Dissertations / Theses on the topic 'Radiologija'

1. INTRODUCTION Lung cancer is the most common malignancy in the world and accounts for 1.09 million new cases with 972 000 deaths per year. In Lithuania too, lung cancer is the most commonly diagnosed cancer in men with nearly 1500 new cases each year. Lung cancer is five times more common in men than in women. At present, most patients who receive an initial diagnosis of lung cancer have advanced stage disease (stage IV – 30.2%), making cure with currently available therapies unlikely. The main prognostic information with regard to survival is associated with the biological characteristics of the primary tumour (histological subtype, aggressiveness, differentiation, etc.), the extent of spread to regional or distant lymph nodes or to the other structures, and the operability of the patient (age, function of residual lung, co-morbidity). Because the outcome is associated with the histological subtype and stage of the lung cancer at the diagnosis, there has been persistent interest in designing and testing various radiological methods for early detection of lung cancer. Chest radiography, computed tomography (CT), magnetic resonance imaging (MRI) can not only identify specific features in lung nodules, but add important information about the localisation, size and extent of the primary tumour (T), detect invasion of major mediastinal structures and chest wall, and locoregional (N) and distal spread of the tumour. Although theoretically features such as nodal shape... [to full text]

Physicians often utilize different imaging techniques to provide clear, visual information about internal parts of the patient. Since the different imaging modalities give different types of information, the combination of them serves as a powerful tool while determining the diagnosis, planning of treatment or during therapy follow-up. To simplify the interpretation of the image information, image registration is often used. The goal of the registration is to put different images in a common coordinate system. It is essential that the registration between the images is accurate. Normalized Mutual Information (NMI) is a metric that quantifies the conformity between images. Even though NMI is a robust method it is often dominated by large structures as the external contour of the patient as well as by the structures of the bones. The prostate is an organ that does not have a fixed position relative to the other organs and host small amounts of image information. The accuracy of the registration is therefore limited with respect to the prostate when using the whole image volume. This master thesis investigates the possibility to restrict the part of the image used for registration to a small volume around the prostate with goal to receive a better registration of the prostate than if full sized images are used. A registration program, utilizing NMI, was written and optimized in MatLab. Four Magnetic Resonance (MR) series and one Computed Tomographic (CT) series where taken over the pelvic area of five patients with the diagnosis prostate cancer. The prostate were delineated by a physician. By adding margin to the delineations five different sized Regions of Interest (ROI) where created.  The smallest ROI precisely covered the prostate while the largest covered the whole image. The deviation in Center of Mass (CoM) between the images and the Percentage Volume Overlap (PVO) were calculated and used as a measure of alignment. The registrations performed with sub-volumes showed an improvement compared to those that used full-volume while registering a MR image to another MR image. In one third of the cases a 2 cm margin to the prostate is preferable. A 3 cm margin is the most favorable option in another third of the cases. The use of sub-volumes to register MR images to CT series turned out to be unpredictable with poor accuracy. Full sized image registration between two MR image pairs has a high precision but, due to the motion of the prostate, poor accuracy. As a result of the high information content in the MR images both high precision as well as high accuracy can be achieved by the use of sub-volume registration. CT images do not contain the same amount of image information around the prostate and the sub-volume based registrations between MR and CT images are hence inconsistent with a low precision.  

Bakgrund: Tidigare forskning visar att röntgensjuksköterskor som gör patienterna delaktiga genom att tillhandahålla information gör det möjligt för patienterna att förstå och själv ta aktiv roll i sin undersökning vilket leder till mindre oro. Med kunskaper och erfarenheter kunde röntgensjuksköterskorna stödja patienterna i samband med undersökningen vilket skapade förtroende och säkerställde trygg atmosfär. Dock kunde sjuksköterskorna även visa brist på känslomässigt engagemang samt bristande förmåga att kommunicera när de var upptagen med praktiska arbetsuppgifter.

Syfte: Syftet med studien var att beskriva patientens upplevelse av det korta mötet inom vården, med tanken att finna överförbarhet till möte med en röntgensjuksköterska.

Metod: Litteraturstudie med en kvalitativ ansats och med en kvalitativ innehållsanalys. Studien inkluderade tio vetenskapliga artiklar, som beskriver möten med vården på röntgen, akut- och operationsavdelning.

Resultat: Resultatet speglar patienternas upplevelser av korta möten, med tonvikten lagd på möten med röntgensjuksköterskor. I resultatet kan referens till källmaterial och dess kontext, såsom röntgen-, akut- och operationsavdelning, utläsas. Dataanalysen resulterade tre huvudkategorier: att bli bekräftad, att uppleva trygghet och att känna maktlöshet. I kategorierna finns totalt sju subkategorier inkluderade. Patienterna kände sig respekterade och bekräftade som individer när sjuksköterskan lyssnade på dem samt tog deras klagomål och önskemål på allvar. Patienterna upplevde trygghet när sjuksköterskan uttryckte intresse och gav dem relevant information. Patienterna upplevde däremot maktlöshet när det var svårt att få kontakt med sjuksköterskan samt göra sina åsikter hörda.

Slutsats: Studiens resultat visar att patienternas upplevelser av korta möten med röntgensjuksköterskor är allmängiltiga i den bemärkelsen att de kan sägas gälla för verksamheter såsom röntgen-, akut- och operationsavdelning. Dock är det viktigt att poängtera att varje möte med en patient är unikt, vilket innebär att varje patient ska bemötas på ett sätt som skapar förutsättningar för ett välbefinnande.

Percutaneous nephrostomy (PCN) is a well-established intervention performed to divert urine from the collecting system in ureteric obstruction or as a prelude to interventional procedures such as stent placement or percutaneous nephrolithotripsy (PCNL). The aim of this thesis is to enhance planning for an optimal insertion of PCN, investigate complications, long-term management, follow-up and outcome in patients with PCN treatment and to increase accuracy in CT-guided punctures.

To enhance planning for an optimal insertion of PCN prior to PCNL, biomodels from CT data were performed. Eight patients with complex urinary calculi were selected. Multislice CT of the kidney was performed and the CT data were transformed into a biomodel. The biomodels visualised unique structures before surgery, which aided the planning of endourological procedures.

PCNL is an essential procedure for treating complex urinary calculi. A subcostal approach is preferred to avoid laceration to the lung and pleura. However, a supracostal approach is often preferable, as it gives a better passage to the renal pelvis. The nature and frequency of complications after supra- versus subcostal punctures were studied in 85 patients treated with PCNL. In 63 patients, a subcostal track was established. In 22, a supracostal puncture was chosen. The main difference in preoperative complications was the higher number of patients in the supracostal group complaining of respiratory correlated pain (32%). In the subcostal group, this was (5%).

401 patients were reviewed retrospectively regarding underlying disease, subsequent management and complications of PCN treatment. The number of major complications was 4%. Minor complications were recorded in 38%, urinary tract infection being the most common. 151/401patients suffered from malignancy. 84/151 of the malignant patients died with the catheter. The median survival time of the patients with malignancies was 255 days and the median catheterisation time was 62 days.

In order to increase accuracy when performing CT guided punctures, a new puncture guide was evaluated. In 15/17 patients the puncture was successful on the first attempt. The benefits of the puncture guide were the artefact from the needle guide pointing at the target indicating the puncture path and the needle support enhancing an accurate puncture.

The purpose of this work was to improve the diagnosis of intracranial hemorrhage with MRI, using, among others, T2*-w GE sequences. Various sequences were tested in rabbits at two magnetic field strengths. Then, the most effective technique was applied to stroke patients.

Experimental studies: The MR detectability of small experimental haematomas in the brain and of blood in the cerebrospinal fluid (CSF) spaces of 30 rabbits was evaluated. MRI examinations were performed at determined intervals. The last MR images were compared to formalin fixed brain sections and, in 16 rabbits, also to the histological findings. T2*-weighted GE sequences revealed all the intraparenchymal haematomas at 1.5 T, appearing strongly hypointense. Their signal patterns remained unchanged during the follow-up. Blood in the CSF spaces was best detected at 1.5T with T2*-weighted GE sequences during the first 2 days. FLAIR and SE sequences were rather insensitive.

Clinical studies: MR examinations were performed at 1.5T, including T1- and T2-w SE, FLAIR and T2*-w GE sequences. In the first clinical study, 66 intraparenchymal hematomas (IPH) of different sizes and ages were examined. T2*-w GE sequence was the most sensitive. On all the sequences, we found a big variety of signal patterns, without a clear relationship to the age of the hematomas.

In a second clinical study, MR examinations were performed to 83 patients with acute stroke: 43 presented acute IPH and 40 were used as controls. Old microhemorrhages (OMHs) were found in 60% of the patients with IPH, and in 15% of the controls.

Conclusion: T2*-weighted GE sequences are capable of revealing very small intraparenchymal hemorrhages at any stage, and blood in CSF spaces during at least the first 2 days. The age of IPHs cannot reliably be estimated with MRI. We have found a correlation between the presence of OMHs and acute intraparenchymal hematomas.

Renal artery stenosis (RAS) is a potentially curable cause of hypertension and azotemia. Besides intra-arterial renal angiography there are several non-invasive techniques utilized to diagnose patients with suspicion of renal artery stenosis. Removing the stenosis by revascularization to restore unobstructed blood flow to the kidney is known to improve and even cure hypertension/azotemia, but is associated with a significant complication rate.

To visualize renal arteries with x-ray techniques a contrast medium must be used. In a randomized, prospective study the complications of two types of contrast media (CO₂ and ioxaglate) were compared. CO₂ was not associated with acute nephropathy, but induced nausea and had lower attenuation differences compared to Ioxaglate. Acute nephropathy was related to the ioxaglate dose and the risk was evident even at very low doses if the patients were azotemic with creatinine clearance <40 ml/min.

Evaluating patients for clinically relevant renal artery stenosis can be done utilizing several non-invasive techniques. MRA was retrospectively evaluated and shown to be accurate in detecting hemodynamically significant RAS. In a prospective study of 58 patients, evaluated with four methods for renal artery stenosis, it was shown that MRA and CTA were significantly better than ultrasonography and captopril renography in detecting hemodynamically significant RAS. The standard of reference was trans-stenotic pressure gradient measurement, defining a stenosis as significant at a gradient of ≥15 mmHg. The discrepancies were mainly found in the presence of borderline stenosis.

The outcome of percutaneous revascularization procedures showed a technical success rate of 95%, clinical benefit in 63% of treated patients, 30-day mortality 1.5% and major complication rate of 13%. The major complication rate for patients with baseline serum creatinine >300µmol/l was 32%. Our results compare favorably with published studies and guidelines.

Las miopatías hereditarias son enfermedades de alta complejidad diagnóstica y pueden presentarse con diferentes fenotipos. Un fenotipo emergente es el fenotipo axial. La enfermedad de Pompe (EP) del adulto es una glicogenosis que provoca una debilidad muscular que generalmente afecta a las cinturas y la musculatura axial. Se asocia a una afectación respiratoria entre otras complicaciones. Las miopatías secundarias a mutaciones en el gen EMD y LMNA pueden cursar con debilidad de cinturas o causar una distrofia tipo Emery-Dreifuss (EDMD). La EDMD cursa con debilidad escapulo-humero-peroneal asociada a contracturas articulares en codos, tobillos y columna. En los últimos años la Tomografía computerizada (TC) y la Resonancia magnética nuclear (RMN) están siendo usadas para el estudio de algunas patologías neuromusculares. La hipótesis de la presente tesis es que la imagen muscular puede ser un buen biomarcador diagnóstico en la EP del adulto y en la miopatía producida por mutaciones en el gen EMD o LMNA. La existencia de un patrón característico en la radiología permitiría un diagnóstico eficaz y precoz. Los objetivos fueron: 1) la descripción del patrón de infiltración grasa muscular en estas miopatías. 2) Estudiar la infiltración muscular en el área paravertebral y abdominal en 30 pacientes con EP. 3) Correlacionar la debilidad muscular con en el grado de infiltración en la radiología en la EP. 4) Describir las características clínicas y de imagen muscular en 42 pacientes con mutaciones en el gen EMD y LMNA. 5) Buscar diferencias radiológicas según el genotipo (EMD o LMNA). En el estudio de la EP, realizado sobre 30 pacientes con RMN o TC del área del tronco, encontramos que los pacientes asintomáticos presentaban infiltración grasa muscular en al menos un músculo y que existía un patrón de infiltración muscular en el área del tronco que además seguía un patrón evolutivo según avanzaba la gravedad clínica. Objetivamos que existía una correlación entre el grado de infiltración muscular y el estadio clínico de los pacientes. En el estudio de las miopatías secundarias a mutaciones en el gen LMNA y EMD, realizado sobre 42 pacientes con RMN o TC de tronco y extremidades inferiores, los pacientes con EDMD no presentaron diferencias clínicas según su genotipo. Describimos un patrón de infiltración en los pacientes con EDMD que afectaba al área paravertebral, compartimento anterior y posterior de muslo y posterior de pierna. Encontramos una diferencia significativa en el grado y la frecuencia de infiltración del músculo Peroneo siendo mayor en las mutaciones del gen EMD. Observamos infiltración de la musculatura paravertebral en los pacientes asintomáticos y una progresión en el patrón radiológico según el estadio clínico. Se puede concluir que la imagen muscular es un biomarcador eficaz para el diagnóstico de la EP del adulto y de la miopatía producida por mutaciones en el gen EMD y LMNA. La imagen muscular puede ser útil para guiar el estudio genético en pacientes que comparten un mismo fenotipo.
Hereditary myopathies are diseases with a complex diagnosis. They may present with different phenotypes of muscle weakness. A relatively new phenotype is the axial phenotype. Adult Pompe’s disease (PD) is a glycogenosis. Glycogen accumulation in lysosomes causes muscle weakness that usually involves girdles and axial muscles associated with respiratory insufficiency. Myopathies due to mutations in EMD and LMNA genes may present with girdles weakness or with Emery-Dreifuss muscular dystrophy phenotype (EDMD). EDMD patients present a scapular-humeral-peroneal weakness associated with joint contractures at elbows, ankles and spine. In recent years computed tomography (CT) and magnetic resonance imaging (MRI) are being used for the study of some neuromuscular diseases. The hypothesis of this thesis is that muscular imaging could be a good diagnosis biomarker of Adult PD and EMD o LMNA genes related myopathy. A characteristic radiological pattern would allow an effective and early diagnosis. Aims were: 1) to describe the pattern of fatty muscle infiltration in these myopathies. 2) to study muscle infiltration in the paravertebral and abdominal area in 30 patients with PD. 3) to correlate muscle weakness with the degree of muscle infiltration in radiology in PD. 4) To describe clinical and radiological characteristics in 42 patients with mutations in EMD and LMNA genes. 5) to search radiological differences according to genotype (EMD o LMNA). PD study was performed in 30 patients with MRI or CT at the trunk level. We found that asymptomatic patients had fatty muscle infiltration in at least one muscle. There was a specific infiltration pattern in trunk area. Moreover this pattern makes evolves according to the clinical severity. There was a correlation between the degree of muscle infiltration and clinical stage. The study of myopathies due to mutations in EMD and LMNA genes was perfomed in 42 patients with MRI or CT of trunk and lower extremities area. We found EDMD patients showed no clinical differences according genotype. We described an infiltration pattern in these patients that affects paravertebral area, anterior and posterior compartment in the thigh and posterior compartment in the leg. Significative difference was found in the degree and frequency of infiltration in peroneal muscle. Peroneal Infiltration was greater in patients with mutations in EMD gene. We showed paravertebral infiltration in asymptomatic patients. We found an evolutive radiological pattern according to the clinical stage evolution. In conclusion muscular radiology is an effective biomarker for the diagnosis of adult PD and myopathies caused by mutations in the LMNA or EMD genes. In patients who share the same phenotype muscle imaging could be a useful tool to guide genetics studies.

PURPOSE: To determine the management performance indicators most frequently utilized in academic radiology departments in the United States. MATERIALS AND METHODS: This investigation met the criteria for an exemption from institutional review board approval. A cross-sectional study in which a validated national survey was sent to members of the Society of Chairmen of Academic Radiology Departments (SCARD) was conducted. The survey was designed to examine the following six categories of 28 performance indicators: (a) general organization, (b) volume and productivity, (c) radiology reporting, (d) access to examinations, (e) customer satisfaction, and (f) finance. A total of 158 variables were included in the analysis. Summary statistics, the 2 test, rank correlation, multiple regression analysis, and analysis of variance were used. RESULTS: A response rate of 42% (55 of 132 SCARD members) was achieved. The mean number of performance indicators used by radiology departments was 16 ± 6.35 (standard deviation). The most frequently utilized performance indicators were as follows: (a) productivity, in terms of examination volume (78% [43 departments]) and examination volume per modality (78% [43 departments]); (b) reporting, in terms of report turnaround (82% [45 departments]) and transcription time (71% [39 departments]); (c) access, in terms of appointment access to magnetic resonance imaging (80% [44 departments]); (d) satisfaction, in terms of number of patient complaints (84% [46 departments]); and (e) finance, in terms of expenses (67% [37 departments]). Regression analysis revealed that the numbers of performance indicators in each category were statistically significant in predicting the total number of performance indicators used (P < .001 for all). Numbers of productivity and financial indicators were moderately correlated (r = 0.51). However, there were no statistically significant correlations between the numbers of performance indicators used and hospital location, hospital size, or department size (P > .4 for all). CONCLUSION: Assessing departmental performance with a wide range of management indicators is not yet an established and standardized practice in academic radiology departments in the United States. Among all indicators, productivity indicators are the most frequently used.

O câncer de mama é uma triste realidade no contexto mundial, sendo o segundo tipo mais frequente entre as mulheres, representando um grave problema de saúde pública. Para diagnosticá-lo, realiza-se a mamografia, interpretada por médicos radiologistas devidamente treinados. Porém, diferentes fatores dificultam a interpretação da imagem mamográfica, como a fadiga visual, stress e distração do profissional, podendo ocasionar falhas ou atraso no diagnóstico. É possível minimizar a taxa de erros se a análise for realizada por meio da dupla leitura, realizada por dois radiologistas ou auxiliada por esquemas computacionais (CAD), no intuito de funcionar como uma segunda opinião. O objetivo do presente estudo foi avaliar a influência do CAD na interpretação de imagens mamográficas de radiologistas experientes, tanto como ferramenta auxiliar na detecção de nódulos e de agrupamentos de calcificações (CADe) quanto como classificador de nódulos (CADx). Os resultados obtidos mostraram que o CAD influenciou positivamente na precisão diagnóstica quando utilizado como classificador, aumentando a sensibilidade e a especificidade dos radiologistas, com a vantagem de não aumentar significativamente a taxa de falsos positivos. Tal fato demonstra que o CAD auxiliou no diagnóstico, sendo ferramenta plausível de ser utilizada na análise mamográfica. Mais estudos devem ser realizados seguindo esta metodologia a fim de realizar novos testes com maior número das amostras e de analisadores. Futuros estudos poderiam explorar especificamente a atuação dos esquemas CADx quando aplicados exclusivamente na análise de mamas densas, em que os sinais radiológicos não são tão evidentes, o que é um grande entrave para diagnósticos corretos.
Breast cancer is a sad reality all over the world, the second most frequent type among women, therefore a serious public health concern. For it diagnosis, mammography is performed and interpreted by qualified medical radiologists. However, several factors have limited the correct interpretation of mammographic images, as visual fatigue, stress and professional distraction, which may result in failed or delayed diagnosis. Its possible to minimize the error rate performing the analysis by means of double reading or by the support of computational schemes (CAD) in order to act as a second opinion. The aim of this study was evaluate the impact of CAD on the interpretation of mammographic images performed by experienced radiologists, aiming to detect nodules and clusters of calcifications (CADe) and as classifier nodules tool (CADx). The results showed that CAD has positively influenced the diagnostic accuracy when used as a classifier, increasing the sensitivity and specificity of radiologists with the advantage of not significantly increasing the rate of false positives. This shows that the CAD really improved the diagnosis, being a useful tool in the analysis of mammographic images.. Additional tests including more samples and analyzers should be performed according to this approach. Future studies could specifically explore the performance of CADx schemes when applied exclusively to the analysis of dense breasts, where the radiological signs are not so obvious, which is a serious difficulty for the medical examination.

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária
Tanto o conhecimento como a prática clinica na área da Radiologia Oral nas crianças, deverão ser atualizados regularmente devido ás novas pesquisas e experiências que nos permitem expandir a nossa compreensão. As orientações aqui apresentadas não têm o objetivo de padronizar o atendimento dos pacientes, mas sim servir como um adjuvante para o diagnóstico. Este trabalho de revisão bibliográfica visa refletir sobre as orientações clinicas clássicas e contemporâneas na área da Radiologia Oral em crianças, com o intuito de poder prestar assim um serviço á comunidade, com práticas baseadas nas orientações clínicas mais atuais. Quando o paciente pediátrico que tem uma experiência positiva no consultório , há uma memória positiva eterna que esperamos que traga um desejo de manutenção da sua saúde oral á medida que se tornam adultos. Para esta revisão bibliográfica foi realizada uma pesquisa nas bibliotecas da Universidade Fernando Pessoa e nos motores de busca na internet, MEDLINE/Pubmed, Science Direct, Google Scholar entre Janeiro e Julho de 2014. Both knowledge as well as practice in the área of Oral Radiology in children, due to the new researches and experiments, should be regulary updated in order to allow us to expand our insight. The guidelines presented here are not intended to standardize patients ´treatment, but rather to serve as a complement to diagnosis. This bibliographic review aims to reflect on both classic as well as contemporary clinical guidelines in children Oral Radiology in children with the intention of thereby providing a service to the community, with practices based on the most current clinical guidelines. When, in dental office, a positive experience is provided to paediatric patient, a positive everlasting memory is created, wich will hopefully bring a desire to maintain oral health as they become adults. The researches for this bibliographical review were held at the University Fernando Pessoa´s libraries, as well search engines on the Internet, MEDLINE / PubMed, ScienceDirect, GoogleScholar between January and July 2014.

OBJETIVOS: Avaliar a certeza de qualidade dos resultados mamográficos em uma instituição de referência para diagnóstico e tratamento do câncer de mama na Região Sul do Brasil, considerando as recomendações da quinta edição do BIRADS (“Breast Imaging Reporting and Data System”) para propósitos de auditoria. MATERIAL E MÉTODOS: Foi realizado um estudo de coorte observacional retrospectivo e transversal com 4911 pacientes que foram submetidas a pelo menos uma mamografia durante o ano de 2013 em um hospital público regional, ligado a uma universidade pública federal na Região Sul do Brasil. Essas pacientes foram acompanhadas até 31 de dezembro de 2014, para checar as taxas de desempenho dos resultados mamográficos na instituição em estudo, incluindo verdadeirospositivos (VP), verdadeiros-negativos (VN), falso-positivos (FP), falso-negativos (FN), valores preditivos positivos (VPP), sensibilidade e especificidade com um intervalo de confiança de 95%. RESULTADOS: O estudo demonstrou alta certeza de qualidade nos resultados das mamografias digitais diagnósticas, especialmente em relação à sensibilidade (90,21%) e especificidade (98,97%). O valor preditivo positivo (VPP) geral foi estimado em 65,3%. A taxa de interpretação anormal (ou reconvocação) foi de 12,26% e a razão de verossimilhança (“likelihood ratio”) das mamografias diagnósticas obtida foi 86,68%. CONCLUSÕES: Conclui-se que os resultados de mamografias digitais diagnósticas foram apropriados e similares aos valores pospostos pelo BIRADS. Além disso, o estudo proporcionou auto-reflexão e auto-avaliação da prática radiológica no serviço, o que é essencial para o melhoramento e processo de colaboração mais efetivo entre todos os profissionais envolvidos com o diagnóstico e tratamento do câncer de mama. Esses resultados podem incentivar outras instituições a atingirem altas taxas de qualidade de desempenho nos resultados mamográficos, apesar de possíveis limitações estruturais quando comparadas a instituições de países desenvolvidos.
OBJECTIVES: To evaluate the quality assurance of the mammography results in a reference institution for breast cancer diagnosis and treatment in southern Brazil, considering the BIRADS (Breast Imaging Reporting and Data System) 5th edition recommendations for auditing purposes. MATERIAL AND METHODS: We performed a retrospective cohort observational and cross-sectional study with 4911 patients who underwent at least one mammography throughout the year of 2013 in a regional public hospital, linked to a federal public university in southern Brazil. These patients were followed until 31st December, 2014 to check the performance rates of mammography results in our institution, including true-positives (TP), true-negatives (TN), false-positives (FP), false-negatives (FN), positive predictive values (PPV), sensitivity and specificity with a confidence interval of 95%. RESULTS: The study has showed high quality assurance on digital diagnostic mammographic results, especially regarding sensitivity (90,21%) and specificity (98,97%). The overall positive predictive value (PPV) was estimated in 65,3%. The abnormal interpretation rate (recall rate) was 12,26% and the likelihood ratio of diagnostic mammograms obtained was 86,68%. CONCLUSIONS: We concluded that our digital diagnostic mammography results were appropriate and similar to values proposed by the BIRADS. Also, the study provided self-reflection and insights on our radiological practice, which is essential to the improvement and more effective collaboration process between all the professionals involved with breast cancer diagnosis and treatment. These results may incentivize other institutions to achieve high quality performance rates in mammography results, despite possible infrastructure and facilities limitations when comparing to developed countries.

Using the example of two patients' asking radiologists to give the results of unfavourable examinations just carried out, I question whether they should speak frankly in these circumstances. From a utilitarian viewpoint I discuss veracity, obligations to speak candidly and prohibitions of deception, arguing that such moral rules are contingent, not absolute. I may justly withhold information to protect an innocent third party; it may not be wrong to do so when that person is the one from whom information is withheld. I discuss whether doctors have a particular obligation to be truthful with patients, concluding that their obligation is to act for the best; if tact is in the patient's interest, any obligation of veracity may be overridden. To trust someone means assuming they protect one's interests, not that they necessarily act in specific ways. I review research indicating that not all patients wish to be given bad news. I note that when patients have false beliefs which appears medically beneficial, or when one wishes to inculcate hope, people who advocate candour may (inconsistently) become more equivocal. In examine the relationships and responsibilities of the members of the health care team in such matters. Seeing this as an example of the tension between (paternalistic) exercise of beneficence and respect for autonomy, I argue that autonomy is simply one instrumental good and that others may take precedence should the patient's interests require it. I claim that, while it is desirable that people indicate their wishes, to accede to them when this significantly harmful or imprudent is morally irresponsible, particularly should the individual not have exercised ideal deliberation. I also argue that to insist upon a putative "right to know", when this is harmful, is irrational. The answers to my question should reflect the way we wish to live together.

CHDS State/Local
From the events of September 11, 2011, the United States learned a large-scale disaster can strike without warning. President Bush issued a series of Homeland Security Presidential Directives (HSPD) intended to increase coordination among response agencies. However, despite the enactment of the HSPDs, coordination and collaboration among response agencies is significantly lacking with respect to radiological emergency planning and preparedness activities. Planning for nuclear/radiological events is unique in that they often occur with no notice, with great complexity, and require broad scenario planning to cover the important potential contingencies. Radiological events demand that actions be taken by responsible organizations, in a timely and effective manner to mitigate consequences on populations, infrastructure and environment. This thesis is intended to help officials better understand the many factors that impact coordination and collaboration. These factors range from information sharing to multidisciplinary participation. This thesis will also assist officials in better understanding the Capabilities Based Planning Model and how it may be implemented to enhance radiological emergency planning and preparedness. The elements included in this paper are intended to enhance the planning and associated decisions made by all partners involved in local radiological planning efforts. In conclusion, the thesis recommends enhancing radiological emergency planning and preparedness at the local level, through integrating the jurisdictions approach with the use of the Capabilities Based Planning Model to encourage performance partnership and collaborative methods.

Amb la revolució de la tecnologia digital d’obtenció d’imatges radiològiques i l’increment de la potència computacional, el camp de la quantificació d’imatges mèdiques ha sorgit. El fet de poder programar un ordinador per a que detecti patrons d’interès en imatges radiològiques i pugui derivar-ne d’aquests indicadors numèrics amb valor clínic fa que, sens dubte, aquest àmbit de coneixement tingui un gran potencial en entorns mèdics i de recerca. En aquesta tesi es presenten un conjunt de contribucions científiques en aquest context. En particular, es descriu el disseny i la implementació d’una sèrie d’estratègies computacionals de quantificació d’imatges de medicina nuclear i neuroradiologia. A continuació es detalla com aquestes tècniques han demostrat ser d’utilitat per a l’estudi de malalties molt rellevants en l’actualitat com són el càncer de mama, el limfoma no-Hodgkin, la pielonefritis, la malaltia d’Alzheimer, la malaltia de Parkinson i l’abús de cànnabis.
Con la revolución de la tecnología digital de obtención de imágenes radiológicas y el aumento de la potencia computacional, el campo de la cuantificación de imágenes médicas ha emergido. El hecho de poder programar un ordenador para que detecte patrones de interés en imágenes radiológicas y pueda derivar de ellos una serie de indicadores numéricos con valor clínico hace que, sin duda, este ámbito de conocimiento tenga un gran potencial en el entorno médico y de investigación. En esta tesis se presentan un conjunto de contribuciones científicas en este contexto. En particular, se describe el diseño y la implementación de una serie de estrategias computacionales de cuantificación de imágenes de medicina nuclear y neuroradiología. A continuación se detalla cómo estas técnicas han demostrado ser de utilidad en el estudio de patologias muy relevantes en la actualidad como son el cáncer de mama, el linfoma no-Hodgkin, la pielonefritis, la enfermedad de Alzheimer, la enfermedad de Parkinson i el abuso de cánnabis.
With the revolution of digital medical imaging and the increasing computational power, the field of quantitative medical image analysis emerged. By programming a computer to detect patterns of interest in medical images and derive clinically meaningful numerical indicators from them, this field shows promising potential for healthcare and medical research systems. In this thesis, the design and implementation of computer-based quantification techniques in nuclear medicine and neuroradiological images led to several contributions in this field. These image-derived indicators contributed to complement the visual diagnosis and to further understand the pathophysiology of important health issues such as breast cancer, non-Hodgkin lymphoma, pyelonephritis, Alzheimer’s disease, Parkinson’s disease and cannabis abuse.

Referred pain is frequently associated with misdiagnosis and unnecessary therapy directed to the pain location instead of its origin. When craniofacial pain is the sole symptom of myocardial ischemia, failure to recognize its cardiac source can endanger the patient. In particular, patients with acute myocardial infarction (AMI) who do not experience chest pain run a very high risk of misdiagnosis and death. Pain that is limited to the craniofacial region during myocardial ischemia has so far been described only in case reports and its overall prevalence is unknown. Experimental research in animals suggests a vagal involvement in the pathological mechanisms of cardiac pain referred to the face. The aim of this study was to gain knowledge about the prevalence, clinical characteristics and possible mechanisms of craniofacial pain of cardiac origin, in order to improve the clinician’s ability to make a correct diagnosis. It was hypothesized that the quality of craniofacial pain from cardiac versus dental origin would differ, implying a high diagnostic validity. It was also hypothesized that craniofacial pain can be the sole symptom of a prodromal (pre-infarction) angina episode and that this pain location would be especially associated with cardiac ischemia in the areas more densely innervated by vagal afferent fibres. The study group was comprised of consecutive patients who experienced craniofacial pain of a verified cardiac (n=326) or dental (n=359) origin. Demographic details on age, gender and pain characteristics (location, quality and intensity) were assessed in both groups. Cardiovascular risk factors, cardiac diagnosis and ECG signs of ischemia were also assessed in the cardiac pain group. Ethics approval and informed consent for each patient was obtained. Craniofacial pain was found to be the sole symptom of myocardial ischemia in 6% of patients and was the sole symptom of an AMI in 4% of patients; this craniofacial pain was more prevalent in women (p=0.031). In those patients without chest pain, it was the most frequent pain location and was the only symptom of prodromal angina in 5% of AMI patients. The craniofacial pain included the throat, the jaws, the temporomandibular joints/ears and the teeth, mainly bilaterally. The pain quality descriptors “pressure” and “burning” were statistically associated with pain of cardiac origin, while “throbbing” and “aching” were associated with an odontogenic cause (p<0.001). In myocardial ischemia patients, the occurrence of craniofacial pain was associated with an inferior localization of ischemia in the heart (p<0.001). In conclusion, this study showed that pain in the craniofacial region could be the sole symptom of cardiac ischemia and AMI, particularly in women. Craniofacial pain of cardiac origin was commonly bilateral, with the quality pain descriptors “pressure” and “burning”, and pain provocation with physical activity and pain relief at rest. The association between the presence of craniofacial pain and inferior wall ischemia suggests a vagal involvement in the mechanisms of cardiac pain referred to the craniofacial region. Since the possibility of misdiagnosis and death in this group of patients is high, awareness of this clinical presentation needs to be brought to the attention of researchers, clinicians and the general public.

L’effetto dell’informatica e dell’automazione sulle procedure medico sanitarie si sta manifestando in maniera sempre più ampia, portando notevoli vantaggi per la salute e il benessere di tutti i pazienti e al tempo stesso ponendo sfide sempre più complesse alle istituzioni sanitarie e ai produttori di dispositivi medico-sanitari. Al di là dei meriti del singolo prodotto o tecnologia, esiste un fattore strategico che dovrebbe essere sempre considerato nel momento di progettare un software o un dispositivo da utilizzare in ambito sanitario (da parte dei produttori) o nel momento di pianificare l’acquisto di sistemi medicali o diagnostici complessi (da parte delle istituzioni sanitarie): l’aspetto dell’Integrazione, ovvero la capacità del sistema di inserirsi in maniera semplice, efficace e poco costosa in un Workflow (flusso di lavoro) completamente integrato. Nel primo capitolo di questo elaborato finale è stato fatto un quadro generale sull’organizzazione del flusso di lavoro in radiologia e sono stati trattati i vari standard di comunicazione e scambio dati in ambito clinico, in primis DICOM, HL7 e IHE. L’oggetto del secondo capitolo è l’organizzazione e gli obbiettivi del Dipartimento di Radiologia attuati dal Gruppo Villa Maria (GVM) e il confronto di questi ultimi con il contenuto del documento: ‘Linee guida per l’assicurazione di qualita` in teleradiologia ‘che è stata redatta dal Istituto Superiore di Sanita` destinata ad apportare, non solo ai medici radiologi ed ai TSRM ma anche agli altri professionisti della sanità coinvolti, gli elementi di informazione e di metodo per l’organizzazione della teleradiologia nel rispetto delle esigenze della deontologia medica, della sicurezza del paziente, compreso il consenso, anche per quanto riguarda la radioprotezione, la privacy e la qualità. Nel terzo capitolo sono elencati gli strumenti con cui il Dipartimento di radiologia intende perseguire i suoi obbiettivi. Il quarto capitolo tratta la mia esperienza presso una clinica esterna al GVM, in particolare la clinica Santo Stefano, di Porto Potenza Picena, dove sono stati fatti dei test volti a valutare i tempi di caricamento di esami di TAC e RMN sul cloud di GVM.

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O medico radiologista atua num campo que utiliza um parque tecnologico com equipamentos modernos, de alto custo e de renovacao intensa em software (programas computadorizados dedicados) e hardware (equipamentos, acessorios e insumos), provocando uma evolucao constante na forma de produzir os servicos na especialidade. Este panorama realca a importancia da Gestão na pratica cotidiana desta especialidade. Objetivo: Investigar, a partir de residentes, docentes e preceptores de radiologia, a aprendizagem sobre Gestão na residencia em radiologia da Escola Paulista de Medicina da UNIFESP, procurando subsidios para o aprimoramento da formacao do medico radiologista. Metodo: Desenvolveu-se uma pesquisa de carater exploratorio, com abordagens quantitativa e qualitativa junto ao universo de residentes, docentes e preceptores atuantes no programa de residencia do Departamento de Diagnostico por Imagem, utilizando-se um questionario no formato de Likert e posterior aprofundamento por meio de entrevistas gravadas, que foram transcritas e categorizadas a partir das suas unidades de significado, por meio de uma analise tematica. Resultados e Discussao: Os resultados apontam para a necessidade da residencia em radiologia estar mais atenta para as diferentes habilidades de Gestão do seu egresso. Residentes, docentes e preceptores concordam que o programa capacita seus residentes para gerir o proprio conhecimento u aprender a aprender, habilidade essencial para a continuidade do processo formativo apos a Residencia. A clareza de papeis e o grau de autonomia dos residentes vao aumentando durante o processo de formacao, e o preparo para participar de equipes multiprofissionais ocorre na interacao diaria entre os residentes e as equipes. No entanto, a Gestão da tecnologia, incluindo uso eficiente, compras e manutencao de equipamentos, mostrou-se pouco contemplada, assim como o aprendizado sobre o SUS
The radiology field uses modern high cost technolog ical equipment, with intense renewal of software (computer-based programs) and h ardware (equipment, accessories and supplies), causing continuous evolu tion to produce services in this specialty. It highlights the management importance on a daily basis of this area of expertise. Objective : To investigate the radiology residents, teachers and tutors’ learning about management in their residency progra m at the EscolaPaulista de Medicina , UNIFESP, seeking for grants to improve the radiol ogist ́s education. Methodology : an exploratory quantitative and qualitative study was developed with residents, faculty staff and tutors working in the residency program of the Department of Diagnostic Imaging. The Likert scale questionnai re was used and further taped interviews were then transcribed and categorized f rom their units of meaning, through the thematic analysis technique. Resultsand Discussion : The results showed that the radiology residency program needs t o be more attentive to different management skills of its egress students. Residents , faculty staff and tutors agreed that the program enables residents to manage their own knowledge - learning how to learn, an essential skill for the continuing traini ng process after residency. Definition of roles and residents ́ autonomy will increase duri ng the training process, and preparing to participate in multidisciplinary teams occurs in daily interaction between residents and the teams. However, management of tec hnology, including efficient use, purchase and equipment maintenance was rarely considered as well as the learning on the Unique Health System (SUS).
BV UNIFESP: Teses e dissertações

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The aim of this study is to evaluate the attenuation properties of the nanocomposites in the energy range between 20 and 120 keV. In order to evaluate the efficiency of nanostructured materials in the attenuation of radiation the results will be compared to data obtained with the same material in the non-nanostructured form. The nanostructured materials are characterized by having a size of crystallites less than 100nm, and shows different properties with respect to conventional materials. The nanocomposites used in this study were produced through the aggregation of nanoparticles of copper oxide (CuO) and zinc oxide (ZnO) to beeswax. The concentration of nanoparticles in the composite was varied between 5% and 10%. For comparison purpose the copper oxide and zinc oxide in a non-aggregated nanoparticles were also agregated in a nonnanoparticulated form to beeswax in the same proportion as for nanostructured materials. Samples were produced with dimensions 10 cm x 10 cm and 2 mm in thicknesses. The attenuation properties of the samples produced were evaluated at high energy X-ray beams, emmited by a X-ray equipment used in conventional radiology, and the low energy x-ray beams are produced by a clinical mammography equipment. The air kerma values, for different material thicknesses, were measured with an ionization chamber for x-ray beam produced at 60 kV and 102 kV. Results shows that the attenuation provided by the copper oxide is slighly higher for the nanoestrured materials compared with for the non-nanoestrutured ones. In the case of the zinc oxide, the material in the non-nanometric form shows an increasing of the attenuation relative to the nanoparticulates ones. In the mammography energy range the study was carried out for beams generated at 22, 26 and 30 kV. It is observed that the copper oxide in nanometric structure attenuate at about 23% more radiation than the same material in the non-nanoparticulate form. In the case of the zinc oxide the attenuation is higher at about 7% for the material in the non-nanometric form. This study suggest that nanostructured materials show great potential for application in radiological protection, because it can be easily incorporated into different compounds allowing the development of new materials for use in radiological protection.
Este estudo tem por objetivo determinar as propriedades de atenuação de nanocompósitos na faixa de energia entre 20 e 120 keV. Com o propósito de avaliar a eficiência dos materiais nanoestruturados na atenuação da radiação os resultados obtidos serão comparados aos dados obtidos com o mesmo material na forma não-nanoestruturada. Os materiais nanoestruturados são caracterizados por terem um tamanho de cristalito inferior a 100nm e apresentar propriedades diferenciadas em relação aos materiais convencionais. Os nanocompósitos utilizados neste trabalho foram obtidos a partir da agregação de nanopartículas de óxido de cobre (CuO) e óxido de zinco (ZnO) a cera de abelha alvejada. A concentração de nanopartículas nos compostos foi variada entre 5% e 10%. Para fins de comparação, o óxido de cobre e o óxido de zinco, na forma nãonanoparticulada também foram agregados na mesma proporção que os materiais nanoestruturados a cera de abelha alvejada. Foram produzidas amostras com dimensões 10 cm x 10 cm e 2 mm de espessura. As propriedades de atenuação destas amostras foram avaliadas em feixes de raios X produzidos por um equipamento de radiologia convencional, e por um equipamento clínico de mamografia. Na região de radiologia convencional foram realizadas medições de kerma no ar para diferentes espessuras de material para feixes de raios X gerados nas tensões de 60 e 102 kV. Os resultados obtidos mostraram uma leve tendência de maior atenuação da radiação pelo o óxido de cobre na forma nanométrica que o óxido de cobre na forma não-nanométrica. Observou-se uma tendência de maior atenuação pelo óxido de zinco na forma não-nanoparticulada. A atenuação da radiação para feixes de mamografia foi avaliada nas tensões de 22, 26 e 30 kV. Os dados obtidos mostraram que para o óxido de cobre na forma nanométrica a atenuação da radiação é maior em até 23% com relação às estruturas na forma não-nanométrica. Para o óxido de zinco a atenuação para o material não-nanométrico foi superior em até 7% relativo às estruturas na forma nanométrica. Os resultados obtidos neste trabalho sugerem que os materiais nanoestruturados mostram um grande potencial para aplicação em proteção radiológica, pois podem ser facilmente incorporados a diferentes compostos possibilitando o desenvolvimento de novos materiais.

O campo da saúde viveu, nos últimos anos, transformações importantes decorrentes da revolução tecnológica e informacional. Na área da tomografia computorizada, a renovação tecnológica passou a determinar a necessidade de atualização permanente dos conteúdos de aprendizagem e de formação profissional dos técnicos de radiologia. A formação é assumida como um instrumento essencial para fazer face a essas mutações. Na verdade, para melhorarem a qualidade dos serviços e aumentarem a sua competitividade, as organizações de saúde, têm apostado na definição e concretização de modelos, de políticas e de sistemas de avaliação da qualidade que exigem dos profissionais saberes que nem sempre foram adquiridos nas escolas e universidades. Esta investigação procurou responder a duas questões centrais: “será que os técnicos de radiologia sentem necessidade de adquirir ou atualizar conhecimentos, capacidades e habilidades para responderem cabalmente aos desafios profissionais na área da tomografia computorizada e às políticas de qualidade da organização com que se confrontam? Se sim, quais são essas necessidades e como podem ser, total ou parcialmente, colmatadas?”. Para encontrar respostas a estas questões de investigação (que decorreu num serviço de radiologia de um hospital privado), procedeu-se a um desenho metodológico que cruza dados recolhidos através de análise documental, questionários a técnicos de radiologia e uma entrevista ao coordenador do serviço. Os principais resultados indicam que os técnicos de radiologia da unidade estudada não sentem grandemente necessidade de formação e que nos casos em que esta ocorre é respeitavamente nos aos domínios do desenvolvimento e valorização profissional, da relação com o doente, do uso de produtos farmacêuticos e da radioprotecção e segurança em tomografia computorizada; ABSTRACT: The health care field has lived in recent years, important changes arising from informational and technological revolution. In the area of CT, a technological renovation started to determine the need for continuous updating of learning content and professional training of radiology technicians. In fact, to improve the quality of services and increase their competitiveness, health organizations, have invested in the definition and implementation of models, policies and systems of quality assessment that require knowledge of the professionals who were not always acquired in schools and universities. This research sought to answer two central questions: "Does the radiology technicians feel the need to upgrade or acquire knowledge, skills and abilities to fully respond to the challenges professionals in the area of CT and the quality policies of the organization faced? If yes, what those needs are and how they can be fully or partially bridged? To find answers to these research questions (which took place in the radiology department of a private hospital), we proceeded to a methodological design that crosses data collected through document analysis, questionnaires and interview radiology technicians to service coordinator. The main results indicate that radiologic technicians studied the unit does not feel much need for training and that in cases where this occurs with regard to the areas of professional development and enhancement of the relationship with the patient, the use of pharmaceutical and radiological protection and safety in CT.

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WMD terrorism is a new concern. The United States is preparing for the possibility of terrorist attacks involving chemical, biological, and nuclear weapons, but the scope of these preparations is too narrow. This thesis argues that radiological devices are also viable weapons of mass destruction for terrorism. Radiological weapons are not nuclear explosives, they are designed to disperse radioactive material over an area by mechanical means or conventional explosives. The potential for radiological terrorism depends upon access to the required nuclear materials and the motivations for terrorists to use radiological weapons. Rasiological weapons can use non-lethal grade nuclear material which is widely accessible throughout the world. The materials is under a spectrum of physical security systems with little accountability and verification. Radiological weapons can further terrorist objectives because they can be used to contaminate individuals without producing the immediate and catastrophic damage normally associated with WMD. This prospect of contamination is enough to incite the public's fear of the nuclear unknown or nuclear phobia. To counter radiological terrorism, the U.S. government should expand indication and warning through efforts to maximize the intelligence community's human intelligence assets and exploit open source collection

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. Psoriasis is a dermatological condition that affects 1-2% of the population. Approximately 10-15% of patients with skin manifestations of psoriasis develop PsA and 0.3-1% of the general population. Moll and Wright defined PsA as psoriasis associated with inflammatory arthritis and usually a negative serological test for rheumatoid factor (RF).

INTRODUCCION: las dosis de referencia (DRLs) son los niveles de dosis administradas a los pacientes en exposiciones de radiodiagnóstico médico que no deben sobrepasarse y pueden ser utilizados como indicadores en los procesos de optimización radiológica. A raíz de las publicaciones iniciales para reducir las dosis de radiación en los EE.UU. En odontología, se incluyen estas recomendaciones en las directrices europeas sobre protección radiológica en radiología dental; sin embargo, hemos encontrado solamente algunas referencias aisladas sobre dicho tema. No hemos encontrado estudios previos realizados de forma continuada durante varios años en ningún país que describan la evolución de las DRLs como se pretende, una guía para la optimización de la protección radiológica como se recoge en las recomendaciones internacionales. Este estudio describe la evolución de las DRL y las dosis medias administradas a pacientes de radiología intraoral durante un período de dieciocho años (1997-2014) en España. MATERIAL Y MÉTODOS: se estudian 34.143 informes oficiales de control de calidad emitidos durante un período de 18 años (1997-2014) de instalaciones radiológicas de radiodiagnóstico intraoral y están distribuidas en 16 comunidades autónomas. Las variables analizadas son las descritas en el Real Decreto 2071/1995 modificado posteriormente por el Decreto 1976/1999 y son: características físicas de los equipos de rayos X, las anomalías encontradas en los equipos y procesamiento de la película, tiempos de exposición, dosis de radiación administradas para cada exploración, teniendo en cuenta las prácticas de trabajo habituales de cada clínica. La dosis media de radiación (10 exposiciones, en mGy, de acuerdo con la legislación española) para obtener una imagen radiográfica del segundo molar superior bajo las condiciones normales de trabajo en cada instalación, se determinó utilizando un detector UNFORS XI (Billdal, Suecia) o PMX III (RTI Electronics, Mölndal, Suecia) Se ha aplicado un factor de retrodispersión de 1,1 a los valores obtenidos siguiendo la normativa española El grado de dependencia y correlación entre variables se evaluó mediante un Análisis de Varianza complementado por una comparación de medias mediante la diferencia mínima significativa (p <0,05). Las medias cuantitativas se compararon mediante análisis de regresión y correlación lineales. RESULTADOS: desde 1997, las películas radiográficas han sido sustituidas progresivamente por sistemas digitales en España a una tasa anual del 3,1%. En 2007, se determinó que el 50% de las instalaciones dentales utiliza sistemas digitales de imágen. Sin embargo, en los últimos años (2007-2014) la tasa de crecimiento para los sistemas digitales ha sido sólo del 1,2% anual. Hemos determinado una DRL de 2,8 mGy en 2014, lo que representa una disminución de 41,7% en comparación con la dosis que establecimos en 2002 (4,8 mGy). Las dosis medias de radiación se ha reducido en un 54,5% desde el inicio del estudio; nuestro estudio muestra que el 99,4% de las instalaciones dentales cumple con las dosis recomendadas por la Unión Europea. Además, hemos determinado una dosis media de 1,3 mGy en 2014, lo que representa un descenso del 55,2% en comparación con la dosis que previamente describíamos en 2002 (2,9 mGy), aunque en los últimos tres años se ha mantenido estabilizada en 1,3 mGy. Durante este período de tres años, la dosis media no ha sido reducida y las DRLs sólo han disminuido en un 6,3%. En conclusión, el progreso en DRLs en los últimos años es el de una reducción gradual, que pueda ser interpretada como un aumento en la optimización de las técnicas de radiología intraorales en España, sin embargo, fundamentalmente es debido a la sustitución de los sistemas de imágenes convencionales a los modernos sistemas digitales.
INTRODUCTION: Diagnostic reference levels (DRLs) are patient dose reference levels for diagnostic medical exposures that can be used as research indicators as part of optimization processes. In dentistry, recommendations are included in the European guidelines on radiation protection in dental radiology. No studies performed continuously over several years in any country which describe the evolution of DRLs as a guide to optimising radiological protection as mentioned in all international recommendations have been found. The present study describes the current progress of DRLs and mean doses administered to intraoral radiology patients monitored over a period of eighteen years (1997--2014) in Spain. MATERIAL AND METHODS: A total of 34,143 official reports from 1997 to 2014 on radiological standards of private dental surgeries were examined. The variables analysed are those described in Royal Decree 2071/1995 modified later by Decree 1976/1999 as described in previous publications, briefly: physical characteristics of the X-ray units, anomalies found in the equipment and film processing procedure, exposure times and radiation doses administered for each dental surgery, taking into account the regular working practices of each clinic. The installations covered in the reports encompass 16 Spanish autonomous regions. The actual mean radiation dose (10 exposures, in mGy, according to Spanish legislation for obtaining a radiographic image of the upper second molar under normal working conditions in each installation was determined using a UNFORS XI (Billdal, Sweden) or PMX III (RTI Electronics, Mölndal, Sweden) detector. A back-scattering factor of 1.1 was applied to the values obtained following the Spanish norm. The degree of dependence and correlation between variables was assessed by an Analysis of Variance complemented by a comparison of means using the minimum significant difference method (p<0.05). Quantitative means were compared by regression and linear correlation analysis. RESULTS Since 1997, radiographic films have been replaced by digital systems in Spain at an annual rate of 3.1%. In 2007, we determined that 50% of dental services utilized digital imaging systems while the other 50% used radiographic film. However, in recent years (2007-2014) the rate of growth for digital systems has been 1.2% only. We set a DRL of 2.8 mGy in 2014, which represents a 41.7 % decrease compared with the dose we set in 2002 (4.8 mGy). Over this same period, the mean dose fell by 54.5%. The DRL recommended by the European Union in 2004 for intraoral radiology was 4 mGy, and our study shows that 99.4% of the installations used a dose below this. Furthermore, we set a mean dose of 1.3 mGy in 2014, which represents a decrease of 55.2% compared with the dose we set in 2002 (2.9 mGy), although over the last three years it has remained at 1.3 mGy. Over this three year period, the mean dose has undergone no reduction whatsoever and DRLs have only decreased by 6.3%. In conclusion, the progress in DRLs over recent years is that of a gradual reduction, which may be interpreted as an increase in the optimization of intraoral radiology techniques in Spain, yet fundamentally is due to the substitution of conventional imaging systems for modern digitals ones.

The aims of this work were to image and analyze the needle behavior at automated core biopsy, to investigate the clinical utility of an alternative core biopsy technique using a semiautomated gun in breast and axillary lesions, and also to compare core biopsy with surgical specimens in malignant breast lesions regarding histologic features and hormone receptor expression.

In two experimental studies, using butter and silicon phantoms, respectively, the needle pass was imaged and its dynamic behavior studied. It was shown that the needle took a curved course in phantoms. It deviated to the same side as where the tip lay, and the degree of the curvature increased with increasing hardness of the phantoms. Our experimental methods can be applied for imaging of needle behavior and thereby improvement of needle configuration.

In two clinical studies, a semiautomated gun was used for large needle core biopsy of breast and axillary lesions in two series of 145 and 21 patients, respectively. The sensitivity of the method for diagnosis of malignancy was 87% (108/124), and in 37% (31/83) of cases the full length of the needle notch was filled with specimen. No injury to the neurovascular structures of the axillary area was observed. It was concluded that the semiautomated gun can be used as an alternative to the automated gun when the size and location of the lesion render use of the automatic device uncertain or dangerous, e.g., in small breast lesions or lesions located in the axilla.

In a series of 129 cases of breast cancer, comparison of core biopsy and surgical specimens showed that core biopsy provided enough information on the histologic type and grade of the lesions. Also, there was moderate to high concordance between the two methods for assessment of progesterone receptors and estrogen receptors (Spearman`s kappa 0.67 and 0.89, respectively).

Nel testo viene descritto passo dopo passo come la tecnologia si è imposta all'interno del campo radiologico. Dallo scenario generale con i vari attori e mezzi di comunicazione, alla realizzazione del progetto di trasformazione di tutta una unità radiologica da analogica a digitale.

Este estudo apresenta a avaliação das condições de radioproteção em radiologia intraoral. A pesquisa foi realizada em parceria com o Instituto de Radioproteção e Dosimetria da Comissão Nacional de Energia Nuclear (IRD/CNEN). A coleta de dados foi feita por meio de pesquisa de campo quantitativa de caráter descritivo durante o período de setembro de 2013 a dezembro de 2014. Participaram voluntariamente do estudo, odontólogos da cidade de Curitiba - PR que atuam com equipamentos de raios X intraorais. A amostra da pesquisa consistiu em 97 odontólogos e 130 equipamentos intraorais instalados em 74 locais de atendimentos distribuídos em 39 bairros da cidade de Curitiba - PR. Foram avaliadas 21 clínicas odontológicas, 40 consultórios odontológicos, 1 hospital universitário, 8 unidades municipais de atendimento odontológico e 4 instituições de ensino. Os dados foram coletados por meio de formulários preenchidos pelo pesquisador, pelos odontólogos, e pela avaliação de controle de qualidade dos equipamentos de raios X. As avaliações de dose de entrada na pele, tamanho de campo de radiação e filtração total foram realizadas com kits dosimétricos fornecidos e avaliados pelo IRD/CNEN. As medidas do tempo de exposição e da tensão dos equipamentos de raios X foram realizadas com detectores não invasivos. A dose ocupacional dos odontólogos foi verificada com dosímetros termoluminescentes. Por meio de formulários e de um questionário (aprovado pelo Comitê de Ética em Pesquisa de Seres Humanos - UTFPR) foi possível identificar as características técnicas dos equipamentos, avaliar os procedimentos de trabalho e o conhecimento dos odontólogos em relação à radioproteção. Com os resultados da pesquisa é possível destacar que apenas 10% dos equipamentos avaliados atendem a todas as exigências das normas de radioproteção do Brasil. Entretanto, 84,5% das doses de entrada na pele dos pacientes foram consideradas como conforme. Em relação à exposição ocupacional, a radiologia intraoral mostra-se segura, porém os procedimentos de trabalho dos odontólogos, referentes à radioproteção podem ser otimizados. Grande parte dos odontólogos não utiliza posicionador na sua rotina, fazem o processamento químico das radiografias através do método visual, usam sempre o mesmo tempo de exposição para todas as regiões anatômicas e não observam os pacientes durante a aquisição das imagens. O estudo sugere que a falta de conhecimento e de interesse dos odontólogos em relação à radioproteção, a falta de manutenção periódica dos equipamentos e a falta de fiscalização da agência regulamentadora são os responsáveis pelas não conformidades observadas.
This study presents an evaluation of the radiation protection conditions in intraoral radiology. The survey was conducted in partnership with the Radiation Protection and Dosimetry Institute of the National Commission of Nuclear Energy (IRD/CNEN). Data collection was performed using quantitative field research in a descriptive way during the period of september 2013 to december 2014. The study had the voluntarily participation of dentists in the city of Curitiba – PR, working with intraoral X-ray equipment. The research sample consisted of 97 dentists and 130 intraoral equipments which are installed in 74 care locations distributed in 39 neighborhoods in the city of Curitiba - PR. The study evaluated 21 dental clinics, 40 dental offices, 1 hospital, 8 municipal units of dental care and 4 educational institutions. Data were collected through forms checked out by the researcher, by dentists and the quality control evaluation of X-ray equipment. The evaluation of the entrance skin dose, radiation field size and total filtration were performed with dosimetric kits supplied and evaluated by IRD/CNEN. The exposure time and voltage measures of X-ray equipment were performed with noninvasive detectors. Occupational dose was measured with thermoluminescent dosimeters. Through appropriate forms and a questionnaire (approved by the Ethics Committee of Human being Research - UTFPR) it was possible to identify the technical characteristics of the equipment, review the working procedures and knowledge of the dentists in relation to radiation protection. Among the search results it is important to emphasize that only 10% of the evaluated equipment reaches all requirements of the Brazilian radiation protection standards. However, 84,5% of the entrance skin dose delivered to the patients was considered in accordance. Regarding occupational exposure, the intraoral X-rays seem to be safe, but the dentist’s working procedures, related to the radiation protection, can be optimized. Most dentists do not use positioners in their routine, make the chemical processing of X-rays through the visual method, routinely use the same exposure time for all anatomic regions and do not observe patients during image acquisition. The study suggests that the dentists’s lack of knowledge and interest in radiological protection, the lack of equipment regular maintenance and the lack of regulatory agency supervision are the responsible for the nonconformities observed.

Mestrado em Gestão Pública
O presente trabalho decorre de um convite da Universidade de Aveiro para o desenvolvimento de um projecto de investigação sobre a qualidade profissional em algumas áreas da saúde, tendo em vista a criação de instrumentos para a sua avaliação. A introdução de melhorias ao nível da formação académica, tendo em consideração os dados resultantes das avaliações, é o propósito principal do projecto. Assim, o objectivo deste estudo é o da criação de um instrumento de avaliação da qualidade profissional dos recém-licenciados em Radiologia (QPdRLeR), com o qual se procura contribuir para que as instituições, principalmente as escolas, possam tirar conclusões sobre a preparação técnica, científica e de relacionamento humano dos técnicos de radiologia, através do conhecimento da forma como estes aplicam na actividade profissional as suas capacidades e conhecimentos. Conforme o objectivo apontado, estas conclusões devem dar origem a medidas de melhoria ao nível do ensino, mas deverão, igualmente, servir para a tomada de medidas de melhoria da qualidade do desempenho profissional. O instrumento de avaliação da qualidade profissional que procurámos conceber, baseia-se num modelo que é considerado de grande precisão na medição de variáveis latentes, criado na década de sessenta pelo matemático de origem dinamarquesa Georg Rasch. Em Portugal, a utilização do modelo de Rasch está ainda a dar os primeiros passos, sendo mesmo pioneira na avaliação da qualidade profissional dos técnicos de radiologia. O presente trabalho procura, em primeiro lugar, caracterizar a Qualidade nos serviços de saúde e, em particular, na prestação de serviços de radiologia. De seguida, são abordados aspectos relacionados com a formação dos técnicos de radiologia e com a avaliação. Por fim, são descritos os processos que utilizámos para a criação do instrumento de avaliação da QPdRLeR, analisados os resultados e retiradas algumas conclusões. O instrumento de avaliação da QPdRLeR foi submetido à avaliação de 40 técnicos de Radiologia com um ano, ou menos, de licenciatura. Os avaliadores são directores e médicos dos serviços de radiologia de 9 instituições de saúde onde os recém-licenciados trabalham há, pelo menos, 3 meses. Apesar do instrumento de avaliação da QPdRLeR precisar de voltar a ser testado numa população mais ampla, os resultados por ele obtidos permitem concluir que o modelo de Rasch é de grande fiabilidade para medir o subjectivo, neste caso, a qualidade profissional dos técnicos de radiologia, podendo ser de muita utilidade para a tomada de medidas relacionadas com a melhoria do ensino e/ou de decisões relacionadas com a melhoria contínua da qualidade. ABSTRACT: The present study has emerged as a result of the solicitation from the Aveiro University to develop an investigation scientific and technological evolution, of the increase in the competitiveness and internationalisation of the professional activities and of t project on the professional quality of some services related to health, having in mind the creation of instruments that can assess those services. To bring in improvement at academic qualifications level, considering the data resulting from the evaluations, is the main purpose of the project professional quality. In this way, the objective of this work is the creation of a skilful assessment tool that can measure the professional quality of the recent graduates in radiology, with which a contribution is attempted to be made so that the institutions, mainly schools, may reach some conclusions about their technical and scientific preparation as well as about the human relationships of radiology technicians in the way they use their abilities and knowledge in their professional activity. These conclusions must give rise to measures that will improve the level of teaching as well as the quality of the professional performance. The professional quality assessment tool that we are trying to create is based on the model invented in the sixties by the Danish mathematician Georg Rasch, and it is considered to be quite accurate in the measurement of latent variables. In Portugal, the use of Rasch’s model for this propose is still getting of the ground and, regarding the assessment of the professional quality of radiology technicians, such a tool hasn’t been used so far. This work, tries, firstly, to characterise the quality of the health services, rendered in the field of radiology. Secondly, it approaches some aspects related with the radiology technician’s qualifications and with their assessment. Finality, it describes the processes in creating the QPdRLeR’s assessment tool, analyses the results and draws some conclusions. The QPdRLeR’s assessment tool was submitted to a test consisting in the evaluation of 40 radiology technicians with a degree for more than a year. The assessors are radiology directors and physicians working in nine health institutions, where the newly radiology technicians have worked for at least three months. Despite the need for the QPdRLeR’s assessment tool to be tested again in a wider population, its results allow us to conclude that Rasch’s model is of great feasibility to measure what is subjective, in this case, the professional quality of the radiology technicians, what might be of great use for political measures concerning education and / or in making decisions related to the continuous improvement of quality.

Mestrado em Engenharia Electrónica e Telecomunicações
As técnicas imagiológicas assumem-se como os meios complementares de diagnóstico e terapêutica (MCDT) de maior relevância no cenário clínico actual. O recurso crescente a estas técnicas surge no sentido de maximizar a acuidade do diagnóstico, procurando correlacionar a informação imagiológica com outros dados clínicos, previamente identificados. A imagiologia médica compreende um vasto conjunto de técnicas de recolha de dados e de equipamentos tecnológicos, usados como complemento ao diagnóstico e tratamento de algumas patologias. A odontologia recorre cada vez com mais proeminência à radiologia projectiva, considerando-a como parte constituinte de um exame dentário. Este trabalho surge no âmbito duma iniciativa a nível europeu, visando a obtenção de dados de um arquivo de radiografias dentárias e a aplicação de técnicas de análise e processamento digital que permitam identificar e correlacionar as estruturas morfológicas dentárias com diversas patologias do foro estomatológico. No âmbito desta dissertação, abordaram-se temas inerentes à formação e visualização de radiografias dentárias, assim como da qualidade expectável para este tipo de imagens. A melhoria da qualidade da imagem em radiologia, enquanto técnica de préprocessamento, reflecte-se credibilidade qualidade dos resultados produzidos pelos métodos de segmentação, usados na identificação dos contornos dos dentes. As técnicas de pré-processamento estudadas neste trabalho podem classificar-se em dois níveis: técnicas de minimização de ruído e técnicas de manipulação do contraste. Neste universo, foram estudados quatro métodos de segmentação orientados ao contorno, os quais foram designados por: método do gradiente; método MAP (maximum aposteriori); GVF – Snakes; e método interactivo baseado em Live Wire. Estas técnicas foram testadas em radiografias dentárias, propondose como principal aplicação prática a avaliação quantitativa da periodontite, baseada na medição da perda de massa óssea alveolar. A depuração e validação dos métodos foi fundamentada pelo estudo estatístico da variabilidade inter observador registada durante a tarefa de medição da perda de massa óssea alveolar. Finalmente, e no sentido de integrar as técnicas estudadas no âmbito desta dissertação, propôs-se um protótipo de um sistema de informação e processamento para radiologia odontológica. ABSTRACT: Image analysis techniques are the most important complementar means of diagnosis and therapeutics (MCDT) in the actual clinical scenery. The growing resource to these techniques appears in order to maximize the diagnosis acuity and to establish a relation between the information of the images with other clinical data, previously identified. Medical imaging contains a large set of data acquirement techniques and of technological equipments, used as complement to the diagnosis and treatment of some pathologies. The dentistry uses the projective radiology with more prominence, considering it as an auxiliary tool of dental exam. This work appears in an European initiative with two main goals. The first is the acquirement of a large data file of dental x-ray images and the second is to construct a software tool, which contains several techniques of digital image analysis and processing that can be used to identify and correlate the morphology of dental structures with several stomatological pathologies. In this dissertation, are presented themes about the formation and visualization of dental x-ray images, as well as about the expected quality for this kind of images. In radiology, the improvement of the image quality as preprocessing technique is reflected in the reliability of the results produced by the segmentation methods and used in the teeth contours identification. The preprocessing techniques that were studied in this work can be classified in two types: techniques of noise minimization and techniques of contrast enhancement. Therefore, were studied four contour oriented segmentation methods, which were designated as: gradient method; MAP method (maximum aposteriori); GVF - Snakes; and interactive method based on Live Wire. These techniques were tested in dental x-ray images, and was proposed as main practical application, the quantitative evaluation of periodontitis, based on the alveolar bone loss measurement. The depuration and validation of the implemented methods was based on the statistical study of the inter-observer variability, observed during the measurement of the alveolar bone loss. Finally, it was proposed a prototype of an information and processing system for odontological radiology, in order to integrate the techniques that were studied in the context of this dissertation.

Bakgrund: Barn som kommer till den radiologiska avdelningen kan uppleva oro i den högteknologiska miljön. Barn med autismspektrumtillstånd kan uppleva mer oro i dessa miljöer då diagnosen innebär nedsatta förmågor gällande social- och språklig kommunikation, föreställningsförmåga samt flexibilitet. För en optimal undersökning ställer det krav på att röntgensjuksköterskan kan ge ett bemötande som minskar oro. Metod/Syfte: Arbetet utformades som en litteraturöversikt med systematiskt tillvägagångssätt för att besvara syftet hur röntgensjuksköterskan kan bemöta barn med autismspektrumtillstånd för att minska oro i samband med undersökning på den radiologiska avdelningen. Resultat: Tre huvudkategorier identifierades i resultatet: vårdmiljö, vårdpersonalens roll samt föräldrarnas roll. För att minska oro hos barnet kan röntgensjuksköterskan anpassa vårdmiljön och genom förberedelser skapa en känd miljö. Röntgensjuksköterskan kan även ha ett förhållningssätt där kommunikation anpassas till barnet och ett samarbete med föräldrarna skapas.   Slutsats: Röntgensjuksköterskan har ansvar att anpassa sitt bemötande och kan genom att tillämpa strategier minska oro hos barnet med autismspektrumtillstånd vid radiologiska undersökningar.

This thesis presents a series of studies aiming to understand young children's (12 to 41 months of age) distress behaviour during radiological examinations. A multifactorial model is proposed to account for variations in the amount of distress behaviour children exhibit during radiological examinations. By way of testing the model, the research examines the relative contribution of a number of variables to such distress behaviour. The Feasibility Study (n=34) was designed mainly to obtain an overall understanding of the different examinations that young children receive at the Department of Paediatric Radiology in a children's hospital. It involved twelve different examinations. The purposes of the Pilot Study (n=48) were to ensure that it was possible to assess in a systematic way the patterns of behaviour presented by young children undergoing ultrasound scans, and to identify and refine the structure of the instruments to be used in a substantial study which would be submitted to the hospital's Research Ethics Committee. The ultrasound scan was the sole examination observed in this study. The Intervention Study's (n=213) main purpose was to assess whether an approach which involved prior rehearsal of the examination and an active, structured role for the parent and child, was effective in reducing children's distress. For this study, two different examinations, i.e., micturating cystogram and ultrasound scan were included. The aims of the Study of Staff Behaviour (n=41) were to show whether the behaviour of the staff contributed to the child's reduced level of distress during the examination. It comprised observations of the ultrasound scan examinations. The results demonstrated that the ultrasound examination, which was not painful or uncomfortable, was almost as distressing for these young children as an examination (the micturating cystogram) which involved substantial discomfort. Parent-child preparation was not effective in preventing or reducing the children's distress. However, staff behaviour during the initial phase of the examination was an important determinant of the child's subsequent distress behaviour.

This thesis addresses the problem of analysing clinical MRI using modern computer vision methods for a variety of clinical and research-related tasks. We use automated machine learning algorithms to develop a spinal MRI analysis framework for a number of tasks such as vertebrae detection, labelling; disc and vertebrae segmentation, and radiological grading, and we validate the framework on a large, heterogeneous dataset of 300 symptomatic back pain patients from multiple clinical sites and scanners. Our framework has a number of back pain research and other spine-related clinical applications and could hopefully find application in a clinical workflow in the future. Our framework has five steps -- detection, labelling, segmentation, support regions and features, and machine learning for radiological measurements. The framework works in full 3D and has currently been implemented on sagittal T2 slices. We use Deformable Part Models along with a chain model to detect and label vertebrae, and a powerful graph cuts based method for vertebrae and disc segmentation. The labelled detections and segmentations are used to place support regions for feature extraction, which are mapped into a number of radiological measurements -- namely Pfirrmann grade, disc space narrowing, and herniation/bulge. The radiological ground truth was provided by a clinical radiologist with 25 years experience. We demonstrate a high performance in the measurement in each. The measurements are performed using support vector machines and support vector regressors learned on training data. We next investigate the problem of what is the best method of obtaining support regions. We first used pixel intensity features to predict the Pfirrmann grade, narrowing and bulge/herniation, with vertebrae segmentation to localise their support regions. Since segmentation of spine images, especially intervertebral discs is an unsolved problem and algorithms are prone to failure, we then ask the question, to segment or not to segment. To answer the question, we compare results on Pfirrmann grade prediction with three different points on the no segmentation to full disc segmentation involving no segmentation, vertebrae segmentation, or disc segmentation and find that vertebrae segmentation suffices. We finally show preliminary results in distinguishing between different radiological conditions related to the posterior side of the disc more finely than before in literature, taking information from both sagittal and axial slices to attempt to distinguish between herniated and bulged discs.

Bakgrund: I Sverige har alla personer rätt till lika vård. För att kunna utföra sitt arbete krävs en god kommunikation mellan röntgensjuksköterskan och patienten. Kommunikation innefattar verbala- och icke verbala uttryck, som är ytterst essentiellt för arbete inom vården. Genom omdöme, kunskap och noggrannhet måste röntgensjuksköterskan kunna ge adekvat information som berör undersökningen eller behandlingen. Informationen bör anpassas utefter patientens förmåga och vitala tillstånd att tillgodose sig denna. Syfte: Syftet var att sammanfatta faktorer som kan påverka kommunikationen mellan röntgensjuksköterskan och patienten. Metod: Denna studie genomfördes som en allmän litteraturstudie där databaserna PubMed och Cinahl användes. Totalt inkluderades och analyserades 10 artiklar i studien.  Resultat: Studiens resultat sammanfattades i 7 olika faktorer; professionalism, språk, information, hög arbetsbelastning, tid, sjukdom och ångest/rädsla. Alla faktorer kunde förbättra kommunikationen, men också försvåra den. Slutsats: Mer kunskap och medvetande om kommunikation hos röntgensjuksköterskan behövs, samt ett samarbete med kollegor för uppmuntran till kommunikation som är individanpassad. Att sammanfatta dessa faktorer kan hjälpa röntgensjuksköterskan i dennes arbete med kommunikationen till patienten i olika situationer.
Background:In Sweden, all persons are entitled to equal health care. In order for the radiographer to carry out their work, good communication between the radiographer and the patient is required. Communication with both verbal expressions and also body language which is necessary when working in health care. Through judgment, knowledge and accuracy, the radiographer must be able to provide adequate information regarding the examination or treatment.The information should be adapted according to the patient's ability and vital condition to accommodate this. Purpose: The purpose of the thesis was to summarize factors that may affect communication between the radiographer and the patient.Method: In order to achieve this, it was decided to make a qualitative, general literature study using the PubMed and Cinahl databases. A total of 10 articles were selected for the thesis. Results: The results were summarized in 7 different factors; professionalism, language, information, high workload, time, illness and anxiety/fear. All factors could improve communication, but some parts could also make it difficult. Conclusion: More knowledge and awareness of communication skills is necessary for the radiographer, as well as collaboration with colleagues to encouraging individualized communication. Summarizing these factors can help us as radiographer in our work on communicating to the patient in different situations.

Questo lavoro si pone l'obiettivo di fornire stime della dose efficace annua e della dose al cristallino annua per operatori di radiologia interventistica. Ci si concentra inoltre sulla dose al cristallino vista la recente direttiva EURATOM che dovrà essere recepita dalla normativa italiana entro febbbraio 2018. Ci si è occupati di una equipe di tre medici radiologi operanti presso il reparto di Neuroradiologia dell'Ospedale Bellaria di Bologna che lavora principalmente con un angiografo biplanare. Il lavoro sperimentale ha avuto inizio delineando il campo di radiazione presente nella sala operatoria ed in particolare, nei pressi del primo medico operatore che è risultato essere quello più esposto alle radiazioni. Il campo di radiazione è stato definito tramite misurazioni con camera a ionizzazzione utilizzando dei fantocci in PMMA simulanti un paziente. Determinati i valori del campo di radiazione e stabiliti alcuni parametri fissi si è cercato un parametro (possibilmente registrato dalla macchina) che permettesse una correlazione tra il carico di lavoro degli operatori e la dose da essi ricevuta in modo da ricavare stime sul lungo periodo. Questo è stato individuato nel DAP totale (registrato automaticamente dopo ogni intervento e presenti nei report) grazie alla presenza di mappe isokerma fornite dalla ditta costruttrice dell'angiografo. Tali mappe forniscono una relazione tra Kerma e DAP al variare di alcuni parametri di macchina. Affinchè fosse possibile utilizzare le mappe isokerma ne è stata necessaria la verifica tramite ulteriori misure sperimentali (nelle stesse condizioni operative definite nelle mappe). Effettuata la verifica si è determinato il carico di lavoro degli operatori per quattro mesi, assunto come periodo sufficientemente lungo per una stima sulla dose assorbita annua. Combinando i carichi di lavoro con i valori di dose assorbita rilevati si sono ottenute le stime obiettivo della tesi che vengono discusse sotto vari aspetti.

Estudos recentes têm indicado o aumento da incidência de opacidade do cristalino para baixas doses de radiação. Considerando os dados epidemiológicos, a Comissão Internacional de Proteção Radiológica (ICRP) emitiu um comunicado que mudou o limite de dose absorvida para o cristalino. A publicação também recomenda a redução dos limites de dose equivalente para os indivíduos ocupacionalmente expostos, agora considerado de 20 mSv em um ano, em média, ao longo de cinco anos. Como consequência, algumas exposições planejadas requerem o uso de dosímetro adicional para estimar a dose no cristalino em profissionais. Este é o caso dos profissionais de radiologia intervencionista. Atualmente, as normas nacionais e internacionais, carecem de uma metodologia específica para a dosimetria em Hp(3). A recomendação ICRP provocou o debate sobre a adequação da grandeza equivalente de dose e sobre os métodos para as suas medições. Os objetivos deste trabalho foram: estudar a metodologia para a calibração de dosímetros pessoais em Hp(3) e monitorar profissionais durante os procedimentos de radiologia intervencionista. Diretrizes internacionais e recomendações da literatura recente foram adotadas para os procedimentos de calibração e testes. Para calibração, o sistema de dosimetria, que consiste em um suporte e um detector termoluminescente LiF:Mg,Cu,P (TLD-100H), foi exposto a radiações de referência em um fantoma cilíndrico preenchido com água, que se simulou a cabeça. Os fatores de calibração foram determinados para o potencial de tubo 20-150 kV da série 4037 estreito espectro de ISO. A monitoração individual foi realizada durante procedimentos vasculares de angioplastia e angiografia. Os resultados mostraram-se satisfatórios comparados à literatura.
Recent studies have indicated the increase of the incidence of lens opacities for low radiation doses. Considering epidemiological data, the International Commission on Radiological Protection (ICRP) issued a statement that changed the absorbed dose threshold for the eye lens. The statement also recommends a reduction in the dose limits to the eye lens for occupationally exposed persons; now it is considered to be 20 mSv in a year averaged over five years. As consequence, some planned exposures require the use of additional dosemeter for estimating eye lens dose in professionals; it is the case of the staff in interventional radiology. Nowadays, in the national and international standards there is a lack of specific methodology for eye lens dosimetry. The ICRP recommendation raised the debate on the adequacy of dose equivalent quantities of radiological protection and on the methods for their measurements. The objectives of this research were to study the methodology for calibrating personal dosemeters in Hp (3) and monitor professionals during interventional radiology procedures. International guidelines and recent literature were adopted for the calibration procedures and tests. For calibration, the dosimetric system, consisting of a holder and thermoluminescent detector LiF:Mg,Cu,P (TLD-100H), was exposed to standard radiation fields on a cylindrical water phantom that simulated the head. The calibration coefficients of the dosimetric system were determined for tube potential from 20 to150 kV of the ISO 4037 narrow spectrum series. The individual monitoring was performed during vascular procedures - angiography and angioplasty. The results were satisfactory were compared to the literature

Este trabalho avalia a distribuição de dose recebida por trabalhadores envolvidos nos procedimentos de radiologia veterinária portátil digital e verifica a redução da dose obtida com a utilização de equipamentos de proteção individual. Para esta avaliação foram feitas medições utilizando dosímetros termoluminescentes tipo TLD-100, posicionados em sete diferentes pontos do corpo dos assistentes: mãos, tórax (por fora do avental), tireoide (por dentro do avental), cantos dos olhos esquerdo e direito e centro dos olhos e em cinco pontos diferente no médico veterinário: tórax (por fora do avental), tireoide (por dentro do avental), cantos dos olhos esquerdo e direito e centro dos olhos. As doses ocupacionais foram avaliadas em 63 procedimentos radiográficos de cães realizados com 49 assistentes e um médico veterinário na região metropolitana de Curitiba, PR. Os resultados mostram a importância do uso do protetor de tireoide e avental de chumbo para a redução da dose recebida pelos profissionais. As doses dos assistentes que seguraram os animais foram mais altas na região das mãos. Este estudo mostra a necessidade de medidas adicionais de proteção e a implementação de mecanismos de treinamento em proteção radiológica para os médicos e assistentes que trabalham com radiologia portátil digital.
This study evaluates the distribution of the dose received by work-people involved in portable digital veterinary radiology procedures and checks the dose reduction obtained with the use of individual protection equipments. For this evaluation measurements were made using TLD-100 thermoluminescent dosimeters,positioned at seven different spots on the body of the assistants: hands, chest (outside the apron), thyroid (inside the apron), left and right eye corners and at the forehead, and in five different spots in the veterinarian: chest (outside the apron), thyroid (inside the apron), left and right eye corners and the center of the eyes. The dosage was evaluated through the 63 procedures performed with 49 assistants and a veterinarian in the metropolitan region of Curitiba, PR. The results show the importance of using thyroid protection and lead aprons to reduce the dosage received by the veterinarian and assistants. The dosages of the assistants who held the animals were higher in the areas of the hands. This study shows the need for additional protective measurements and the implementation of training mechanisms in radiation protection for physicians and assistants who work with portable digital radiology.

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Para medir a dose em procedimentos que utilizam raios X foi desenvolvido um sistema dosimétrico. O equipamento desenvolvido consiste de um dosímetro portátil de leitura direta com base em detectores semicondutores e um sistema computacional de processamento de dados instalado em um computador. A comunicação entre o dosímetro portátil e o sistema computacional pode ser realizada via rede sem fio ou conexão USB. Diversos dosímetros podem ser conectados a um mesmo sistema computacional. Os dados que trafegam pela rede são transmitidos em tempo real para todos os usuários através de um protocolo de comunicação desenvolvido especialmente para este projeto. O sistema tem potencial de aplicação tanto na dosimetria de paciente como na monitoração ocupacional. O sistema dosimétrico foi testado nas qualidades de radiodiagnóstico definidas pela IEC 61267 denominadas de RQR3, RQR5, RQR8, RQRI0. Na monitoração ocupacional foram utilizadas as qualidades de radioproteção definidas pela ISO 4037 conhecidas como 40, N60, N80, NI00 e N120. Além disso, o dosímetro foi também avaliado com energias dos raios gama do Cs-137 e Co-60. Com base nos resultados, pode-se observar que a resposta do dosímetro possui coeficiente de variação menor 1 % e desvio padrão inferior a 10 % nos testes de reprodutibilidade. O sistema apresenta uma resposta linear quando exposto ao kerma no ar nas qualidades de radiação estudadas.
A dosimetric system has been developed for dose measurement in procedures which makes use of X-rays. The developed instrument consists of a semiconductor-detector based portable wireless dosimeter and a computational data processing system installed in a computer. Communication between the portable dosimeter and the system installed on the computer can be performed via wireless network or USB. Several portable dosimeters can be connected to one computational system. The data that travel over the network are transmitted in real time to all users through a communication protocol specifically designed for this application. The system has potential application in both for patient dosimetry and occupational monitoring. The dosimetric system has been tested at the IEC 61267 radiation qualities RQR3, RQR5, RQR8 and RQR10, for radiology, and, ISO 4037 N40, N60, N80, N100 and N120, for occupational monitoring. Moreover, the dosimeter has also been evaluated in gamma ray energies of Cs-137 and Co-60. Based on the results, one can observe that the dosimeter response has a coefficient of variation below 1 %, and a standard deviation lower than 10 % for reproducibility tests. The system displays a linear response when exposed to Air Kerma for the studied radiation qualities.

Mestrado em Supervisão
A supervisão clínica na formação inicial dos Técnicos de Radiologia representa uma dimensão crucial no seu processo de educação pessoal e profissional, conduzindo ao desenvolvimento de competências em contexto de trabalho real. O supervisor (mentor) assume, assim, um papel predominante no processo supervisivo e um impacto considerável no processo de aprendizagem dos alunos. Por essa razão, o supervisor deve possuir um elevado nível de competências técnicas e pedagógicas. O objectivo deste estudo de caso é compreender o que os alunos pensam sobre as competências dos seus supervisores e de que forma elas interferem, influenciam e condicionam o seu processo de aprendizagem. Participaram neste estudo 32 alunos (do 3º ano do Curso de Radiologia), de uma escola politécnica situada no norte de Portugal. Foi utilizado como instrumento de recolha de dados, uma versão adaptada do questionário “Clinical Learning Assessment Invenctory – Mentor (CLASI-M)” de Abreu e Calvário (2005). Dos resultados do estudo emerge a relação supervisiva em conjunto com o feedback transmitido pelo supervisor ao longo do processo, como os factores que, na óptica dos participantes no estudo, mais contribuem para o sucesso da sua aprendizagem. O estudo identifica também algumas deficiências ao nível das competências pedagógicas dos supervisores. Acreditamos que este estudo poderá contribuir para uma melhor compreensão sobre o que os alunos pensam sobre o processo supervisivo e os papeis que devem desempenhar, nesta matéria, a escola, as organizações de saúde e o supervisor. ABSTRACT: Supervision of clinical learning in the initial training of Radiology Technicians is a crucial dimension in their process of personal and professional education, leading to the development of competencies in real context of working. A supervisor (mentor) has a predominant role in the supervising process, and considerable impact on students learning process. For this reason, the supervisor must have a high level of technical and pedagogic competencies. The aim of this case study was to understand what students think about the competencies of their supervisors and in which way they interfere, influence and shape the learning process. The participants of this study were 32 students (3rd year of a Radiology class), from a polytechnic school in the North of Portugal. An adaptation of the questionnaire “Clinical Learning Assessment Inventory – Mentor (CLASI-M)” (Abreu e Calvário, 2005) was used for data collection. The results show that the relationship between the student and the supervisor and the supervisor’s feedback during the process, are the most important factors that contribute to the students successful learning. The study has also identify some needs concerning supervisors’ pedagogical competencies. We believe that this study can contribute to a better understanding of what students think about the supervision process and what is important to do in this matter by the school, by the health organizations and by the supervisors.

Mestrado em Gestão da Informação
A evolução tecnológica vivida nas últimas décadas revolucionou o ambiente formativo e os recursos utilizados nos processos de ensino e aprendizagem. A utilização das Tecnologias de Informação e Comunicação para a disseminação de informação em ambiente educativo promoveu o surgimento de metodologias de ensino fortemente dependentes da tecnologia disponível. Esta evolução tecnológica repercutiu-se também na formação dos profissionais de imagiologia médica, nomeadamente dos técnicos de radiologia. A existência de sítios web com material formativo, a par com o crescente desenvolvimento da formação baseado em e-learning, tornaram o acesso a estes recursos de informação uma mais valia no processo educativo. Mas, a utilização de grande parte destes recursos implica que o utilizador conheça os conceitos adjacentes ao domínio do problema. Por outro lado, o utilizador tem, geralmente, dificuldade em obter uma perspectiva integrada. No âmbito no trabalho aqui apresentado, é proposto um modelo de informação genérico designado como Caso de Estudo (CE), o qual se pretende que seja a base para o desenvolvimento de sistemas de informação de suporte ao ensino da radiologia. O CE constitui o repositório de dados para o que foi definido um modelo de informação genérico que permite a utilização de narrativas de estudos de caso de forma integrada com outros conteúdos de apoio à formação em ambiente digital. O modelo de informação genérico é baseado nos conceitos entrada, colecção e item, os quais são estruturados segundo arquétipos. Estes conceitos foram validados a partir da informação que faz parte da narrativa de um estudo de caso em radiologia convencional.
The technological evolution lived in the last few decades have revolutionized the teaching/learning process and the used resources. The use of information and communication technologies for the information dissemination in learning scenarios has promoted the birth of new methodologies of teaching, strongly dependent of the available technology. This technological evolution had also effects in the formation of radiology professionals, such as x-ray technologists. The existence of sites with radiology formative material, along with the increasing development of the e-learning, makes the access to these new information resources, of a great importance for the teaching/learning process. However, the use of great part of these new resources is dependent of the user knowledge of the problem domain, and, on the other hand, these resources do not give an integrated perspective of the learning materials. This work pretends to propose a generic information model named Caso de Estudo (CE) that may be used on the construction of new information systems that will support radiology teaching and learning activities. The CE is a data repository and for that it was developed a generic information structure witch provides the utilization of a study case narrative integrated with other digital resources. The generic information structure is based on the concepts entry, collection, and item, which are organised by archetypes. These concepts were validated with the information of a conventional radiography case study narrative.