Diagnóstico precoz de la osteoporosis transitoria de la cadera versus necrosis isquémica de la cabeza femoral: ¿existen realmente signos diferenciales?

—Se han estudiado de forma retrospectiva las posibles diferencias clínicas y en pruebas de imagen de 2 procesos patológicos: la osteoporosis transitoria de la cadera (OTC) y la necrosis isquémica de la cabeza femoral (NICF). El estudio se ha llevado a cabo sobre 7 pacientes diagnosticados de OTC y se han comparado los hallazgos obtenidos con 12 casos de NICF en fase inicial de evolución. Se debate si la OTC es un síndrome distinto a la NICF o si es la manifestación de un estadio precoz y reversible de la misma. Las pruebas de imagen en que se ha basado el estudio han sido: la radiografía simple, el rastreo óseo isotópico y, principalmente, la resonancia magnética (RM). Se han encontrado signos diferenciales entre ambos procesos, pero éstos no nos permiten concluir que se trata de 2 entidades patológicas totalmente diferentes. Se discute por último la actitud terapéutica a llevar a cabo ante un caso de OTC.We report a retrospective study about the differences in clinical signs and in imaging techniques between transient osteoporosis of the hip and avascular necrosis. The study was done on 7 patients of transient osteoporosis and the results obtained were compared with 12 cases of avascular necrosis. We discuss if transient osteoporosis is an individual syndrome or it is an early and reversible stage of avascular necrosis. The imaging techniques studies were: standard X-ray, radionuclide, bone-scanning and MRI. We found differential signs between there two process, but this don't allow us to conclude that the two illness are different. Finally, we discuss the treatment lo carry out in case of transient osteoporosis of the hi

Increasing the Efficiency on Producing Radiology Reports for Breast Cancer Diagnosis by Means of Structured Reports

Background: Radiology reports are commonly written on free-text using voice recognition devices. Structured reports (SR) have a high potential but they are usually considered more difficult to fill-in so their adoption in clinical practice leads to a lower efficiency. However, some studies have demonstrated that in some cases, producing SRs may require shorter time than plain-text ones. This work focuses on the definition and demonstration of a methodology to evaluate the productivity of software tools for producing radiology reports. A set of SRs for breast cancer diagnosis based on BI-RADS have been developed using this method. An analysis of their efficiency with respect to free-text reports has been performed. Material and Methods: The methodology proposed compares the Elapsed Time (ET) on a set of radiological reports. Free-text reports are produced with the speech recognition devices used in the clinical practice. Structured reports are generated using a web application generated with TRENCADIS framework. A team of six radiologists with three different levels of experience in the breast cancer diagnosis was recruited. These radiologists performed the evaluation, each one introducing 50 reports for mammography, 50 for ultrasound scan and 50 for MRI using both approaches. Also, the Relative Efficiency (REF) was computed for each report, dividing the ET of both methods. We applied the T-Student (T-S) test to compare the ETs and the ANOVA test to compare the REFs. Both tests were computed using the SPSS software. Results: The study produced three DICOM-SR templates for Breast Cancer Diagnosis on mammography, ultrasound and MRI, using RADLEX terms based on BIRADs 5th edition. The T-S test on radiologists with high or intermediate profile, showed that the difference between the ET was only statistically significant for mammography and ultrasound. The ANOVA test performed grouping the REF by modalities, indicated that there were no significant differences between mammograms and ultrasound scans, but both have significant statistical differences with MRI. The ANOVA test of the REF for each modality, indicated that there were only significant differences in Mammography (ANOVA p = 0.024) and Ultrasound (ANOVA p = 0.008). The ANOVA test for each radiologist profile, indicated that there were significant differences on the high profile (ANOVA p = 0.028) and medium (ANOVA p = 0.045). Conclusions: In this work, we have defined and demonstrated a methodology to evaluate the productivity of software tools for producing radiology reports in Breast Cancer. We have evaluated that adopting Structured Reporting in mammography and ultrasound studies in breast cancer diagnosis improves the performance in producing reports.INDIGO - DataCloud receives funding from the European Union's Horizon 2020 research and innovation programme under grant agreement RIA 653549.Segrelles Quilis, JD.; Medina, R.; Blanquer Espert, I.; Marti Bonmati, L. (2017). Increasing the Efficiency on Producing Radiology Reports for Breast Cancer Diagnosis by Means of Structured Reports. Methods of Information in Medicine. 56:1-13. https://doi.org/10.3414/ME16-01-0091S1135

Magnetic resonance spectroscopy and brain volumetry in mild cognitive impairment. A prospective study

Objective To assess the accuracy of magnetic resonance spectroscopy (1H-MRS) and brain volumetry in mild cognitive impairment (MCI) to predict conversion to probable Alzheimer''s disease (AD). Methods Forty-eight patients fulfilling the criteria of amnestic MCI who underwent a conventional magnetic resonance imaging (MRI) followed by MRS, and T1-3D on 1.5 Tesla MR unit. At baseline the patients underwent neuropsychological examination. 1H-MRS of the brain was carried out by exploring the left medial occipital lobe and ventral posterior cingulated cortex (vPCC) using the LCModel software. A high resolution T1-3D sequence was acquired to carry out the volumetric measurement. A cortical and subcortical parcellation strategy was used to obtain the volumes of each area within the brain. The patients were followed up to detect conversion to probable AD. Results After a 3-year follow-up, 15 (31.2%) patients converted to AD. The myo-inositol in the occipital cortex and glutamate + glutamine (Glx) in the posterior cingulate cortex predicted conversion to probable AD at 46.1% sensitivity and 90.6% specificity. The positive predictive value was 66.7%, and the negative predictive value was 80.6%, with an overall cross-validated classification accuracy of 77.8%. The volume of the third ventricle, the total white matter and entorhinal cortex predict conversion to probable AD at 46.7% sensitivity and 90.9% specificity. The positive predictive value was 70%, and the negative predictive value was 78.9%, with an overall cross-validated classification accuracy of 77.1%. Combining volumetric measures in addition to the MRS measures the prediction to probable AD has a 38.5% sensitivity and 87.5% specificity, with a positive predictive value of 55.6%, a negative predictive value of 77.8% and an overall accuracy of 73.3%. Conclusion Either MRS or brain volumetric measures are markers separately of cognitive decline and may serve as a noninvasive tool to monitor cognitive changes and progression to dementia in patients with amnestic MCI, but the results do not support the routine use in the clinical settings

Optimisation of ultrasound liver perfusion through a digital reference object and analysis tool

[EN] Background Conventional ultrasound (US) provides important qualitative information, although there is a need to evaluate the influence of the input parameters on the output signal and standardise the acquisition for an adequate quantitative perfusion assessment. The present study analyses how the variation in the input parameters influences the measurement of the perfusion parameters. Methods A software tool with simulator of the conventional US signal was created, and the influence of the different input variables on the derived biomarkers was analysed by varying the image acquisition configuration. The input parameters considered were the dynamic range, gain, and frequency of the transducer. Their influence on mean transit time (MTT), the area under the curve (AUC), maximum intensity (MI), and time to peak (TTP) parameters as outputs of the quantitative perfusion analysis was evaluated. A group of 13 patients with hepatocarcinoma was analysed with both a commercial tool and an in-house developed software. Results The optimal calculated inputs which minimise errors while preserving images¿ readability consisted of gain of 15¿dB, dynamic range of 60¿dB, and frequency of 1.5¿MHz. The comparison between the in-house developed software and the commercial software provided different values for MTT and AUC, while MI and TTP were highly similar. Conclusion Input parameter selection introduces variability and errors in US perfusion parameter estimation. Our results may add relevant insight into the current knowledge of conventional US perfusion and its use in lesions characterisation, playing in favour of optimised standardised parameter configuration to minimise variability.Alberich-Bayarri, Á.; Tomás-Cucarella, J.; Torregrosa-Lloret, A.; Saiz Rodríguez, FJ.; Martí-Bonmatí, L. (2019). 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A Systematic Approach for Using DICOM Structured Reports in Clinical Processes: Focus on Breast Cancer

The final publication is available at Springer via http://dx.doi.org/10.1007/s10278-014-9728-6.This paper describes a methodology for redesigning the clinical processes to manage diagnosis, follow-up, and response to treatment episodes of breast cancer. This methodology includes three fundamental elements: (1) identification of similar and contrasting cases that may be of clinical relevance based upon a target study, (2) codification of reports with standard medical terminologies, and (3) linking and indexing the structured reports obtained with different techniques in a common system. The combination of these elements should lead to improvements in the clinical management of breast cancer patients. The motivation for this work is the adaptation of the clinical processes for breast cancer created by the Valencian Community health authorities to the new techniques available for data processing. To achieve this adaptation, it was necessary to design nine Digital Imaging and Communications in Medicine (DICOM) structured report templates: six diagnosis templates and three summary templates that combine reports from clinical episodes. A prototype system is also described that links the lesion to the reports. Preliminary tests of the prototype have shown that the interoperability among the report templates allows correlating parameters from different reports. Further work is in progress to improve the methodology in order that it can be applied to clinical practice.We thank the subject matter experts for sharing their insights through this study. We are especially appreciative of the efforts of the Radiology Unit and Medical Oncology Unit teams at the University Hospital Dr. Peset. This work was partially supported by the Vicerectorat d'Investigacio de la Universitat Politecnica de Valencia (UPVLC) to develop the project "Mejora del proceso diagnostico del cancer de mama" with reference UPV-FE-2013-8.Medina, R.; Torres Serrano, E.; Segrelles Quilis, JD.; Blanquer Espert, I.; Martí Bonmatí, L.; Almenar-Cubells, D. (2015). A Systematic Approach for Using DICOM Structured Reports in Clinical Processes: Focus on Breast Cancer. Journal of Digital Imaging. 28(2):132-145. doi:10.1007/s10278-014-9728-6S132145282Ratib O: Imaging informatics: From image management to image navigation. Yearb Med Inform 2009; 167–172Oakley J. Digital Imaging: A Primer for Radiographers, Radiologists and Health Care Professionals. Cambridge University Press, 2003.Prokosch HU, Dudeck J: Hospital information systems: Design and development characteristics, impact and future architecture. Elsevier health sciences, 1995Foster I, Kesselman C, Tuecke S. 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Liver Gene Therapy: Employing Surgery and Radiology for Translational Research

Gene therapy is a therapeutic strategy that aims to employ nucleic acids as drugs for the transient or permanent treatment of inherited or acquired pathologies. Based on the type of vector employed for the gene transfer, gene therapy can be classified as viral gene therapy and nonviral gene therapy. Nonviral gene therapy is less efficient but safer than viral gene therapy. Hydrodynamic naked DNA transfer has shown great translational potential, achieving therapeutic levels of a human protein in the murine model. The translational process of the procedure has already been performed. Different radiologic and surgical approaches permitted pressurizing the liver in vivo by excluding its vascularization partially or totally. These approaches mediated a tissue rate of human alpha-1-antitrypsin protein translation (100–1000 copies per cell) close to those obtained with the mouse gold standard model in a safe mode that could be translated to human settings

First-Episode Psychotic Patients Showed Longitudinal Brain Changes Using fMRI With an Emotional Auditory Paradigm

Most previous longitudinal studies of functional magnetic resonance imaging (fMRI) in first-episode psychosis (FEP) using cognitive paradigm task found an increased activation after antipsychotic medications. We designed an emotional auditory paradigm to explore brain activation during emotional and nonemotional word processing. This study aimed to analyze if longitudinal changes in brain fMRI BOLD activation is present in patients vs. healthy controls. A group of FEP patients (n = 34) received clinical assessment and had a fMRI scan at baseline and follow-up (average, 25-month interval). During the fMRI scan, both emotional and nonemotional words were presented as a block design. Results were compared with a pair of healthy control group (n = 13). Patients showed a decreased activation at follow-up fMRI in amygdala (F = 4.69; p = 0.04) and hippocampus (F = 5.03; p = 0.03) compared with controls. Middle frontal gyrus was the only area that showed a substantial increased activation in patients (F = 4.53; p = 0.04). A great heterogeneity in individual activation patterns was also found. These results support the relevance of the type of paradigm in neuroimaging for psychosis. This is, as far as we know, the first longitudinal study with an emotional auditory paradigm in FEP. Our results suggested that the amygdala and hippocampus play a key role in psychotic disease. More studies are needed to understand the heterogeneity of response at individual level

Prevalencia del síndrome de desgaste en radiólogos españoles

Objetivos Analizar la prevalencia y grado del síndrome de desgaste profesional entre radiólogos en España. Como objetivos secundarios se pretende identificar sus posibles factores desencadenantes y atenuantes para implementar intervenciones preventivas y correctivas, disminuyendo el estrés asociado y aumentando el rendimiento y la satisfacción laboral de los radiólogos. Material y métodos Estudio transversal y observacional realizado mediante una encuesta en línea, anónima y voluntaria, desarrollada a través de formularios de Google® y dirigida a radiólogos especialistas y en formación. La encuesta se estructura en tres apartados: una valoración cualitativa del grado del síndrome de desgaste profesional a través del Maslach Burnout Inventory Human Services Survey (MBI-HSS), el segundo constituido por una serie de preguntas sociodemográficas y laborales, y el último apartado centrado en las posibles causas de estrés y de mejora en el entorno laboral. Los resultados de la encuesta se analizaron estadísticamente para determinar la asociación entre las variables y el síndrome, así como para determinar posibles factores de riesgo y protectores. Resultados Tras difundir la encuesta en redes sociales y correo electrónico se recibieron un total de 226 respuestas (175 de especialistas y 51 de residentes). La media de edad fue 41 años (desviación estándar de 11 años, rango de 25 a 68), sin predominancia de género (52% hombres). La prevalencia del síndrome fue del 33%, sin diferencias significativas entre adjuntos y residentes. No se han identificado factores de riesgo que se asocien con el desgaste profesional. Tener docencia en el lugar de trabajo fue el único factor de protección. Conclusiones Un tercio de los radiólogos que han contestado padecen síndrome de desgaste profesional. Dado que las consecuencias de este síndrome pueden afectar al entorno personal y al desempeño laboral del profesional, debería priorizarse su identificación temprana e implementarse una intervención adecuada.Background and aims The primary objective was to analyze the prevalence and degree of professional burnout in radiologists in Spain. Secondary objectives were to identify possible factors that increase or decrease the risk of burnout to enable preventive and corrective measures, decrease the stress associated with this condition, and thereby increase radiologists’ performance and satisfaction at work. Material and methods This cross-sectional observational study used a voluntary, anonymous online survey of attending radiologists and residents through Google Forms®. The survey was structured into three sections: a qualitative assessment of the degree of professional burnout with the Maslach Burnout Inventory Human Services Survey (MBI-HSS), a series of sociodemographic and work-related questions, and a final section centered on possible causes of stress and improvements to the working environment. The results of the survey were analyzed statistically to determine which variables were associated with burnout syndrome as well as to identify possible risk factors and protective factors. Results After disseminating the survey through social networks and email contacts, we received a total of 226 responses (175 from attending radiologists and 51 from residents; 52% men; mean age, 41±11 years; age range, 25-68). The prevalence of the syndrome was 33%, without significant differences between attending radiologists and residents. No risk factors associated with burnout were identified. Teaching in the workplace was the only protective factor. Conclusions One-third of the respondents had burnout syndrome. Because the consequences of this syndrome can affect professionals’ personal life and their ability to do their jobs, early detection and intervention should be prioritized

Medical imaging clinical trials unit: a professional need

Purpose To design and describe a management and control tool and the human resources needed to efficiently manage the imaging process within clinical trials for a better quality of care for the patient. Methods A unit was created to efficiently organise the participation of our Medical Imaging Department in clinical trials. This entity was defined and monitored using a customized, flexible and modular software package that provides the necessary information to execute and monitor requests (appointments, protocols, reports, complaints, billing). Various indicators of activity and professional satisfaction were parameterised. Results From 2016 to 2020, 367 trials were participated and monitored, 50% of all the hospital clinical trials. The budget of the Medical Imaging Department grew by 47% in this period. The coordination with other departments and principal investigators improved, as shown by surveys (62% fluid and 38% very fluid), with a high perception of collaboration (86%). Conclusions The implementation of a Medical Imaging Clinical Trials Unit involve identifying the tasks, personnel, organisational needs, workflow, monitoring and invoicing. The creation of this Unit has improved the control and traceability of clinical trials within the Department.Peer ReviewedPostprint (published version