OBJECTIVE: To present a data analysis toolkit that may be utilized with the purpose of radiation protection of hospital inpatients and workers in areas where mobile apparatuses are used. MATERIALS AND METHODS: An Excel^® ActiveSheet was utilized to develop a computational toolkit with exposure measurements to generate a database of shape factors and to calculate the air kerma around hospital beds. The initial database included data collected with three mobile apparatuses. A non-anthropomorphic phantom was utilized and exposure measurements were performed on a (4.2 × 4.2) m² mesh-grid at 0.3 m steps. RESULTS: The toolkit calculates the air kerma (associated with patients' radiation exposure and with ambient equivalent dose) under secondary radiation. For distances lower than 60.0 cm, values above the maximum ambient equivalent dose threshold defined for radiation free areas (0.5 mSv/year) were verified. Data collected at 2.1 m have always presented values lower than 12% of that threshold. CONCLUSION: The toolkit can aid in the radiological protection of patients and workers, provided it is combined with appropriate data collection, since it allows the determination of radiation free areas around beds in rooms where mobile X-ray apparatuses are utilized.

Keywords: Radiology; Radiological protection; Software toolkit.

OBJECTIVE: To estimate extracranial doses on eyes, thyroid, chest and pelvis in patients submitted to radiosurgery with 6 MV linear accelerator. MATERIALS AND METHODS: The present study evaluated 11 patients, 7 of them with primary, and 4 with secondary brain tumors. In the latter group, 2 patients had two lesions. Thermoluminescent dosimeters were utilized to estimate the extracranial dose. Radiosurgery cones ranges between 1.50 and 3.75 cm and doses between 1300 and 2000 cGy. RESULTS: Mean patients' age was 52 years, and 63.6% of them were women and 36.4%, men. Lesion locations were the following: right acoustic nerve (1), frontal (2), parietal (5), right occipital (1), cerebellum (2) and parasagittal (2). Mean received doses were the following: 5.1 cGy between the eyes; 4.8 cGy in the right eye; 6.5 cGy in the left eye; 4.2 cGy in the thyroid; 1.65 cGy in the chest; and 0.45 cGy in the pelvis. CONCLUSION: The results demonstrate that that although the eye doses do not exceed the tolerance limits for occurrence of lens opacity, it is important that the risks associated with radiation doses are taken into consideration by radiotherapists in the planning of cranial radiosurgery procedures.

Keywords: Brain tumor; Radiotherapy; Radiosurgery; Dosimetry.

OBJECTIVE: To determine the level of quality in radiation protection of patients during radiological examination, evaluating the effectiveness of an intervention aimed at enhancing the quality of such a protection. MATERIALS AND METHODS: A quality improvement cycle was implemented in a radiology service of the Regional Health Administration, in Algarve, Portugal. Based on six quality criteria, an initial evaluation was performed and followed by an intervention focused on the most problematic points (over an eight-month period) and a subsequent quality reassessment. A random sampling (n = 60) has allowed the authors to infer the point estimates and confidence intervals for each criterion, as well as calculating the statistical significance of the results by means of the Z-test. RESULTS: Initially, deficiencies were observed in relation to all the quality criteria. After the intervention, a minimum relative improvement of 33% was observed in five of the six criteria, with statistical significance (p < 0.05) in two of them. The absolute frequency of noncompliance decreased from 38 (first evaluation) to 21 (second evaluation), corresponding to a 44.7% improvement. CONCLUSION: The first institutional evaluation cycle showed a seemingly incipient improvement margin. However, the implemented intervention was effective in stimulating good practices and improving the level of radiological protection of patients.

Keywords: Radiological protection; Quality enhancement; Institutional evaluation; Health care quality assurance.

OBJECTIVE: To determine correction factors for the variation in volume of radiopharmaceuticals in containers of different geometries, comparing the influence of such factors on the determination of ^99mTc and ¹²³I activity with two types of calibrators – one with ionization chamber and another with Geiger-Müller (G-M) detector –; and to evaluate calibrators performance in the measurement of ^99mTc and ¹²³I activities. MATERIALS AND METHODS: Eight calibrators, 10R glass vials, 3 and 5 mL plastic syringes and ^99mTc and ¹²³I solutions were utilized. The correction factors were determined with basis on practical measurements of the variation in the calibrators' response according to the volume of radionuclide solution in the glass vials. The performance was evaluated according to the acceptance criterion of ±10% accuracy required by the Brazilian standard. RESULTS: The variation of the calibrators' response according to the variation in radionuclide volume was reasonably greater in the calibrator with G-M detector. It was also greater for ¹²³I than for ^99mTc. CONCLUSION: The results confirm that the calibrators' response depends on the radionuclide volume contained in the vials. Such dependence is more critical for the calibrators equipped with G-M detector and for ¹²³I as compared with ^99mTc.

Keywords: Radionuclides calibrator; Nuclear medicine; Activity; Tc-99m; I-123.

Thoracolumbar burst fractures are defined as those fractures involving compromise of the anterior, middle and posterior vertebral columns. The treatment for such vertebral fractures still remains undefined, raising questions about the best form of intervention in these cases. Because of these doubts, imaging methods play a key role in the preoperative workup. However, several tests and measurements are performed by spine surgeons before deciding on the best approach to be adopted, with no standardization and neither consensus. The present review was aimed at standardizing and describing the main techniques and radiological findings on the basis of instability criteria adopted by surgeons in the assessment of thoracolumbar burst fractures, namely extent of height loss of the anterior wall of the fractured vertebra, level of spinal canal compromise by bone fragments and degree of widening of interspinous and interpedicular distance. It is the authors' opinion that the standardization of the main measurements in the evaluation of thoracolumbar burst fractures by radiological methods will provide the information required for a better interpretation of tests results and consequently aiding in the decision making about the most appropriate treatment.

Keywords: Radiology; Fracture; Spine.

Breast cancer is the most common cancer in women and the leading cause of cancer death among the female population. Extramammary findings related to breast cancer play an important role in the prognosis and treatment of such entity and the correct diagnosis of such alterations is essential for increasing the chance of cure. Most of the times, such manifestations result from complications arising from treatment, and may be associated with lymph node involvement, locoregional recurrence or distant metastasis.

Keywords: Multislice computed tomography; Staging; Breast cancer; Extramammary changes.

Based on the classification of congenital choledochal cysts, images of different cyst types were selected to compose a pictorial essay about this disease, which is not frequently observed in the medical practice, but is included in the differential diagnosis of most common lesions of the biliary tract. Choledochal cysts present nonspecific symptoms and low prevalence. The correct diagnosis based on imaging findings is mandatory to avoid complications, and to aid in the approach and definite treatment.

Keywords: Magnetic resonance imaging; Choledochal cyst; Bile ducts.

Infantile myofibromatosis is a rare disease with various presentations. Usually, such condition manifests itself as subcutaneous nodules, either in association or not with visceral nodules. The diagnosis should be achieved by means of physical examination and imaging studies, with emphasis on the lesions pattern to allow the staging and classification of the disease. The treatment is still controversial.

Keywords: Myofibromatosis.

Intrathoracic rib is defined as a rare congenital anomaly, possibly caused by an incomplete fusion of cephalic and caudal processes of sclerotomes during embryogenesis. Frequently, such abnormality is incidentally found, but may be associated with vertebral malformation and some symptoms such as chest pain. The authors report the case of a patient with leftsided intrathoracic rib in association with vertebral malformation, with a non-specific clinical picture.

Keywords: Intrathoracic rib; Costal anomaly; Computed tomography.

Primary ovarian carcinoma rarely metastasizes to the breast, and few cases are described in the literature. The authors report the case of a patient with ovarian carcinoma that developed breast metastasis eight years after the initial diagnosis, and present a literature review on this subject, emphasizing imaging findings.

Keywords: Ovarian carcinoma; Breast metastasis; Imaging findings.

Gastrointestinal bleeding is a common cause of admission to emergency services. Hemorrhages originated from arteriovenous malformations in the stomach have been rarely described in the literature. Embolization offers a good chance for the control of bleeding. We describe the case of a patient with recurrent hematemesis and melena whose angiography identified arteriovenous malformations in the greater curvature of the stomach. The bleeding was treated by arterial embolization.

Keywords: Arteriovenous malformation; Gastrointestinal hemorrhage; Embolization.

Madelung's disease is characterized by the presence of symmetric masses of adipose tissue on the neck, shoulders, arms and the upper trunk. Computed tomography demonstrates characteristic imaging findings, and it is considered to be the method of choice for diagnosis, pre-operative staging, and postoperative follow-up. The authors report the case of a man with typical tomographic findings of Madelung's disease.

Keywords: Madelung's disease; Benign multiple symmetric lipomatosis; Lipomas; Alcoholism.

Takotsubo cardiomyopathy corresponds to a syndrome characterized by a transient myocardial dysfunction affecting the left ventricular apex that classically occurs after major physical or emotional stress (also called "broken heart syndrome" or "stress-induced cardiomyopathy"). The author describes the case of a patient with takotsubo cardiomyopathy induced by subarachnoid hemorrhage.

Keywords: Subarachnoid hemorrhage; Aneurysm; Takotsubo cardiomyopathy.