Hungarian Radiology

[The ‘Oulu’ model - Leonardo da Vinci mobility programme Oulu, April 1st-August 31st, 2009.]

BORA László

DECEMBER 21, 2009

Hungarian Radiology - 2009;83(04)

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Further articles in this publication

Hungarian Radiology

[Residents here and over the rainbow]

LOMBAY Béla

Hungarian Radiology

[Cervical space occupying lesions: diagnosis at sonoelastography]

UJLAKI Mátyás, MAGYAR Péter, KARLINGER Kinga

[Among cervical (neck) region tumours, the thyroid lesions and the metastatic lymph nodes are the most detectable with conventional B-mode ultrasonography (US). The use of MRI and CT scans are limited because of the cost, and in case of CT, the radiation. With the introduction and constant development of sonoelastography, we have in our hands a new imaging procedure which is cheap, fast and harmless, yet giving more information to the examiner than conventional US. The elastographic examination of thyroid lesions is a more explored area than the elastographic visualisation of cervical lymph nodes. The ‘off-line’ elastography showed the highest accuracy allowing to calculate and analyse the strain index of cervical lymph nodes - strain index > 1.5 (85% sensitivity, 98% specificity) - but the ‘off-line’ processing of US elastograms is still too time consuming to be used in busy clinical settings. During the examinations of the thyroid gland both real-time and off-line processed strain imaging were used. An Italian team made a great leap forward as they standardized the degree of distorsion under the application of the external force. Then using the Ueno and Itoh elasticity score they achieved remarkable accuracy with real-time sonoelastography (P <0.0001). On the other hand only those organs are suitable for the US elastography characterization which can be slightly compressed, consequently the examination of a lesion with calcified shell cannot give useful information. Near to the pulsating arteries substantial amounts of decorrelation noise may appear and the examiner has to pay attention what structures are in the ROI box since the sonoelastography method assumes computations relative to the average strain inside the box. To detect a follicular carcinoma in the thyroid gland remains a big challenge. Despite of the limitations most researchers agree on the fact that sonoelastography is a perfect tool to use in addition to the conventional US examination. B-mode US combined with sonoelastography raised the accuracy in differentiation in all cases. With this modality it is also possible to deduce the number of cases when healthy lymph nodes or tissue peaces are taken for biopsy during FNAB.]

Hungarian Radiology

[Clinical significance of nuclear scans in assessing function of thyroid nodules]

NAGY Dezső, BORBÉLY Katalin

[Functional and anatomical imaging plays an important role in the diagnosis and treatment of thyroid nodules presenting with continuously increasing number. In the first part of the paper the usefulness and recent trends of the classical nuclear medicine is discussed. The second part presents the interpretation of incidental thyroid lesions detected by PET-CT and the usefulness of PET in the evaluation of thyroid carcinoma.]

Hungarian Radiology

[Digital volume tomography - The use of cone beam CT in dentistry, oral and maxillofacial surgery]

PLACHTOVICS Márk

[Oral and maxillofacial radiology is a subspecialty with its own field of indication. The goal is to achieve proper diagnostic image quality with the minimal amount of harmful radiation. The most common acquisition techniques are the intraoral radiograph and the panoramic radiograph which result in an overview picture of the whole dental status of the patient or the full mouth survey with the higher doses of radiation indicated for periodontological treatment. The next level is the supplementary radiograph such as occlusal radiograph, transversal tomography (some panoramic radiographs have this option), lateral cephalometric projection, submentovertex view or Waters projection, etc. More over cone beam CT acquisition or digital volume tomography as is called. In case of some described special indications CT, MRI or sometimes US acquisition can be made. In the field of three dimensional radio-diagnostics, the CT has a superior place with well-known advantages for everybody, and the usage has been limited only by the high radiation dose. The main point of the acquisition is the image quality. The load of radiation only makes the field of indication narrow. In every day practice - because of the higher radiation load of each high quality CT - the pictures passing to the doctor are preferred to take with lower resolution and wider slices although the diagnostic value of this never reaches the wanted level. This is why this new acquisition system also mentioned in the title would be better known. This system works with reasonable low radiation coupling with the possibilities of the high fidelity 3D imaging focusing on the bony structures of the head and neck region. The purpose of this article is to give a comprehensive introduction to this method in use for more than a decade. From 2006 in Hungary we also have the option to use the technology.]

Hungarian Radiology

[Voiding sonocystography with ultrasound contrast material for the diagnosis of vesicoureteral reflux]

KIS Éva

[Voiding sonocystography with intravesical administration of ultrasound contrast agent is a sensitive method to detect vesicoureteral reflux without irradiation. Depicting microbubbles in the ureters and collecting system is feasible even with very small amounts of a second-generation ultrasound contrast agent, Sonovue. The reflux is graded (I-V) in a similar manner to the system used in voiding cystourethrography. In this article a detailed description is presented.]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

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[8th of August was this year's Overconsumption Day; it is a model calculation of when humanity will use up the total global biocapacity for a given year. The data series and calculation methods are available for anyone to download from the Global Footprint Network website. We...]

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