The current situation of Radiology training in medical studies in Spain.

Radiology is now an essential part of Clinical Medicine, but undergraduate training does not reflect its importance in medical practice. In the current course, there are 46 medical schools in our country. According to the information published on the institutional websites, the study plans are very different in terms of the presence of Diagnostic Radiology and the organization of teaching. The estimated number of teaching hours in diagnostic radiology (mean ±â€¯standard deviation) is 61.3 ±â€¯22.2 h (range from 26 h to 137 h). There is a great shortage of clinical university professors, and a generational change is essential. The current situation poses various challenges, including adapting to new teaching methods and technologies and promoting the presence of radiology in medical study plans, paying special attention to hospital practices, the Final Degree Project (FDP) and the Objective Structured Clinical Examination (OSCE).

Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y coils intracraneales / The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling

Objetivo: Evaluar la capacidad de la TC de energía dual (TCED) para reducir el artefacto metálico en pacientes con clips y coils intracraneales en estudios de angio-TC cerebral, y analizar el diferente impacto que dicha reducción tiene en función del tipo de dispositivo estudiado. Material y métodos: Se analizaron retrospectivamente 13 pacientes (6 clips, 7 coils). Se obtuvieron imágenes virtuales monoenergéticas (IVM) en un rango de 40 a 150 keV. Se midió el ruido dentro del área de máximo artefacto. La evaluación subjetiva del ruido fue realizada independientemente por dos radiólogos. Las diferencias encontradas se evaluaron mediante el test ANOVA. El test Mann-Whitney se utilizó para comparar las diferencias entre clips y coils. Se determinó el grado de concordancia interobservador (coeficiente κ). Resultados: El ruido fue más bajo en los niveles energéticos más altos (p < 0,05). El ruido fue mayor en pacientes con coils (p < 0,001). La correlación interobservador fue buena (κ = 0,72). Conclusiones: El uso de TCED con reconstrucciones virtuales monoenergéticas ayuda a minimizar el artefacto producido por clips y coils intracraneales en estudios de angio-TC cerebral. La reduccción del artefacto conseguida es mayor en el grupo de pacientes con clips que en el grupo de pacientes con coils

Objective: To assess the ability of dual-energy CT (DECT) to reduce metal-related artifacts in patients with clips and coils in head CT angiography, and to analyze the differences in this reduction between both type of devices. Materials and methods: Thirteen patients (6 clips, 7 coils) were selected and retrospectively analized. Virtual monoenergetic images (MEI) with photon energies from 40 to 150 keV were obtained. Noise was measured at the area of maximum artifact. Subjective evaluation of streak artifact was performed by two radiologists independently. Differences between noise values in all groups were tested by using the ANOVA test. Mann-Whitney U test was used to compare the differences between clips and coils. Cohen??s κ statistic was used to determine interobserver agreement. Results: The lowest noise value was observed at high energy levels (p<0,05). Noise was higher in the coil group than in the clip group (p<0.001). Interobserver agreement was good (κ=0.72). Conclusions: TCED with MEI helps to minimize the artifact from clips ands coils in patients who undergo head CT angiography. The reduction of the artifact is greater in patients with surgical clipping than in patients with endovascular coiling

The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling. / Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y coils intracraneales.

OBJECTIVE: To assess the ability of dual-energy CT (DECT) to reduce metal-related artifacts in patients with clips and coils in head CT angiography, and to analyze the differences in this reduction between both type of devices. MATERIALS AND METHODS: Thirteen patients (6 clips, 7 coils) were selected and retrospectively analized. Virtual monoenergetic images (MEI) with photon energies from 40 to 150 keV were obtained. Noise was measured at the area of maximum artifact. Subjective evaluation of streak artifact was performed by two radiologists independently. Differences between noise values in all groups were tested by using the ANOVA test. Mann-Whitney U test was used to compare the differences between clips and coils. Cohens κ statistic was used to determine interobserver agreement. RESULTS: The lowest noise value was observed at high energy levels (p<0,05). Noise was higher in the coil group than in the clip group (p<0.001). Interobserver agreement was good (κ=0.72). CONCLUSIONS: TCED with MEI helps to minimize the artifact from clips ands coils in patients who undergo head CT angiography. The reduction of the artifact is greater in patients with surgical clipping than in patients with endovascular coiling.

Expanding the use of flow diverters beyond their initial indication: treatment of small unruptured aneurysms.

BACKGROUND: Experience with the endovascular treatment of unruptured small intracranial aneurysms by flow diverter devices is still limited. OBJECTIVE: To assess the safety and efficacy of the SILK flow diverter (SFD) in the treatment of small unruptured cerebral aneurysms (<10 mm). METHODS: We performed a retrospective review of a prospectively maintained database of patients treated with a SFD between July 2008 and December 2013 at 4 institutions in Spain to identify all patients with small unruptured aneurysms (<10 mm). Data for patient demographics, aneurysm characteristics, and technical procedures were analyzed. Angiographic and clinical findings were recorded during the procedure and at 6- and 12-month follow-ups. RESULTS: A total of 109 small aneurysms were treated with a SFD in 104 patients (78 women; 26 men; mean, median, and range of age: 55.2, 57.1, and 19-80 years, respectively). A total of 60 patients were asymptomatic (57.7%). All except 7 aneurysms (6.4%) arose from the anterior circulation. The mean size of the aneurysms was 4.7±1.9 mm. At 6 months, the neuromorbidity and neuromortality rates were 2.9% and 0.9%, respectively. Imaging at the 12-month follow-up showed complete occlusion, neck remnants, and residual aneurysm in 88.5% (69/78), 7.7% (6/78), and 3.3% (3/78) of cases, respectively. No delayed hemorrhage occurred. CONCLUSIONS: The findings suggest that the indications for SFD can be safely extended to small intracranial aneurysms.

Análisis de la función ventricular derecha en resonancia magnética cardíaca. Comparación de la cuantificación en los planos eje corto y 4 cámaras / Cardiac magnetic resonance analysis of right ventricular function: comparison of quantification in the short-axis and 4-chamber planes

Objetivo. Comparar los métodos de segmentación del ventrículo derecho en los planos eje corto y 4 cámaras, en los estudios de resonancia magnética cardíaca, y realizar una correlación con el método ecocardiográfico tricuspid annular plane systolic excursion (TAPSE). Material y métodos. Se estudiaron 26 pacientes con diversas enfermedades cardiovasculares con un equipo de resonancia magnética de 1,5 T. Se adquirieron en todos los estudios imágenes en modo cine en eje corto y en 4 cámaras (steady-state free precession, 6 mm de grosor de corte, desde la base al ápex ventricular). En todos los pacientes se cuantificaron los volúmenes telediastólico, telesistólico y la fracción de eyección del ventrículo derecho. A 14 pacientes se les practicó también una ecocardiografía y se calculó la función ventricular derecha (TAPSE), el mismo día que se realizó el estudio de resonancia magnética cardíaca. Resultados. No hubo diferencias estadísticamente significativas en los volúmenes y la función del ventrículo derecho determinados con los 2 métodos de segmentación. La correlación al estimar los volúmenes fue excelente (r > 0,95) y disminuyó levemente para la fracción de eyección (r > 0,84). La correlación entre fracción de eyección del ventrículo derecho y TAPSE fue muy baja (r = 0,2; p < 0,01). Conclusión. Ambos métodos de segmentación ventricular cuantifican adecuadamente la función del ventrículo derecho. La correlación con el método ecocardiográfico es discreta (AU)

Objective. To compare the methods of right ventricle segmentation in the short-axis and 4-chamber planes in cardiac magnetic resonance imaging and to correlate the findings with those of the tricuspid annular plane systolic excursion (TAPSE) method in echocardiography. Material and methods. We used a 1.5 T MRI scanner to study 26 patients with diverse cardiovascular diseases. In all MRI studies, we obtained cine-mode images from the base to the apex in both the short-axis and 4-chamber planes using steady-state free precession sequences and 6 mm thick slices. In all patients, we quantified the end-diastolic volume, end-systolic volume, and the ejection fraction of the right ventricle. On the same day as the cardiac magnetic resonance imaging study, 14 patients also underwent echocardiography with TAPSE calculation of right ventricular function. Results. No statistically significant differences were found in the volumes and function of the right ventricle calculated using the 2 segmentation methods. The correlation between the volume estimations by the two segmentation methods was excellent (r = 0,95); the correlation for the ejection fraction was slightly lower (r = 0,8). The correlation between the cardiac magnetic resonance imaging estimate of right ventricular ejection fraction and TAPSE was very low (r = 0,2, P < .01). Conclusion. Both ventricular segmentation methods quantify right ventricular function adequately. The correlation with the echocardiographic method is low (AU)

Cardiac magnetic resonance analysis of right ventricular function: comparison of quantification in the short-axis and 4-chamber planes.

OBJECTIVE: To compare the methods of right ventricle segmentation in the short-axis and 4-chamber planes in cardiac magnetic resonance imaging and to correlate the findings with those of the tricuspid annular plane systolic excursion (TAPSE) method in echocardiography. MATERIAL AND METHODS: We used a 1.5T MRI scanner to study 26 patients with diverse cardiovascular diseases. In all MRI studies, we obtained cine-mode images from the base to the apex in both the short-axis and 4-chamber planes using steady-state free precession sequences and 6mm thick slices. In all patients, we quantified the end-diastolic volume, end-systolic volume, and the ejection fraction of the right ventricle. On the same day as the cardiac magnetic resonance imaging study, 14 patients also underwent echocardiography with TAPSE calculation of right ventricular function. RESULTS: No statistically significant differences were found in the volumes and function of the right ventricle calculated using the 2 segmentation methods. The correlation between the volume estimations by the two segmentation methods was excellent (r=0,95); the correlation for the ejection fraction was slightly lower (r=0,8). The correlation between the cardiac magnetic resonance imaging estimate of right ventricular ejection fraction and TAPSE was very low (r=0,2, P<.01). CONCLUSION: Both ventricular segmentation methods quantify right ventricular function adequately. The correlation with the echocardiographic method is low.

[Semiautomatic quantification of left and right ventricular function in cardiac magnetic resonance imaging: a preliminary study]. / Cuantificación semiautomática de la función ventricular izquierda y derecha en resonancia magnética cardíaca. Estudio preliminar.

OBJECTIVES: The aim of this study was to compare a semiautomatic segmentation method to quantify the function of both ventricles in magnetic resonance imaging (MRI) with the manual tracing method. MATERIAL AND METHODS: We examined 17 patients with diverse cardiovascular diseases on a 1.5 Tesla MRI unit (Magnetom Symphony Quantum; Siemens Medical Systems, Erlangen, Germany) using the following parameters: maximum gradient, 30 mT/m; and slew rate, 125 T/m/s. In all studies, we acquired images in cine mode in the short axis (SSFP, 6mm slice thickness, from the base to the ventricular apex) with breath holding. To reduce the user interaction, we used only one image per patient to initiate the semiautomatic method. The semiautomatic method was based on a specifically designed algorithm of regional growth and border detection. We quantified the end-diastolic volume (EDV), end-systolic volume (ESV), and the ejection fraction (EF) for both ventricles in all patients. RESULTS: No significant differences between the two segmentation techniques were found in the quantification of either ventricle (p>0.05). The difference in the volumes, although nearly significant, are clinically irrelevant. The correlation for the estimation of left ventricular function was excellent (r>0.9), and the correlation for the estimation of right ventricular function was good (r>0.7). CONCLUSIONS: Our semiautomatic segmentation method enables the function of both ventricles to be quantified as accurately as the conventional method.

Cuantificación semiautomática de la función ventricular izquierda y derecha en resonancia magnética cardíaca. Estudio preliminar / Semiautomatic quantification of left and right ventricular function in cardiac magnetic resonance imaging: a preliminary study

Objetivos. El objetivo de este estudio es comparar un método de segmentación semiautomático para cuantificar la función de ambos ventrículos en imágenes de resonancia magnética (RM), con el trazado manual de los contornos. Material y métodos. 17 pacientes con diversas enfermedades cardiovasculares fueron examinados con un equipo de RM de 1,5 Tesla (Magnetom Symphony Quantum; maximum gradient, 30 mT/m; slew rate, 125 T/m/s- Siemens Medical Systems, Erlangen, Germany). Se adquirieron, en todos los estudios, imágenes en modo cine, en eje corto (SSFP, 6mm de grosor de corte, en apnea, desde la base al ápex ventricular). Para reducir la interacción del usuario, solo se utilizó una imagen por paciente para iniciar el método semiautomático. Este método se basa en un algoritmo de crecimiento regional y detección de bordes específicamente diseñado. En todos los pacientes, se cuantificaron los volúmenes telediastólico (VTD), telesistólico (VTS) y la fracción de eyección (FE) de ambos ventrículos. Resultados. No se detectaron diferencias estadísticamente significativas en la cuantificación de la función de ambos ventrículos con los métodos de segmentación propuestos (p>0,05). La diferencia de los volúmenes, aunque cercana a la significación, no conlleva un valor clínico relevante. La correlación al estimar la función ventricular izquierda fue excelente (r>0,9), disminuyendo levemente para la función ventricular derecha (r>0,7). Conclusiones. Nuestro método de segmentación semiautomático permite una cuantificación de la función de ambos ventrículos tan exacta como el método convencional(AU)

Objectives. The aim of this study was to compare a semiautomatic segmentation method to quantify the function of both ventricles in magnetic resonance imaging (MRI) with the manual tracing method. Material and methods. We examined 17 patients with diverse cardiovascular diseases on a 1.5 Tesla MRI unit (Magnetom Symphony Quantum; Siemens Medical Systems, Erlangen, Germany) using the following parameters: maximum gradient, 30 mT/m; and slew rate, 125 T/m/s. In all studies, we acquired images in cine mode in the short axis (SSFP, 6mm slice thickness, from the base to the ventricular apex) with breath holding. To reduce the user interaction, we used only one image per patient to initiate the semiautomatic method. The semiautomatic method was based on a specifically designed algorithm of regional growth and border detection. We quantified the end-diastolic volume (EDV), end-systolic volume (ESV), and the ejection fraction (EF) for both ventricles in all patients. Results. No significant differences between the two segmentation techniques were found in the quantification of either ventricle (p>0.05). The difference in the volumes, although nearly significant, are clinically irrelevant. The correlation for the estimation of left ventricular function was excellent (r>0.9), and the correlation for the estimation of right ventricular function was good (r>0.7). Conclusions. Our semiautomatic segmentation method enables the function of both ventricles to be quantified as accurately as the conventional method(AU)