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Resumen: Objetivo: Evaluar los resultados de estudios histológicos y si estos se justifican en pacientes categorizados como PI-RADS 2. Materiales y métodos: Se realizó una búsqueda en el PACS de nuestra institución de todos los informes de RM de próstata que incluyeran categoría "PI-RADS 2" entre enero del 2015 y junio del 2017, identificando 1287 informes. Resultados: De los 1287 informes PI-RADS 2, 646 pacientes fueron controlados posterior a la RM en nuestra institución. De ellos, 91 (14,08%) tuvieron un estudio histológico. Se encontraron 10 casos (10,98%) de cáncer prostático (6 con score de Gleason 6, y 4 score de Gleason 7). Conclusión: En nuestro estudio la RM score PI-RADS 2 descartó correctamente neoplasia clínicamente significativa en el 95,6% de los casos. Dar a conocer esta información podría tener un impacto en la conducta del tratante, disminuyendo el número de biopsias prostáticas.

Abstract: Objective: To evaluate the results of histological studies and if these are justified in patients categorized as PI-RADS 2. Materials and methods: A search was made in the PACS of our institution of all prostate MRI reports that included category "PI-RADS 2" between January 2015 and June 2017, identifying 1287 reports. Results: Of the 1287 PI-RADS 2 reports, 646 patients were monitored after the MRI in our institution. Of these, 91 (14.08%) had an histological study. We found 10 cases (10.98%) of prostate cancer (6 with Gleason score 6, and 4 Gleason score 7). Conclusion: In our study, the MR PI-RADS 2 score correctly ruled out clinically significant neoplasia in 95.6% of cases. Making this information known could have an impact on the doctor's course of action, decreasing the number of prostate biopsies.

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BACKGROUND: Radiology processes are commonly supported by Radiology Information System (RIS), Picture Archiving and Communication System (PACS) and other software for radiology. However, these information technologies can present usability problems that affect the performance of radiologists and physicians, especially considering the complexity of the tasks involved. OBJECTIVES: The purpose of this study was to extract, classify and analyze qualitatively the usability problems in PACS, RIS and other software for radiology. METHOD: A systematic review was performed to extract usability problems reported in empirical usability studies in the literature. The usability problems were categorized as violations of Nielsen and Molich's usability heuristics. RESULTS: The qualitative analysis indicated the causes and the effects of the identified usability problems. From the 431 papers initially identified, 10 met the study criteria. The analysis of the papers identified 90 instances of usability problems, classified into categories corresponding to established usability heuristics. The five heuristics with the highest number of instances of usability problems were "Flexibility and efficiency of use", "Consistency and standards", "Match between system and the real world", "Recognition rather than recall" and "Help and documentation", respectively. CONCLUSION: These problems can make the interaction time consuming, causing delays in tasks, dissatisfaction, frustration, preventing users from enjoying all the benefits and functionalities of the system, as well as leading to more errors and difficulties in carrying out clinical analyses. Furthermore, the present paper showed a lack of studies performed on systems for radiology, especially usability evaluations using formal methods of evaluation involving the final users.

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OBJECTIVE: To evaluate the differences in sonographic (US) distance and volume measurements from different sonologists and identify the optimal parameters to avoid clinically relevant variations in the measurement of BI-RADS 3 breast masses. METHODS: For this cross-sectional study with prospectively collected data, four physicians with various levels of experience in US, herein called sonologists, performed distance and volume US measurements of 80 masses classified as BI-RADS 3. The Cochran Q test was used to compare the matched sets of rates of clinically relevant variability between all pairs of sonologists' measurements. RESULTS: There were clinically relevant differences between sonologists in the measurements of the longest diameter (range, 17.5-43.7%, p = 0.003), the longest diameter perpendicular to the previous one (anteroposterior diameter) (17.5-33.7%, p = 0.06), the third diameter orthogonal to the plane defined by the previous two (transverse diameter) (28.7-55%, p = 0.001), and at least two of those three diameters (18.7-38.7%, p = 0.015). The smallest clinically relevant differences were observed with volume measurements (range of differences, 6.2-13.7%, p = 0.51). CONCLUSIONS: Volume measurement technique was associated with the least variations, whereas distance measurements, which are used routinely, were associated with unacceptable rates of clinically relevant variations. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:252-260, 2017.

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The expression "there is an elephant in the room" refers to an obvious problem that goes unnoticed. Often we wonder how it was possible that we have not reported a major lesion ("the size of an elephant") in the report that comes into our hands for review. Unlike clinical findings such as the anamnesis and the physical examination, evidence from the radiological examination remains available for subsequent reviews. The error and its consequences are a phenomenon that vertically and horizontally traverse all the medical specialties and those who perform within them. Radiologists are not exempt from this. During each stage of the reporting process, the radiologist may make mistakes. In this article we will concentrate on those errors in which the radiologist participates directly, with graphical representations that illustrate the nature of the error in each case. We will review the phases of the imaging diagnosis and the different types of errors such as Perceptual Errors (error by under-reading, search satisfaction errors, and error due to alterations outside the study area), Cognitive errors (complacency error, error of reasoning, alliterative error, error due to lack of knowledge, error due to lack of clinical records and error due to lack of consultation of previous examinations), Communication error and study type error. Because we cannot completely eliminate the diagnostic errors in our daily practice, we cannot guarantee the outcome; but we can demonstrate that we have done our best, with duly justified technical quality examinations, in the adequate time and with the necessary security.

La expresión "hay un elefante en la habitación", se refiere a que existe un problema obvio que pasa inadvertido. Muchas veces nos preguntamos cómo fue posible que no hayamos reportado una gran lesión ("del tamaño de un elefante") en el informe que llega a nuestras manos para revisión. A diferencia de los hallazgos clínicos como la anamnesis y el examen físico, la evidencia del examen radiológico permanece disponible para revisiones subsecuentes. El error y sus consecuencias son un fenómeno que cruza vertical y horizontalmente todas las especialidades médicas y a quienes en ellas se desempeñan. Los radiólogos no estamos exentos de ello. Durante cada etapa del proceso de informe, el médico radiólogo puede cometer errores. En este artículo nos concentraremos en aquellos errores en los que el radiólogo participa directamente, con representaciones gráficas que ilustran la naturaleza del error en cada caso. Revisaremos las fases del diagnóstico por imágenes y los diferentes tipos de errores como los Errores de percepción (error por sub-lectura, error por satisfacción de la búsqueda y error debido a alteraciones fuera del área de estudio), Errores cognitivos (error de complacencia, error de razonamiento, error aliterativo, error por falta de conocimientos, error por falta de antecedentes clínicos y error por falta de consulta de exámenes previos), Error de comunicación y Error de tipo de estudio. Debido a que no podemos eliminar completamente los errores diagnósticos en nuestra práctica diaria, no podemos garantizar el resultado; pero podemos demostrar que hicimos lo mejor posible, con exámenes de calidad técnica, debidamente justificados, en el tiempo adecuado y con la seguridad necesaria.

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OBJETIVO: Pesquisar visualizadores de imagens médicas gratuitos disponíveis na internet capazes de funcionar como cliente PACS (picture archiving and communication system) e avaliar suas principais funções e a viabilidade do uso em computadores pessoais. MATERIAIS E MÉTODOS: Foi feita pesquisa, no Google e em sites especializados, por programas gratuitos disponíveis para o Windows. Foram encontrados cerca de 70, sendo 11 capazes de funcionar como cliente PACS, e selecionados seis destes para análise: ClearCanvas Workstation, KPACS, Onis, Synedra View Personal, Mito e Tudor DicomViewer. Com base nas necessidades dos autores, 16 funções foram avaliadas. RESULTADOS: Dos seis programas avaliados, dois possuem 10 das 16 funções avaliadas e um possui apenas duas. Três realizam MPR (reconstrução multiplanar), um realiza MIP (reconstrução por projeção de intensidade máxima), dois realizam VR (renderizações volumétricas), dois funcionam como servidor PACS, dois geram CDs, um realiza fusão de imagens, três permitem utilizar múltiplos monitores e apenas um não é compatível com Windows 7. CONCLUSÃO: Diversos programas gratuitos estão disponíveis e não existe nenhum completo. Cabe ao usuário analisar e selecionar o programa que melhor se enquadra nas suas necessidades, porém, os programas Onis, Synedra e ClearCanvas se destacam, cada um com suas peculiaridades. É totalmente viável o uso de programas gratuitos para o dia-a-dia do radiologista.

OBJECTIVE: To search in the internet for freeware medical image viewers capable of running as a PACS (picture archiving and communication system) client, and to evaluate their main functions as well as the feasibility of their use in personal computers. MATERIALS AND METHODS: The Google search engine and specialized sites were utilized in the search for freeware softwares for Windows. The authors have found about 70 and among them 11 were able to run as PACS clients. Six were selected for analysis: ClearCanvas Workstation, KPACS, Onis, Synedra View Personal, Mito and Tudor DicomViewer. Sixteen functions selected according to the authors' needs were evaluated. RESULTS: Among the six applications, two presented 10 of the 16 functions, and one of them presented only two. Three perform MPR (multiplanar reconstruction), one performs MIP (maximum intensity projection), two perform VR (volume rendering), two can run as a PACS server, two can create CDs, one performs images fusion, three allow the use of multiple monitors and only one is not compatible with Windows 7. CONCLUSION: Although several freeware applications are available, no one of them is complete. It is up to the users to analyze and select the software that best suits their needs. However, Onis, Synedra and ClearCanvas stand out because of their own peculiarities. The use of freeware image viewers is entirely feasible in the radiologists' daily routine.

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Purpose: Quantification of the impact of a PACS/RIS-integrated speech recognition system (SRS) on the time expenditure for radiology reporting and on hospital-wide report availability (RA) in a university institution. Material and methods: In a prospective pilot study, the following parameters were assessed for 669 radiographic examinations (CR): 1. time requirement per report dictation (TED: dictation time (s)/number of images (examination) x number of words (report)) with either a combination of PACS/ tape-based dictation (TD: analog dictation device/ minicassette/transcription) or PACS/RIS/speech recognition system(RR: remote recognition/transcription and OR: online recognition/self-correction by radiologist), respectively, and 2. the ReportTur-naround Time (RTT) as the time interval from the entry of the first image into the PACS to the available RIS/HIS report. Two equal time periods were chosen retrospectively from the RIS database: 11/2002-2/2003 (only TD) and 11/2003-2/2004 (only RR or OR with speech recognition system (SRS)). The midterm (> 24 h, 24 h intervals) and short-term (< 24 h, 1 h intervals) RA after examination completion were calculated for all modalities and for CR, CT, MR and XA/DS separately. The relative increase in the mid-term RA (RIMRA: related to total number of examinations in each time period) and increase in the short-term RA (ISRA: ratio of available reports during the 1st to 24th hour) were calculated. Results: Prospectively there was a significant difference between TD/RR/OR (n = 151/257/261) regarding mean TED (0.44/0.54/0.62 s (per word and image)) and mean RTT.

Objetivo: Cuantificar la repercusión de un sistema de reconocimiento del habla integrado en un PACS/RIS en el tiempo invertido en los informes radiológicos y su disponibilidad en una Clínica Universitaria. Material y métodos: Estudio piloto prospectivo; en 669 radiografías se registró el tiempo invertido por dictado con cinta y sistemas PACS/RIS de reconocimiento (dictado por lotes o dictado en línea) y el Report Turnaround Time, intervalo de tiempo desde la introducción de imagen en PACS hasta tener informe disponible en RIS/CIS. En análisis retrospectivo de base de datos de RIS se estudió 11/2002-02/2003 y 11/2003-02/2004. Se calculó la media y el aumento relativo de la disponibilidad de informes a mediano y corto plazo tras la finalización del estudio. Resultados: Se observaron importantes diferencias en el tiempo invertido para cada modalidad (0,44/0,54/0,62 s por palabra e imagen) y del RTT medio (10,47/6,65/1,27 h). Se evaluaron retrospectivamente 37.898/39.680 informes de los períodos mencionados. En CR/TC, se observó un aumento medio del 20 por ciento en la disponibilidad de informes a corto plazo y en todas las modalidades fue más del triple en las primeras 24 h. En el caso de CR/TC/RM, el primer día hubo un aumento máximo de la disponibilidad a mediano plazo (factor 3,1/5,8/4,0) y en el caso de XA/DS, en el segundo día (factor 2,0). Conclusión: Cuando se utiliza un sistema de reconocimiento del habla se modifica el flujo de trabajo y se invierte inicialmente más tiempo para la elaboración de informes. Los sistemas de reconocimiento integrados en PACS/RIS mejoran considerablemente la disponibilidad de los informes a corto y mediano plazo, redundando en la calidad de la atención de los pacientes.

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CONTEXT AND OBJECTIVE: Breast cancer screening programs are critical for early detection of breast cancer. Early detection is essential for diagnosing, treating and possibly curing breast cancer. Since there are no data on the incidence of breast cancer, nationally or regionally in Brazil, our aim was to assess women by means of mammography, to determine the prevalence of this disease. DESIGN AND SETTING: The study protocol was designed in collaboration between the Department of Diagnostic Imaging (DDI), Institute of Diagnostic Imaging (IDI) and São Paulo Municipal Health Program. METHODS: A total of 139,945 Brazilian women were assessed by means of mammography between April 2002 and September 2004. Using the American College of Radiology (ACR) criteria (Breast Imaging Reporting and Data System, BIRADS), the prevalence of suspected and highly suspected breast lesions were determined. RESULTS: The prevalence of suspected (BIRADS 4) and highly suspected (BIRADS 5) lesions increased with age, especially after the fourth decade. Accordingly, BIRADS 4 and BIRADS 5 lesions were more prevalent in the fourth, fifth, sixth and seventh decades. CONCLUSION: The presumed prevalence of suspected and highly suspected breast cancer lesions in the population of São Paulo was 0.6% and it is similar to the prevalence of breast cancer observed in other populations.

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CONTEXT AND OBJECTIVE: Breast cancer screening programs are critical for early detection of breast cancer. Early detection is essential for diagnosing, treating and possibly curing breast cancer. Since there are no data on the incidence of breast cancer, nationally or regionally in Brazil, our aim was to assess women by means of mammography, to determine the prevalence of this disease. DESIGN AND SETTING: The study protocol was designed in collaboration between the Department of Diagnostic Imaging (DDI), Institute of Diagnostic Imaging (IDI) and São Paulo Municipal Health Program. METHODS: A total of 139,945 Brazilian women were assessed by means of mammography between April 2002 and September 2004. Using the American College of Radiology (ACR) criteria (Breast Imaging Reporting and Data System, BIRADS®), the prevalence of suspected and highly suspected breast lesions were determined. RESULTS: The prevalence of suspected (BIRADS® 4) and highly suspected (BIRADS® 5) lesions increased with age, especially after the fourth decade. Accordingly, BIRADS® 4 and BIRADS® 5 lesions were more prevalent in the fourth, fifth, sixth and seventh decades. CONCLUSION: The presumed prevalence of suspected and highly suspected breast cancer lesions in the population of São Paulo was 0.6 percent and it is similar to the prevalence of breast cancer observed in other populations.

CONTEXTO E OBJETIVO: Os programas de rastreamento para câncer de mama são fundamentais para a detecção precoce da doença. A detecção precoce de lesões suspeitas é essencial para diagnóstico, tratamento e possível cura do câncer de mama. Como no Brasil não há dados nacionais ou regionais sobre a prevalência do câncer de mama, nosso objetivo foi avaliar mulheres através da mamografia para determinar a prevalência da doença no Brasil no período de abril de 2002 a setembro de 2004. TIPO DE ESTUDO E LOCAL: Este trabalho foi realizado com a colaboração do Departamento de Diagnóstico por Imagem (DDI), Instituto de Diagnóstico por Imagem e da Prefeitura da cidade de São Paulo. MÉTODOS: Um total de 139.945 mulheres brasileiras foram avaliadas através de mamografias no período de abril de 2002 a setembro de 2004. Utilizando o sistema Birads® ACR (Breast Imaging Reporting and Data System, American College), a prevalência de lesões suspeitas e altamente suspeitas foi determinada. RESULTADOS: A prevalência de lesões suspeitas (BIRADS® 4) e altamente suspeitas (BIRADS® 5) aumentou com a idade, especialmente após a quarta década. De acordo com isso, as lesões BIRADS® 4 e BIRADS® 5 são mais prevalentes nas quarta, quinta, sexta e sétima décadas de vida. CONCLUSÕES: A prevalência presumida de lesões suspeitas e altamente suspeitas de câncer de mama na população da cidade de São Paulo é 0,6 por cento e esta prevalência é similar a de outras populações observadas.

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