Radiología en la pandemia COVID-19: uso actual, recomendaciones para la estructuración del informe radiológico y experiencia de nuestro departamento / Radiology in the COVID-19 pandemic: current role, recommendations for structured reporting and experience of our department

Resumen: La pandemia causada por el nuevo coronavirus (SARS-CoV-2) ha derivado en nuevos desafíos en la manera que radiología apoya el trabajo clínico y presta servicios oportunos. El presente artículo revisa las principales publicaciones en la literatura radiológica a la fecha, con énfasis en los sistemas de informe estructurado en tomografía computada y radiografía de tórax. Se relata además nuestra experiencia en las modificaciones realizadas en el Departamento de Radiología para hacer frente a la pandemia.

Abstract: The pandemic caused by the new coronavirus (SARS-CoV-2) has imposed new challenges to the way radiology supports referring clinicians and provides timely services. This article reviews the main radiological publications on COVID-19 to date, with an emphasis on structured reporting schemes in computed tomography and chest radiography. The modifications to clinical practice and academic activities made in our Radiology Department to face the pandemic are also provided.

Evaluación de habilidades transversales de comunicación y colaboración a través de un examen clínico objetivo estructurado de radiología de urgencias para residentes de un programa universitario de especialidad en radiología / Assessment of generic skills in communication and collaboration through an objective structured clinical examination in emergency radiology in a university residency program in Chile

Introducción: La Radiología de Urgencias es una unidad de aprendizaje longitudinal a toda la residencia. En ella los residentes se enfrentan a patología de urgencia en distintas modalidades de imagen. Además del dominio cognitivo, los residentes deben desarrollar habilidades de comunicación y colaboración que les permitan enfrentar adecuadamente los turnos de residencia. Previo a incorporarse a los turnos nocturnos, los residentes deben aprobar un Examen Clínico Objetivo Estructurado (ECOE). Propósito: Evaluar competencias de comunicación y colaboración a través de estaciones de ECOE de Radiología de Urgencias aplicado a residentes de 2º año de residencia. Metodología: Se seleccionaron objetivos específicos a evaluar para las competencias de comunicación y colaboración y contenidos de Radiología Abdominal, Osteoarticular y Pediátrica para diseñar tres estaciones de ECOE, las cuales fueron incorporadas en el instrumento de evaluación aplicado el año 2017. Se calcularon porcentajes de logro por estación y tipo de pauta de evaluación. Para evaluar la implementación de las estaciones, se diseñó y aplicó una encuesta de percepción a los residentes. Resultados: Se diseñaron tres estaciones, dos para el rol Comunicador y una para el rol Colaborador. La validez de contenido se aseguró a través de un panel de expertos. Los porcentajes de logro global en las estaciones fluctuaron entre 74,7% y 95,6%. Las estaciones fueron bien evaluadas por parte de los residentes, quienes valoraron la incorporación de competencias diferentes al dominio cognitivo en el instrumento de evaluación. Conclusión: El ECOE permite certificar habilidades transversales como comunicación y colaboración de manera apropiada

Introduction: Emergency radiology (ER) is taught and learned throughout the entire residency. Trainees are exposed to different subspecialties ER cases and through varied imaging techniques. In addition to the "medical expert" domain, residents must develop communication and collaboration skills that will help them during their call schedule. Before they can take night-call, radiology residents must pass an Objective Structured Clinical Examination (OSCE). Purpose: To evaluate communication and collaboration competencies on an ER-OSCE applied to second-year radiology residents. Methods: Specific learning objectives were defined to evaluate communication and collaboration skills in abdominal, musculoskeletal and pediatric ER. Three OSCE stations were designed for this purpose and added to the evaluation instrument in 2017. On each station, resident performance was assessed with a specific template and percentage of goal achievement was calculated. Trainee´s opinion of this new modality was obtained through a perception survey. Results: Three stations were designed, two for the communicator role and one for the collaborator competency. Validity of content confirmed through an expert panel. Percentages of goal achievement on each station varied between 74,7% and 96,6. The new stations were positively evaluated by residents, which valued that competencies other than "medical expert" were being assessed. Conclusion: ER-OSCE allows the appropriate assessment of generic competencies such as communication and collaboration in radiology.

Herramientas útiles y métodos de búsqueda bibliográfica en PubMed: guía paso a paso para médicos / Useful tools and methods for literature retrieval in pubmed: step-by-step guide for physicians

Developing skills to search the medical literature has potential benefits on patient care and allow physicians to better orient their efforts when answering daily clinical questions. The objective of this paper is to share useful tools for optimizing medical literature retrieval in MEDLINE using PubMed including MeSH terms, filters and connectors.

[Useful tools and methods for literature retrieval in pubmed: step-by-step guide for physicians]. / Herramientas útiles y métodos de búsqueda bibliográfica en PubMed: guía paso a paso para médicos.

Developing skills to search the medical literature has potential benefits on patient care and allow physicians to better orient their efforts when answering daily clinical questions. The objective of this paper is to share useful tools for optimizing medical literature retrieval in MEDLINE using PubMed including MeSH terms, filters and connectors.

Rol de la imagenología en el proceso diagnóstico de la patología ginecológica benigna

En la actualidad, la selección y uso correcto de los diferentes métodos de imágenes disponibles (ecografía, tomografía axial computada y resonancia magnética) constituye uno de los pilares fundamentales para el adecuado proceso diagnóstico en ginecología. Para la mayoría de las patologías benignas que comprometen al aparato genital femenino, la ecografía transvaginal es una herramienta sensible, de fácil acceso, costo-efectiva y por tanto debiese constituir el método inicial de elección. Sin embargo, su eficacia depende de que el operador sea entrenado y experimentado en su interpretación. El uso de la tomografía computada (TC) y la resonancia magnética (RM) debiese restringirse a condiciones específicas, en especial para caracterizar lesiones que no son completamente evaluables por ultrasonido. La mayor utilidad de la TC está en el diagnóstico diferencial de las urgencias ginecológicas, en evaluar el compromiso extra pelviano de neoplasias anexiales y en el estudio preoperatorio de anomalías de la vía urinaria. Respecto de la RM, su mayor utilidad está en el estudio de lesiones anexiales complejas a la ultrasonografía, endometriosis pélvica profunda y extra pelviana, adenomiosis, malformaciones uterinas, etapificación local de neoplasias endometriales, cervicales y vaginales, y en la evaluación de miomas múltiples o extra pelvianos.

In gynecology, the selection and proper use of the different available imaging methods (ultrasound, computed tomography and magnetic resonance) is paramount for a proper diagnostic process. For most benign conditions affecting the female genital tract, transvaginal ultrasound constitutes an exam with has excellent sensitive, is readily accessible and cost-effective, therefore being the initial method of choice. However, its effectiveness depends on the operator training and expertise in interpretation. The use of computed tomography (CT) and magnetic resonance imaging (MRI) ought to be restricted for specific conditions, especially to characterize lesions not completely evaluated by ultrasound. The main benefit of CT is in the differential diagnosis of gynecological emergencies, in assessing extra pelvic extension of adnexal masses and in the preoperative assessment of urinary tract abnormalities. Regarding MRI it is most useful in the study of complex adnexal lesions, extra pelvic and deep pelvic endometriosis, adenomyosis, uterine malformations, local staging of endometrial, cervical and vaginal neoplasms, and multiple or extra pelvic leiomyomas.

Desarrollo y validación del instrumento meduc-rx32, para la evaluación de docentes de programas de la especialidad de postítulo en radiología / Development and validation of the meduc-Rrx32 questionnaire, to evaluate teachers of postgraduate radiology programs

El objetivo de este estudio es desarrollar y validar una pauta para la evaluación del proceso de enseñanza clínica en radiología; Medicina Universidad Católica, Radiología 32 ítems (MEDUC-RX32). Se utilizó metodología mixta para el desarrollo del instrumento: dos entrevistas grupales (residentes y docentes) y una individual a un jefe de programa de radiología. Utilizando técnica Delfi modificada para lograr acuerdo, un panel de validez nacional evaluó la importancia de cada ítem. El panel Delfi refinó el instrumento de 88 a 32 ítems luego de dos rondas. La pauta final fue piloteada en 55 residentes del programa. El instrumento definitivo presenta alta confiabilidad (coeficiente alfa de Cronbach de 0,957). El promedio de las evaluaciones del desempeño de los docentes fue de 6,23 mas menos 0,8 (escala Likert 0 a 7) constituyéndose en una pauta válida y confiable para la evaluación de docentes de programas de la especialidad de radiología en países de habla hispana.

The objective of this study is to develop and validate a guideline for the evaluation of the clinical teaching process in radiology; Catholic University Medical School, Radiology 32 items (MEDUC-RX32). A mixed methodology was used for the development of the questionnaire; two interview groups (residents and faculty) and one individual to a radiology program head. Using a modified Delphi technique to reach an agreement, a national validity panel assessed the importance of each item. The Delphi panel refined the questionnaire from 88 to 32 items after two rounds. The final guideline was perfomed in 55 residents of the program. The final instrument shows high reliability (Cronbach's alpha coefficient of 0.957). The average performance evaluations of teachers was 6.23 ± 0.8 (Likert scale 0 to 7) becoming a valid and reliable guideline for teacher evaluation of programs in the specialty of radiology, in Spanish speaking countries.

Quiste hidatídico retro-peritoneal: Una enfermedad frecuente en una ubicación inusual / Retroperitoneal hydatid cyst: A common disease in a rare location

Echinococcal disease remains a major problem within some endemic areas. We report a case of a single primary echinococcal cyst located in the retroperitoneal space. A 54-year-old woman, born in a rural area of southern Chile, was admitted with a 3-month history of right hip pain and painful swelling of the gluteal region. Hidatid disease was confirmed with serologic test, radiological examinations and histo-pathology. There were no cysts in any other location. A percutaneous drainage was performed and antihelminthics were administered for 12 weeks and is now being closely followed up, with good response to therapy. Especially in the endemic areas hydatid cyst should be considered when evaluating retroperitoneal cystic masses.

La hidatidosis sigue siendo un problema prevalente en áreas endémicas. Presentamos el caso de un quiste hidatídico primario ubicado en el espacio retro-peritoneal. Mujer de 54 años, procedente de área rural del sur de Chile, hospitalizada por cuadro de coxalgia derecha y aumento de volumen glúteo, con tres meses de evolución. Se realizó el diagnóstico de hidatidosis complicada por medio de exámenes de imágenes, tests serológicos y anatomía patológica. No se demostraron quistes hidatídicos en otras ubicaciones. Se realizó un drenaje percutáneo del quiste infectado y se administraron antihelmínticos durante 12 semanas y actualmente permanece en seguimiento cercano con buena respuesta al tratamiento. El quiste hidatídico debe ser considerado en el diagnóstico diferencial de masas quísticas retro-peritoneales, especialmente en áreas endémicas.

Incidencia, factores de riesgo y tratamiento de las complicaciones biliares del trasplante hepático / Biliary tract complications after liver transplantation

Biliary tract complications (BC) are cause of mortality after liver transplantation (LT). There are different treatment alternatives for this complication. Aim: to determ¨ªnate incidence, risk factors and treatment of biliary complications after LT. Materials and Methods: A retrospective descriptive cohort of patients undergoing LT between March 1994 and March 2009. Risk factors and incidence for BC were ex-plored. Also the BC impact on overall survival on LT patients was assessed. We used SPSS 15.0 for statistical analysis and considered a significant p value less than 0.05. Results: 107 LT were performed in 102 patients. In 30 (28 percent) there was some biliary complication. Ten (33.3 percent) were early complications (< 3 months) and 20 (66.7 percent) were late ( > 3 month). Anastomotic stricture was the more frequent BC. The gender male recipient, the cold ischemic time and biliary reconstruction technique without tutor were associated with an increased risk for BC. Endoscopic treatment of biliary stricture was successful in 91 percent of cases at one year follow up. Three (10 percent) patients died due to BC or their long-term treatment. Conclusions: Biliary Complications after Liver Transplantation are frequent and are cause of mortality. Decrease cold ischemic time and improve te-chniques for biliary reconstruction could reduce the high incidence of this complication.

Introducción: Las complicaciones biliares (CB) en el trasplante hepático (TH) son causa de mortalidad post-trasplante. Existen diferentes alternativas terapéuticas para su tratamiento. Objetivo: Determinar la incidencia, factores de riesgo y evaluar los resultados del tratamiento de las CB posterior al TH. Materiales y Método: Estudio retrospectivo, descriptivo de una cohorte de pacientes sometidos a un TH entre marzo-1994 y marzo-2009. Se analizó los factores de riesgo para CB, su incidencia en el tiempo, su tratamiento y se determinó su impacto en la sobrevida global de los pacientes. Se utilizó el programa SPSS 15.0 para cálculos estadísticos y se consideró significativo un p < 0,05. Resultados: Se realizaron 107 TH en 102 pacientes. En 30 (28 por ciento), se consignó una o más CB. En 10 (33,3 por ciento), la CB fue precoz y en 20 (66,7 por ciento) tardía. La estenosis de la anastomosis fue la CB más frecuente. El sexo masculino del receptor, el tiempo de isquemia fría y la técnica de reconstrucción biliar sin tutor, se asociaron significativamente a un mayor riesgo de CB. El tratamiento endoscópico de la estenosis biliar fue exitoso en el 91 por ciento de los casos a un año de seguimiento. Tres (10 por ciento) pacientes fallecieron por una CB o su tratamiento a largo plazo. Conclusiones: Las CB del TH son frecuentes y son causa de mortalidad. Disminuir el tiempo de isquemia fría y mejorar las técnicas de reconstrucción biliar podrían disminuir su incidencia.

Utilidad y complicaciones de la biopsia percutánea esplénica con aguja tru-cut guiada por imágenes / Ultrasound guided needle biopsy of the spleen: review of 13 procedures

Background: Needle biopsies of the spleen were avoided due to the fear of bleeding in a highly vascularized organ. However their safety, even using 18 gauge needles, has been demonstrated. Aim: To report the experience with ultrasound guided needle biopsies of the spleen. Material and Methods: Retrospective review of records of ultrasound guided biopsies of the spleen using Tru-cutTM needles, performed between 2005 and 2009. Results: Thirteen procedures performed in 12 patients were identified. A specific diagnosis was achieved in nine (69 percent) procedures (lymphoma in four, melanoma in 2, sarcoma in 1, extremedullary erythropoiesis in one and splenic cryptococcosis in one. Two patients with negative results were subjected to a new biopsy, which yielded the diagnosis of lymphoma. A third patient was studied elsewhere, finding a malignant tumor. Two patients had complications, one had a vagal reaction and other had a perisplenic hematoma without clinical repercussion. Conclusions: Ultrasound guided needle biopsy of the spleen is a safe and useful procedure.

Objetivo: Reportar la experiencia de biopsias percutáneas esplénicas con aguja tru-cut guiadas por imágenes. Materiales y Métodos: Revisión retrospectiva de biopsias esplénicas con aguja tru-cut guiadas por ultrasonido (US) y tomografía computada (TC) realizadas en nuestro hospital desde Enero de 2005 a Abril de 2009. Resultados: Se identificaron un total de 13 procedimientos. La biopsia percutánea logró un diagnóstico específico en 9 (69 por ciento) de las 13 intervenciones. Los diagnósticos fueron linfoma (n = 4), melanoma (n = 2), sarcoma (n = 1), hematopoyesis extramedular (n = 1) y criptococosis esplénica (n = 1). De las biopsias no diagnósticas 3 casos correspondieron a patología neoplásica y uno a patología benigna. Se reportaron 2 complicaciones (15 por ciento). Discusión: La biopsia esplénica percutánea guiada por imágenes con aguja tru-cut es un procedimiento útil y seguro, capaz de determinar el diagnóstico definitivo en la mayoría de los pacientes y evitar la mayoría de las esplenectomías diagnósticas.

[Retroperitoneal hydatid cyst: a common disease in a rare location]. / Quiste hidatídico retro-peritoneal: Una enfermedad frecuente en una ubicación inusual.

Echinococcal disease remains a major problem within some endemic areas. We report a case of a single primary echinococcal cyst located in the retroperitoneal space. A 54-year-old woman, born in a rural area of southern Chile, was admitted with a 3-month history of right hip pain and painful swelling of the gluteal region. Hidatid disease was confirmed with serologic test, radiological examinations and histo-pathology. There were no cysts in any other location. A percutaneous drainage was performed and antihelminthics were administered for 12 weeks and is now being closely followed up, with good response to therapy. Especially in the endemic areas hydatid cyst should be considered when evaluating retroperitoneal cystic masses.

Fasciolasis hepática: enfermedad con múltiples presentaciones / Hepatic fascioliasis: a disease with multiple presentations

Human Fascioliasis is a zoonosis produced by the liver fluke fasciola. Its diagnosisrequires a high index of suspicion because of the polymorphism in its presentation. However, treatment with triclabendazole is highly effective. We report three cases that, in spite off presenting with diverse clinical severity, all had good response to treatment. Patient 1 presented with nonspecific recurrent abdominal pain with a normal CT scan of abdomen. Patient 2 presented with an abdominal CT scan showing multiple hepatic nodules. Patient 3 with an asymptomatic liver tumor requiring a comprehensive and expensive evaluation. All had eosinophilia and all responded to triclabendazole therapy without adverse effects.

La fasciolasis humana es una zoonosis producida por el trematodo fasciola hepática. Su diagnóstico requiere un alto índice de sospecha dado el polimorfismo en su presentación. Pese a esto, el tratamiento con triclabendazol es muy efectivo. Se reportan tres casos clínicos que, pese a presentar muy distinta clínica y gravedad, todos tuvieron buena respuesta al tratamiento con Triclabendazol. El paciente 1 se presentó con dolor abdominal inespecífico y recurrente, sin compromiso del estado general con tomografía de abdomen normal. La paciente 2 presentó dolor abdominal intenso, baja de peso y gran compromiso del estado general que requirió hospitalización, con tomografía de abdomen que mostró lesiones nodulares hepáticas. La paciente 3 se presentó como hallazgo de tumor hepático asintomático que requirió amplio estudio y grandes costos. Todos presentaron eosinofilia y todos respondieron a terapia con triclabendazol sin efectos adversos.

Masas suprarrenales: evaluación por tomografía computada y resonancia magnética / Suprarenal masses: evaluation through computed tomography and magnetic resonance imaging

Despite being small, suprarenal glands constitute a frequent milieu for diseases, since some type of gland anomaly can be present in 9 percent of the population. Because of the increasing massive use of computed tomography and magnetic resonance imaging, damage detection at this level has been incremented. The usefulness of these techniques lies not only in their ability in timely and accurate detection of lesions but also in the characterization of them, distinguishing benign from malignant masses. Nevertheless, sometimes it is not possible to determine their nature and therefore complementary imaging techniques such as possitron emission tomography or even a biopsy must be performed to reach a conclusive diagnosis. At the end of our revision we propose an action algorithm for assessing suprarenal damages.

Las glándulas suprarrenales, a pesar de ser pequeñas, son sitio frecuente de enfermedad, presentando algún tipo de alteración en el 9 por ciento de la población. Con el uso cada vez más masivo de la tomografía computada y de la resonancia magnética, ha aumentado la detección de lesiones a este nivel. El rol de estas modalidades no sólo radica en la detección de las lesiones sino que también en la caracterización de éstas, diferenciándolas en benignas o malignas. Sin embargo, en ocasiones no es posible determinar su naturaleza, por lo que debe recurrirse a exámenes complementarios como la tomografía de emisión de positrones, o incluso la biopsia, para llegar a un diagnóstico definitivo. Al final de la revisión, proponemos un algoritmo de acción para la evaluación de las lesiones suprarrenales.

Tratamiento endovascular de la disección aórtica tipo B mediante endoprótesis / Endovascular treatment of type B aortic dissection

Background: Dissections that involve the ascending aorta are classified as type A, regardless of the site of the primary intimal tear, and all other dissections as type B. Type B dissections can have fatal ischemic and hemorrhagic complications. In the chronic state, dilatation and rupture can be mortal. Endovascular surgery is a therapeutic alternative, considering the high rate of complications of conventional surgery Aim: To report the results of endovascular treatment of type B aortic dissection. Material and methods: Report of 36 treated patients (30 males) aged 43 to 87 years, with a type B aortic dissection. Seventy eight percent were hypertensive and 39 percent smoked. The diagnosis was conñrmed by CAT sean. Acute patients were treated for complications and chronic patients, for dilatation. In the operating room, an endoprothesis was placed through the femoral artery, to cover the tear. The tear was located and the lumens were differentiated using angiography and transesophageal echocardiography. Results: All procedures were successful. In 16 acute dissections the indications were malperfusion syndrome or unmanageable hypertension in seven patients and imminent rupture or persistent pain in nine. Twenty chronic patients were operated due to dilatation (mean 6 cm). One patient died due to cardiac failure. One patient had a transient paraparesia and two had pulmonary embolism. No patient died in a follow up períod ranging from 2.5 to 74 months. Four patients required a new aortic endovascular procedure due to progressive dilatation or endoleak. Conclusión: Endovascular treatment of type B aortic dissection has good immediate andlong term results.

Efecto de un inhibidor tirosina kinasa (imatinib) en pacientes con tumores estromales gastrointestinales metastásicos: Experiencia preliminar / Treatment of metastatic gastrointestinal stromal tumors with Imatinib: Report of four cases

Gastrointestinal stromal tumors (GIST) have mutations of the tyrosine kinase receptor. When they are localized, the treatment of choice is surgical excision, but advanced tumors have a limited response to chemo or radiotherapy. Imatinib (STI571 or Glivec®) is a selective inhibitor or tyrosine kinase proteins that has been used successfully in the treatment of advanced GIST. We report four patients (two women) with a metastatic GIST that were treated with Imatinib 400 mg day and followed for 40 months. The disease tumor stabilized in three patients and in one it had an initial reduction and progressed at the end of follow up. Therefore Imatinib can be a therapeutic alternative in patients with metastatic GIST.

[Extra anatomical revascularization and endovascular stent-grafting for thoracoabdominal aneurysm repair. Report of four cases]. / Tratamiento "híbrido" del aneurisma tóraco-abdominal: revascularización visceral extraanatómica e inserción de endoprótesis.

Surgical treatment of thoracoabdominal aneurysms is a big technical challenge with a high rate of complications and mortality. It requires a large exposure and transient interruption of vital organ perfusion during its repair. Endovascular repair is a less invasive alternative available over the last decade. We report four male patients aged 44 to 76 years, with thoracic aortic aneurysms and involvement of visceral aorta, treated with a two stage procedure. During the first stage, a retrograde revascularization of the superior mesenteric and renal arteries from the infrarenal aorta was done, associated in two cases to a concomitant repair of an infrarenal aortic aneurysm. In the second stage, an endovascular graft was placed through the femoral artery, from the segment proximal to the aneurysm to the infrarenal aorta, above the origin of the visceral artery reconstructions, excluding the aneurysm from circulation. In one patient, both stages were concomitant and in three the second stage was delayed. One patient presented a postoperative bleeding that required reintervention without adverse consequences. No patient died, presented paraplegia or deterioration of renal function. After follow up of 6 to 20 months, there is no evidence of aneurysm growth or complications derived from the procedure.

Tratamiento "híbrido" del aneurisma tóraco-abdominal: revascularización visceral extraanatómica e inserción de endoprótesis / Extra anatomical revascularization and endovascular stent-grafting for thoracoabdominal aneurysm repair: Report of four cases

Surgical treatment of thoracoabdominal aneurysms is a big technical challenge with a high rate of complications and mortality. It requires a large exposure and transient interruption of vital organ perfusion during its repair. Endovascular repair is a less invasive alternative available over the last decade. We report four male patients aged 44 to 76 years, with thoracic aortic aneurysms and involvement of visceral aorta, treated with a two stage procedure. During the first stage, a retrograde revascularization of the superior mesenteric and renal arteries from the infrarenal aorta was done, associated in two cases to a concomitant repair of an infrarenal aortic aneurysm. In the second stage, an endovascular graft was placed through the femoral artery, from the segment proximal to the aneurysm to the infrarenal aorta, above the origin of the visceral artery reconstructions, excluding the aneurysm from circulation. In one patient, both stages were concomitant and in three the second stage was delayed. One patient presented a postoperative bleeding that required reintervention without adverse consequences. No patient died, presented paraplegia or deterioration of renal function. After follow up of 6 to 20 months, there is no evidence of aneurysm growth or complications derived from the procedure.