Certificação digital de exames em telerradiologia: um alerta necessário

A crescente popularização das atividades de telemedicina em todo o mundo tem exigido de médicos e demais profissionais da saúde novas abordagens em sua prática profissional. No que se refere à telerradiologia, observamos forte tendência à transformação de documentos clínicos - como resultados de exames, que até hoje existiam na forma de filmes impressos e laudos em papel - em documentos eletrônicos, disponibilizados em redes internas de clínicas e hospitais, ou pela internet. Esta tendência torna necessária a divulgação e o esclarecimento de conceitos como a certificação digital, a criptografia de dados na internet, a confiabilidade de sites, o documento eletrônico confiável e a assinatura digital. Os princípios básicos desses conceitos, embora por vezes complexos para os profissionais da saúde, podem ser compreendidos de forma efetiva sem que o leitor tenha de mergulhar de cabeça em labirintos como a matemática da criptografia de chaves assimétricas ou os protocolos de comunicação digital de dados. Neste artigo abordaremos de forma direta e com exemplos práticos os aspectos de segurança e confiabilidade de documentos clínicos eletrônicos baseados na internet, com o objetivo de que os usuários médicos possam interagir de forma informada, segura e bem fundamentada com serviços de telerradiologia.

Uso de software como ferramenta pedagógica no processo de ensino-aprendizagem da mamografia digital

OBJETIVO: Avaliar o impacto sobre o treinamento de residentes utilizando uma ferramenta computacional dedicada à avaliação do desempenho da leitura de imagens radiológicas convencionais e digitais. MATERIAIS E MÉTODOS: O treinamento foi realizado no Laboratório de Qualificação de Imagens Médicas (QualIM). Os residentes de radiologia efetuaram cerca de 1.000 leituras de um total de 60 imagens obtidas de um simulador estatístico (Alvim®) que apresenta fibras e microcalcificações de dimensões variadas. O desempenho dos residentes na detecção dessas estruturas foi avaliado por meio de parâmetros estatísticos. RESULTADOS: Os resultados da probabilidade de detectabilidade foram de 0,789 e 0,818 para os sistemas convencional e digital, respectivamente. As taxas de falso-positivos foram de 8% e 6% e os valores de verdadeiro-positivos, de 66% e 70%, respectivamente. O valor de kappa total foi 0,553 para as leituras em negatoscópio e 0,615 em monitor. A área sob a curva ROC foi de 0,716 para leitura em filme e 0,810 para monitor. CONCLUSÃO: O treinamento proposto mostrou ser efetivo e apresentou impacto positivo sobre o desempenho dos residentes, constituindo-se em interessante ferramenta pedagógica. Os resultados sugerem que o método de treinamento baseado na leitura de simuladores pode produzir um melhor desempenho dos profissionais na interpretação das imagens mamográficas.

Hardcopy quality parameters to ensure structures detection at digital mammography

Objective To develop procedures to ensure consistency of printing quality of digital images, by means of hardcopy quantitative analysis based on a standard image. Materials and Methods Characteristics of mammography DI-ML and general purpose DI-HL films were studied through the QC-Test utilizing different processing techniques in a FujiFilm®-DryPix4000 printer. A software was developed for sensitometric evaluation, generating a digital image including a gray scale and a bar pattern to evaluate contrast and spatial resolution. Results Mammography films showed maximum optical density of 4.11 and general purpose films, 3.22. The digital image was developed with a 33-step wedge scale and a high-contrast bar pattern (1 to 30 lp/cm) for spatial resolution evaluation. Conclusion Mammographic films presented higher values for maximum optical density and contrast resolution as compared with general purpose films. The utilized digital processing technique could only change the image pixels matrix values and did not affect the printing standard. The proposed digital image standard allows greater control of the relationship between pixels values and optical density obtained in the analysis of films quality and printing systems.

Reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications

Objective The present study evaluated the reliability of digital panoramic radiography in the diagnosis of carotid artery calcifications. Materials and Methods Thirty-five patients under high-risk for development of carotid artery calcifications who had digital panoramic radiography were referred to undergo ultrasonography. Thus, 70 arteries were assessed by both methods. The main parameters utilized to evaluate the panoramic radiography reliability in the diagnosis of carotid artery calcifications were accuracy, sensitivity, specificity and positive predictive value of this method as compared with ultrasonography. Additionally, the McNemar's test was utilized to verify whether there was a statistically significant difference between digital panoramic radiography and ultrasonography. Results Ultrasonography demonstrated carotid artery calcifications in 17 (48.57%) patients. Such individuals presented with a total of 29 (41.43%) carotid arteries affected by calcification. Radiography was accurate in 71.43% (n = 50) of cases evaluated. The degree of sensitivity of this method was 37.93%, specificity of 95.12% and positive predictive value of 84.61%. A statistically significant difference (p < 0.001) was observed between the methods evaluated in their capacity to diagnose carotid artery calcifications. Conclusion Digital panoramic radiography should not be indicated as a method of choice in the investigation of carotid artery calcifications.

Monte Carlo derivation of filtered tungsten anode X-ray spectra for dose computation in digital mammography

Abstract Objective: Derive filtered tungsten X-ray spectra used in digital mammography systems by means of Monte Carlo simulations. Materials and Methods: Filtered spectra for rhodium filter were obtained for tube potentials between 26 and 32 kV. The half-value layer (HVL) of simulated filtered spectra were compared with those obtained experimentally with a solid state detector Unfors model 8202031-H Xi R/F & MAM Detector Platinum and 8201023-C Xi Base unit Platinum Plus w mAs in a Hologic Selenia Dimensions system using a direct radiography mode. Results: Calculated HVL values showed good agreement as compared with those obtained experimentally. The greatest relative difference between the Monte Carlo calculated HVL values and experimental HVL values was 4%. Conclusion: The results show that the filtered tungsten anode X-ray spectra and the EGSnrc Monte Carlo code can be used for mean glandular dose determination in mammography.

Sistema automático para análise direta de ligas metálicas por eletrodissolução anódica e espectrometria de absorção atômica

An automatic system for the direct determination of lead and tin by atomic absorption spectrometry is described. The on-line treatment of the metallic samples was obtained by anodic electrodissolution in a flow injection system. Lead was determined by flame atomic absorption spectrometry (FAAS) and tin by graphite furnace atomic absorption spectrometry (GFAAS). A computer program managed the current source and the solenoid valves that direct the fluids. Good linear correlations between absorbance and current intensity for lead and tin were observed. Results were in agreement with the certified values. Precision was always better than 5%. The recommended procedure allows the direct determination of 60 or 30 elements/h using FAAS or GFAAS, respectively.

Sistema automático para determinação seqüencial de cianeto livre e total empregando eletrodo tubular íon-seletivo de membrana homogênea

This study presents an automated system for potentiometric determination of free and total cyanide which employs a homogeneous membrane tubular ion-selective electrode. After the electrode is assembled, it is connected to a system composed of 3 three-way solenoid valves, sample line, carrier line, acid stream, and gas diffusion chamber. A Turbo Pascal® computer program, developed specifically for this task, automatically performs all the steps involved in data acquisition and processing. The proposed analytical procedure offers operational simplicity, since detection is performed by a tubular electrode, whose assembly is fast and easy. The system has shown reproducibility (r.s.d. < 0.5%, n=6) and high speed (30 readings/hour); it is efficient for determination of free and total cyanide in waste waters of starch processing plants. The detection limit was 1.2x10-5 and 1.5x10-5 mol L-1, for determination of free and total cyanide, respectively. The linear response range was between 1.2x10-5 and 1.0x10-2 mol L-1 for free cyanide and between 1.5x10-5 and 1.0x10-2 for total cyanide.

Reciclagem de cobre proveniente de analisador automático de carbono e nitrogênio

Isotopic and elemental analysis of N, C and S in liquid and solid samples has been simplified with the advent of automated systems. The simplest method of automation for this kind of analysis involves an elemental analyzer interfaced directly to the ion source of an IRMS (Isotope Ratio Mass Spectrometry). In the analyzer reduction system, an expressive amount of oxidized copper is generated as solid residue. This material is normally imported and the price is very high. A methodology was proposed for the recovery of metallic copper in order to recycle this reagent in the reduction system of a GC-IRMS, using the hydrogen gas in the vacuum line. Results show that it is possible to obtain a recycle of about 95 % of the initial metallic copper used in the reduction system.

Do termoscópio ao termômetro digital: quatro séculos de termometria

This work describes the evolution of temperature measurement in the last four centuries using thermometers based on the thermal expansion of liquids such as ethyl alcohol and mercury. The concept of temperature was strongly dependent on the researcher and there was no systematic temperature scale for universal use. The precursor of the common thermometer was the thermoscope, probably invented at the end of the XVIth century. In the XVIIIth century the instrument was greatly improved and several thermometric scales were proposed some of which have been in use until now. These scales were based on arbitrary points. Mercury and ethyl alcohol were the most employed thermometric fluids. In the XIXth century, the concept of absolute zero was a great advance in this field. The most important contribution during the XXth century was the establishment of international temperature scales. The design of the thermometer has been essentially the same along the last 300 years, but many models were proposed for industrial and research purposes. Its association with the densimeter was of great importance for control of industrial chemical processes and also for teaching purposes in the past. Nowadays, there is a clear tendency to replace mercury-based thermometers by electronic digital models. Thermochemistry is the natural relationship between temperature and chemistry.

De Svante Arrhenius ao peagâmetro digital: 100 anos de medida de acidez

This work describes the establishment of the concept of pH and the evolution of its measurement. The origin of the pH definition can be found in the development of the chemistry of aqueous solutions during the XIXth century. The electrolytic dissociation theory by Svante Arrhenius played a central role. After the proposal of the pH scale by Sörensen, many years were necessary for the acceptance of this new parameter among chemists in general. Its importance was first recognized in biochemistry and related areas. Twenty years after, its importance had been recognized in many industrial and laboratorial practices. The previous methods were based on colorimetric and electrometric methods, but both suffered from many problems. Acceptance of pH in Chemistry was only possible after the development of experimental trustable measurements. The invention of the pH meter was the primordial step.

Avaliação da classificação digital de povoamentos florestais em imagens de satélite através de índices de acurácia

A utilização de matéria-prima de origem florestal aumentou significativamente nas últimas décadas. A busca por alta produtividade concretizou-se com a introdução de espécies exóticas, principalmente Eucalyptus sp. e Pinus sp. Neste trabalho avaliou-se a precisão da classificação digital obtida no levantamento de povoamentos florestais implantados e naturais da área da carta de Cachoeira do Sul - RS, utilizando técnicas de geoprocessamento, sensoriamento remoto, SIG (sistema de informação geográfica) e GPS (sistema de posicionamento global). Verificou-se que a área é ocupada por vegetação natural (35,54%), Pinus sp. (1,89%) e Eucalyptus sp. (0,77%), cuja precisão na classificação supervisionada digital foi: Exatidão global (85,23%), Kappa (84,90%) e Tau (77,74%). Concluiu-se que os três índices de acurácia podem ser utilizados, apesar de os índices Kappa e Tau mostrarem-se mais consistentes.