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- ItemAcesso aberto (Open Access)O aprendizado sobre os recursos do Sistema Único de Saúde na residência em radiologia(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2014-06-01) Oliveira, Aparecido Ferreira de; Lederman, Henrique Manoel [UNIFESP]; Batista, Nildo Alves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To investigate the learning on the management of resources of the Unified Health System (Sistema Único de Saúde - SUS) and its interfaces with private institutions in the radiology residency program of Escola Paulista de Medicina - Universidade Federal de São Paulo, in order to improve radiologists' training. Materials and Methods: Exploratory research with quantitative and qualitative approach to residents, faculty staff and preceptors of the program, utilizing Likert questionnaires (46), deepening interviews (18) and categorization based upon meaning units (thematic analysis). Results: Sixty-three per cent of the respondents claim the non-existence of an opportunity for the residents to be acquainted with the management of SUS resources, and were even more categorical (76%) regarding the knowledge about resources from private institutions in the intersection with SUS. Conclusion: The learning on the management of SUS resources represents a relevant challenge to be overcome by residency programs, considering the extensiveness and complexity of the Brazilian health system, that is not sufficiently approached during the program, even in its most basic aspects, with daily experiences involving an excessive number of patients and a busy agenda, besides the inadequate public health infrastructure. The present study indicates the need for a greater emphasis on the development of the learning on aspects related to the management of resources from the SUS, assimilating particularities and overcoming the frequent difficulties, thus improving the training of radiologists.
- ItemAcesso aberto (Open Access)Avaliação de um sistema de segunda opinião em radiologia(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2010-06-01) Neira, Ricardo Alfredo Quintano [UNIFESP]; Puchnick, Andrea [UNIFESP]; Cohrs, Frederico Molina [UNIFESP]; Lopes, Paulo Roberto De Lima [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]; Pisa, Ivan Torres [UNIFESP]; Zilics Sistemas de Informação em Saúde; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: A second medical opinion can aid in the investigation of a health problem as well as in the definition of the therapeutic approach. The present study is aimed at demonstrating a process of second medical opinion by means of a web-based multispecialty system adapted for radiology. MATERIALS AND METHODS: The system was utilized by 49 residents at Universidade Federal de São Paulo (UNIFESP), Brazil, who gave their medical opinion on 52 second opinion requests. Questionnaires were utilized as an evaluation tool. RESULTS: A total of 1704 medical second opinions were evaluated and 514 (29.1%) of them were defined as satisfactory. In 64.4% of cases, the answers of the questionnaires indicated that the images quality did not affect the diagnosis. On average, 6 minutes and 26 seconds was the time required to issue a remote second medical opinion. CONCLUSION: A process of second medical opinion by means of a web-based multispecialty system adapted for radiology has shown to be an excellent tool in the management of therapeutic approaches.
- ItemSomente MetadadadosConstrução de algoritmos de Machine Learning na Radiologia(Universidade Federal de São Paulo (UNIFESP), 2020-09-17) Kitamura, Felipe Campos [UNIFESP]; Abdala, Nitamar [UNIFESP]; Universidade Federal de São PauloRecent research in artificial intelligence has shown great potential to change radiology as we know it today. The tools to aid the radiological diagnosis can bring numerous benefits to the patients, radiologists and referring physicians. Despite the high expectations for this technology, the path to the creation of clinically useful and safe tools is a huge challenge that involves several aspects. In this work, we will address ethical, regulatory, technical and cultural considerations that need to be addressed to expand the scope of artificial intelligence algorithms in practice. Next, we present 7 projects developed by our group that address some of the challenges in the area: (1) the lack of reproducibility when reading exams, (2) the creation of optimized algorithms for each clinical problem, (3) the limitation to access large volumes of quality annotated data, (4) the lack of reproducibility of artificial intelligence researches, (5) the difficulty of integrating algorithms in medical practice, (6) errors in the registration of exams types and (7) the risk of exposure of sensitive patient information.
- ItemAcesso aberto (Open Access)Construção e avaliação de sistema de segunda opinião médica em radiologia(Universidade Federal de São Paulo (UNIFESP), 2009-06-24) Neira, Ricardo Alfredo Quintano [UNIFESP]; Pisa, Ivan Torres [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION. The second opinion can be defined as the search of advices or medical information between health professionals. OBJECTIVE. The objective of this work is to present the steps of the construction of a second opinion system, as well as the evaluation results of the developed system. METHODS. In this work an observational study with an empirical ethnographic research focus was implemented. A web system was developed based on open-source technologies. For the evaluation, the system was used by 49 residents from the Federal University of São Paulo that informed their opinion to 52 medical second opinion requests. Questionnaires of previous knowledge, request, opinion and satisfaction where employed as evaluation tools. RESULTS. 1.891 second opinion responses were given by the physicians to the 52 requests. Regarding to the user satisfaction evaluation, the system presents a 87,8% mean in the easy utilization item and a 95,6% mean in learning to operate the system. The physicians showed the necessity to add resources to help observing images, as example, magnifying, brightness and contrast, on 38,2% of the responses. 47,3% responses indicated also that clinical information is the most important information for a second opinion emission. Inappropriate language was found on responses for medical second opinion requests which could difficult physicians’ cooperation. CONCLUSION. The results of the development and evaluation of the second opinion system show that the defined process was effective for the achievement of remote radiology second opinion.
- ItemAcesso aberto (Open Access)Desenvolvimento e validação de arquétipos de radiologia para registro eletrônico de saúde(Universidade Federal de São Paulo (UNIFESP), 2016-08-31) Araujo, Tiago Veloso [UNIFESP]; Paiva, Paulo Bandiera [UNIFESP]; http://lattes.cnpq.br/0947654602498462; http://lattes.cnpq.br/8036401125824969; Universidade Federal de São Paulo (UNIFESP)Purpose: To develop a sum of radiology archetypes for openEHR and to propose a method for the creation of new archetypes in many areas. Methods: There were been selected the modalities of radiology and imaging studies and the archetype entry classes. Using an archetype editor, they have been developed, based on specific terminologies for definition of terms and nouns, in English and Portuguese. The archetypes have been submitted to a validation tool, finishing their development. Results: There were been created 26 archetypes in thee 04 entry classes. In each one are inserted fields and general and specific information, according to the archetype class and type of study. Conclusion: The development of these archetypes creates a conceptual basis of radiology for an openEHR based Electronic Health Records (EHR), and enables the creation of archetypes based radiology systems. It also proposes a method for the development of new archetypes in other health areas.
- ItemSomente MetadadadosDistância base de língua - parede posterior da faringe, aspiração laringotraqueal e resíduos faríngeos pós acidente vascular cerebral(Universidade Federal de São Paulo (UNIFESP), 2021) Zica, Guilherme Maia [UNIFESP]; Goncalves, Maria Ines Rebelo [UNIFESP]; Universidade Federal de São PauloObjective: To investigate the association between base tongue-posterior pharyngeal wall distance (BT-PPW) at rest with supraglottic penetration, laryngotracheal aspiration and pharyngeal residues in individuals after stroke. Method: Descriptive, cross-sectional and retrospective study of swallowing videofluoroscopy exams in 56 patients with medical diagnosis of stroke and a control group with 84 individuals. The distance between the base of the tongue and the posterior wall of the pharynx at rest was measured using the Image J program. The measure found was correlated with the sociodemographic characteristics and the clinical findings of swallowing. Results: Regarding the BT-PPW measures, statistical significance was observed in relation to gender; male patients had greater distance means than female patients (M>F). Regarding the BT-PPW measures, statistical significance was observed in relation to age; being that elderly patients had greater distance means than adult patients (elderly>adults). Conclusions: Male patients had significantly greater distance means than female patients (M>F). Elderly patients had significantly higher mean distances than adult patients (elderly>adults). There were no statistically significant correlations in relation to the BT-PPW distance with the swallowing findings (penetration, aspiration and residues).
- ItemAcesso aberto (Open Access)The learning about imaging diagnosis technology(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2014-01-01) Oliveira, Aparecido Ferreira de; Lederman, Henrique Manoel [UNIFESP]; Batista, Nildo Alves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective To investigate the learning about management of the technology (efficient use, acquisition and maintenance of imaging diagnosis equipment) in the radiology residency program of Escola Paulista de Medicina - Universidade Federal de São Paulo, with a view to improving the education of radiologists. Materials and Methods Exploratory research where residents, faculty staff and tutors of the program were quantitative and qualitatively approached with Likert scale questionnaires (46), and deepening with recorded interviews (18) and categorization based upon meaning units (thematic analysis). Results Among the participants, 66% agreed that they had the opportunity of learning about the use of radiological equipment; for 61% the program should include knowledge on the importance of acquiring equipment; and 72% emphasized the lack of learning about equipment management and maintenance. Conclusion As the major moment in the education of specialists, the medical residency program provides residents with a favorable environment to the learning of the skills required to the future of their professional practice, but with limited emphasis on the management of the technology: efficient use, acquisition and mainly maintenance of equipment, still poorly explored. Both the investigated program and the medical residency in radiology should incorporate, whenever possible, the commitment with the training in supplementary skills related to equipment management, developing the competence of the future radiologists.
- ItemAcesso aberto (Open Access)Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?(Hospital Clinicas, Univ Sao Paulo, 2016) Andrade, Felipe P.; Montoro Neto, Roberto; Oliveira, Renan; Loures, Gabriela; Flessak, Luana; Gross, Roberta; Donnabella, Camille; Puchnick, Andrea [UNIFESP]; Suzuki, Lisa; Regacini, RodrigoOBJECTIVES: 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. METHODS: Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale >= 13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, > 12 hours of observation, or neuro-specialist evaluation. RESULTS: Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery. No statistically significant relationship was observed between patient age, time between trauma and admission, or signs/symptoms related to trauma and abnormal imaging results. A statistically significant relationship between abnormal image results and a fall higher than 1.0 meter was observed (p=0.044). The mean effective dose was 2.0 mSv (0.1 to 6.8 mSv), corresponding to an estimated additional cancer risk of 0.05%. CONCLUSION: A computed tomography scan after minor head injury in pediatric patients did not show clinically relevant abnormalities that could lead to neurosurgical indications. Patients who fell more than 1.0 m were more likely to have changes in imaging tests, although these changes did not require neurosurgical intervention
- ItemAcesso aberto (Open Access)Proposta de um programa básico para a formação do médico residente em radiologia e diagnóstico por imagem(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2007-02-01) Boéchat, Ana Luiza; Sousa, Evandro Guimarães De; Moreira, Fernando Alves [UNIFESP]; Koch, Hilton Augusto; Universidade Federal do Rio de Janeiro Faculdade de Medicina; Instituto Nacional de Cardiologia de Laranjeiras; Universidade Federal de São Paulo (UNIFESP); Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Hospitais 9 de Julho e Paulistano; Universidade Federal do Rio de Janeiro Departamento de Radiologia; Pontifícia Universidade Católica do Rio de Janeiro Curso de Pós-graduaçãoOBJECTIVE: To propose a model of a program of medical residence in radiology and diagnostic imaging comprising theoretical and practical training. MATERIALS AND METHODS: The program was based on a literature review and critical analysis, following recommendations from Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (Brazilian College of Radiology and Image Diagnosis) and Comissão Nacional de Residência Médica (National Commission for Medical Residency), and based on the program of Accreditation Council for Graduate Medical Education. RESULTS: The present proposal has been developed for a three-year-duration program divided into modules by subspecialties or diagnostic methods. Objectives have been described and targeted proficiencies specified. Evaluation models have been presented and discussed. CONCLUSION: Changes in the current teaching-learning model have become necessary because of the increasing information availability and fast technological development in the latest years. The hierarchical organization of the knowledge acquisition process with essential programmatic contents allows an appropriate education of the future specialist. It is anticipated that the present proposal may contribute to improve the medical residency programs, thus stimulating the implementation of a countrywide model.
- ItemRestritoRadiologia Forense o uso da Radiologia para elucidação de crimes(Universidade Federal de São Paulo, 2022-08-11) Santos, Heloisa Schellerg; Valiengo Filho, Antônio Geraldo; http://lattes.cnpq.br/7079601962012057O serviço de Radiologia Forense tem um importante papel na investigação criminal, interagindo com as Unidades de Medicina Legal e Antropologia. Entre essas aplicações estão: estudo de óbitos por acidentes aéreos e desastres, documentação de lesões em acidentes de trânsito, autópsias médico-legais em óbitos por asfixia mecânica, estudo de óbitos associados a ferimentos por projéteis de arma de fogo, diagnóstico de maus-tratos infantis, verificação de a autenticidade de provas físicas, identificação de cadáveres, exame em óbitos fetais, lesões corporais, determinação de idade, exame de restos esqueléticos e necropsia virtual (virtuopsia). Desse modo, o tema do presente estudo é radiologia forense: o uso da radiologia para elucidação de crimes. Tem-se por objetivo compreender a importância da radiologia forense na identificação de pessoas vivas e cadáveres sendo um dos requisitos que a autoridade faz ao médico legista e que em muitos casos é essencial para uma investigação judicial. O método aplicado é de pesquisa bibliográfica, de natureza qualitativa, realizada através de livros, artigos acadêmicos, periódicos e sites especializados quanto ao tema escolhido. Como resultados destaca-se o fato de que as imagens são essenciais na determinação do trauma, constituindo evidência confiável, objetiva e científica na hora de comprovar a lesão. Pode-se concluir que a radiologia tem aplicações de grande importância para esclarecer crimes e, assim, apoiar a administração da justiça.
- ItemAcesso aberto (Open Access)O transplante hepático por hepatocarcinoma na era MELD em São Paulo: avaliação de 414 casos transplantados pelo critério de Milão/Brasil(Universidade Federal de São Paulo (UNIFESP), 2015-11-30) Sá, Gustavo Pilotto Domingues [UNIFESP]; Gonzalez, Adriano Miziara [UNIFESP]; Salzedas Netto, Alcides Augusto [UNIFESP]; http://lattes.cnpq.br/2580534578039797; http://lattes.cnpq.br/6234829429056217; http://lattes.cnpq.br/9311192779485846; Universidade Federal de São Paulo (UNIFESP)Introdução: O critério de Milão (CM) vem sendo utilizado como padrão para indicação do transplante hepático (TxH) por hepatocarcinoma (HCC) em todo o mundo, há quase 20 anos. Diversos centros têm adotado critérios expandidos com o intuito de aumentar o número de pacientes candidatos ao TxH, mantendo bons índices de sobrevida. No Brasil, desde 2006, o critério de Milão/Brasil (CMB), que desconsidera nódulos menor que 2 cm, é adotado, incluindo maior número de pacientes com nódulos pequenos. O objetivo deste estudo foi avaliar o resultado do transplante hepático de acordo com o CMB e a forma de controle da fila de espera, enquanto os pacientes aguardam pelo transplante. Métodos: Foram analisados os prontuários dos pacientes com HCC submetidos ao TxH na cidade de São Paulo, entre 2007 e 2011, em relação à recidiva e sobrevida. Foram comparados os exames de imagens préoperatórios com o anatomopatológico do fígado explantado (BX) e sua relação com o resultado dos transplantes. Resultados: Em 414 TxH por HCC, a sobrevida em 1 e 5 anos foi de 84,1 e 72,7%. Destes, 7% atingiram o CMB através de Downstaging, com sobrevida em 1 e 5 anos, de 93,1 e 71,9%. O grupo de pacientes do CMB que excedeu o CM (8,6%) teve sobrevida de 58,1% em 5 anos. Não houve diferença estatística na sobrevida entre os grupos CM, CMB e Downstaging. A invasão vascular (p < 0,001), tamanho do maior nódulo (p = 0,001) e n de nódulos maiores que 2 cm (p = 0,028) se associaram com recidiva. A idade (p = 0,001), sexo feminino (p < 0,001), MELD real (p < 0,001), invasão vascular (p = 0,045) e o n de nódulos maiores que 2 cm (p < 0,014) estiveram associados a piora na sobrevida. Os exames de imagem diferiram da BX em cerca de 30% dos casos. 11,3% dos pacientes transplantados estavam fora do CMB de acordo com a BX. Conclusões: O CMB aumentou em 8,6% as indicações de TxH e apresentou índices de sobrevida semelhantes ao CM. A margem de erro na indicação e acompanhamento na fila de espera foi de 11,3%.