A 76-year-old male patient presented to the emergency room with acute decompensated right heart failure and presyncope episodes. Upon admission, his electrocardiogram (ECG) showed sustained monomorphic ventricular tachycardia at 180 bpm, which was electrically cardioverted, and the patient was subsequently admitted to the intensive care unit. The echocardiography showed a very dilated right ventricle (RV) with global systolic dysfunction and akinetic anterior and lateral walls. The coronary angiography was normal. The cardiac magnetic resonance showed signs of fibro-fatty replacement of the RV myocardium. Furthermore, the ECG after cardioversion showed inverted T waves and an epsilon wave in V1-V3 leads and late potentials by signal-averaged ECG. As such, a diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) was suspected. However, he presented no familial history of ARVC, was 76 years of age at the time of diagnosis and was asymptomatic until now. Given these considerations, we performed a right ventricular angiography which showed dilatation of the RV with akinetic/dyskinetic bulging, creating the \"pile d\'assiettes\" image suggestive of ARVC. In the case of this patient, the RV angiography contributed to establish a diagnosis of ARVC with a very late presentation, to our knowledge the latest presentation in terms of age described in the literature.

Ambulatory 24-72 h Holter ECG monitoring is recommended for patients with suspected arrhythmias, which are often transitory and might remain unseen in resting standard 12-lead ECG. Holter manufacturers provide software diagnostic tools to assist clinicians in evaluating these large amounts of data. Nevertheless, the identification of short arrhythmia events and differentiation of the arrhythmia type might be a problem in limited Holter ECG leads. This observational clinical study aims to explore a novel and weakly investigated ECG modality integrated into a commercial diagnostic tool ECHOView (medilog DARWIN 2, Schiller AG, Switzerland), while used for the interpretation of long-term Holter-ECG records by a cardiologist. The ECHOView transformation maps the beat waveform amplitude to a color-coded bar. One ECHOView page integrates stacked color bars of about 1740 sequential beats aligned by R-peak in a window (R ± 750 ms). The collected 3-lead Holter ECG recordings from 86 patients had a valid duration of 21 h 20 min (19 h 30 min-22 h 45 min), median (quartile range). The ECG rhythm was reviewed with 3491 (3192-3723) standard-grid ECG pages and a substantially few number of 51 (44-59) ECHOView pages that validated the ECHOView compression ratio of 67 (59-74) times. Comments on the ECG rhythm and ECHOView characteristic patterns are provided for 14 examples representative of the most common rhythm disorders seen in our population, including supraventricular arrhythmias (supraventricular extrasystoles, paroxysmal supraventricular arrhythmia, sinus tachycardia, supraventricular tachycardia, atrial fibrillation, and flutter) and ventricular arrhythmias (ventricular extrasystoles, non-sustained ventricular tachycardia). In summary, the ECHOView color map transforms the ECG modality into a novel diagnostic image of the patient\'s rhythm that is comprehensively interpreted by a cardiologist. ECHOView has the potential to facilitate the manual overview of Holter ECG recordings, to visually identify short-term arrhythmia episodes, and to refine the diagnosis, especially in high-rate arrhythmias.

Lung ultrasound (LUS) is now widely used in the diagnosis and monitor of neonatal lung diseases. Nevertheless, in the published literatures, the LUS images may display a significant variation in technical execution, while scanning parameters may influence diagnostic accuracy. The inter- and intra-observer reliabilities of ultrasound exam have been extensively studied in general and in LUS. As expected, the reliability declines in the hands of novices when they perform the point-of-care ultrasound (POC US). Consequently, having appropriate guidelines regarding to technical aspects of neonatal LUS exam is very important especially because diagnosis is mainly based on interpretation of artifacts produced by the pleural line and the lungs. The present work aimed to create an instrument operation specification and parameter setting guidelines for neonatal LUS. Technical aspects and scanning parameter settings that allow for standardization in obtaining LUS images include (1) select a high-end equipment with high-frequency linear array transducer (12-14 MHz). (2) Choose preset suitable for lung examination or small organs. (3) Keep the probe perpendicular to the ribs or parallel to the intercostal space. (4) Set the scanning depth at 4-5 cm. (5) Set 1-2 focal zones and adjust them close to the pleural line. (6) Use fundamental frequency with speckle reduction 2-3 or similar techniques. (7) Turn off spatial compounding imaging. (8) Adjust the time-gain compensation to get uniform image from the near-to far-field.

Echocardiographic cardiac parameters in the prone position are usually obtained with an esophageal probe. The feasibility of obtaining them by means of a transthoracic approach is unknown.
Estimating the feasibility to obtain parameters of the right ventricle by transthoracic echocardiography in prone position on the subject.
Pilot design of consecutive case series without cardiopulmonary disease. Demographic, vital signs and echocardiographic variables were defined in the ventral initial, prone and ventral final decubitus positions. The data are shown with averages and standard deviations, and frequencies and percentages according to the variable. The differences between the positions were calculated with ANOVA of repeated samples and adjustment of Bonferroni test. Intra-subject variability was obtained by the Bland-Altman procedure and its 95% confidence interval.
We studied 50 subjects, 44 (88%) males, age 30 ± 6 years and body mass index 25.65 ± 2.71 kg/m2. Tricuspid annular plane systolic excursion (TAPSE) and S\'-wave were measured 100% of the time. The vital signs and echocardiographic variables according to the position had differences in: heart rate (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 beats/min), partial oxygen saturation (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) and mean systemic blood pressure (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 ± 2.84 mm), mean difference (bias) 0 (2, -2.0) and S\'-wave (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), mean difference (bias) -0.46 (1.21, -2.14) respectively.
Obtaining right ventricle parameters by transthoracic ecocardiopraphy is feasible in the prone position.
Los parámetros cardiacos ecocardiográficos en posición de decúbito prono usualmente se obtienen con sonda esofágica. Se desconoce la factibilidad de obtenerlos mediante aproximación transtorácica.
Estimar la factibilidad para obtener parámetros del ventrículo derecho mediante ecocardiografía transtorácica en el sujeto en posición de decúbito prono.
Diseño piloto de serie de casos consecutivos sin enfermedad cardiopulmonar. Se acotaron variables demográficas, signos vitales y ecocardiográficas en posición decúbito ventral inicial, prono y ventral final. Los datos se muestran con promedios y desviaciones estándar, y frecuencias y porcentajes de acuerdo con la variable. La diferencia entre las posiciones se calculó con ANOVA de muestras repetidas y ajuste de Bonferroni. Se obtuvo la variabilidad intrasujetos mediante el procedimiento de Bland-Altman y su intervalo de confianza al 95%.
Se estudiaron 50 sujetos, 44 (88%) masculinos, edad 30 ± 6 años e índice de masa corporal 25.65 ± 2.71 kg/m2. El TAPSE (excursión sistólica del plano del anillo tricuspídeo) y la onda S’ se midieron en el 100% de las veces. Los signos vitales y variables ecocardiográficas de acuerdo con la posición tuvieron diferencias en: frecuencia cardiaca (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 lpm), saturación parcial de oxígeno (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) y la presión arterial sistémica media (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 vs. 2.84 mm), diferencia media (sesgo) 0 (2, –2.0) y onda S’ (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), diferencia media (sesgo) –0.46 (1.21, –2.14) respectivamente.
En posición de decúbito prono es factible obtener parámetros del ventrículo derecho por ecocardiografía transtorácica.

Some radiologic patient positioning techniques that can be used for X-ray examinations can be difficult to apply. One method involves using ultra-low-dose X-ray images to confirm positioning. These positioning images are typically discarded and not used for diagnosis. The purpose of this study was to improve the signal-to-noise ratio (SNR) in diagnostic imaging by including these ultra-low-dose positioning images rather than discarding them. To add two images together, we devised a method in which one image is multiplied by the coefficient calculated from its SNR before the addition. The images were dichotomized into a high SNR group and a low SNR group. The images in the high SNR group and the low SNR group were summed. When doing so, the images of the low SNR group were multiplied. There was one maximum SNR point while the SNR was being changed. The maximum SNR of the synthesized images was equal to the value of the square root of the sum of the squares of the two images. The multiplication coefficient, in the case of the maximum SNR, was near 1 when an image agreed with the Poisson distribution; when it did not, it was far from 1. The difference between the calculated values of the hypothetical measurement of the multiplication coefficient was small. In this study, we showed that improving SNR of a diagnostic image could be achieved by adding a positioning image. The multiplication coefficient in the case of the SNR maximum of a synthesized image is calculable. The measurement of a Wiener spectrum is needed for noise evaluation. There can be problems where there is motion after a positioning image is exposed.

Echocardiographic cardiac parameters in the prone position are usually obtained with an esophageal probe. The feasibility of obtaining them by means of a transthoracic approach is unknown.
Estimating the feasibility to obtain parameters of the right ventricle by transthoracic echocardiography in prone position on the subject.
Pilot design of consecutive case series without cardiopulmonary disease. Demographic, vital signs and echocardiographic variables were defined in the ventral initial, prone and ventral final decubitus positions. The data are shown with averages and standard deviations, and frequencies and percentages according to the variable. The differences between the positions were calculated with ANOVA of repeated samples and adjustment of Bonferroni test. Intra-subject variability was obtained by the Bland-Altman procedure and its 95% confidence interval.
We studied 50 subjects, 44 (88%) males, age 30 ± 6 years and body mass index 25.65 ± 2.71 kg/m2. Tricuspid annular plane systolic excursion (TAPSE) and S\'-wave were measured 100% of the time. The vital signs and echocardiographic variables according to the position had differences in: heart rate (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 beats/min), partial oxygen saturation (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) and mean systemic blood pressure (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 ± 2.84 mm), mean difference (bias) 0 (2, -2.0) and S\'-wave (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), mean difference (bias) -0.46 (1.21, -2.14) respectively.
Obtaining right ventricle parameters by transthoracic ecocardiopraphy is feasible in the prone position.
Los parámetros cardiacos ecocardiográficos en posición de decúbito prono usualmente se obtienen con sonda esofágica. Se desconoce la factibilidad de obtenerlos mediante aproximación transtorácica.
Estimar la factibilidad para obtener parámetros del ventrículo derecho mediante ecocardiografía transtorácica en el sujeto en posición de decúbito prono.
Diseño piloto de serie de casos consecutivos sin enfermedad cardiopulmonar. Se acotaron variables demográficas, signos vitales y ecocardiográficas en posición decúbito ventral inicial, prono y ventral final. Los datos se muestran con promedios y desviaciones estándar, y frecuencias y porcentajes de acuerdo con la variable. La diferencia entre las posiciones se calculó con ANOVA de muestras repetidas y ajuste de Bonferroni. Se obtuvo la variabilidad intrasujetos mediante el procedimiento de Bland-Altman y su intervalo de confianza al 95%.
Se estudiaron 50 sujetos, 44 (88%) masculinos, edad 30 ± 6 años e índice de masa corporal 25.65 ± 2.71 kg/m2. El TAPSE (excursión sistólica del plano del anillo tricuspídeo) y la onda S’ se midieron en el 100% de las veces. Los signos vitales y variables ecocardiográficas de acuerdo con la posición tuvieron diferencias en: frecuencia cardiaca (74 ± 9 vs. 77 ± 9 vs. 75 ± 8 lpm), saturación parcial de oxígeno (94.40 ± 1.70 vs. 96.64 ± 1.79 vs. 95.32 ± 1.36%) y la presión arterial sistémica media (65.33 ± 5.38 vs. 67.69 ± 6.31 vs. 65.29 ± 5.62 mmHg); TAPSE (19.74 ± 3.24 vs. 21.60 ± 2.97 vs. 19.44 vs. 2.84 mm), diferencia media (sesgo) 0 (2, –2.0) y onda S’ (13.52 ± 1.87 vs. 15.02 ± 2.09 vs. 13.46 ± 1.55 cm/s), diferencia media (sesgo) –0.46 (1.21, –2.14) respectivamente.
En posición de decúbito prono es factible obtener parámetros del ventrículo derecho por ecocardiografía transtorácica.

A bimodal tomographic system with a RTW MCBM 65B-50Mo X-ray tube and a XPAD3s semiconductor camera that contains 8 bars, each one with 67,200 hybrid pixels are modeled in GEANT4 simulation code. Several conical X-ray spectra were simulated, particularly a spectrum with a peak energy of 17.4 keV used in tomography on small animals. Three phantoms located in the tomographic center were added to the simulation to evaluate the image quality and its magnification based on the simulation of different photon fluences and the rotation effect of the tomographic system with an average angular velocity of 360o per minute. The images were recorded and analyzed in 2D through ROOT software toolkit in virtual XPAD3 detector. The quantitative method 20-80% of the maximum intensity of radiation was used for obtain the contouring of the phantoms, this method is used in radiotherapy and radiodiagnosis imaging. For this purpose, the images were taken to DICOM format in order to estimate the optical density of the contours and to evaluate the optimum and minimum photon fluence to be used in the tomographic system in order to reduce the absorbed doses in the individuals. This study allowed to determine the optimal fluence to validate it with realistic fluences used in the tomographic prototype ClearPET /XPAD-CT and to make an intercomparison with the absorbed doses measured with detectors located in the tomographic center.