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OBJECTIVE: to know the contributions of nursing in the implementation of the quality management principle of the accreditation program in imaging diagnosis. METHODS: a single, qualitative case study carried out in an accredited radiology and imaging diagnosis service. The data collection took place through semi-structured interviews, direct observation, and documentary analysis with the support of software in organizing the data for analysis. RESULTS: a total of four thematic units emerged: the accreditation process in imaging services, the implementation of the program, the role of nursing in imaging services and patient safety and the management of non-conformities in imaging services. Of the other data sources, the word risk was highlighted and a non-conformity was evidenced in the external audit. FINAL CONSIDERATIONS: nursing contributed mainly to the management of the risks involved in the performance of imaging and patient safety tests, requirements of the quality management principle of the accreditation program.

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PURPOSE: Provide evidence- and expert-based recommendations for optimal use of imaging in advanced prostate cancer. Due to increases in research and utilization of novel imaging for advanced prostate cancer, this guideline is intended to outline techniques available and provide recommendations on appropriate use of imaging for specified patient subgroups. METHODS: An Expert Panel was convened with members from ASCO and the Society of Abdominal Radiology, American College of Radiology, Society of Nuclear Medicine and Molecular Imaging, American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology to conduct a systematic review of the literature and develop an evidence-based guideline on the optimal use of imaging for advanced prostate cancer. Representative index cases of various prostate cancer disease states are presented, including suspected high-risk disease, newly diagnosed treatment-naïve metastatic disease, suspected recurrent disease after local treatment, and progressive disease while undergoing systemic treatment. A systematic review of the literature from 2013 to August 2018 identified fully published English-language systematic reviews with or without meta-analyses, reports of rigorously conducted phase III randomized controlled trials that compared ≥ 2 imaging modalities, and noncomparative studies that reported on the efficacy of a single imaging modality. RESULTS: A total of 35 studies met inclusion criteria and form the evidence base, including 17 systematic reviews with or without meta-analysis and 18 primary research articles. RECOMMENDATIONS: One or more of these imaging modalities should be used for patients with advanced prostate cancer: conventional imaging (defined as computed tomography [CT], bone scan, and/or prostate magnetic resonance imaging [MRI]) and/or next-generation imaging (NGI), positron emission tomography [PET], PET/CT, PET/MRI, or whole-body MRI) according to the clinical scenario.

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Abstract Evolution of digital Health-care Information System established Medical Image Security as the new contemporary research area. Most of the researchers used either image watermarking or image encryption to address medical image security. However, very few proposals focused on both issues. This paper has implemented a Fast Medial Image Security algorithm for color images that uses both watermarking and encryption of each color channel. The proposed method starts with embedding of a smoothened key image (K) and patient information over the original image (I) to generate a watermarked image (W). Then, each color channel of the watermarked image (W) is encrypted separately to produce an encrypted image (E) using the same smoothened key image (K). This image can be transmitted over the public network and the original image (I) can be achieved using decryption algorithm followed by de-watermarking using the same key image (K) at the receiver. Qualitative and quantitative results of the proposed method show good performance when compared with the existing method with high Mean, PSNR and Entropy.

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Resumen: Objetivo: Describir la participación de los exámenes de imagen en el Régimen de Garantías Explícitas en Salud en Chile y analizar el papel de los radiólogos en este campo. Materiales y métodos: todas las patologías incluidas en el Programa de garantías explícitas en salud, cuentan con una guía de práctica clínica (GC) y un listado de prestaciones específicas (LP). Ambos fueron analizados respecto a la cantidad y la modalidad de los exámenes de imagen recomendados, la presencia de radiólogos dentro de los paneles de expertos y la concordancia entre las recomendaciones de las guías y los Listados de Prestaciones. Resultados: 60 GC (67%) y 55 LP (69%) incluyen pruebas de imagen dentro de sus prestaciones garantizadas. 7 GC (8%) recomiendan pruebas de imágenes no cubiertas en su listado de prestaciones respectivos y 5 pruebas de imágenes del LP (6%) no están incluídas en las guías clínicas. La participación de un radiólogo en el panel de expertos se asoció con la ausencia de discrepancias en las pruebas de imagen entre GC y LP (p = 0,007). Discusión: el diagnóstico por imágenes juega un papel importante dentro del Programa de garantías explícitas y se asocia al aumento de los costos de atención médica. Algunos casos de discordancia entre las guías clínicas y los Listados de Prestaciones representan costos económicos y sociales significativos que podrían reducirse al incluir radiólogos en los paneles de expertos, así como optimizar el uso de recursos y reducir la exposición de los pacientes a la radiación ionizante.

Abstract: Objective: To describe the involvement diagnostic imaging exams in the framework of Regime of Explicit Health Guarantees in Chile and analyze the role of radiologists in this field. Materials and methods: Every pathology included in the Explicit Healthcare Guarantees Program encompasses an expert consensus clinical guideline (CG) and a specific services list (SL). Both of them were analyzed regarding the amount and modality of imaging exams recommended, the presence of radiologists within the expert panels and the concordance between guidelines recommendations and service lists. Results: 60 CG (67%) and 55 SL (69%) include imaging tests within their guaranteed services. Seven CG (8%) recommend medical imaging tests not covered in their respective services list and 5 SL (6%) reference imaging tests not included in the clinical guidelines. The involvement of a radiologist on the expert panel was associated with the absence of imaging test discrepancies between CG and SL (p=0.007). Discussion: Diagnostic imaging plays an important role within the Explicit Healthcare Guarantees Program and is associated with rising healthcare costs. There are cases of discordance between clinical guidelines and specific services lists that account for significant economic and social costs, which may be reduced by including radiologists on expert panels, optimizing resource use and lowering patients' exposure to ionizing radiation.

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Few economic sectors are more regulated than healthcare. While excessive healthcare regulation is a bad thing, regulation compliance brings with it the benefits of market entry, product quality and availability, as well as access to tax rebates and credit benefits. In this paper, we investigate some connections between regulatory compliance and normative technical requirements. We present a multi-company exploratory case study on the variability of mean times-to-benefit after compliance. We focus here on the diagnostic imaging equipment segment and the normative context in Brazil. We show that, in what regards current tax benefit regulations, time-to-benefit depends on the normative technical requirements that different categories of diagnostic imaging equipment comply with. This suggests that product-engineering practices should be concerned not only with analyzing and ensuring compliance, but also with regulation diversity and dynamics.

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OBJECTIVES: This study aimed to establish a concise method for determining a diagnostic reference level (DRL) for adult and pediatric nuclear medicine patients on the basis of diagnostic procedures and administered radioisotope as a means of controlling medical exposure. METHODS: A screening was carried out in all Brazilian Nuclear Medicine Service (NMS) establishments to support this study by collecting the average activities administered during adult diagnostic procedures and the rules applied to adjust these according to the patient's age and body mass. Percentile 75 was used in all the activities administered as a means of establishing DRL for adult patients, with additional correction factors for pediatric patients. Radiation doses from nuclear medicine procedures on the basis of average administered activity were calculated for all diagnostic exams. RESULTS AND DISCUSSION: A total of 107 NMSs in Brazil agreed to participate in the project. From the 64 nuclear medicine procedures studied, bone, kidney, and parathyroid scans were found to be used in more than 85% of all the NMSs analyzed. There was a large disparity among the activities administered, when applying the same procedures, this reaching, in some cases, more than 20 times between the lowest and the highest. Diagnostic exams based on Ga, Tl, and I radioisotopes proved to be the major exams administering radiation doses to patients. On introducing the DRL concept into clinical routine, the minimum reduction in radiation doses received by patients was about 15%, the maximum was 95%, and the average was 50% compared with the previously reported administered activities. CONCLUSION: Variability in the available diagnostic procedures as well as in the amount of activities administered within the same procedure was appreciable not only in Brazil, but worldwide. Global efforts are needed to establish a concise DRL that can be applied in adult and pediatric nuclear medicine procedures as the application of DRL in clinical routine has been proven to be an important tool for controlling and reducing radiation doses received by patients in medical exposure.

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O objetivo do presente estudo foi verificar a acurácia in vitro do ICDAS visual e baseado em imagens digitais no diagnóstico de cárie oclusal incipiente em molares permanentes e compará-los com um padrão ouro em micro-CT. Para este fim, foram utilizados 40 molares permanentes, obtidos através de um biorrepositório, onde três avaliadores calibrados atribuíram escores ICDAS. Primeiramente os escores foram atribuídos através de exame visual e este foi repetido após uma semana. Em seguida, passado um mês da primeira avaliação visual, os mesmos avaliadores receberam imagens digitais dos espécimes utilizados anteriormente para nova atribuição de scores ICDAS, sendo repetido também após uma semana. Os dentes foram então escaneados através de micro-CT que foi definido como método padrão-ouro para comparação. O coeficiente de correlação de Spearman foi utilizado para comparar as pontuações de consenso com o padrão-ouro. Os métodos de detecção foram comparados por meio de sensibilidade, especificidade, área sob a curva (AUC), valores preditivos positivos e negativos e precisão para dois limiares diferentes (dentes hígidos versus dentes cariados e dentes que necessitam de tratamento operatório versus tratamento não ­ operatório). Os valores médios de kappa para o intra-examinador foram 0,68 e 0,74 para inspeção visual e método baseado em imagens, respectivamente. Os valores de sensibilidade para o limiar de "presença de cárie" no método ICDAS visual e ICDAS fotográfico foram elevados quando comparados com micro-CT (0,93 e 0,97, respectivamente), mesmo com valores de precisão (0,83 e 0,85). Já a especificidade foi mais expressiva para o limiar de "cárie com necessidade de tratamento operatório" com 0,77 e 0,82 para os mesmos métodos. O coeficiente de correlação de Spearman foi de 0,53 e 0,43 (p <0,05). Em vista disso, conclui-se que o ICDAS visual e o baseado em imagens digitais foram semelhantes quanto à exatidão diagnóstica em comparação com um padrão - ouro em micro-CT, podendoe ser uma prosposta para estudos epidemiológicos. (AU)

The aim of the present study was to verify the in vitro accuracy of visual and digital-based ICDAS in the diagnosis of incipient occlusal caries in permanent molars compared to a micro-CT gold standard. For this purpose, 40 permanent molars were obtained from a pool of extracted teeth, cleaned and mounted in gypsum bases where three calibrated examiners assigned ICDAS scores. The scores were attributed by means of visual examination and were repeated after one week. One month after the first visual evaluation, the same examiners received digital images of the previously used specimens for re-assignment of ICDAS scores, which were also repeated after one week. The teeth were then scanned through a micro-CT device which was defined as gold standard method for comparison. The Spearman correlation coefficient was used to compare the consensus scores with the gold standard. The detection methods were compared by means of sensitivity, specificity, area under the curve (AUC), positive and negative predictive values and precision for two different thresholds (healthy teeth X decayed teeth and teeth requiring operative treatment X non - operative treatment). Mean kappa values for the intra-examiner agreement were 0.68 and 0.74 for visual inspection and image-based method, respectively. Sensitivity values for the "decayed teeth" threshold in the visual ICDAS method and the photographic ICDAS were high compared with the micro-CT golden standard (0.93 and 0.97, respectively), even with precision values (0.83 and 0.85). The specificity was more significant for the "caries in need for operative treatment" threshold, with 0.77 and 0.82 for the same methods. The Spearman correlation coefficient was 0.53 and 0.43 (p <0.05). It can be concluded that the visual and digital-based ICDAS were similar in terms of diagnostic accuracy compared to a gold standard in micro-CT, and may be advocated for epidemiological studies. (AU)

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The 2015 Academic Emergency Medicine (AEM) consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to: 1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; 2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and 3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified prior to the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were 164 individuals involved in the conference spanning various specialties, including emergency medicine (EM), radiology, surgery, medical physics, and the decision sciences. This issue of AEM is dedicated to the proceedings of the 16th annual AEM consensus conference as well as original research related to emergency diagnostic imaging.

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Because diagnostic and interventional radiology procedures represent one of the main sources of irradiation by ionizing radiation in the population, it has become a priority to become familiar with the quantities and units that account for patient dosimetry. There are countless documents and international recommendations on names, concepts, definitions and areas of application for various quantities and units used in patient dosimetry, in interventional and diagnostic radiology procedures. However, national legislation is not updated in this regard and does not provide, in any of its documents, an updated glossary that enables finding this type of information quickly and precisely. Therefore, this review paper presents in a didactic way and in plain language, the main quantities and units to be used in the dosimetry of patients undergoing diagnostic and interventional radiology procedures.

Debido a que los procedimientos de radiodiagnóstico e intervencionismo representan una de las principales fuentes de irradiación a la población por radiaciones ionizantes, se vuelve prioritario conocer las magnitudes y unidades que dan cuenta de la dosimetría a los pacientes. Existen innumerables documentos y recomendaciones internacionales sobre nombres, conceptos, definiciones y campos de aplicación para diversas magnitudes y unidades utilizadas en la dosimetría de pacientes en procedimientos de radiodiagnóstico e intervencionismo. Sin embargo, la legislación nacional no se encuentra actualizada en este sentido y no contempla en ninguno de sus documentos, un glosario actualizado que permita encontrar en forma rápida y precisa este tipo de información. Por lo anterior, este trabajo de revisión presenta de manera didáctica y en un lenguaje sencillo, las principales magnitudes y unidades que se deben utilizar en la dosimetría de pacientes sometidos a procedimientos de radiodiagnóstico e intervencionismo.

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The goal of this review article is to highlight the appropriateness criteria programs available to clinicians, to review the current state of decision-support systems for imaging, and to briefly review the accreditation requirements currently in place in cardiothoracic imaging.

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La evolución de la endodoncia en los últimos tiempos es evidente debido a los avances científicos y tecnológicos que elevan significativamente la previsión de las intervenciones, permitiendo solucionar casos extremos de forma satisfactoria y con buen pronóstico, en un menor tiempo. La tecnología produce diferencia y genera renombre profesional, aunque requiere cierto tiempo para su dominio, ya que estudiar y practicar endodoncia de alto nivel exige entrega y dedicación. Con la radiovisiografía, que reduce la exposición a las radiaciones y cuya técnica es más rápida, se dispone de un nuevo procedimiento alternativo más innovador. Este trabajo demuestra que la decisión de valerse de la tecnología en la práctica odontológica cotidiana debe basarse en conocer y entender los recursos informáticos, a fin de obtener imágenes radiográficas que optimizan los tratamientos.

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Se presenta un trabajo en el que se expone la importancia del diagnóstico por imágenes en la pericia odontológica. En él se pone de manifiesto la ayuda invalorable de los diversos recursos imagenológicos para obtener precisión en lo que respecta a la toma de decisiones en los peritajes. Basado en lo expuesto, se relaciona la utilización de las imágenes en odontología y el manejo legal de éstas en los diferentes fueros. Se ha tomado en consideración la opinión de los diversos autores especializados en medicina legal, odontología legal y derecho, así como en radiología odontológica, como apoyo al trabajo que se expone.(AU)

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Se presenta un trabajo en el que se expone la importancia del diagnóstico por imágenes en la pericia odontológica. En él se pone de manifiesto la ayuda invalorable de los diversos recursos imagenológicos para obtener precisión en lo que respecta a la toma de decisiones en los peritajes. Basado en lo expuesto, se relaciona la utilización de las imágenes en odontología y el manejo legal de éstas en los diferentes fueros. Se ha tomado en consideración la opinión de los diversos autores especializados en medicina legal, odontología legal y derecho, así como en radiología odontológica, como apoyo al trabajo que se expone.

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Este estudo analisou o processamento radiográfico e a qualidade das radiografias nos consultórios odontológicos de São Luis/MA. Cento e trinta cirurgiões-dentistas foram avaliados através de questionários e receberam um filme, já exposto aos raios X, para processamento. Foi observado que: 98,46% da amostra utilizam câmara escura do tipo portátil, sendo que apenas 16,92% utilizam câmaras portáteis opacas sem visor; o método de revelação mais empregado foi visual (67,69%); o tempo utilizado para revelação do filme teste foi de 7s a 30s em 24,62% da amostra e somente 30,78% das imagens obtidas estavam em condições ideais de diagnóstico.

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A mamografia é atualmente o método de diagnóstico mais eficaz para detecção de patologias nas mamas. Contudo, o uso de radiação ionizante está associado a um risco de indução de câncer nos pacientes, o que torna imprescindível a implantação de programas de conotrole de qualidade para a otimização do procedimento e a obtenção de imagens de qualidade para o diagnóstico com a menor dose ao paciente. Este trabalho tem como objetivo a avaliação da resposta de um distema dosimétrico desenvolvido para auxiliar nos programas de controle de qualidade em mamografia, através de medidas simultâneas da tensão do tudo de raios-X, do tempo de irradiação e do kerma ar na entrada da pele do paciente. Este sistema dosimétrico consiste de três sensores semicondutores (fotodiodos comerciais), acoplados a um sistema eletrônico e associados a um conjunto de filtros de Al e Cu. Um dos fotodiodos é usado para o controle do processo de leitura e medição do tempo de irradiação. A razão entre as leituras dos outros dois é utilizada para a determinação da tensão dotubo de raios-X através do método não invasivo baseado na diferença de atenuação com diferentes absorvedores. O sinal do semicondutor sem filtro também é usado para obter o valor do kerma no ar na entrada da pele do paciente. Todo processo de medição é controlado por um dispositivo microcontrolador e os valores obtidos são visualizados em um display. O instrumento foi testado em um equipamento de raios-X mamográfico. Os resultados obtidos mostraram uma resposta linear e uma repetibilidade de 2 por cento para as medidas do kerma ar na entrada da pele do paciente. A estabilidade na resposta da medida de tensão se mostrou reprodutível dentro de mais ou menos 1,5 por cento. O teste das medids do tempo de irradiação indicou uma variação inferior a 0,5 por cento.

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