parámetros), las propiedades y el comportamiento de los tejidos con exactitud y veracidad. En conclusión, los datos digitales estructurados (imágenes, texto, mediciones, radiómica, biomarcadores de imagen) deben integrarse en un informe informatizado que permita su indexación en grandes repositorios. Estos bancos de datos radiológicos son fundamentales en la medicina personalizada para explotar la información sanitaria, fenotipificar las lesiones y enfermedades, y extraer conclusiones

Nowadays, the images and information generated in imaging tests, as well as the reports that are issued, are digital and represent a reliable source of data. Reports can be classified according to their content and to the type of information they include into three main types: organized (free text in natural language), predefined (with templates and guidelines elaborated with previously determined natural language like that used in BI-RADS and PI-RADS), or structured (with drop-down menus displaying questions with various possible answers that have been agreed on with the rest of the multidisciplinary team, which use standardized lexicons and are structured in the form of a database with data that can be traced and exploited with statistical tools and data mining). The structured report, compatible with Management of Radiology Report Templates (MRRT), makes it possible to incorporate quantitative information related with the digital analysis of the data from the acquired images to accurately and precisely describe the properties and behavior of tissues by means of radiomics (characteristics and parameters). In conclusion, structured digital information (images, text, measurements, radiomic features, and imaging biomarkers) should be integrated into computerized reports so that they can be indexed in large repositories. Radiologic databanks are fundamental for exploiting health information, phenotyping lesions and diseases, and extracting conclusions in personalized medicine

Reflections on the impact of advances in the assessment of genetic risks of exposure to ionizing radiation on international radiation protection recommendations between the mid-1950s and the present.

Efforts at protecting people against the harmful effects of radiation had their beginnings in the early 1900s with the intent of protecting individuals in medicine and associated professions. Such efforts remain vital for all of us more than 100 years later as part of our 'learning to live with ionizing radiation.' The field of radiation protection has evolved slowly over time with advances in knowledge on hereditary (i.e., genetic) and carcinogenic effects of radiation continually improving our ability to make informed judgments about how best to balance risks against benefits of radiation exposure. This paper examines just one aspect of these efforts, namely, how advances in knowledge of genetic effects of radiation have impacted on the recommendations of the International Commission on Radiological Protection (ICRP). The focus is on the period from the mid-1950s (when genetic risk estimates were first made) to 2007. This article offers a detailed historical analysis and personal perspective, and concludes with a synopsis of key developments in radiation protection.