Objective: The present study is aimed at describing the experience of an oncology center with computed tomographyguided core-needle biopsy of pulmonary lesions. Materials and Methods: Retrospective analysis of 97 computed tomography-guided core-needle biopsy of pulmonary lesions performed in the period between 1996 and 2004 in a Brazilian reference oncology center (Hospital do Câncer – A.C. Camargo). Informations regarding material appropriateness and the specific diagnoses were collected and analyzed. Results: Among 97 lung biopsies, 94 (96.9%) supplied appropriate specimens for histological analyses, with 71 (73.2%) cases being diagnosed as malignant lesions and 23 (23.7%) diagnosed as benign lesions. Specimens were inappropriate for analysis in three cases. The frequency of specific diagnosis was 83 (85.6%) cases, with high rates for both malignant lesions with 63 (88.7%) cases and benign lesions with 20 (86.7%). As regards complications, a total of 12 cases were observed as follows: 7 (7.2%) cases of hematoma, 3 (3.1%) cases of pneumothorax and 2 (2.1%) cases of hemoptysis. Conclusion: Computed tomography-guided coreneedle biopsy of lung lesions demonstrated high rates of material appropriateness and diagnostic specificity, and low rates of complications in the present study.

Keywords: Needle; Biopsy; Lung; Cancer; Computed tomography.

Objective: To highlight the relevance and necessity of implementing a service to provide psychological support to physicians specializing in radiology and imaging diagnosis. Materials and Methods: Qualitative research with application of a questionnaire to 219 residents and trainees in radiology and imaging diagnosis, in the period between 2007 and 2009. The questionnaire included questions regarding their psychosocial profile, perception of the level of relationship with the service team, level of learning, psychological difficulties and evaluation of the prevalence of anxiety and depression symptoms according to the Hospital Anxiety and Depression Scale. Results: Among the respondents, 116 (53%) were women and 103 (47%) were men. Most of them, 170 (77.6%), were in the age range between 20 and 30 years. It was observed that 51.1% of the respondents presented anxiety and 54.8%, depression symptoms. Among the respondents, 44.8% showed interest in seeking psychological assistance to address their problems. Conclusion: The implementation of a service to provide psychological support to residents and trainees in radiology and imaging diagnosis should be done by psychologists specialized in hospital and clinical psychology, skilled to welcome and assist them to deal with difficulties in the training, as well as in their adaptation and integration, thus contributing to reduce stress and symptoms of anxiety and depression.

Keywords: Internship and medical residency; Anxiety; Depression.

Objective: The present study was aimed at assessing the quality of articles related to diagnostic accuracy of ultrasonography both in idiopathic and occupational carpal tunnel syndrome. Materials and Methods: A search was undertaken in electronic databases, selecting reports on systematic reviews, randomized clinical trials and observational studies. After four stages of analysis, from an initial screening to the evaluation by means of the assessment scale developed by the Critical Appraisal Skills Programme, the articles were classified according to levels of evidence, with their respective grades of recommendation. Results: Among 68 articles initially identified, only 4 have met all the methodological quality criteria proposed in the present study. Measurement of the cross-sectional area of the median nerve was the most important criterion for the diagnosis of carpal tunnel syndrome (cut-off point between 9 and 10 mm²: sensitivity = 82–86.3%; specificity = 48-87%). The four articles were given level of evidence “1b” and grade of recommendation “A”. Conclusion: The sonographic evaluation of patients with clinical suspicion of carpal tunnel syndrome can be cost-effectively performed as a first-line test, reducing the need for electrodiagnostic testing in these patients.

Keywords: Ultrasonography; Carpal tunnel syndrome; Sensitivity and specificity; Evidence-based medicine.

Objective: The present study was aimed at estimating the values of radiation doses received by physicians and patients during interventional cardiology procedures performed at a public hospital in the city of Recife, Pernambuco, Brazil. Materials and Methods: Measurements were made in two cardiologists with more than ten years of experience and in 31 adult patients, with 22 of them being clinically followed-up after the procedure. The individual irradiation parameters were documented. Results: The values for maximum patients skin dose ranged between 612 and 8,642 mGy, achieving more than 2,000 mGy in 53% of the patients; such dose values may cause deterministic effects. As regards the physicians, the mean effective dose per procedure was 11 µSv, and the highest mean equivalent doses in the limbs were 923 µSv in the left foot, 514 µSv in the right foot, 382 µSv in the left hand, and 150 µSv in the left eye. Depending on the number of procedures, the doses received by the physician may exceed the dose limits established by the Brazilian and international standards. Conclusion: The obtained results indicate the necessity of adopting strategies for optimizing the radiological protection for both patients and physicians.

Keywords: Dosimetry in physicians and patients; Interventional cardiology; Dosimetry in interventional cardiology.

Objective: The present study was aimed at evaluating the relation between the use of radiation protection gear and the decrease in absorbed dose of ionizing radiation, thereby reinforcing the efficacy of its use by both the patients and occupationally exposed personnel. Materials and Methods: The integrative literature review method was utilized to analyze 21 articles, 2 books, 1 thesis, 1 monograph, 1 computer program, 4 pieces of database research (Instituto Brasileiro de Geografia e Estatística and Departamento de Informática do Sistema Único de Saúde) and 2 sets of radiological protection guidelines. Results: Theoretically, a reduction of 86% to 99% in the absorbed dose is observed with the use of radiation protection gear. In practice, however, the reduction may achieve 88% in patients submitted to conventional radiology, and 95% in patients submitted to computed tomography. In occupationally exposed individuals, the reduction is around 90% during cardiac catheterization, and 75% during orthopedic surgery. Conclusion: According to findings of several previous pieces of research, the use of radiation protection gear is a low-cost and effective way to reduce absorbed dose both for patients and occupationally exposed individuals. Thus, its use is necessary for the implementation of effective radioprotection programs in radiodiagnosis centers.

Keywords: Radiation protection; Dose in computed tomography; Dose reduction; Radiation protection gear.

Objective: The present study was aimed at determining the acceptability of a national or regional phantoms bank to be deployed in Brazil for shared use in quality control activities by nuclear medicine centers. Materials and Methods: The authors analyzed the answers to a questionnaire applied to medical physicists and radioprotection supervisors in Brazilian nuclear medicine centers. Initially, the questionnaire was validated by professionals in the city of Aracaju, SE, which is located in the Northeast region. The present study sample was geographically distributed as follows: the Northeast region, with answers from 13 professionals of nuclear medicine centers; the North region, with 2 professionals; the South region, with 7 professionals; the Southeast region, with 43 professionals; and the Midwest region, with 2 professionals. Results: According to the data analyzed, 82% of the respondents consider that the implementation of a phantoms bank would be a suitable alternative for improving nuclear medicine quality control. The interest in sharing the bank was reported by 87% of the respondents. Conclusion: The present study demonstrated the motivation for a shared use of a future phantoms bank.

Keywords: Nuclear medicine; Quality control; Phantom.

Objective: The present paper describes a procedure for conversion of computed tomography or magnetic resonance images into a three-dimensional voxel model for dosimetry purposes. Such model is a personalized representation of the patient that can be utilized in nuclear particle transport simulations by means of the MCNP (Monte Carlo N-Particle) code, reproducing the stochastic process of nuclear particles interaction with human tissues. Materials and Methods: The developed computational system – SISCODES – is a tool designed for 3D planning of radiotherapy or radiological procedures. Based on tomographic images of the patient, the treatment plan is modeled and simulated. Then, the absorbed doses are shown by means of isodose curves superimposed on the model. The SISCODES couples the threedimensional model with the MCNP5 code, simulating the protocol of exposure to ionizing radiation. Results: The SISCODES has been utilized by the NRI/CNPq in the creation of anthropomorphic and anthropometric voxel models which are coupled with the MCNP code for modeling brachytherapy and teletherapy applied to lung, pelvis, spine, head and neck tumors, among others. The current SISCODES modules are presented together with examples of cases of radiotherapy planning. Conclusion: The SISCODES provides a fast method to create personalized voxel models of any patient which can be used in stochastic simulations. The combination of the MCNP simulation with a personalized model of the patient increases the dosimetry accuracy in radiotherapy.

Keywords: SISCODES; Radiotherapy; Dosimetry; Absorbed dose; Teletherapy; Brachytherapy.

The knowledge of meniscal anatomic variants and of the normal perimeniscal structures is essential to understand magnetic resonance imaging studies of the knee, both for the diagnosis of meniscal lesions and to avoid potential interpretation pitfalls. The present article reviews anatomic variants that change the size, shape and stability of the menisci, including the different types of discoid menisci, other less frequent meniscal malformations and the meniscal ossicle. Additionally, the anatomy of perimeniscal structures, particularly those including the meniscocapsular, intermeniscal, meniscofemoral ligaments and other menisco-ligamentous structures is reviewed.

Keywords: Knee; Discoid meniscus; Anatomic variants; Magnetic resonance imaging.

The use of signs or analogies for interpretation and description of medical images is an old and common practice among radiologists. Comparison of findings with animals, food or objects is not unprecedented and routinely performed. Many signs are quite specific and, in some cases, pathognomonic. Indeed, notwithstanding their degree of specificity, signs may help in the characterization of certain diseases. Several neuroradiological signs have been already described. The authors will present 15 neuroradiology signs in the present essay, approaching their main characteristics, the significance of their role in the clinical practice, as well as their respective imaging findings.

Keywords: Radiological signs; Neuroradiology; Computed tomography; Magnetic resonance imaging.

The use of signs for interpretation of images in neuroradiology is extremely useful. Some signs are quite specific and, in some cases, pathognomonic. In this second part of their essay, the authors describe 15 additional neuroradiological signs. Main characteristics of imaging findings will be approached and the significance of their role in the clinical practice will be discussed.

Keywords: Radiological signs; Neuroradiology; Computed tomography; Magnetic resonance imaging.

Jejunal diverticulitis is a rare disease that primarily affects the elderly. Clinical signs and symptoms are nonspecific, a fact that complicates and delays the diagnosis. Computed tomography is very valuable in defining the diagnosis. The present report describes a case of jejunal diverticulosis complicated with acute perforated obstructive diverticulitis, and presents a brief discussion on jejunal diverticulitis and its complications.

Keywords: Jejunal diverticulitis; Computed tomography; Complications.