OBJECTIVE: To assess the rate of geographic miss on conventional radiotherapy planning of patients with cervical cancer, using magnetic resonance imaging. MATERIALS AND METHODS: Thirty-two patients with squamous cell carcinoma of the uterine cervix were studied. Magnetic resonance imaging of the pelvis was performed after clinical staging. Magnetic resonance imaging findings were compared with the classic fields described for the "box" technique. Target volume within less than 1 cm margins of the fields' limits was considered as geographic miss. RESULTS: Classical radiation field limits were inadequate in 24 cases (75%), all in the anterior (46%) or posterior (40%) border of the lateral fields. CONCLUSION: Magnetic resonance detected a high probability of geographic miss on conventional radiotherapy planning in this population, both in initial and advanced stages of the disease.

Keywords: Uterine cervix cancer, Radiotherapy, Magnetic resonance imaging

OBJECTIVE: To review the results of adjuvant external beam radiation therapy (EBRT) combined with high-dose rate brachytherapy (HDR-BT) for the treatment of endometrial carcinoma. MATERIALS AND METHODS: We retrospectively evaluated 141 patients treated with EBRT and HDR-BT after surgery between January 1993 and January 2001. EBRT was performed with a median dose of 45 Gy, and HDR-BT was performed with a median dose of 24 Gy, with four weekly insertions of 6 Gy. The median age of the patients was 63 years and the disease stage distribution was: CS I (FIGO), 52.4%; CS II, 13.5%; CS III, 29.8%; CS IV, 4.3%. RESULTS: With a median follow-up of 53.7 months, the disease free survival (DFS) at five years was: CS I, 88.0%; CS II, 70.8%; CS III, 55.1%; CS IV, 50.0% (p = 0.0003). Global survival after five years was: CS I, 79.6%; CS II, 74.0%; CS III, 53.6%; CS IV, 100.0% (p = 0.0062). Factors affecting the DFS were histological grade and serous-papillary histology. Recurrence of the disease was observed in 33 cases, 13 (9.2%) of these occurred in the pelvis, vagina or vaginal vault. EBRT + HDR-BT of the vaginal vault allowed disease control in 90.8% of the cases. CONCLUSION: Radiation therapy is essential for loco-regional control of endometrial cancer and can achieve excellent cure rates in the initial stages. In more advanced stages, therapeutic failure frequently appears as distant metastases suggesting the need for complementary systemic therapy using new treatment modalities, particularly chemotherapy.

Keywords: Carcinoma, Endometrium, Radiation therapy, Brachytherapy

OBJECTIVE: The aim of this study was to quantitatively evaluate the histological changes produced by radiation therapy both on the stroma and the parenchyma of submandibular gland in rats. MATERIALS AND METHODS: The sample size consisted of 30 Wistar rats, divided in two groups: test and control. The 15 animals of the test group were irradiated daily on the head and neck region with a dose of 2 Gy for six weeks using a rotational fractionated modality of 60Co-gamma rays. At the end of the experimental period the animals had received a total dose of 60 Gy. Sixty hours after the last radiation therapy session the submandibular glands of the animals from both groups were excised, processed using paraffin technique, stained with hematoxiline-eosin and analyzed by optical microscopy. RESULTS: The mean proportional volume of the glandular parenchyma and stroma was obtained using a stereological method of manual point counting. The proportional volume of the acini on the irradiated group (60.67% ± 6.43) was significantly lower than the control group (67.42% ± 10.90) (p = 0.048), however there was no statistical difference between the groups for parenchyma, ducts and stroma (Student t test, p > 0.05). CONCLUSION: The radiation therapy produced acinar atrophy in submandibular glands. No total quantitative changes in the stroma or in the parenchyma were observed.

Keywords: Rats, Salivary gland, Radiotherapy, Microscopy

OBJECTIVE: To develop and implement a software based on the manual calculation algorithm for verification of the calculations in radiotherapy monitor units and to establish acceptance levels as a mechanism of quality assurance. MATERIALS AND METHODS: Data were obtained from Clinac 600C and 2100C Varian linear accelerators and the computerized treatment planning system used was CadPlan™. RESULTS: For the 6 MV beams the acceptance levels for deviations among the calculations of monitor units, divided by treatment area, were the following: breast (0.0% ± 1.7%), head and neck (1.5% ± 0.5%), hypophysis (-1.7% ± 0.5%), pelvis (2.1% ± 2.1%) and thorax (0.2% ± 1.3%). For the 15 MV beams the suggested level for pelvis in all the treatment techniques was (3.2% ± 1.3%). CONCLUSION: The present data are sufficient to justify the use of the software in the clinical practice as a tool for the quality assurance program.

Keywords: Monitor units calculation, Quality assurance, Computerized treatment planning system

OBJECTIVE: To characterize interstitial lesions in anterior-posterior chest X-rays based on the analysis of textural statistical features that allow the detection of abnormalities with diffuse pattern. MATERIALS AND METHODS: Image analysis begins with the semiautomatic segmentation of the lungs, marking the external contour of the lung manually followed by an automatic division of each lung in six regions. The data base of images used in this study consisted of 482 regions obtained from examinations in which lesions were detected and 324 regions from normal examinations. Textural features were automatically extracted from each area and the selection of the best set of features was made based on the Jeffries-Matusita distance. The regions were classified as normal or suspected using the k nearest-neighbor method and half-half, and cross-correlation methodologies were used for training the classifier. RESULTS: Results were assessed based on the value of the area under the ROC (receiver operating characteristic) curve that indicates an ideal response for an area equal to 1. The results showed an area under the ROC curve (A Z) of 0.887, sensitivity of 0.804, and specificity of 0.793. CONCLUSION: These results indicate that the implemented system has a good potential for computer-aided diagnosis of interstitial lung lesions.

Keywords: Computer-aided diagnosis, Interstitial lung lesions, Texture characteristics, Pattern recognition

OBJECTIVE: To implement a protocol for correction of images acquired by videofluoroscopy based on the mathematical model described by Baltzopoulos (1995) and to evaluate the magnitude of error in the linear and non-linear calibration methods. MATERIALS AND METHODS: The images were acquired using a Axion Siemens Iconos R100 videofluoroscope from one individual during knee extension exercise. A non-linear calibration pattern was used for the correction of the images. Data was processed using a Silicon Graphics 320 capture plate and subsequently analyzed using the Matlab software. RESULTS: In order to demonstrate the method's applicability, the deformation of the patellar ligament was evaluated. The use of a linear calibration pattern produced a maximum error of 0.086 mm, while the non-linear calibration pattern reached a maximum value of 0.019 mm. According to the mean error, the linear calibration was 0.024 mm, and the non-linear presented a value of 0.007 mm. CONCLUSION: The results show the need to use a non-linear calibration procedure.

Keywords: Videofluoroscopy, Images calibration, Patellar ligament, Knee

OBJECTIVE: To present an audit model for mammography results used on the examinations performed at "Centro de Diagnóstico Mamário da Santa Casa da Misericórdia do Rio de Janeiro", Rio de Janeiro, Brazil. MATERIALS AND METHODS: Between May 1997 and September 1998, 2,000 mammography examinations were performed, 1,570 in asymptomatic women, which results were assessed in this audit. RESULTS: The mammography examinations of the asymptomatic women were classified as follow: category 1 - 1,362 cases; category 2 - 9 cases; category 3 - 95 cases; category 4 - 24 cases; category 5 - 6 cases; category 0 - 74 cases. Out of 199 abnormal examinations (categories 0, 3, 4 and 5), 107 (54%) were followed-up and 92 (46%) were lost to follow-up. The 107 cases included in the study were classified as follows: category 3 - 48 cases; category 4 - 18 cases; category 5 - 4 cases; category 0 - 37 cases. No cases of cancer were detected among the 48 cases in category 3; two cases of cancer were seen among the 18 cases in category 4; all four cases in category 5 were cancer; one case of cancer was seen among the 37 cases in category 0. The audit values obtained were the following: positive predictive value (based on the exam with abnormal result) - 11%; positive predictive value (when there was indication for biopsy) - 31%. The rate of cancer detection in 1,570 women was of seven cases; the sensitivity was 100%; the specificity was 96%; and the recall rate was 4.7%. CONCLUSION: All these results reproduce data from the literature.

Keywords: Audit, Mammography, BI-RADS

OBJECTIVE: To observe digital sucking or hand sucking habits in fetuses using ultrasound, to identify pregnancy related factors that influence its appearance and to evaluate the persistence of digital sucking after delivery. MATERIALS AND METHODS: Two ultrasound examinations were performed in 55 pregnant women with 20-24 and 25-32 weeks of pregnancy. Questionnaires were used to evaluate the factors related to pregnancy. In order to verify the persistence of digital sucking, visits to the newborns were performed one week after delivery. RESULTS: Digital sucking was detected in 35 of the 55 fetus studied. Digital sucking in fetuses was not associated with the health status of the pregnant women and the level of pregnancy acceptance. The Q Cochran test showed no relationship between the observation of digital sucking in the fetuses and the development of sucking habit in the newborns. CONCLUSION: Ultrasound is an effective method to observe digital sucking in the fetus. There is no association between prenatal digital sucking and the development of sucking habits after delivery.

Keywords: Fetal ultrasound, Obstetric ultrasound, Oral habits, Digital sucking, Malocclusion

Bone marrow transplantation has been the treatment of choice for many hematologic diseases. However, pulmonary complications, which may occur in up to 60% of the patients, are the main cause of treatment failure and may be divided in three phases according to the patient's immunity. In the first phase, up to 30 days after the procedure, there is a predominance of non-infectious complications and fungal pneumonia. Viral infections, mainly by cytomegalovirus, are common in the second phase (up to 100 days after bone marrow transplantation). Finally, in the late phase after bone marrow transplantation, non-infectious complications as bronchiolitis obliterans organizing pneumonia and graft-versus-host disease are most commonly seen. The authors present a pictorial essay of the high-resolution computed tomography findings in patients with pulmonary complications after bone marrow transplantation.

Keywords: High-resolution computed tomography, Bone marrow transplantation, Pulmonary infections

X-ray examinations may be necessary during pregnancy for an accurate diagnosis and adequate treatment administration. In these cases, the exposure to ionizing radiation and its effects on the fetus are a major concern to the patient and to the clinician. In fact, most of these examinations are safe and do not represent a significant risk to the fetus. However, the radiologist must know the potential risks to be able to instruct all personnel involved in the care of the patient.

Keywords: Ionizing radiation, Pregnancy, Computed tomography, X-ray studies

Pancreatic cystic lesions, particularly small lesions, are more easily diagnosed nowadays with the use of imaging methods. In some cases, the diagnosis represents a challenge to establish the treatment, as it can range from inflammatory pseudocysts to primary or metastatic cystic neoplasms. In order to choose the treatment, it is necessary to determine if the lesion is benign, borderline, or malignant. Currently, echoendoscopy is considered the gold standard procedure for pancreatic evaluation as it clearly shows the morphology of the lesion, and also allows the acquisition of pancreatic material for cytological and tumor markers studies using fine needle aspiration biopsy. This procedure is considered safe and efficient with high rates of sensibility and specificity and low rates of complications and morbidity. The presence of septa, mural nodules and irregularities in the parenchyma are the most significant predictive factors for the differential diagnosis of mucinous pancreatic-cystic lesions for which sensibility, specificity and accuracy rates are 94%, 85% and 88%, respectively. The aim of the authors in this study is to review the major primary-cystic-pancreatic neoplasms with emphasis in the application of echoendoscopy for the definite diagnosis of these lesions.

Keywords: Echoendoscopy, Endoscopic ultrasound, Endosonography, Pancreatic cystic neoplasm

The influence of chemical and physical agents (specially radiation) on the frequency of mutations has been widely studied by means of the analysis of changes observed in Tradescantia, a plant used as a bioindicator. The evaluation of these genetic changes may be performed both by detection of somatic mutations or chromosome abnormalities induced by mutagens that are present in the air, soil, or water. The results obtained from several studies support the use of Tradescantia for monitoring the effects of ionizing radiation. Studies of mutagenicity and chromosomal abnormalities may be carried out in future to compare the effects of other types of radiation, evaluation of the effects of the combined use of radiation and drugs or other chemical agents, and to monitor high risk environments.

Keywords: Radiobiology, Mutation, Tradescantia, Ionizing radiation

We report a case of 35 year-old male patient presenting with a mass in the left breast. After conventional imaging examinations the patient was submitted to a biopsy, which showed folliculosebaceous cystic ham-artoma. The authors present a brief review of the literature on this rare lesion in the male breast and its differential diagnosis with malignant masses.

Keywords: Folliculosebaceous cystic hamartoma, Breast, Male, Review

The aim of this study is to report a rare case of hepatic artery aneurysm simulating a lesion in the head of the pancreas. A precise evaluation using computed tomography and magnetic resonance imaging is important in the treatment planning, which will influence the prognosis.

Keywords: Hepatic artery, Aneurysm, Pancreas, Computed tomography, Magnetic resonance imaging

We report a case of Camurati-Engelmann disease in a 32-year-old male patient. This patient was submitted to radiological evaluation including plain X-rays, bone scintigraphy and computed tomography, which showed typical findings of this syndrome and uncommon aspects seen only in cases of severe bone involvement.

Keywords: Camurati-Engelmann disease, Progressive diaphyseal dysplasia