Rubens Chojniak

In May 2025, the World Health Assembly adopted Resolution WHA78.13, formally recognizing medical imaging as a fundamental pillar of universal health coverage. Brazil, as a co-sponsor of the Resolution, plays a decisive role in promoting equitable access to imaging services throughout Latin America. This article explores the implications of the resolution for Brazil, highlighting its leadership and the need to address regional disparities in imaging infrastructure and workforce distribution. On the basis of data from the 2025 Atlas of Radiology in Brazil, the article highlights the unequal distribution of radiologists and imaging equipment, especially in underserved areas. Strategic priorities for regional action are outlined, including workforce development, infrastructure investments, and public policy integration. The Brazilian College of Radiology and Diagnostic Imaging is positioned to participate in national efforts, advocating for medical imaging as a public health priority. By aligning national initiatives with global strategies and embracing innovation, Brazil and Latin America can transform diagnostic equity and improve health outcomes.

Objective: The Laudo Estruturado e Léxico em Oncologia (LELEX, Lexicon and Structured Reporting in Oncology) initiative was established to develop a standardized lexicon and structured reporting system applicable across cancer types. Methods: The São Paulo Radiology Society and Brazilian Society of Medical Oncology assembled a 27-member multidisciplinary consensus panel that included radiologists, medical and radiation oncologists, surgeons, and a patient representative. A literature review identified relevant oncologic reporting frameworks to guide the creation of a draft template and lexicon by the LELEX executive committee. Panelists were surveyed to assess current reporting practices and preferences between free-text and structured reports. Consensus (i.e., agreement by more than 80% of panelists) on the final lexicon and reporting system was reached through post-survey panel discussions. Results: Compared with a traditional free-text report, a structured report incorporating the LELEX lexicon received significantly higher ratings for precision and was deemed better for guiding clinical decisions by > 88% of panelists. In post-survey discussions, consensus was achieved for all lexicon components, including diagnostic certainty terms, lesion count descriptors, and longitudinal comparison language. The structured report template was also agreed upon by the panel members. Conclusion: The LELEX initiative established a consensus-driven structured reporting system and lexicon for general oncologic imaging baseline and follow-up assessments.

Prone contrast-enhanced chest multidetector row CT showed high agreement with MRI for locoregional staging in patients with breast cancer, using the same examination acquired for distant staging.

This project aims to enhance oncological neurosurgery by displaying brain tumors using Augmented Reality (AR) as an overlay image during surgical procedures. Its purpose is to assist neurosurgeons in tasks such as brain biopsies by providing a clear and precise visualization of the affected area, thus enabling faster and less invasive surgeries, ultimately offering a more comfortable experience for patients. Currently, medical procedures achieve this through neuronavigation systems, which display two-dimensional images of the patient’s brain on a screen, typically positioned beside the patient or in separate imaging support rooms. By utilizing AR, surgeons can directly visualize the tumor on the patient’s body through a virtual 3D model, eliminating the need to frequently refer to external images. This project was developed using Microsoft HoloLens, a specialized AR headset, and Unity, a game engine widely used for 3D environment development. The system uses DICOM files as input, which are converted into 3D objects displayed through the AR headset.

Objetivo: Avaliar a taxa de sucesso diagnóstico e complicações da biópsia percutânea por fragmentos guiada por tomografia computadorizada (TC) em nódulos pulmonares menores que 10 mm.

Objective: To assess the diagnostic success rate and complications of computed tomography (CT)-guided percutaneous biopsy in pulmonary nodules < 10 mm in diameter.

Objective: To evaluate the results obtained with an artificial intelligence-based software for predicting the risk of malignancy in breast masses from ultrasound images. Materials and Methods: This was a retrospective, single-center study evaluating 555 breast masses submitted to percutaneous biopsy at a cancer referral center. Ultrasonographic findings were classified in accordance with the BI-RADS lexicon. The images were analyzed by using Koios DS Breast software and classified as benign, probably benign, low to intermediate suspicion, high suspicion, or probably malignant. The histological classification was considered the reference standard. Results: The mean age of the patients was 51 years, and the mean mass size was 16 mm. The radiologist evaluation had a sensitivity and specificity of 99.1% and 34.0%, respectively, compared with 98.2% and 39.0%, respectively, for the software evaluation. The positive predictive value for malignancy for the BI-RADS categories was similar between the radiologist and software evaluations. Two false-negative results were identified in the radiologist evaluation, the masses in question being classified as suspicious by the software, whereas four false-negative results were identified in the software evaluation, the masses in question being classified as suspicious by the radiologist. Conclusion: In our sample, the performance of artificial intelligence-based software was comparable to that of a radiologist.

Objective: The purpose of our study was to evaluate the transmission of information from radiologists to physicians, focusing on the level of certainty and the use of imaging descriptors from the tumor–node–metastasis (TNM) staging system. Materials and Methods Radiologists (n = 56) and referring physicians (n = 50) participated in this questionnaire-based, single-center study, conducted between March 20, 2020, and January 21, 2021. Participants were presented with terms commonly used by the radiologists at the institution and were asked to order them hierarchically in terms of the level of certainty they communicate regarding a diagnosis, using a scale ranging from 1 (most contrary to) to 10 (most favoring). They then assessed TNM system descriptors and their interpretation. Student’s t-tests and the kappa statistic were used in order to compare the rankings of the terms of certainty. Items related to T and N staging were analyzed by Fisher’s exact test. The confdence level was set to 97% (p < 0.03). Results: Although overall agreement among the radiologists and referring physicians on term ranking was poor (kappa = 0.10–0.35), the mean and median values for the two groups were similar. Most of the radiologists and referring physicians (67% and 86%, respectively) approved of the proposal to establish a standard lexicon. Such a lexicon, based on the participant responses, was developed and graphically represented. Regarding the TNM system descriptors, there were significant differences between the two groups in the reporting of lymph node numbers, of features indicating capsular rupture, and of vessel wall irregularities, as well as in the preference for clear descriptions of vascular involvement. Conclusion: Our findings indicate that ineffective communication and differences in report interpretation between radiologists and referring physicians are still prevalent in the fields of radiology and oncology. Efforts to gain a better understanding of those impediments might improve the objectivity of reporting and the quality of care.