Percepciones de estudiantes de Medicina sobre el impacto de la inteligencia artificial en radiología

ObjectivesTo analyze medical students’ perceptions of the impact of artificial intelligence in radiology.Material and methodsA structured questionnaire comprising 28 items organized into six sections was distributed to students of medicine in Spain in December 2019.ResultsA total of 341 students responded. Of these, 27 (7.9%) included radiology among their three main choices for specialization, and 51.9% considered that they clearly understood what artificial intelligence is. The overall rate of correct answers to the objective true-or-false questions about artificial intelligence was 70.7%. Whereas 75.9% expressed their disagreement with the hypothesis that artificial intelligence would replace radiologists, only 41.9% disagreed with the hypothesis that the demand for radiologists would decrease in the future. Only 36.7% expressed concerns about the role of artificial intelligence related to choosing radiology as a specialty. A greater proportion of students in the early years of medical school agreed with statements that radiologists accept artificial-intelligence-related technological changes and work with the industry to apply them as well as with statements about the need to include basic training about artificial intelligence in the medical school curriculum.ConclusionsThe students surveyed are aware of the impact of artificial intelligence in daily life, but not of the current debate about its potential applications in radiology. In general, they think that artificial intelligence will revolutionize radiology without having an alarming effect on the employability of radiologists. The students surveyed think that it is necessary to provide basic training about artificial intelligence in undergraduate medical school programs.     

Utilidad de la tomografía computarizada de doble energía con un programa específico para la identificación de litiasis renales de ácido úrico

ObjectiveTo prospectively evaluate the usefulness of dual-energy computed tomography (DECT) with and without dedicated software in identifying uric acid kidney stones in vivo.Material and methodsWe studied 65 kidney stones in 63 patients. All stones were analyzed in vivo by DECT and ex vivo by spectrophotometry. We evaluated the diagnostic performance in identifying uric acid stones with DECT by analyzing the radiologic densities with dedicated software and without using it (through manual measurements) as well as by analyzing the attenuation ratios of the stones in both energies with and without the dedicated software.ResultsThe six uric acid stones included were correctly identified by evaluating the attenuation ratios with a cutoff of 1.21, both with the dedicated software and without it, yielding perfect diagnostic performance without false positives or false negatives. The study of the attenuations of the stones obtained the following values on the receiver operating characteristic curves in the classification of the uric acid stones: 0.92 for the measurements done with the software and 0.89 for the manual measurements; a cutoff of 538 HU yielded 84% (42/50) diagnostic accuracy for the software and 83.1% (54/65) for the manual measurements.ConclusionsDECT enabled the uric acid stones to be identified correctly through the calculation of the ratio of the attenuations in the two energies. The results obtained with the dedicated software were similar to those obtained manually.     

Valor de la enterografía por tomografía computarizada con doble energía en el análisis de segmentos intestinales patológicos en pacientes con enfermedad de Crohn

Objective

To analyze whether there are significant differences in the objective quantitative parameters obtained in the postprocessing of dual-energy CT enterography studies between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments.

Estudio de las complicaciones de la cirugía bariátrica por tomografía computarizada multidetector con contraste intravenoso

Objective

To review the complications of bariatric surgery and their diagnosis with intravenous contrast-enhanced multidetector computed tomography (MDCT).

Uso de un nuevo dispositivo para la prevención de embolias pulmonares previo a una trombectomía farmacomecánica

We have used a new device to prevent pulmonary embolism during pharmacomechanical thrombectomy in a 25-year-old postpartum woman. The Angel® catheter (BiO2 Medical Inc., Golden, CO, USA) is a temporary device that combines the functions of a vena cava filter (VCF) with those of a triple-lumen central venous catheter. Normally, a VCF is implanted to prevent pulmonary embolism during pharmacomechanical thrombectomy. However, the complications associated with VCFs increase with time, not all of the filter can always be retrieved, and there can be iatrogenic effects both during implantation and retrieval. In our experience, this new device is much simpler to deploy and to retrieve. As is shown in this case, this temporary device can be an interesting alternative to a VCF for preventing pulmonary embolisms during pharmacomechanical thrombectomy.     

Incidencia de nefropatía inducida por contraste tras una tomografía computarizada

Background and aimsThe term contrast-induced nephropathy is used to describe acute deterioration of renal function after the intravenous administration of iodinated contrast material. We aimed to estimate the incidence of contrast-induced nephropathy and to analyze the evolution of different biomarkers of renal function in patients who underwent computed tomography with intravenous contrast administration after premedication with oral hydration and N-acetylcysteine.Material and methodsThis prospective observational study included 112 patients with chronic renal failure (glomerular filtration rate (GFR) 30 mL—60 mL/min/1.73 m²) scheduled for computed tomography with intravenous iodinated contrast material. We recorded demographic variables, dose of contrast material, diabetes mellitus, hypertension, and serum hemoglobin. We measured serum creatinine and GFR after premedication and after the CT examination. We summarized variables as means, standard deviations, and percentages. We used the Wilcoxon and Mann-Whitney tests to compare pre- and post-CT values and Pearson's r to analyze correlations.ResultsIncidence acute kidney injury: 0.9%; 95%CI: 0.36—1.4. Mean difference between pre- and post-CT creatinine: 0.04; 95%CI: 0.002—0.09, p < 0.004. Mean difference between pre- and post-CT GFR: -3.06; 95%CI: -4.66— -1,47), p < 0.001.ConclusionsThe incidence of contrast-induced nephropathy in patients with chronic renal failure and GFR 30 mL—60 mL/min/1.73 m² is low. The biomarkers of renal function analyzed improve in patients who receive premedication and the minimum dose of contrast material.     

Tour de France versus Vuelta a España: which is harder?

PURPOSE: To compare the total exercise loads (intensity x volume) of the Vuelta a Espa?a and Tour de France during the last year. METHODS: Seven professional road cyclists (28 +/- 1 yr; [OV0312]O(2max): 74.6 +/- 2.2 mL.kg-1.min-1) who participated in both Tour and Vuelta during the years 1997, 1999, 2000, or 2001 were collected as subjects. They wore a heart rate (HR) telemeter during each stage of the two races, and exercise intensity was divided into three phases according to the reference HR values obtained during a previous ramp cycle-ergometer test: phase I (RCP). Total volume and intensity were integrated as a single variable. The score for volume x intensity in each phase was computed by multiplying the accumulated duration in this phase by a multiplier for this particular phase. The total score for Tour and Vuelta was obtained by summating the results of the three phases. RESULTS: The total loads (volume x intensity) did not significantly differ between the two races (P > 0.05), despite a significantly longer total exercise time of the Tour (P < 0.05) (5552 +/- 176 vs 5086 +/- 290 min). CONCLUSION: The physiological loads imposed on cyclists' bodies do not differ between the Tour and Vuelta, despite the longer duration of daily stages in the former race.     

Defectos de perfusión en el mapa de iodo pulmonar: causas y semiología

Objective

to describe the usefulness of dual-energy CT for obtaining pulmonary perfusion maps to provide morphological and functional information in patients with pulmonary embolisms. To review the semiology of perfusion defects due to pulmonary embolism so they can be differentiated from perfusion defects due to other causes: alterations outside the range used in the iodine map caused by other diseases of the lung parenchyma or artifacts.

Análisis de las fortalezas,oportunidades, debilidades y amenazas de la tomografía computarizada de doble energía en el diagnóstico por la imagen de la cabeza y el cuello

Technological development of dual-energy computed tomography (DECT) can play an important role in head and neck area. Multiple innovative applications have evolved, optimizing images, achieving metallic artifact reduction, differentiating materials with better primary tumor delineation, thyroid cartilage and bone invasion. Furthermore, quantification algorithms allow measuring iodine concentration, reflecting the blood supply of a lesion indirectly.DECT enables acquiring images with lower radiation doses and iodine intravenous contrast load to obtain the same CT values. However, DECT uses ionizing radiation, which does not occur with MRI, and requires long post-processing times. Artifacts on iodine maps may be a potential source of pseudolesions. Besides, photon-counting CT scanners are a promising technique that may displace some DECT advantages.A review analyzing the current status of DECT applied to head and neck imaging from the scope of strengths, weaknesses, opportunities, and threatsanalysis would be very interesting to facilitate a realistic, fact-based, data-driven look of this technique.     

Enfermedad hepática crónica asociada a la cirugía de Fontan

ObjectiveTo review the pathophysiology of Fontan-associated liver disease, its histologic changes, and its radiologic manifestations.ConclusionsFontan-associated liver disease is the result of a set of structural and functional changes in the liver that occur secondary to hemodynamic changes brought about by Fontan surgery. The radiologic manifestations of Fontan-associated liver disease consist of changes in the size and shape of the liver, alterations in the signal intensity or pattern of enhancement, abnormalities in the vascular structures, and focal lesions, which include benign nodules with intense uptake in the arterial phase and hepatocellular carcinoma. Radiologists need to be familiar with this disease and its complications, because the number of patients who undergo Fontan surgery continues to increase, and these patients undergo an increasing number of imaging tests.     

Radiografía lateral de tórax. Anatomía radiográfica

Lateral chest views constitute an essential part of chest X-ray examinations, so it is fundamental to know the anatomy on these images and to be able to detect the variations manifested on these images in different diseases. The aim of this article is to review the normal anatomy and main normal variants seen on lateral chest views. For teaching purposes, we divide the thorax into different spaces and analyze each in an orderly way, especially emphasizing the anatomic details that are most helpful for locating lesions that have already been detected in the posteroanterior view or for detecting lesions that can be missed in the posteroanterior view.     

Conocimientos en materia de radioprotección en radiólogos del noroeste de España

Objectives

To estimate radiologist? level of knowledge of and their implication in radioprotection.

Ablación percutánea mediante radiofrecuencia de tumores renales en pacientes de alto riesgo: 10 años de experiencia

ObjectiveTo retrospectively evaluate the efficacy and safety of percutaneous radiofrequency ablation (RFA) done to treat renal tumors in patients with high surgical risk or with the risk of developing multiple renal tumors in the medium term at our center over a period of 10 years.Material and methodsBetween 2005 and 2015, we used RFA to treat 89 T1a or T1b tumors in 87 patients (mean age, 73.7 ± 10.87 years) with high surgical risk. We excluded patients treated with radiofrequency and embolization or microwave ablation. The tumors treated were clear cell carcinomas (43.6%), papillary renal carcinomas (17.2%), chromophobe renal cell carcinomas (10.3%), cystic tumors (2.2%), and an angiomyolipoma (1.1%). The mean size of the tumors was 2.6 cm. Computed tomography and/or ultrasonography were used to guide the procedure. We analyzed the relation between the efficacy of the procedure and patients’ age, the type of needle, the source of the patients, the size and location of the tumor, and the number of sessions required to achieve ablation. We recorded all complications.ResultsThe RFA procedure was completed in all patients. The mean follow-up period was 32.1 months. The efficacy was 93.7%. A single session was sufficient in 87.5% of patients; 8% required two sessions and 4.5% required three sessions. The only factor associated with worse efficacy was the size of the tumor (p = 0.03). The rate of complications was 5.6%.ConclusionsRFA is efficacious and safe, with results comparable to those reported in the literature.     

Sintomatología derivada de los pares craneales: Clínica y topografía

The detection of pathological conditions related to the twelve cranial pairs represents a significant challenge for both clinicians and radiologists; imaging techniques are fundamental for the management of many patients with these conditions. In addition to knowledge about the anatomy and pathological entities that can potentially affect the cranial pairs, the imaging evaluation of patients with possible cranial pair disorders requires specific examination protocols, acquisition techniques, and image processing.This article provides a review of the most common symptoms and syndromes related with the cranial pairs that might require imaging tests, together with a brief overview of the anatomy, the most common underlying processes, and the most appropriate imaging tests for different indications.     

Ecografía de la patología infecciosa y tumoral del intestino y el peritoneo

Ultrasonography is not the most cited imaging technique for the evaluation of infectious and neoplastic diseases of the gastrointestinal tract and the peritoneum, but it is often the initial technique used in the initial workup for nonspecific clinical syndromes. Despite its limitations, ultrasonography's strengths enable it to provide meaningful diagnostic information.To discuss the most important ultrasonographic, clinical, and epidemiological findings for infectious disease, we follow a topographical approach: stomach (Anisakis), proximal small bowel (Giardia lamblia, Strongyloides stercoralis, Mycobacterium avium-intracellulare complex, and Cryptosporidium), distal small bowel (Yersinia, Salmonella, and Campylobacter), terminal ileum and cecum (tuberculosis), right colon (Entamoeba histolytica), left colon (Shigella), sigmoid colon and rectum, pancolitis (Clostridium difficile, Cytomegalovirus, and Escherichia coli), and peritoneum.To discuss the ultrasonographic and clinical findings of the most common neoplastic diseases, we follow a nosological approach: polyploid lesions as precursors of tumors, carcinomas, neuroendocrine tumors, hematological tumors, mesenchymal tumors, and metastases. We briefly discuss tumors of the peritoneum and the use of ultrasonography to guide percutaneous biopsy procedures.     

Étude des modifications de la balance ortho–parasympathique à l’issue de vols acrobatiques chez des pilotes de voltige aérienne

Objectives – Study was the ortho-parasympathetic balance changes assessment after an aerobatics flight (called push-pull).Conclusion – Post flight fatigue of the autonomic nervous system involved by the “push-pull” accelerations was expressed by changes of the resting ortho-parasympathetic balance.Protocol – Five pilots performed a training flight of 30 minutes with 5 series of 30 seconds of spirals down under negative acceleration (–3 Gz; –4 Gz) followed by 30 seconds of spirals down under positive acceleration (+3 Gz; +4 Gz). Between each series, pilots carried off a flat flight. A stand-test (10 minutes fall flat on the ground, 10 minutes stand up) was realised before flight, 5 minutes after landing, 1 et 2 hours after flight. Electrocardiogram was recorded during the stand-test with an analogical device). Blood pressure was recorded with an automatic monitor.Results – Spectral analysis of resting heart rate variability and blood pressure variability recorded during stand-tests revealed a continuous disturbance of the ortho-parasympathetic balance after flight probably related to the disturbance of the baroreflexe control. Indeed the compared evolutions of heart rate and blood pressure variability before versus after flight showed an increase in sympathetic tone just after flight and an increase in parasympathetic tone during 2 hours after flight.     

Estudio retrospectivo y comparativo de la utilidad y del valor predictivo positivo de la ecografía y la tomografía computarizada en el diagnóstico de apendicitis aguda en adultos

ObjectiveTo analyze the evolution of the use of imaging tests (ultrasonography and computed tomography (CT)) in the diagnosis of acute appendicitis. To determine the positive predictive value of these tests and the percentage of negative and complicated appendectomies.Material and methodsThis retrospective study compared adults who underwent appendectomy for suspected acute appendicitis at our tertiary hospital during 2015 versus similar patients at our center during 2007.ResultsA total of 278 patients were included. The rate of negative appendectomies descended to 5%. The positive predictive value of ultrasonography increased to 97.4% in 2015, and the positive predictive value of CT and combined CT and ultrasonography was 100%. The rate of complicated appendicitis increased (23% in 2015).ConclusionsThe use of imaging tests increased, and the rate of “blind” laparotomies decreased. Nevertheless, the rate of complicated appendicitis increased.