El nuevo formato de los documentos de evaluación de la formación sanitaria especializada: una revolución inadvertida

The recent publication of the resolution through which the basic directives about the contents of the documents to accredit the assessments of specialists in training maintains the model but incorporates new elements that enable important changes in the assessment.The resolution has errors and is confusing because the rules are hidden in the instructions for filling out the forms and in footnotes. Nevertheless, the resolution is more than a simple change in the forms: it is a step toward a more current assessment based on the evaluation of residents’ competence. The most significant changes are a stronger role for collaborating teachers, an increase in the number of possible reasons for negative assessments, and the establishment of the rotation as the basic unit of analysis.     

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.     

Resonancia magnética de próstata: utilidad de la secuencia de difusión en la detección de isquemia postembolización en pacientes con hiperplasia prostática benigna

ObjectiveTo analyze the usefulness of diffusion magnetic resonance (MR) sequences before and after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH).Material and methodsWe analyzed MR studies done before (7-10 days) and after (30 days) PAE in 19 patients with BPH treated with PAE between June 2012 and December 2013. We used 1.5 Tesla scanners with body surface coils. In pre-PAE MR studies, we recorded mean b40 values and minimum (min) and maximum (max) apparent diffusion coefficient (ADC) values. In post-PAE MR studies, we recorded b40, b400, and b1000 values and min, mean, and max ADC values. We compared diffusion behavior/ADC before and after PAE and areas without ischemia. We correlated these with decreased prostatic volume (PV).ResultsWe identified ischemia with contrast in 8 (42.1%) patients. No significant difference was found in mean b40 (p= 0.1650) or in the b40 ratio (p= 0.8868) between patients with ischemia and those without before PAE. Min b40, b40 ratio, and min ADC values differed significantly between ischemic areas and nonischemic areas within patients [p= 0.048 (b40 min and ratio) and p= 0.002 (min ADC)]. No significant correlation was found between the percentage decrease in PV and mean b40 (p= 0.8490) or b40 ratio (p = 0.8573).ConclusionPost-PAE ischemia generates objective changes in diffusion and ADC values that enable ischemic sectors to be differentiated from nonischemic sectors. Future studies should analyze whether it is possible to subjectively differentiate between these areas through the visualization of nonischemic sectors and the feasibility of replacing them with contrast to detect ischemia.     

Administración de contrastes intravenosos: las extravasaciones

Local extravasation of intravenous contrast material is a relatively common complication that radiologists need to know about. The risk of extravasation is greater in children, the elderly, and unconscious patients. Although most extravasations are mild and do not lead to further complications, some can result in severe lesions that require surgery, especially in cases that are associated with compartment syndrome. We describe the main characteristics of extravasations, comment on different treatments, and propose a protocol for dealing with them.     

¿Se debe realizar como primera prueba de imagen una radiografía de tórax en inspiración o en espiración ante la sospecha de neumotórax?

Chest radiography for pneumothorax screening is a frequently employed test. However, there is some controversy about which radiographic technique to choose. Posteroanterior chest radiography taken during expiration has been the technique used for many decades because several experts in classical thoracic radiology, such as Greene and Felson, recommended it. However, chest radiography, with posteroanterior and lateral projections, taken during deep breath is the appropriated technique to initially assess the whole thoracic pathology. In this review we have tried to establish, based on the best available evidence, which is the initial examination of choice to diagnose pneumothorax.     

Conocimientos en materia de radioprotección en radiólogos del noroeste de España

Objectives

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

Cuantificación de la fibrosis hepática mediante biomarcadores de imagen

There is a need for early identification of patients with chronic liver diseases due to their increasing prevalence and morbidity-mortality. The degree of liver fibrosis determines the prognosis and therapeutic options in this population. Liver biopsy represents the reference standard for fibrosis staging. However, given its limitations and complications, different non-invasive methods have been developed recently for the in vivo quantification of fibrosis. Due to their precision and reliability, biomarkers’ measurements derived from Ultrasound and Magnetic Resonance stand out. This article reviews the different acquisition techniques and image processing methods currently used in the evaluation of liver fibrosis, focusing on their diagnostic performance, applicability and clinical value. In order to properly interpret their results in the appropriate clinical context, it seems necessary to understand the techniques and their quality parameters, the standardization and validation of the measurement units and the quality control of the methodological problems.     

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.     

Valoración del grado de resección de los macroadenomas hipofisarios en la resonancia magnética posquirúrgica inmediata

Objective

To evaluate if it is possible to determine the extent of pituitary macroadenomas resection in the immediate postoperative pituitary magnetic resonance imaging (MRI).

Cáncer de esófago: particularidades anatómicas,estadificación y técnicas de imagen

Cancer of the esophagus is a tumor with aggressive behavior that is usually diagnosed in advanced stages. The absence of serosa allows it to spread quickly to neighboring mediastinal structures, and an extensive lymphatic drainage network facilitates tumor spread even in early stages. The current TNM classification, harmonized with the classification for gastric cancer, provides new definitions for the anatomic classification, adds non-anatomic characteristics of the tumor, and includes tumors of the gastroesophageal junction. Combining endoscopic ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging provides greater accuracy in determining the initial clinical stage, and these imaging techniques play an essential role in the selection, planning, and evaluation of treatment. In this article, we review some particularities that explain the behavior of this tumor and we describe the current TNM staging system; furthermore, we discuss the different imaging tests available for its evaluation and include a diagnostic algorithm.     

Comparación de la calidad de imagen y dosis de radiación en angio-tomografía computarizada de arterias periféricas con 80 y 100 kV

ObjectiveTo compare the image quality and dose of radiation in two groups of patients undergoing CT angiography of the lower limbs, one with tube voltage of 80 kV and the other with tube voltage of 100 kV.Material and methodsWe performed CT angiography of the lower limbs in 60 patients with suspected peripheral arterial disease. Patients were randomly assigned to one of two groups; in one group, CT angiography was performed using a tube voltage of 80 kV, whereas in the other it was performed using 100 kV. The remaining acquisition parameters were the same in both groups. The images were analyzed by quantifying vascular density (VD) and noise (N) and by calculating the quotients density/noise (QVDN) and contrast/noise (QCN). Two radiologists working independently evaluated the subjective quality of the images. We calculated the estimated effective dose (EED) based on the dose-length product (DLP).ResultsIn the group studied at 80 kV, VD was significantly higher (462.5 UH ± 95.6 vs. 372 UH ± 100.9; P <. 001), QVDN was significantly higher (241.9 ± 48.1 vs. 194.3 ± 49.6; P < .001), and there were trends toward higher N (21.3 UH ± 13 vs. 16.3 UH ± 3.5; P = .098) and toward higher QCN (21.4 ± 12.1 vs. 22.9 ± 9.1; P = .15). No significant differences were found in the subjective quality of the images. The EED was significantly lower in the group studied at 80 kV (4.73 mSv ± 1.1 vs. 9.6 mSv ± 2.2; P <. 001).ConclusionUsing 80 kV instead of 100 kV for CT angiography of the lower limbs reduces the dose of radiation without affecting the diagnostic efficacy of the study.     

Lesión de Morel-Lavallée: diagnóstico y tratamiento con técnicas de imagen

Objectives

We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment.

Tratamiento de fugas biliares mediante colocación transparietohepática de endoprótesis metálicas recubiertas

Objectives

To analyze the safety and efficacy of percutaneous placement of coated self-expanding metallic stents (SEMS) in patients with biliary leaks.

Descripción radiológica de las neoplasias quísticas pancreáticas

Although most cystic pancreatic lesions are pseudocysts, it is important to do a thorough differential diagnosis with true cystic tumors because cystic tumors are potentially malignant. Sometimes computed tomography and magnetic resonance imaging cannot establish the definitive diagnosis, making it necessary to perform other imaging tests such as endoscopic ultrasound, which in addition to morphological information, can also enable cytologic and biochemical analysis of the lesion through puncture and aspiration of its contents. Combining all these findings nearly always provides enough diagnostic information to allow the appropriate approach in each case.This article describes the specific morphological characteristics for each cystic pancreatic tumor on computed tomography, magnetic resonance imaging, and endoscopic ultrasound and reviews the guidelines for managing these types of lesions.     

Diagnóstico por imagen de anomalías en el número y localización del bazo

In imaging studies, some developmental anomalies such as perisplenic accessory spleen are easily recognizable due to their high incidence. However, other, less common anomalies such as intrapancreatic accessory spleen, splenopancreatic fusion, splenogonadal fusion, heterotaxy, and wandering spleen, as well as acquired conditions such as splenosis, can pose diagnostic difficulties. This aim of this review is to show the imaging diagnosis and differential diagnoses of these uncommon splenic anomalies.