Guía de la SERAM para la renovación y actualización tecnológica en radiología

The recent financial crisis has led to a substantial reduction in public investment and technological renovation in Spain, resulting in a significant increase in the rate of obsolescence of diagnostic imaging equipment.The Spanish Society of Medical Radiology, aware of the importance of maintaining appropriate technological measures to ensure the quality of health care, has elaborated a document with the aim of analyzing and promulgating the state of diagnostic imaging technology in Spain (depending on the imaging modality, between 32% and 59% of the equipment is more than 10 years old) as well as of establishing criteria and recommendations to guide the management of technology in medical imaging.     

Un año completo de pandemia COVID-19 y su impacto en la Unidad de Radiología Intervencionista

ObjectivesTo describe the impact of the Covid-19 pandemic on the interventional radiology unit at our hospital in the first year of the pandemic.Material and methodsThis prospective observational study included 83 consecutive patients with confirmed SARS-CoV-2 infections who underwent an interventional radiology procedure in the period comprising March 13, 2020 through March 13, 2021. We describe the repercussions of the situation on the unit's total activity, as well as on its activity during the different phases of the pandemic.ResultsTechnical and clinical success were achieved in 96.43% and 82.14% of cases, respectively. During follow-up throughout the year, 68 patients remained alive and 15 died from their underlying disease. No complications related with interventional procedures occurred, and activity declined by only 12% in comparison with the same period in the previous year (2019-2020, without COVID). Similarly, the decrease in relative value units and radiology activity units was only 13% and 12%, respectively.ConclusionThe Covid-19 pandemic has been a challenge in our daily work, leading to an overall decrease in the number of procedures. Nevertheless, the interventional radiology unit has been actively involved in caring for Covid-19 patients, performing a wide variety of necessary procedures. Following a series of specific measures and protocols has enabled us to perform interventional radiology procedures safely during the pandemic.     

Organización y gestión de la radiología urgente

Urgent imaging accounts for more than 50% of the overall activity in diagnostic imaging departments. The enormous impact of this workload makes the appropriate organization and management of urgent imaging essential. Providing urgent imaging services aims to meet the needs of urgent and critical patients from both within the hospital (wards) and outside it (emergency department). To achieve these aims, all hospitals should have a specific unit for urgent imaging. This unit should be large enough to deal with the volume of activity and it should be provided with the human, technological, structural, and organizational resources necessary to fulfill this mission.     

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.     

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.     

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.

Utilidad de la ecografía intestinal en la enfermedad inflamatoria intestinal

Imaging techniques play a fundamental role in the initial diagnosis and follow-up of inflammatory bowel disease. Intestinal ultrasound has high sensitivity and specificity in patients with suspected Crohn's disease and in the detection of inflammatory activity. This technique enables the early diagnosis of intra-abdominal complications such as stenosis, fistulas, and abscesses. It has also proven useful in monitoring the response to treatment and in detecting postsurgical recurrence. Technical improvements in ultrasound scanners, technological advances such as ultrasound contrast agents and elastography, and above all increased experience have increased the role of ultrasound in the evaluation of the gastrointestinal tract. The features that make ultrasound especially attractive include its wide availability, its noninvasiveness and lack of ionizing radiation, its low cost, and its good reproducibility, which is important because it is easy to repeat the study and the study is well tolerated during follow-up. This review summarizes the role of intestinal ultrasound in the detection and follow-up of inflammatory bowel disease.     

Influencia del realce de contraste al inyectar un medio de contraste en el brazo o la pierna en pacientes neonatos y lactantes durante la angiografía por cardiotomografía

Introduction and ObjectivesObtaining CCTA images with optimal injection location such as the arm or leg is important to avoid the artifacts caused by the CM. This study compares the computed tomography (CT) numbers and visualization scores of the three-dimensional (3 D) images of the lumens of the blood vessels in the arm or leg during cardiac computed tomography angiography (CCTA) in neonatal and infant patients.Patients or Materials and MethodsBetween January 2017 and January 2020, 253 consecutive patients were considered for inclusion. We used the estimated propensity scores as a function of the demographic data, including age, body weight, and injection location (right or left side) in the arm (n = 58) and leg (n = 58) of neonatal and infant patients. We compared the mean CT numbers of the pulmonary artery, ascending aorta, and left superior vena cava; contrast–noise ratios (CNR); and visualization scores between the arm and leg as the injection locations.ResultsThe mean CT numbers during CCTA for the arm and leg were 479.4 and 461.3 HU in the ascending aorta, 464.2 and 448.1 HU in the pulmonary artery, and 232.8 and 220.1 HU in the left superior vena cava, respectively. The mean image noise (SD) and CNR values, respectively, were 38.9 HU and 12.1 for the arm as the injection location and 39.1 HU and 12.3 for the leg as the injection location. The median visualization scores of volume rendering of the 3 D images were 3.0 and 3.0 for the arm and leg injection sites, respectively. There were no significant differences in the mean CT numbers of the ascending aorta, pulmonary artery, and left superior vena cava; SD value; CNR; and visualization scores between the arm and leg injection locations.ConclusionsThe CT numbers of the lumen of the blood vessel and visualization scores of the 3 D images of the arm and leg injection locations are equal during CCTA in neonatal and infant patients with congenital heart disease.     

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.     

Guía SEOM-SERAM-SEMNIM sobre el empleo de las técnicas de imagen funcional y molecular en el cáncer de pulmón no microcítico avanzado

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.     

Aplicaciones de la técnica de difusión por resonancia magnética en el manejo de la patología tumoral osteomuscular

Magnetic resonance imaging (MRI) is the technique of choice in the diagnosis, staging, and follow-up of musculoskeletal tumors. Diffusion imaging is a new functional MRI technique that provides information that is complementary to that obtained in conventional MRI sequences. Diffusion imaging has proven useful in different clinical situations like the characterization of disease involving the bone marrow (bone metastases, benign fractures, or hematological disease), the evaluation of tumors of the bones and soft tissues, and the monitoring of the response to treatment in patients with tumors. The aim of this article is to review the diffusion technique in MRI and its current clinical applications in the management of musculoskeletal tumors.     

Uso de la tomosíntesis digital en reumatología: revisión sistemática de la literatura en cuatro patologías

Background and aimsDigital tomosynthesis has proven useful in the evaluation of damage to joints. This study aims to describe the most common digital tomosynthesis findings for four rheumatological entities and to compare the usefulness of this technique with that of other imaging techniques.Materials and methodsFollowing the PRISMA guidelines, we systematically searched the literature for articles about the use of digital tomosynthesis in rheumatoid arthritis, osteoarthritis, spondyloarthritis, and gout. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) criteria to evaluate the quality of the articles included.ResultsWe included 13 articles. For rheumatoid arthritis, osteoarthritis, and spondyloarthritis, digital tomosynthesis detected bone abnormalities better than plain-film X-rays; however, for gout, the results were variable.ConclusionsDigital tomosynthesis can play an important role in the evaluation of skeletal abnormalities in rheumatological disease, especially compared to plain-film X-rays.     

Análisis bibliométrico de la revista Radiología en el periodo 2010-2019

Background and aimsBibliometrics makes it possible to measure the relative importance of a scientific journal in its field. The current study analyzed the scientific publications in Radiología and the bibliometric parameters of the journal in the period comprising 2010 through 2019.Materials and methodsWe reviewed the bibliometrics for Radiología through information obtained from three sources: Scopus, the online version of the journal, and the publisher (Elsevier). We retrospectively analyzed aspects related to the editorial process (final decision and speed), the articles published (type, subspecialty of radiology, and imaging technique), the trends in citation and various indices(CiteScore, SNIP, and SJR), visibility, downloads, author characteristics (geographical origin and institutional collaboration), and the most cited articles.ResultsThe number of articles published in Radiología gradually decreased during the decade, and the time to publication increased. Original research articles account for the largest share of the articles published. The most common subject areas were radiology of the digestive tract and neuroradiology. Nevertheless, the bibliometric indicators and the number of downloads of articles increased every year. Regarding the authorship of the articles published, although authors from Spain predominate, the participation of authors from other countries became increasingly common. Collaboration among different institutions also became increasingly common in the period analyzed.ConclusionsThis review shows the progression of the journal's scientific work and some aspects that must be addressed to favor the growth of Radiología.     

Ante la sospecha de abdomen agudo, ¿es necesario el contraste oral positivo en la tomografía computarizada?

The number of computed tomography studies done in emergency departments has increased substantially, and with this increase the controversy about whether positive oral contrast agents are necessary in all patients has also grown. The great image quality provided by multidetector computed tomography scanners, the increase in intraabdominal fat (as a natural element that provides contrast for separating the bowel loops) related with the increased prevalence of obesity in the population, and the potential drawbacks associated with the use of high-density oral contrast agents argue against the generalized us of these agents. This article aims to evaluate the effects of omitting the use of this type of oral contrast material for computed tomography examinations required in the emergency department for suspicion of acute abdominal pathology through an efficient literature search among recent publications.     

Posibilidades del entorno virtual tridimensional Second Life® para la formación en radiología

Three-dimensional virtual environments enable very realistic ludic, social, cultural, and educational activities to be carried out online. Second Life^® is one of the most well-known virtual environments, in which numerous training activities have been developed for healthcare professionals, although none about radiology. The aim of this article is to present the technical resources and educational activities that Second Life^® offers for training in radiology based on our experience since 2011 with diverse training activities for undergraduate and postgraduate students. Second Life^® is useful for carrying out radiology training activities online through remote access in an attractive scenario, especially for current generations of students and residents. More than 800 participants have reported in individual satisfaction surveys that their experiences with this approach have been interesting and useful for their training in radiology.     

Valor pronóstico de la tomografía computarizada en la tromboembolia pulmonar aguda

In addition to being the standard reference for the diagnosis of acute pulmonary thromboembolism, CT angiography of the pulmonary arteries can also provide valuable information about the patient's prognosis. Although which imaging findings are useful for prognosis remains controversial, signs of right ventricular dysfunction on CT are now included in clinical algorithms for the management of pulmonary thromboembolism. However, the optimal method for obtaining these measurements while maintaining a balance between the ease of use necessary to include their evaluation in our daily activity and the loss of precision in its predictive capacity remains to be determined. Moreover, other variables associated with pulmonary thromboembolism that often go unobserved can complement the prognostic information we can offer to clinicians. This review aims to clarify some of the more controversial aspects related to the prognostic value of CT in patients with pulmonary embolisms according to the available evidence. Knowing which variables are becoming more important in the prognosis, how to detect them, and why it is important to include them in our reports will help improve the management of patients with pulmonary embolism.     

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.

La evaluación clínica objetiva estructurada (ECOE): aspectos principales y papel de la radiología

The objective structured clinical examination (OSCE) is a format of examination that enables students to be evaluated in a uniform, standardized, reliable, and objective way. It is carried out in different clinical stations that simulate real clinical situations and scenarios. Numerous universities in Spain and other countries employ this approach for the final examination for medical school students. This update describes the organization, design, and fundamentals for the OSCE, proposing that radiology should form part of multidisciplinary OSCEs to the extent that it forms part of clinical practice. Moreover, it is interesting and opportune to introduce the OSCE in undergraduate and postgraduate training in radiology. Online platforms enable bidimensional OSCEs that are cost-effective in terms of staff, resources, and physical space, although this approach has certain limitations. Virtual world technologies make it possible to reproduce OSCE stations in three-dimensional scenarios; recent experiences in radiology have shown that this approach interests and motivates students and is widely accepted by them.     

Hallazgos en la tomografía computarizada de tórax en las fases evolutivas de la infección por SARS-CoV-2

ObjectiveTo compare the findings on chest computed tomography (CT) in patients with COVID-19 during different phases of the disease and to evaluate the reproducibility of a visual radiologic score for estimating the extent of lung involvement.MethodsWe retrospectively reviewed chest CT studies from 182 patients with RT-PCR findings positive for SARS-CoV-2. Patients were classified according to the time elapsed from the onset of symptoms, as follows: early (0-4 days), intermediate/progressive (5-9 days), or advanced (≥10 days). We analyzed the frequency of each radiologic finding, as well as the pattern, appearance, and predominant distribution of lung involvement. A visual tomographic score (range, 0-25) was used to estimate the extent of involvement in each lobe and in the total lung volume.ResultsThe predominant CT finding was the ground-glass pattern (n=110; 60.4%), the most common distribution was peripheral (n = 116; 66.7%), and the most prevalent appearance was typical (n=112; 61.5%). The halo sign was seen most frequently in the early phase (25%), whereas ground-glass opacities were more common in the intermediate/progressive and advanced phases. The median severity score was 10 (IQR: 5-13), and the scores increased as the disease progressed. The interobserver agreement (kappa) was 0.92 for the appearance, 0.84 for the distribution, 0.70 for the predominant pattern, and 0.89 for the visual score.ConclusionThe CT findings in patients with COVID-19 vary with the course of the infection. The proposed visual radiologic score is a simple, reproducible, and reliable tool for assessing lung involvement in COVID-19 pneumonia.