Diagnostic Radiology Procedures Research Articles

A 360-degree evaluation of the professionalism and communication skills of technologists working in the radiology department of a public sector tertiary care hospital in Karachi, Pakistan

BackgroundRadiologic technologists (RTs) are at the forefront of radiology departments and require optimal skills to demonstrate professionalism and effective provider–patient communication. Hence, the objective of this study was to determine the reliability of 360-degree evaluation as a feedback tool to improve competencies in this crucial workforce.MethodsA planned 360-degree evaluation was conducted using a 10-item tool to evaluate communication skills and professionalism among radiological technologists working at Dow University Hospital, Karachi. In total, 311 evaluations of fifteen radiological technologists were conducted while performing various diagnostic radiology procedures at the radiology department of Dow University Hospital. The data were analysed using SPSS version 26 to compute the evaluation scores and the reliability of 360-degree evaluation.ResultsA total of 311 RT-patient interactions were recorded over 48 days, with scores from all three raters. The evaluation tool was found to have good internal consistency for patients, faculty, and RT, with Cronbach’s alpha values of 0.89, 087, and 0.74, respectively. The study found an intraclass correlation of 0.66 (95% CI; 0.58–0.72), showing moderate reliability of the 360-degree evaluation across different raters.ConclusionWe conclude that 360-degree evaluation is a valid and reliable tool for determining the professionalism and communication skills of radiologic technologists and should be incorporated into training programs for formative and summative assessments. However, large-scale multicenter studies are crucial for generalizing these findings and incorporating 360 evaluations in radiological technologist training programs for formative and summative assessments.

Do dynamic changes in haematological and biochemical parameters predict mortality in critically ill COVID-19 patients?

BACKGROUND: Critically ill COVID-19 patients are usually subjected to clinical, laboratory, and radiological diagnostic procedures resulting in numerous findings. Utilizing these findings as indicators for disease progression or outcome prediction is particularly intriguing. OBJECTIVES: Exploring the significance of dynamic changes in haematological and biochemical parameters in predicting the mortality of critically ill COVID-19 patients. METHODS: The present study was a prospective and observational study involving mechanically ventilated 75 critically ill adult COVID-19 patients with hypoxemic respiratory failure. The collected data included baseline patient characteristics, treatment options, outcome, and laboratory findings at admission and 7 days after. The dynamics of the obtained findings were compared between survivors and non-survivors. RESULTS: The 28-day survival rate was 61.3%. In the group of non-survivors significant dynamic changes were found for C-reactive protein (p= 0.001), interleukin-6 (p< 0.001), lymphocyte (p= 0.003), neutrophil-lymphocyte ratio (p= 0.003), platelets (p< 0.001), haemoglobin (p< 0.001), iron (p= 0.012), and total iron-binding capacity (p< 0.001). Statistically significant changes over time were found for ferritin (p= 0.010), D-dimer (p< 0.001), hs-troponin T (p< 0.002), lactate dehydrogenase (p= 0.001), glucose (p= 0.023), unsaturated iron-binding capacity (p= 0.008), and vitamin D (p< 0.001). CONCLUSION: The dynamic changes in inflammatory, haematological and biochemical parameters can predict disease severity, and outcome.

Rare interstitial lung diseases: a narrative review.

Interstitial lung diseases (ILDs) encompass over 200 entities. Among them, fibrosing lung diseases, have recently generated special interest due to the emerging therapies for their management. However, it is important to deepen our knowledge of other less prevalent ILD, since many of them are associated with a poor prognosis. This narrative review aims to provide a practical and up-to-date description of some poorly recognized ILD. It covers rare idiopathic interstitial pneumonias and their histologic patterns, genetic disorders with interstitial lung involvement (Hermansky-Pudlak syndrome), and ILD associated with benign proliferation of pulmonary lymphoid tissue, namely follicular bronchiolitis and granulomatous-lymphocytic interstitial lung disease. Electronic searches of PubMed and Google Scholar using specific keywords were conducted. Articles underwent screening for relevance, covering review articles, meta-analyses, systematic reviews, case series, prospective studies, society guidelines, editorials in peer-reviewed journals; scientific books on the subject. The data included was limited to English and Spanish publications. Despite the low prevalence of these diseases, the increased recognition of radiological patterns, pathological features, and diagnostic procedures, have permitted their better characterization. This review highlights epidemiology, clinical presentation, diagnosis, natural history, and treatment. Lesser-studied ILD represent a diagnostic and therapeutic challenge and can be frequently misdiagnosed. Also, due to the lack of randomized controlled trials, there are no well-established therapeutic options. Further studies or registries are needed to improve accurate diagnosis and management.

Vitamin E for the Prevention of Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis.

Contrast-induced nephropathy (CIN) is a serious condition that may develop in patients undergoing diagnostic radiologic procedures. Several treatments have been assessed to prevent CIN development. This study aims to assess the efficacy and safety of vitamin E in the prevention of CIN compared to intravenous (IV) saline hydration. The literature search included MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, the Web of Science, ProQuest, and Scopus for articles published until May 11, 2024, without language or time limits. The outcomes included the incidence of CIN, new-onset dialysis, and death (primary), as well as the change in serum creatinine and glomerular filtration rate (GFR) (secondary). Numerical and dichotomous outcomes were presented as standardized mean difference (SMD) and risk ratio (RR), respectively, with 95% confidence intervals (CI). Six clinical trials were included. Vitamin E was administered orally in varying doses, but one study used IV infusion. Vitamin E decreased the risk of developing CIN by 59% (n=5;pooled RR: 0.41; 95% CI: 0.25, 0.65; P<0.001) compared to IV hydration. None of the patients required renal replacement therapy. One patient on vitamin E died due to the occurrence of acute coronary syndrome. Vitamin E is a promising effective prophylaxis against CIN. However, the number of included studies and their sample sizes are small. The studies showed several limitations. There is a need for further high-quality clinical trials to ascertain the effectiveness of vitamin E compared to IV hydration and to compare vitamin E to other therapies, such as N-acetyl cysteine.

Procedural sedation and analgesia in pediatric diagnostic and interventional radiology: An expert DELPHI consensus document developed by the ITALIAN scientific society of anesthesia, analgesia, resuscitation and intensive care (SIAARTI).

Children undergoing diagnostic and interventional radiology procedures often require sedation to achieve immobility and analgesia if the procedure is painful. In the past decades, leading scientific organizations have developed evidence-based guidelines for procedural sedation and analgesia in children outside of the operating room. Their recommendations are being applied to procedural sedation in radiology. However, some questions remain open regarding specific aspects contextualized to the radiology setting, such as elective prone sedation, the urgency of the procedure, when venous access or airway protection is required, and others. To address the unresolved issues of procedural sedation and analgesia in pediatric diagnostic and interventional radiology. An expert panel of pediatricians, pediatric anesthesiologists, intensivists, and neuroradiologists selected topics representative of current controversies and formulated research questions. Statements were developed by reviewing the literature for new evidence, comparing expertise and experience, and expressing opinions. Panelists' agreement with the statements was collected anonymously using the DELPHI method. Twelve evidence-based or expert opinion incorporate are presented, considering risks, benefits, and applicability. This consensus document, developed by a multidisciplinary panel of experts involved in the field, provides statements to improve the quality of decision-making practice in procedural sedation and analgesia in pediatric radiology.

First implementation of quality control procedures on selected X-ray machines in South of Benin

Abstract Introduction: The use of X-ray equipment for medical diagnostic radiography procedures has increased due to advances and complexity of radiological procedures. Achieving good image quality while keeping exposure of workers, public and patient exposure to an acceptable level has become a prerequisite for the radiology department in order to comply with best international practices. The aim of this study was to undertake quality control measurement of seven (7) diagnostic radiography equipment in the south of Benin, the first of its kind. Material and methods: Multifunction detector (Piranha) and beam alignment test tool were used to perform quality control tests on seven (7) X-ray units. The method used as well as the interpretation of the results was based on the American Association of Physicists in Medicine (AAPM), United States Food and Drug Administration (FDA), Healing Arts Radiation Protection (HARP), Institute of Physics and Engineering in Medicine (IPEM), International Atomic Energy Agency (IAEA) and Canadian Safety code 35 (S.C 35) recommendations. Results: The quality control results showed that all X-ray equipment investigated were within standard limits for accuracy of exposure time below 10 ms; reproducibility of kVp, exposure time and dose output; specific dose-kVp2 linearity; and specific dose-mAs linearity. Five (5) out of seven (7) diagnostic X-ray machines passed quality control tests such as X-ray beam alignment, exposure time above 10 ms and kVp accuracy. One (1) X-ray machine failed the quality control test of beam filtration at 70 kVp and above. Conclusions: The findings of this study have provided baseline data for other radiology departments to embark on similar QA/QC activities, and also explore options for optimization of patient dose. However, there is a need to extend the study to cover more diagnostic X-ray machines throughout the country. It is anticipated that this would ultimately assist in improving radiation protection and safety during medical diagnostic radiological procedures.

Review of pediatric sedation and anesthesia for radiological diagnostic and therapeutic procedures

This review aims to synthesize the current body of knowledge surrounding the complexities, advancements, and best practices in sedation and anesthesia for pediatric patients undergoing radiological diagnostic and therapeutic procedures. The article examines several types of procedures that necessitate sedation, pre-sedation assessment protocols, and pharmacological considerations. It explores into the intricacies of patient monitoring, potential benefits and risks, and special considerations that healthcare providers must account for. Emphasis is placed on the qualifications required for non-anesthesiologists involved in administering anesthesia or sedation, along with the essential equipment and safety protocols. The review also addresses the ethical, legal, and psychosocial facets of this multifaceted clinical issue, culminating in an overview of future research directions and concluding remarks on quality improvement measures. The review found that pediatric sedation and anesthesia for radiological procedures have improved significantly in terms of safety, administration, and monitoring; however, several research gaps and opportunities remain, such as: quantifying the effectiveness of non-pharmacological interventions; exploring individualized sedation protocols; investigating the impact of cultural and psychosocial factors; assessing the long-term neurodevelopmental effects; developing machine learning algorithms; and evaluating the post-procedural quality of life in pediatric patients.

National survey to update the diagnostic reference levels in interventional radiology procedures in Italy: working methodology.

Interventional Radiology (IR) deals with the diagnosis and treatment of various diseases through medically guided imaging. It provides unquestionable benefits to patients, but requires, in many cases, the use of high doses of ionizing radiation with a high impact on radiation risks to patients and to overall dose to the population. The International Commission on Radiological Protection introduced Diagnostic reference levels (DRLs) as an effective tool to facilitate dose verification and optimize protection for patients undergoing radiological procedures. In addition, EURATOM Council Directive 2013/59 and its Italian transposition (Legislative Decree 101/2020) have reiterated that DRLs must be established for many common radiological diagnostic procedures to compare the radiation dose delivered for the same diagnostic examination. Within this framework, Istituto Superiore di Sanità-Italian National Institute of Health (ISS)-, in collaboration with relevant Italian Scientific Societies, has provided documents on DRLs in radiological practices such as diagnostic and IR and diagnostic nuclear medicine. These reference documents enable National Hospitals to comply national regulation. The implementation of DRLs in IR is a difficult task because of the wide distribution of doses to patients even within the same procedure. Some studies have revealed that the amount of radiation in IR procedures is influenced more by the complexity of the procedure than by the weight of the patient, so complexity should be included in the definition of DRLs. For this reason, ISS promoted a survey among a sample of Italian Centers update national DRL in IR procedures with related complexity factors than can be useful for other radiological centers and to standardize the DRLs values. In the present paper the procedural methodology developed by ISS and used for the survey will be illustrated.

Determining the Ability of Senior Dental Students to Detect Interproximal Caries Using Different Radiographic Techniques.

Objective: To evaluate the diagnostic capability of 5th-year students using digital imaging, conventional bitewing (BW) radiographs, and printed film on paper to detect interproximal caries lesions. Methods: A cross-sectional study was conducted with senior dental students. Three different radiographs: digital, BW, and printed films on paper were used; thus, nine radiographs, each with a 2-min viewing time, were considered by students along with a questionnaire. A control group of specialists from Prosthodontics and Radiology had finalized the answers prior to conducting the study. The appropriate responses were divided into five categories: R0: Intact surface, R1: Radiolucency in the outer half of enamel, R2: Radiolucency in the inner half of enamel, R3: Radiolucency in the outer half of dentin, and R4: Radiolucency in the inner half of dentin. Students' responses were analyzed using a one-way analysis of variance (ANOVA) test and a t-test. Results: Ethics for the study was obtained from the institutional committee (Reg No: BM19/9/8). When compared with the control group using ANOVA testing, the results showed good detection accuracy with a success rate of ~64 accuracy. There was a significant difference in the outcomes when detecting the presence of the caries lesion between the three diagnostic techniques (p > 0.001). In detecting the size of the carious lesion, the students' ability was recorded as poor. The highest average for detecting the presence of the carious lesion was correspondent to the printed film on paper method. Conclusions: Senior dental students have shown good accuracy in detecting the presence but not the size of interproximal caries on all radiographs viewed. Clinical Significance: Teachings and availability of diverse radiological diagnostic techniques ensured a reasonable level of understanding and use of the diagnostic caries risk assessment methodologies as required in restorative treatment planning.

Management of pregnant or potentially pregnant patients undergoing diagnostic and interventional radiology procedures: Investigation of clinical routine practice

It is well known that foetuses are highly sensitive to ionising radiation and special attention to justification and optimisation of radiological procedures involving a pregnant patient is required. A task to review, validate and compare different approaches to managing the pregnant patient and to estimating the associated foetal doses arising from a diagnostic or interventional radiology (DIR) procedure was designed in the framework of EURADOS working group 12.As a first step, a survey of radiation protection practice including dosimetry considerations among EURADOS members was performed using online questionnaire. Then, to evaluate the possible differences in the estimated foetal doses, a comparison of assessed dose values was made for three cases of pregnant patients that underwent different CT procedures.More than 120 professionals from 108 institutions and 17 countries that are involved in managing pregnant patients undergoing DIR procedures answered the questionnaire. Most of the respondents use national or hospital guidelines on the management of pregnant patients undergoing DIR procedures. However, the guidelines differ considerably among respondents. Comparison of foetal dose assessments performed by dosimetry experts showed the variety of methods used as well as large variability of estimated foetal doses in all three cases.Although European and International commission on radiation protection guidelines already exist, they are more than 20 years old and, in some aspects, they are obsolete. This paper shows that there is a need to revise and update these guidelines.

Anatomical study of the distal course of the posterior tibial artery: A cadaver study.

This study aimed to describe the course, branches, and variances of the posterior tibial artery, which provides the arterial supply of the plantar surface of the foot, starting from the tarsal tunnel level to provide descriptive information for all surgical interventions, diagnostic radiological procedures, and promising endovascular therapies in the tarsal region. In this study, a dissection of 48 feet was performed on 25 formalin-fixed cadavers (19 males and 6 females). Surgical instruments and a digital caliper were used for dissection and measurements, and the critical structures were recorded by a Canon 250D camera to be illustrated later. All parameters were significantly longer in male cadavers compared to females. According to the correlation analysis, while there was a significant and robust correlation between the axial line and pternion-deep plantar arch (R=.830, P .05), a moderate correlation was found between the axial line and sphyrion-bifurcation (R=.575; P < .05), axial line and deep plantar arch-2nd interdigital commissure (R=.457; P < .05), and sphyrion-bifurcation and pternion-deep plantar arch (R=.480; P < .05). Variation in any branch of the posterior tibial artery was observed in 27 of the 48 studied sides. In our study, the branching and variability of posterior tibial artery on the plantar surface of the foot were described in detail with the determined parameters. In conditions that cause tissue and function loss and require reconstruction, such as diabetes mellitus and atherosclerosis, the most critical factor in increasing treatment success is a better understanding of the region's anatomy.

მაიონებელი გამოსხივების ზემოქმედება სამედიცინო პერსონალზე და მისი კონტროლი კლინიკურ პრაკტიკაში

Ionizing radiation (IR) has been used for more than a century in clinical practice. It forms the basis for diagnostic and preventive radiology. However, medical professionals who work under constant radiation are at huge risk of developing different types of chronic or acute diseases such as malignant tumors, chronic dermatitis, hyperthyroidism, etc. &nbsp;Depending on clinical practice, nurses are at higher risk of being influenced by ionizing radiation, caused by their specific job of being close to the patients who are under performing&nbsp;of some diagnostic or therapeutic radiological procedures. By the influence of constant ionizing radiation, at the expense of oxidation, the structure of DNA damages, which can cause carcinogenesis, chromosome instability etc. Historically, control of the effects of &nbsp;IR started at the beginning of the 20th century when the impact of exposure was more harmful. &nbsp;Nowadays, the world’s leading countries as well as the Republic of Georgia have the appropriate legislation that obligates hospitals to create safe working space for employees, and medical professionals to follow all guidelines to protect each other from exposure effects. Despite that fact, how the control of low-dose constant radiation performs is questionable. This opinion is proven by some official statistical data about radiation-caused diagnoses in medical professionals. Despite the revolutionary development of radiology through the past century, ionizing radiation effects on medical professionals remain one of the biggest problems and require specific attention.&nbsp;&nbsp;&nbsp;&nbsp

Fighting against COVID‐19: Innovations and applications

Fighting against <scp>COVID</scp>‐19: Innovations and applications

Subinternship in Diagnostic Radiology: Bringing the Shadowers Out of the Shadows

Diagnostic radiology subinternships are uncommon. We started a diagnostic radiology subinternship at our institution in 2020 and present 3 years of data assessing the impact of the course on students' perceptions of and interest in diagnostic radiology. The initial course design consisted of daily shadowing shifts, small group lectures with attending radiologists, asynchronous self-paced learning assignments, an ultrasound skills session, multidisciplinary tumor board attendance, and completion of 2 formal case presentations. "Junior resident" shifts, where students dictated studies under attending supervision, an emergency radiology call shift, and an ultrasound procedures shift were subsequently added in response to student feedback. Students were asked to complete surveys before and after completing the course. Forty-seven fourth-year medical students completed the course over 3 years. The first 2 groups were predominantly male, whereas the third group showed near even gender representation (54% male). 21 (45%) chose to apply to diagnostic radiology for residency. Student reported interest in diagnostic radiology as a career, valuation of diagnostic radiology as a specialty, comfort with imaging interpretation, and perceptions of the availability of patient interaction and procedures in diagnostic radiology all significantly increased after participation in the course. Students ranked the junior resident shifts and small group attending lectures as the most valuable course components. Implementation of a diagnostic radiology subinternship significantly improved students' interest in and perceptions of the field. We encourage the creation of similar courses in other radiology departments and stress the importance of active learning experiences.

Evaluation occupationally radiation exposure during diagnostic imaging examinations

Occupational radiation exposure can occur due to various human activities, including the use of radiation in medicine. Occupationally exposed personnel surpassing 7.4 millions, and respresent the biggest single group of employees who are exposed to artificial radiation sources at work. This study compares the occupational radiation dose levels for 145 workers in four different hospitals located in the Aseer region in Saudi Arabia. The occupational exposure was quantified using thermoluminescence dosimeters (TLD-100). The levels of annual occupational exposures in targeted hospitals were calculated and compared with the levels of the international atomic energy agency (IAEA) Safety Standards. An average yearly cumulative dose for the two consecutive years. The average, highest and lowest resulted occupational doses under examination in this work is 1.42, 3.9 mSv and 0.72 for workers in various diagnostic radiology procedures. The resulted annual effective dose were within the IAEA approved yearly dose limit for occupational exposure of workers over 18, which is 20 mSv. Staff should be monitored on a regular basis, according to current practice, because their annual exposure may surpass 15% of the annual effective doses.

Is it tuberculosis mastitis or granulomatous mastitis? A thirteen-year experience at a university hospital.

Granulomatous mastitis (GM) is a rare inflammatory disease of the breast. Tuberculosis mastitis (TM), one of the causes of GM, is a rare form of extrapulmonary tuberculosis. The clinical, radiological, and histopathological findings of TM and GM are similar, and sometimes it is difficult to make a distinction between these disease states. In this study, we aimed to evaluate the clinical and radiological features, diagnostic techniques, treatment modalities and treatment outcomes of the patients with GM and TM. The data of the patients with confirmed GM by histopathologic examination of biopsy specimens between 2007 and 2020 were retrospectively analyzed. Demographic features, main complaints, physical findings, radiological and laboratory data, treatment modalities, and treatment outcomes were recorded. Sixty-eight GM patients with a mean age of 35.8 (18-63) years were evaluated. The patients had a mass lesion, pain, ulceration,and abscess in their breasts. All of the cases were female. Ultrasonographic examinations were performed on 62 cases. Abscess and/or sinus tract formation was detected in 34, heterogeneous hypoechoic mass in 15, heterogeneous parenchyma or parenchymal edema in 15, axillary lymphadenopathy in 18 and cysts in 13 patients. A total of 10 patients were lost to follow-up. Twenty-six patients underwent surgery for their breast lesions or had antibiotherapy (n = 13) or corticosteroid therapy (n = 7). Eleven (16.1%) patients were diagnosed with TM. These patients were evaluated by clinical examination, chest radiography, and tuberculin skin test. Acid-fast bacilli (AFB) staining and culture were negative in all cases. The diagnosis of TM was based on histopathological evaluation results. Eight of the 11 patients achieved complete remission with antituberculosis treatment. The etiological diagnosis of GM must be based on a multidisciplinary approach. Tuberculosis mastitis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis.

Radiation Protection Issues in Clinical Research Involving X-Ray Diagnostic Radiology Procedures

Aim: To review radiation protection issues in clinical diagnostic studies that involves the use of x-rays. The Issue: X-rays imparting low dose have some dominance in the use of ionising radiation (IR) in clinical radiological investigations. In good clinical diagnostic practice, with radiation effects anticipated to be wholly stochastic, it is simply not possible to be specific about risks to health other than to acknowledge an anticipated increase in probability with dose. Difficulties in making an assessment of risk can be further compounded given possible cumulative effects from previous exposures and from varying clinical state. Scientific Considerations: Clinically focused research involving IR and subjects (reviewed by ethics committees and other parties) necessarily involves assessment of the study protocol. In addition to the embodiment of radiation protection principles, the protocol must conform to the general ethical principles of beneficence, prudence, justice and dignity, all of which are important. The protection aspects arising from the use of radiation needs to be assessed by radiation experts, the safety of study participants needing to be weighed against the necessity for the study. This information must be fully explained to the participant as part of the process of seeking consent. In obtaining consent, the participant information sheet must be of an appropriate quality of language and possible specific risks provided in a transparent manner. Conclusion: In clinical studies that involve the use of IR, the study protocol must contain all relevant radiation protection measures. It is important that review of the protocol should involve IR experts.

Radiation exposure from radiological procedures in liver transplant candidates with hepatocellular carcinoma

PurposeCandidates for liver transplantation (LT) with hepatocellular carcinoma (HCC) undergo a large number of diagnostic and interventional radiology procedures. A significant proportion of such procedures involve ionizing radiation with increased lifetime risk of cancer. The objective of our study was to review LT candidates with HCC to quantify ionizing radiation doses from different radiology procedures performed at a single transplant center. MethodWe retrospectively reviewed 179 adult patients with HCC (median age 58.6 years [IQR, 55–62]; 155 [86.6%] males) who were accepted for LT between April 2010 and Dec 2018. Radiology procedures and radiation doses were retrieved and the total and median radiation effective dose in millisieverts (mSv) were calculated for different procedures. Exposure to ionizing radiation was categorized based on previously reported thresholds. ResultsWe assessed 9,986 radiology procedures for our cohort. Patients had a median effective dose prior to transplantation of 254 mSv (IQR, 130–421) with an annualized rate of 152 mSv (IQR, 92–266). Patient median dose increased to 316 mSv (IQR, 159–478) when including exposures post-LT within the study period. 85% of overall exposure was in the extremely high exposure category (>100 mSv). Interventional procedures represented 13% of procedures with substantial radiation and contributed to 45% of radiation exposure while abdominal CTs represented 39% of total procedures and contributed to 45% of radiation exposure. ConclusionsPatients with HCC considered for LT undergo radiology procedures with significant cumulative radiation exposure. Attempts to reduce radiation exposure are suggested by minimizing unnecessary procedures and utilizing ones without ionizing radiation. Improving interventional techniques to reduce radiation doses is needed without compromising treatment delivery.

Hybrid computational pregnant female phantom construction for radiation dosimetry applications

The number of patients undergoing diagnostic radiology and radiation therapy procedures has increased drastically owing to improvements in cancer diagnosis and treatment, and consequently, patient survival. However, the risk of secondary malignancies owing to radiation exposure remains a matter of concern. We previously published three hybrid computational fetal phantoms, which contained 27 fetal organs, as a starting point for developing the whole hybrid computational pregnant phantom set, which is the final objective of this study. An International Commission on Radiological Protection (ICRP) reference female voxel model was converted to a non-uniform rational B-spline (NURBS) surface model to construct a hybrid computational female phantom as a pregnant mother for each fetal model. Both fetal and maternal organs were matched with the ICRP- 89 reference data. To create a complete standard pregnant computational phantom set at 20, 30, and 35 weeks of pregnancy, the model mother’s reproductive organs were removed, and fetal phantoms with appropriate placental and uterine models were added to the female pelvis using a 3D-modeling software. With the aid of radiological image sets that had originally been used to construct the fetal models, each fetal position and rotation inside the uterus were carefully adjusted to represent the real fetal locations inside the uterus. The major abdominal soft tissue organs below the diaphragm, namely the small intestine, large intestine, liver, gall bladder, stomach, pancreas, uterus, and urinary bladder, were removed from non-pregnant females. The resulting fetal phantom was positioned in the appropriate location, matching the original radiological image sets. An obstetrician-gynecologist reviewed the complete internal anatomy of all fetus phantoms and the pregnant women for accuracy, and suggested changes were implemented as needed. The remaining female anatomical tissues were reshaped and modified to accommodate the location of the fetus inside the uterus. This new series of hybrid computational pregnant phantom models provides realistic anatomical details that can be useful in evaluating fetal radiation doses in pregnant patients undergoing diagnostic imaging or radiotherapy procedures where realistic fetal computational human phantoms are required.

POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) : WHAT A PHYSICIAN SHOULD KNOW ABOUT!

Among the myriad of diseases that can cause acute reversible neurological dysfunctions, the Posterior Reversible Encephalopathy Syndrome (PRES) with its diverse etiology and varied presentation needs attention. At risk population includes those with chronic hypertension, eclempsia, auto- immune disease, chronic kidney disease and drug induced especially anti-cancer and immunosuppressant drugs. Once thought of its relation only to existing hypertension, its always reversibility and affection only to posterior cerebral cortex, the term PRES is now a misnomer as this is not always reversible and is not necessarily restricted to posterior region of brain with advancement in radiological diagnostic techniques, the kidney diseases as risk factor for PRES is getting more and more popularity in a good subset of patients. However a prompt diagnosis and rapid correction of underline cause makes it reversible both clinically and radiologically.