Radiological Support Research Articles

Reviving the poppy seed test for the diagnosis of colovesical fistula: A case report from a single rural center experience.

The poppy seed test is a valuable, cost-effective, and sensitive initial diagnostic investigation to identify the presence of colovesical fistula, particularly for clinicians in remote or rural areas with lack of access to specialist radiologic, endoscopic, surgical, or urological support. The poppy seed test therefore may act as a bridge toward the commencement of appropriate referral pathways for the management of colovesical fistula. The diagnosis of colovesical fistula is resource intensive, often requiring a combination of radiological investigation and endoscopy. The poppy seed test is a non-invasive and cost-effective alternative that has been demonstrated to identify presence of colovesical fistula with high sensitivity. There is however a noticeable paucity of recommendations for the poppy seed test in the diagnostic approach to colovesical fistula due to significant advancements in alternative radiologic and endoscopic technologies. Despite this, in resource-challenged areas with lack of specialist support, the poppy seed test is a cost-effective, accessible and safe test that can be performed to confirm the presence of colovesical fistula. We report a case of a 79-year-old man with a past history of colorectal cancer managed surgically with adjuvant chemoradiotherapy who develops noisy micturition, pneumaturia, and fecaluria 22 years after treatment. Given the suspicion of colovesical fistula, computed tomography imaging and cystoscopy were performed which was unable to demonstrate an overt fistula. The poppy seed test was utilized and demonstrated presence of poppy seeds in the urine, confirming the presence of a fistula. The patient was referred to a specialist surgical center for consideration of further management. The poppy seed test is a valuable initial diagnostic investigation for clinicians in remote or rural areas with lack of access to specialist radiologic, endoscopic, surgical, or urological support in confirming the presence of a colovesical fistula and initiating referral pathways for the management of this condition.

Successful Repair of Distal Aortic Arch and Proximal Descending Aortic Aneurysm with Coronary Artery Bypass Grafting- a case report.

Thoracic aortic aneurysm (TAA) is a rare condition causing dilatation of the thoracic aorta. TAA puts the individual at the risk of aortic dissection, aortic rupture and ultimate death. Diagnosis often requires good radiological support, whereas treatment requiring dedicated aortic program. In a third world country like us, with a population of 170 million or more, due to scarce facilities, surgeons are less interested to perform these types of surgeries. We hereby presenting a case of aortic aneurysm that involved distal aortic arch and proximal descending thoracic aorta (DTA) with significant double vessel coronary artery disease, who was successfully treated by our team. (Bangladesh Heart Journal 2024; 39(2): 172-176

3D Printed Lung Phantom for Individual Monitoring.

The Human Monitoring Laboratory, Health Canada (HML), has used a 3D printer to re-engineer its Lawrence Livermore National Laboratory (LLNL) foam lung sets (manufactured by Radiology Support Devices, Inc., Long Beach, CA). The foam sets are currently the HML standard for calibrating and performance testing lung-counting systems in Canada. This paper describes the process of creating and validating new 3D-printed lung sets modeled from one of the HML's existing RSD foam sets. The existing sets were custom made, making them costly and difficult to obtain or replace. Also, after many years of use, the HML has found that they are prone to wear and tear. When used with planar inserts containing various isotopes, the blank sets can become contaminated and are difficult to clean. Using 3D printing, the HML has created new blank lung sets that are nearly identical copies of the originals and are inexpensive and easily manufactured. Measurements using natural uranium (Nat U), 241Am, and 152Eu planar lung inserts were performed to compare obtained efficiencies at a wide range of energies using the original RSD foam sets and the 3D-printed ones. Both the foam and the 3D-printed lung sets were counted using the LLNL chest phantom positioned in the same counting geometry in the lung counting system. Biases, all below 15%, were obtained between the foam and the 3D-printed sets for energies above 40 KeV. Based on these results, as well as cost benefits and ease of use, the HML has decided to replace its original RSD foam lung set with the 3D-printed version for its lung performance testing program.

Diagnostic support in pediatric craniopharyngioma using deep learning.

We studied a pediatric group of patients with sellar-suprasellar tumors, aiming to develop a convolutional deep learning algorithm for radiological assistance to classify them into their respective cohort. T1w and T2w preoperative magnetic resonance images of226 Chilean patientswere collected at theInstitute of Neurosurgery Dr. Alfonso Asenjo (INCA), which were divided into three classes: healthy control (68subjects), craniopharyngioma (58 subjects) and differential sellar/suprasellar tumors (100 subjects). The PPV among classes was 0.828±0.039, and the NPVwas 0.919±0.063. Also explainable artificial intelligence (XAI) was used, finding thatstructures that are relevantduring diagnosis and radiological evaluationhighly influence the decision-making process of the machine. This is the first experience of this kind of study in our institution, and it led to promising results on the task of radiological diagnostic support based on explainable artificial intelligence (AI) and deep learning models.

PENGARUH KUALITAS JASA PELAYANAN TERHADAP CITRA INSTALASI RADIOLOGI DI RUMAH SAKIT GIGI DAN MULUT PENDIDIKAN UNIVERSITAS MUHAMMADIYAH YOGYAKARTA

Background : RSGM-P UMY already have tools such as the installation of radiological medical support enforcement destined diagnose oral disease. Problems that arise sometimes results are not as expected , and response less in service . The purpose of this study to analyze and explain the effect of partial and simultaneous quality radiology services to the installation image in RSGM-P UMY. Method : using quantitative methods , research subjects dentists and coass student in RSGM- P UMY . Installation of radiological research object . Types of studies using cross-sectional data was obtained from questionnaires and analyzed using multiple regression. Results: The regression equation based on existing variables positively influence the assurance (0.069), empathy (0.171), reliability (0.073), responsiveness (0,037), services (0.450), professionalism (0.326) and there was a negative , namely physical appearance (-0.016). Based on the t test of the quality of service simultaneously affect the installation image RSGMP UMY , based on the F test ( Anova : Sig . 0,000 ) is the quality of service simultaneously affect the image RSGMP UMY installation , and test results influence the determination coefficient percentage at 39.5 % . Conclusion: The services quality there are assurance, empathy , reliability , responsiveness , physical appearance have partial can’t effect on image radiologi installation. Variable service and professionalism have an influence on the image of radiological installations RSGMP UMY . The variable quality services have an simultan effect on the image of radiological installations RSGMP UMY.

Retrospective Evaluation of Primary Bone Tumors and Their Incidence in the “Ignacio García Téllez” Specialty Hospital CMN IMSS

In 1948, Steiner conducted an analysis of cancer registries in the United States of America, estimating that primary bone tumors constituted approximately 1% of all fetal malignancies. For its part, in Great Britain, a similar incidence of primary bone tumors is observed, fluctuating between 0.8% and 0.9%. A later statistic from the United States at v of 1.87:1000 000 deaths among children under 14 years of age, increasing to 11.97:1000 000 deaths in people aged 11 to 19 years. Since all bone components are derived from the mesoderm, they have the potential to be composed of any of the four basic types of cells: fibroblasts, chondroblasts, osteoblasts and the reticulo-myelogenous series, to achieve a correct diagnosis it is necessary to have the complementary radiological and pathological support to part of biochemical and hematological investigations. The present investigation focused on a retrospective, observational, quantitative, risk-free study, based on the review of records and tracking of histological reports of patients who were treated at the “Ignacio García Téllez” CMN IMSS Specialty Hospital in a period of 5 years, including all those cases with primary tumors of bone or cartilage origin, both benign and malignant of bone marrow and vascular, in addition to pseudotumor lesions such as fibrous dysplasia, metaphyseal fibrous defect, solitary bone cyst. A total of 182 histological records and reports were recorded in a period of 5 years where a total of 93 women and 89 men were recorded, with ages ranging from 3 months of extrauterine life to 87 years. With a mean of 56.53 years and a standard deviation of 18.48 years. 129 benign tumors were reported in 63 men and 66 women; Meanwhile, a total of 53 malignancies were counted in 26 men and 27 women. The current study facilitates the evaluation of the most common neoplasms in our environment, with the aim of raising awareness about the importance of having adequate resources to develop a timely diagnosis and treatment plan for the benefit of patients.

Defining quality assessment in vascular surgery training: an expert Delphi process.

A robust and reproducible way of assessing training should optimise and standardise vascular surgical training. This study describes the methodology supporting the Vascular Surgery Specialty Advisory Committee regional quality assurance reports for vascular surgery training programmes in the UK. A Delphi consensus exercise was performed to establish the domains of training that most appropriately assess the quality of a vascular surgery training programme. A total of 54 stakeholders were invited to participate, including trainees, training programme directors and members of the vascular speciality advisory committee (SAC), vascular society executive and education committees. A total of 39 stakeholders successfully completed the three-stage Delphi process over 15 weeks. The domains identified as most appropriate to assess the quality of a vascular training programme were: Joint Committee on Surgical Training (JCST) survey results, clinical experience, regional education programmes, radiology support, timetable, regional support for trainees, trainer support for trainees, opportunities for professional development, trainee-rated quality of consultant teaching and training, and trainee recommendation of the post. This study describes a method to identify and prioritise domains that are appropriate to assess the quality of a vascular training programme. The domains that were identified as appropriate to assess quality are transferable internationally and the Delphi methodology could be used by other training schemes to 'fine-tune' their own domains to review and optimise the quality of their own training programmes.

Patient Position in Operative Endoscopy.

It is well known by surgeons that patient positioning is fundamental to exposing the organs when performing an operation via laparoscopy, as gravity can help move the organs and facilitate the exposure of the surgical site. But is it also important for endoscopic procedures? This paper examines various types of endoscopic operations and addresses the issue of the patient's position. The patient's position can be changed not only by rotating the patient along the head-toe axis but also by tilting the surgical bed, as is undertaken during laparoscopic surgical procedures. In particular, it is useful to take into account the effect of gravity on lesion exposure, tumour traction during dissection, crushing by body weight, risk of sample drop, risk of damage to adjacent organs, and anatomical exposure for procedures with radiological support. The endoscopist should always keep in mind the patient's anatomy and the position of the endoscope during operative procedures, not limited to considering only intraluminal vision.

Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit.

The management of high-grade pancreatic trauma is controversial. To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries. A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma (AAST) Grade III or greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified. Over a twenty-year period, 14 patients underwent pancreatic resection for high-grade injuries. Seven patients sustained AAST Grade III injuries and 7 were classified as Grades IV or V. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy (PD). Overall, there was a predominance of blunt aetiologies (11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases (7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies. We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.

Ubiquity and attribution of Haller cells – A CBCT study

With the increasing popularity of sinus surgeries and the prolific advances in imaging technology, there is a major inclination towards the in-depth study of the anatomy of paranasal sinuses and the osteomeatal complex. Anatomical variations like deviation of nasal septum, paradoxical middle turbinate, double middle turbinate, and concha bullosa are seen in routine clinical examinations, but variations like Haller cells and Onodi cells require explicit radiological support. CBCT has the unique advantage of obtaining isometric images in all three planes with 3-Dimensional viewing and circumvent the obscurity of images due to superimposition. CBCT enables detection of even miniscule Haller cells along with discernment into the disease process and is a crucial preoperative planning tool. There has been a dearth of studies in the literature in this regard, and our study is a promising attempt to elucidate the significance of Haller cells with respect to surgical aspects

Leveraging technology to provide continuous remote radiology support for neurosurgery at a rural Kenyan teaching hospital

Leveraging technology to provide continuous remote radiology support for neurosurgery at a rural Kenyan teaching hospital

Comparison Ultrasound-Guided Handheld Vacuum Assisted Breast Biopsy and Core Biopsy in Breast Cancer

Introduction. Needle biopsy, including core needle biopsy (CNB) and vacuum-assisted breast biopsy (VABB) with or without radiological support) is the initial investigative method of choice for the preoperative diagnosis of breast lesions. Ultrasound-guided VABB (US-VABB) has become widely accepted because of its high accuracy. In this review, the diagnostic performance indices of CNB were compared with US-VABBB techniques. Method. A literature search proceeded in online databases compiling studies from the last 20 years in the PubMed, EBSCOhost, ScienceDirect, and ProQuest databases. Eighteen eligible studies compared US-VABB and CNB for diagnostic accuracy. All studies were cohort retrospective. This literature search proceeded according to the PRISMA. Results. Eighteen retrospective studies in three categories: comparative studies of US-VABB and CNB and the diagnostic accuracy of US-VABB and CNB. The studies showed that US-VABB has higher sensitivity and specificity than CNB but lower inadequacy and underestimation rates in the comparative studies group. In addition, the diagnostic accuracy of US-VABB is higher than CNB when comparing the other two subgroups (sensitivity and specificity: 94.4%-100% vs. 82%-90% and 98%-100% vs. 96%-98%, respectively). Conclusion. US-VABB has higher overall diagnosis accuracy than CNB

50 (PB-050) Poster - Alternative breast cancer localisation techniques in Wales: an early experience

Background: Accurate peri-operative localisation of breast tumours is an important component of breast conserving surgery. While radiologically inserted hook-wires have been the cornerstone of breast localisation for many years, newer techniques are now available. Some of these techniques have several advantages over traditional wire-guided procedures, including greater flexibility in terms of when the localisation procedure can be performed prior to the patients operation, avoiding the need for radiology support on the day of surgery.

Case Report: A Rare Co-Incidence Chronic Appendicitis with Koch’ Abdomen

Appendicitis is a common disease while abdominal tuberculosis is rare. Diagnosing appendicitis is comparatively easier while for abdominal tuberculosis till date no definitive diagnostic tool is available. All Clinical, hematological and radiological only support the diagnosis but not confirm the diagnosis. In this study both appendicitis and abdominal tuberculosis were present simultaneously which is very rare incidence in medical literature.

Long follow-up of Multiple Recurrent Calcific Masses–A rare case report of Hyperphosphatemic Familial Tumoral Calcinosis

Hyperphosphatemic familial tumoral calcinosis (HFTC) is an autosomal recessive benign condition of dysregulated phosphate metabolism (biallelic mutation in GLANT3, KLOTHO or FGF23) due to deficiency or resistance of intact fibroblast growth factor 23 resulting in deposition of large amount of ectopic calcium salts in periarticular soft tissues. We present a 21-year male with multiple recurrent masses around both hips, feet, left knee, and left elbow. His serum inorganic phosphate levels and ratio of renal tubular reabsorption rate of phosphate to corrected glomerular filtration rate were markedly elevated. Medical treatment to lower serum phosphate levels by placing him on tablet sevelamer hydrochloride and acetazolamide and surgical excision of the periarticular masses lead to disease remission. At 4 years follow up he has no recurrence and his functional scores (SF 36 and Harris Hip Score) have tremendously improved. Tumoral calcinosis, though rare must be kept in mind as a differential in abnormal calcific masses and with good radiological and laboratory support can be diagnosed early.

Under 40s one stop clinic run by breast surgeons who can do ultrasound helps manage capacity and reduces waiting time. A possible model for training of future breast surgeons

Background: Breast services are heavily dependent on radiology support for diagnostic tests. Breast ultrasound is the preferred imaging tool in the under 40s. The covid pandemic has resulted in a huge increase in waiting times for breast patients throughout the country. Additionally, there is a shortage of radiologists to support screening and breast services. Surgeons who are experienced in breast ultrasound are able to reduce the workload of radiologists and reduce waiting times. We present our results of one stop under 40s clinic by breast surgeons who do ultrasound and the impact it has had on waiting times within our unit.

Haemorrhage post biopsy of a bronchial carcinoid

Background: Bronchial carcinoid tumours are rare, indolent, malignant neuroendocrine tumours derived from Kulchitsky cells and are not related to smoking. As these tumours can be asymptomatic or present with nonspecific symptoms, a high index of suspicion is essential to make an early diagnosis which determines the prognosis. Surgery is curative and remains the mainstay of treatment.
 Case presentation: A 41-year-old female with no background medical illness first presented with a spontaneous left sided pneumothorax requiring a chest tube insertion. High-resolution CT (HRCT) thorax detected an incidental solitary pulmonary nodule. Bronchoscopy revealed a smooth round tumour sitting at the ostium of the basal right lower lobe bronchus. Endobronchial biopsy was complicated with massive bleeding requiring emergency exploration via rigid bronchoscopy. Multiple attempts to secure haemostasis using Watanabe spigot and argon plasma coagulation failed. She was intubated with a double lumen tube to isolate the healthy left lung. An urgent CT pulmonary angiogram (CTA) was performed to look for collaterals and feasibility of embolization, but no collaterals were seen. She was then referred to the cardiothoracic surgeon for an emergency right lobectomy. Histopathological examination revealed typical carcinoid tumour. She was discharged from the hospital in a stable condition.
 Discussion: Bronchial carcinoids embryologically originate from the foregut and patients rarely present with features suggestive of carcinoid syndrome and crisis. Mostly are asymptomatic resulting in late presentation and diagnosis. Majority of the typical carcinoids are centrally located and may present with obstructive symptoms and recurrent pneumonia. Bronchoscopists may face massive bleeding following endobronchial biopsy in bronchial carcinoids.
 Conclusion: Massive bleeding after endobronchial biopsy can occur and therefore the bronchoscopist should have anaesthesia, interventional radiology, and cardiothoracic support to handle this complication. Using tumour markers may obviate the need for biopsy in typical bronchial carcinoids to prevent massive bleeding after endobronchial biopsy.

Abstract 146: Cleidocranial dysplasia: A rare cause of severe short stature

Background: Cleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal dysplasia due to Runx 2 mutation with 1:1,000,000 incidence, characterized by hypoplastic clavicles, delayed closure of the cranial sutures, dental abnormalities, and short stature.Aims and Objectives: We report a case of 11year old boy presenting with short stature and classical features of cleidocranial dysplasia.Results: A 11 year boy with poor height gain since 2 years of age, was found to have severe disproportionate short stature with deciduous teeth, supernumerary teeth, midfacial hypoplasia, flattened nasal bridge, hypertelorism, high arched palate, short thumbs, clinodactyly and anterior apposition of shoulders. Skeletal survey confirmed these findings, along with Brachycephaly with open fontanelles, clavicular hypoplasia, bell shaped thorax, hypoplasia of the pelvis with widened symphysis pubis, coxa vara, pseudoepiphysis of 2nd metacarpal and severe dental anomalies.Conclusion: A thorough history and examination with radiological support will help in timely diagnosis of CCD in children and adequate treatment.

CLINICAL AND DIAGNOSTIC ASPECTS OF FIRE I NFLAMMATION INJURIES OF HOLLOW ABDOMINAL ORGANS (ATO / OOS EXPERIENCE)

Among the features of radiological diagnosis for the wounded with injuries of the gastrointestinal tract, we can point to a set of radiological methods of research, among which the leading place is occupied by X-ray contrast studies of the abdomen — vulnerography, fistulography, enterography, irigoscopy. The most important task of special methods of X-ray examination of gastrointestinal injuries, accompanied by the introduction of X-ray contrast agents, is the control of the postoperative period, radiological support during surgery and diagnosis of failure of sutures, anastomoses, intraperitoneal walls fistula, phlegmon of retroperitoneal tissue. Materials and methods. The results of retrospective analysis of radiological diagnostics of 76 (7.5 ± 1.6) % of wounded in the abdomen, waist, retroperitoneal space from the total mass of subjects (n = 1013 people), due to the mechanical and multifactorial nature of the lesion. Of these, 42 subjects with a predominant abdominal component of gastric injury injuries were in 6 cases out of 42 (14.3 %), 3 (7.1 %) cases of esophageal and duodenal injuries, small bowel injuries were observed in 12 cases (28, 6 %), colon damage in 14 cases (33.4 %) and rectal damage in 4 cases (9.5 %). All X-ray contrast studies of different parts of the digestive tract were performed with one-time double contrast and other methods in the X-ray diagnostic department of the clinic (radiation diagnostics and therapy) of the National Military Medical Clinical Center «GVKG» on modern X-ray machine expert class OPERA SWING. Discussion of results. There are no fundamental differences in the tactics of radiation control of injuries (TCU) of the gastrointestinal tract in abdominal injuries. However, in the preoperative period of urgent radiological diagnosis of damage to the esophagus, stomach, small, colon, and other parts of the colon, preference is given to non-contrast radiological examination of the abdomen (review radiography in direct projection standing / lying, lateroposition and lateral projection). In the future, the postoperative period of the wounded is accompanied by the widespread use of X-ray contrast studies of internal organs with gastrointestinal damage for radiation support during surgery and diagnosis of complications in the early and late postoperative periods. Conclusions. Given the multiple and combined nature of gunshot and non-gunshot injuries to the abdomen, lower back, retroperitoneal space in the wounded with injuries of the esophagus, stomach, small, colon and other parts of the colon, immediate radiological diagnosis should be provided to all wounded. preoperative period to address the clinical and diagnostic problem of emergencies. Since the natural X-ray contrast of the abdominal cavity and retroperitoneal space is very low, and damaged hollow organs increase pneumatization of the gastrointestinal tract, the use of artificial contrast (barium mixture, iodine-containing water-soluble X-ray contrast agents) significantly increases the diagnostic value. The use of special methods of X-ray examination with artificial contrast in the postoperative period is determined by the condition of the wounded and the specific clinical situation.

Evaluation of cancer outcome assessment using MRI: A review of deep-learning methods.

Accurate evaluation of tumor response to treatment is critical to allow personalized treatment regimens according to the predicted response and to support clinical trials investigating new therapeutic agents by providing them with an accurate response indicator. Recent advances in medical imaging, computer hardware, and machine-learning algorithms have resulted in the increased use of these tools in the field of medicine as a whole and specifically in cancer imaging for detection and characterization of malignant lesions, prognosis, and assessment of treatment response. Among the currently available imaging techniques, magnetic resonance imaging (MRI) plays an important role in the evaluation of treatment assessment of many cancers, given its superior soft-tissue contrast and its ability to allow multiplanar imaging and functional evaluation. In recent years, deep learning (DL) has become an active area of research, paving the way for computer-assisted clinical and radiological decision support. DL can uncover associations between imaging features that cannot be visually identified by the naked eye and pertinent clinical outcomes. The aim of this review is to highlight the use of DL in the evaluation of tumor response assessed on MRI. In this review, we will first provide an overview of common DL architectures used in medical imaging research in general. Then, we will review the studies to date that have applied DL to magnetic resonance imaging for the task of treatment response assessment. Finally, we will discuss the challenges and opportunities of using DL within the clinical workflow.