Artifical intelligence and nuclear cardiology - a current overview / Inteligência artifical e cardiologia nuclear – um panorama atual

The aim of this article is to analyze the current overview of machine learning applied to cardiac imaging in nuclear medicine through a review of the recent literature. In recent years, new highly efficient artificial intelligence tools are revolutionizing the field of image analysis, being developed with the purpose of integrating the large volume of clinical and image information to improve the diagnosis of the disease and the risk estimate. The integration of artificial intelligence in daily clinical practice is being evaluated on several fronts and nuclear cardiology can benefit from the improvement in sensitivity, specificity, and diagnostic accuracy that the incorporation of these technologies can provide.

Padrão cintilográfico ósseo de superscan decisivo para o diagnóstico de hiperparatireoidismo: relato de caso / Superscan bone scintigraphic pattern decisive for the diagnosis of hyperparathyroidism: case report

O padrão superscan da cintilografia óssea é descrito como um aumento uniforme da captação do traçador pelo esqueleto, com pouca atividade no parênquima renal e radiação de fundo reduzida, sendo evidenciado em doenças malignas em estágio avançado e em doenças osteometabólicas. Apresentamos o caso clínico de uma paciente com história de tumor ósseo na tíbia direita que, na avaliação da cintilografia óssea, apresentou um padrão de superscan. Adicionalmente a paciente apresentava elevação do PTH sérico e alteração no exame de cintilografia das paratireoides sugestivo de adenoma. No presente relato observamos como a cintilografia óssea pode auxiliar no diagnóstico clínico e manejo terapêutico nos casos de hiperparatireoidismo

Artefatos na cintilografia de perfusão miocárdica na CZT / Myocardial perfusion scintigraphy artifacts in CZT

O presente artigo teve como objetivo identificar os principais artefatos que podem ser gerados na cintilografia de perfusão miocárdica executada em gama câmara dedicada ao estudo cardíaco com detectores CZT através da análise de exames de cintilografia de perfusão miocárdica realizados no nosso serviço. Dentre os possíveis artefatos que podem ser gerados na CZT durante a cintilografia de perfusão miocárdica destacam-se os artefatos de movimentação do paciente, posicionamento inadequado no aparelho, atenuações, captações extra cardíacas e artefatos causados por condições cardíacas pré-existentes. Na prática diária é essencial saber os tipos de artefatos que podem ocorrer na cintilografia de perfusão miocárdica, para que os mesmos possam ser reconhecidos e corrigidos – quando possível – visando a melhoria na qualidade do nosso exame

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.Funding/Support: The Institute for Health Metrics and Evaluation received funding from the Bill & Melinda Gates Foundation and the American Lebanese Syrian Associated Charities. Dr Aljunid acknowledges the Department of Health Policy and Management of Kuwait University and the International Centre for Casemix and Clinical Coding, National University of Malaysia for the approval and support to participate in this research project. Dr Bhaskar acknowledges institutional support from the NSW Ministry of Health and NSW Health Pathology. Dr Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, which is funded by the German Federal Ministry of Education and Research. Dr Braithwaite acknowledges funding from the National Institutes of Health/ National Cancer Institute. Dr Conde acknowledges financial support from the European Research Council ERC Starting Grant agreement No 848325. Dr Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia, IP under the Norma Transitória grant DL57/2016/CP1334/CT0006. Dr Ghith acknowledges support from a grant from Novo Nordisk Foundation (NNF16OC0021856). Dr Glasbey is supported by a National Institute of Health Research Doctoral Research Fellowship. Dr Vivek Kumar Gupta acknowledges funding support from National Health and Medical Research Council Australia. Dr Haque thanks Jazan University, Saudi Arabia for providing access to the Saudi Digital Library for this research study. Drs Herteliu, Pana, and Ausloos are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Dr Hugo received support from the Higher Education Improvement Coordination of the Brazilian Ministry of Education for a sabbatical period at the Institute for Health Metrics and Evaluation, between September 2019 and August 2020. Dr Sheikh Mohammed Shariful Islam acknowledges funding by a National Heart Foundation of Australia Fellowship and National Health and Medical Research Council Emerging Leadership Fellowship. Dr Jakovljevic acknowledges support through grant OI 175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Dr Katikireddi acknowledges funding from a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). Dr Md Nuruzzaman Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Bangladesh. Dr Yun Jin Kim was supported by the Research Management Centre, Xiamen University Malaysia (XMUMRF/2020-C6/ITCM/0004). Dr Koulmane Laxminarayana acknowledges institutional support from Manipal Academy of Higher Education. Dr Landires is a member of the Sistema Nacional de Investigación, which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación. Dr Loureiro was supported by national funds through Fundação para a Ciência e Tecnologia under the Scientific Employment Stimulus–Institutional Call (CEECINST/00049/2018). Dr Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. Dr Moosavi appreciates NIGEB's support. Dr Pati acknowledges support from the SIAN Institute, Association for Biodiversity Conservation & Research. Dr Rakovac acknowledges a grant from the government of the Russian Federation in the context of World Health Organization Noncommunicable Diseases Office. Dr Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. Dr Sheikh acknowledges support from Health Data Research UK. Drs Adithi Shetty and Unnikrishnan acknowledge support given by Kasturba Medical College, Mangalore, Manipal Academy of Higher Education. Dr Pavanchand H. Shetty acknowledges Manipal Academy of Higher Education for their research support. Dr Diego Augusto Santos Silva was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil Finance Code 001 and is supported in part by CNPq (302028/2018-8). Dr Zhu acknowledges the Cancer Prevention and Research Institute of Texas grant RP210042

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Valor prognóstico da cintilografia de mamas com Sestamibi-99mTc na predição da resposta do tumor localmente avançado da mama a quimioterapia neoadjuvante

Este estudo teve como objetivo avaliar a eficácia da cintilografia de mamas com sestamibi-99mTc na predição da resposta tumoral à quimioterapia neoadjuvante, em pacientes com tumor localmente avançado da mama (estadio T3 e T4, maiores que 5 cm, com invasão de parede ou pele). Foram selecionadas 33 pacientes do sexo feminino com câncer de mama que realizaram cintilografia de mamas antes, durante e após quimioterapia neoadjuvante (QT), seguida de cirurgia (mastectomia ou quadrantectomia). A cintilografia de mamas foi realizada nas incidências anterior e laterais, 10 minutos (precoce) e 60 minutos (tardia) após a injeção de 740 a 925 MBq de sestamibi-99mTc. A aquisição foi realizada em três momentos: estudo basal (antes da QT), após quatro ciclos de QT e após término do esquema quimioterápico, antes da cirurgia. Foi calculada a relação Tumor/Radiação de fundo, através de regiões de interesse com contagens/pixel, nas imagens precoces e tardias de cada estudo. Houve correlação estatisticamente significativa entre a imagem de aquisição tardia (60 minutos após a injeção) e a resposta tumoral à quimioterapia. Apesar de não ter sido estatisticamente significativo, observou-se que um valor de cutoff que separa os respondedores dos não respondedores seria de 28%, ou seja, taxa de washout 28% seria o grupo dos não respondedores. Os resultados encontrados são compatíveis com outras publicações disponíveis, sendo encorajadores, porém mais estudos e novas investigações são necessáriosThis study aimed to evaluate the efficacy of breast scintigraphy with 99mTc-sestamibi predicting tumor response to neoadjuvant chemotherapy in patients with locally advanced breast tumors (stage T3 and T4, larger than 5 cm, with chest wall or skin invasion). 33 female patients with breast cancer who underwent scintigraphy breast before, during and after neoadjuvant chemotherapy (NAC) followed by surgery (mastectomy or lumpectomy) were chosen. Breast scintigraphy was performed in front and side view, 10 minutes (early) and 60 min (delayed) after injection of 740-925 MBq of 99mTc-sestamibi. The acquisition was performed at three time points: baseline study (before NAC), after four cycles of NAC and after completion of chemotherapy regimen before surgery. The tumor / background radiation ration was calculated through regions of interest in counts / pixel in early and late images of each study. There was a statistical significant positive correlation in the Student t test between the mean values of the ratio tumor / background radiation of 10 and 60 minutes in the first and second studies. However, there was no statistical significance, cutoff value to distinguish responders would be 28%, that is, washout ratio 28% nonresponders. Our results are encouraging and similar to some available publications; more research needed and further are investigation