Medical Specialties Commons^™

Morphological And Metabolic Criteria Of Covid-19 Vaccine Associated Axillary Nodes On 18-Fluorodeouxyglucose Pet/Ct Imaging In Breast Cancer Patients, Nosheen Fatima, Unaiza Zaman, Areeba Zaman, Sidra Zaman, Rabia Tehseen, Maseeh Uz Zaman

Department of Radiology

Background: In the current era vaccine-associated lymphadenopathy (VAL) is not an uncommon presentation on 18F-FDG PET/CT examinations in patients inoculated with Coronavirus disease 2019 (COVID-19) vaccination. In this study, we are presenting data of VAL on 18F-FDG PET/CT regarding its prevalence, temporal response to vaccination and imaging characteristics of VAL.
Methods: Seventy-eight (78) consecutive vaccinated breast cancer (BC) patients who had 18FDG PET/CT were retrospectively analyzed. All patients had COVID-19 vaccine shots in contralateral arms and none in breast cancer site axilla (BSA). In 35 patients 18FDG avid nodes were found in vaccine site axilla (VSA). In 25 patients 18FDG …

Sentinel Lymph Node Identification Using Contrast Lymphosonography: A Systematic Review, Priscilla Machado, Ji-Bin Liu, Flemming Forsberg

Department of Radiology Faculty Papers

The sentinel lymph node (SLN) concept hypothesizes that metastatic cancer cells will spread through the lymphatic system to the SLN being the first one in the lymphatic chain to receive the metastatic cells, indicating that if the SLN is free of cancer cells the rest of the lymphatic chain is also without metastatic disease. Diagnostic ultrasound imaging (US) has been used to evaluate lymph nodes (LN) to determine level of suspicion and to guide LN biopsies. However, conventional US cannot be used for lymphatic mapping, which requires administration of a tracer. This has been changed with the use of contrast-enhanced …

A Single Centre Experience Of Local Perforator Flaps In Oncoplastic Breast Surgery: A Cross-Sectional Study, Sana Zeeshan, Lubna Vohra, Uzma Shamsi, Nida Zahid, Danish Ali, Nargis Asad, Cristina Garusi

Section of General Surgery

Background & objectives: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fasciocutaneous pedicled chest wall perforator flaps or local perforator flaps (LPF). The objectives of this study were to document the details of the surgical procedure as well as patient-reported satisfaction and well-being following the procedure using a validated BREAST-Q tool among Pakistani women.
Materials & methods: This cross-sectional study was conducted from March 2019 to February 2021 enrolling …

Neither Tumor-Infiltrating Lymphocytes Nor Cytotoxic T Cells Predict Enhanced Benefit From Chemotherapy In The Dbcg77b Phase Iii Clinical Trial, Elahe Shenasa, Elisabeth Specht Stovgaard, Maj-Britt Jensen, Karama Asleh, Nazia Riaz, Dongxia Gao, Samuel Leung, Bent Ejlertsen, Anne-Vibeke Laenkholm, Torsten O. Nielsen

Section of General Surgery

Recent studies have shown that immune infiltrates in the tumor microenvironment play a role in response to therapy, with some suggesting that patients with immunogenic tumors may receive increased benefit from chemotherapies. We evaluated this hypothesis in early breast cancer by testing the interaction between immune biomarkers and chemotherapy using materials from DBCG77B, a phase III clinical trial where high-risk premenopausal women were randomized to receive chemotherapy or no chemotherapy. Tissue microarrays were evaluated for tumor-infiltrating lymphocytes (TILs) assessed morphologically on hematoxylin and eosin-stained slides, and by immunohistochemistry for CD8, FOXP3, LAG-3, PD-1 and PD-L1. Following REMARK reporting guidelines, data …

Radiation Therapy For Older Women With Early Breast Cancer: An Unnecessary Hardship, Lauren E. Shawver

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM; PRIME II investigators. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial [published correction appears in Lancet Oncol. 2015 Mar;16(3):e105]. Lancet Oncol. 2015;16(3):266-273. https://doi.org/10.1016/S1470-2045(14)71221-5

for an older patient seeking treatment for Stage 1 Ductal Breast Carcinoma

The Association Of Age At Menarche And Adult Height With Mammographic Density In The International Consortium Of Mammographic Density, Sarah V. Ward, Anya Burton, Rulla M. Tamimi, Ana Pereira, Maria Luisa Garmendia, Marina Pollan, Norman Boyd, Isabel Dos-Santos-Silva, Sudhir Vinayak, Rose Ndumia

Imaging & Diagnostic Radiology, East Africa

Background: Early age at menarche and tall stature are associated with increased breast cancer risk. We examined whether these associations were also positively associated with mammographic density, a strong marker of breast cancer risk.

Methods: Participants were 10,681 breast‐cancer‐free women from 22 countries in the International Consortium of Mammographic Density, each with centrally assessed mammographic density and a common set of epidemio‐ logic data. Study periods for the 27 studies ranged from 1987 to 2014. Multi‐level linear regression models estimated changes in square‐root per cent density (√PD) and dense area (√DA) associated with age at menarche and adult …

Male Breast Cancer: The Three Decades' Experience Of A Tertiary Care Hospital In A Lower-Middle Income Country, Sana Zeeshan, Muhammad Tayyab, Fatima Shaukat, Muhammad Usman Tariq, Nargis Khan, Lubna Vohra

Section of General Surgery

Introduction Male breast cancer is uncommon and managed on the guidelines of female breast cancer due to tumor rarity. We sought to identify the incidence, clinicopathological features, and survival of all male breast cancer patients managed in our hospital. Methods A retrospective cross-sectional study was conducted at Aga Khan University Hospital (AKUH), Karachi, Pakistan, from January 1986 to December 2018. Demographic data, treatment records, and follow-up data of all male breast cancer patients who were treated at AKUH was reviewed. Results Thirty-eight out of 42 patients who presented over a period of 32 years were included. The mean age was …

Prone Versus Supine Position For Breast Cancer Treatment, Alexis Wychock

Student Research Poster Presentations 2022

This project explains the two most common positions to treat breast cancer: prone and supine. Radiation therapy, breast cancer, complications of radiation therapy to the breast, and the new set-up for prone positioning called Crawl Couch are also discussed on the poster. Breast cancer is the second most common cancer in women in the United States. Men can also develop breast cancer, but it is less common. Supine is performed utilizing deep inspiration breath hold and the prone is completed using free breathing. Prone and supine are the two positions used but some researchers found a better way to treat …

Factors Associated With Mammographic Breast Density Among Women In Karachi Pakistan, Uzma Shamsi, Shaista Afzal Saeed, Azra Shamsi, Syed Iqbal Azam, David Callen

Community Health Sciences

Background: There are no studies done to evaluate the distribution of mammographic breast density and factors associated with it among Pakistani women.
Methods: Participants included 477 women, who had received either diagnostic or screening mammography at two hospitals in Karachi Pakistan. Mammographic breast density was assessed using the Breast Imaging Reporting and Data System. In person interviews were conducted using a detailed questionnaire, to assess risk factors of interest, and venous blood was collected to measure serum vitamin D level at the end of the interview. To determine the association of potential factors with mammographic breast density, multivariable polytomous logistic …

Guided Imagery And Sentinel Lymph Node Biopsy Pain, Brandy Alicia Kirk

Evidence-Based Practice Project Reports

The standard of care in the treatment for women diagnosed with breast cancer includes identification and biopsy of the sentinel lymph nodes (SLN) of the breast (Chaterjee et al., 2017; Kneece, 2017). The process of identifying the SLNs involves radioisotope injections into or near the areola. Because this area is highly sensitive, women report this procedure to be considerably painful. The purpose of this evidence-based practice (EBP) project was to determine if the provision of a 5-minute session of guided imagery (GI), as a complementary alternative medicine, prior to SLN injections was effective in mitigating reports of procedural pain. A …

Recurrent Breast Cancer Diagnosis Delayed By Covid-19 Pandemic, Hannah K. Thompson, Paul J. Spicer

Radiology Faculty Publications

We describe the case of a 65-year-old female with a history of left-sided ductal carcinoma in situ in 2008. Mammography in January 2020 demonstrated calcifications in the previously affected breast. Subsequent stereotactic biopsy results were benign. In the months that followed, the patient experienced breast changes but avoided returning to the facility as the COVID-19 pandemic worsened. In August of 2020, the patient returned for a repeat mammogram, which indicated 2 suspicious masses in the left breast. Further analysis through ultrasound-guided core biopsy ultimately led to a left mastectomy and lymph node biopsy, which were performed in September 2020. Pathology …

A Multidisciplinary Approach To Triage Patients With Breast Disease During The Covid-19 Pandemic: Experience From A Tertiary Care Center In The Developing World, Abida K. Sattar, Hania Shahzad, Adnan Abdul Jabbar, Azmina Tajdin Valimohammad, Sadaf Khan, Yasmin Vellani, Romana Idrees, Nasir Ali, Imrana Masroor, Humera Saeed, Gulzar S. Lakhani, Nadia Ayoub, Atif Waqar, Muhammad Zia-Ul Islam, Salman Kirmani, Asad Latif, Ather Enam

Section of General Surgery

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.
Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.
Methods and results: The breast disease management guidelines were developed and approved …

Variability Of Breast Density Assessment And The Need For Additional Imaging: A Comparison Between Computed Mammography And Digital Mammography, Shaista Afzal Saeed, Imrana Masroor, Hina Iqbal, Saira Naz Sufian, Muhammad Awais

Department of Radiology

Objective: To determine the variability of breast density assessment and the need for additional imaging using computed radiography (CR) mammography versus digital radiography (DR) mammography.
Study design: Cohort study.
Place and duration of study: Department of Radiology, The Aga Khan University Hospital, Karachi from March to June 2018.
Methodology: Patients who underwent screening CR mammography, followed by DR mammography a year later, were selected. Only disease-free individuals were included in the study. Evaluation of breast density was done subjectively, using the breast imaging reporting and data system (BI-RADS) by two independent experienced radiologists. Statistical analysis was performed using the Wilcox …

Value Of Elastography In Differentiating Benign From Malignant Breast Lesions Keeping Histopathology As Gold Standard, Faryal Farooq, Syed Mubarak, Shaista Shaukat, Noman Khan, Kahkashan Jafar, Tariq Mahmood, Muhammad Arif Saeed

Department of Radiology

Background: Breast cancer is the most common cancer in females, both in developed and developing countries. Pakistan has the highest breast cancer incidence rate in Asia. Guidelines recommend screening for detecting breast cancer with mammography and ultrasonography (US). Shear-wave elastography (SWE) is a newer technique that can aid additional characterization of breast lesions.
Objective: The aim of this study was to determine the diagnostic accuracy of breast ultrasound elastography in differentiating benign from malignant breast lesions using histology diagnosis as the gold standard.
Materials and methods: The study was conducted at the Abbasi Shaheed Hospital and Jinnah Post Graduate Medical …

Experiences Of The Breast Cancer Patients Undergoing Radiotherapy At A Public Hospital Peshawar Pakistan, Gulzar Habibullah, Raisa Raisa, Shanaz Hussein Cassum, Rehana Elahi

School of Nursing & Midwifery

Objective: This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan.
Methods: This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually.
Results: Four main categories emerged from data analysis, which were: …

Accuracy Of Specimen Radiography In Assessing Complete Local Excision With Breast-Conservation Surgery, Saira Naz, Imrana Masroor, Shaista Afzal Saeed, W. Akhtar, Sehrish Butt, Zafar Sajjad, Anwar Ahmad

Department of Radiology

OBJECTIVE: The aim of this study was to evaluate the accuracy of “X- ray examination of surgically resected specimen‘‘ in assessing complete local excision (CLE).

MATERIALS AND METHODS: In this retrospective cross sectional study, data were collected for all female breast cancer cases who underwent breast-conserving surgery after needle localization of mammographically visible disease. Males, patients with mammographically invisible disease and cases with benign or inconclusive histopathology, those undergoing modified radical mastectomy and individuals with dense breast parenchyma were excluded. We evaluated radiography of resected specimens to assess margin spiculation, distance of mass/microcalcification from the excised margin, presence of a …

Mammographic Density Assessed On Paired Raw And Processed Digital Images And On Paired Screen-Film And Digital Images Across Three Mammography Systems, Anya Burton, Graham Byrnes, Jennifer Stone, Rulla M. Tamimi, John Heine, Celine Vachon, Vahit Ozmen, Ana Pereira, Maria Luisa Garmendia, Christopher Scott, John H. Hipwell, Caroline Dickens, Joachim Schüz, Mustafa Erkin Aribal, Kimberly Bertrand, Ava Kwong, Graham G. Giles, John Hopper, Beatriz Pérez Gómez, Marina Pollán, Soo-Hwang Teo, Shivaani Mariapun, Nur Aishah Mohd Taib, Martín Lajous, Ruy Lopez-Riduara, Megan Rice, Isabelle Romieu, Anath Arzee Flugelman, Giske Ursin, Samera Qureshi, Huiyan Ma, Eunjung Lee, Reza Sirous, Mehri Sirous, Jong Won Lee, Jisun Kim, Dorria Salem, Rasha Kamal, Mikael Hartman, Hui Miao, Kee-Seng Chia, Chisato Nagata, Sudhir Vinayak, Rose Ndumia, Carla H. Van Gils, Johanna O. P. Wanders, Beata Peplonska, Agnieszka Bukowska, Steve Allen, Sarah Vinnicombe, Sue Moss, Anna M. Chiarelli, Linda Linton, Gertraud Maskarinec, Martin J. Yaffe, Norman F. Boyd, Isabel Dos-Santos-Silva, Valerie A. Mccormack

Imaging & Diagnostic Radiology, East Africa

Background: Inter-women and intra-women comparisons of mammographic density (MD) are needed in research, clinical and screening applications; however, MD measurements are influenced by mammography modality (screen film/ digital) and digital image format (raw/processed). We aimed to examine differences in MD assessed on these image types.

Methods: We obtained 1294 pairs of images saved in both raw and processed formats from Hologic and General Electric (GE) direct digital systems and a Fuji computed radiography (CR) system, and 128 screen-film and processed CR-digital pairs from consecutive screening rounds. Four readers performed Cumulus-based MD measurements (n = 3441), with each image pair read …

Non-Invasive Imaging For The Assessment Of Cardiac Dose And Function Following Focused External Beam Irradiation, Omar El-Sherif

Electronic Thesis and Dissertation Repository

Technological advances in imaging and radiotherapy have led to significant improvement in the survival rate of breast cancer patients. However, a larger proportion of patients are now exhibiting the less understood, latent effects of incidental cardiac irradiation that occurs during left-sided breast radiotherapy. Here, we examine the utility of four-dimensional computed tomography (4D-CT) for the accurate assessment of cardiac dose; and a hybrid positron emission tomography (PET) magnetic resonance imaging (MRI) system to longitudinally study radiation-induced cardiac effects in a canine model.

Using 4D-CT and deformable dose accumulation, we assessed the variation caused by breathing motion in the estimated dose …

Evaluation Of A Pacap Peptide Analogue Labeled With (68)Ga Using Two Different Chelating Agents., Pardeep Kumar, Sushil Kumar Tripathi, Chang-Po Chen, Neil Mehta, Bishnuhari Paudyal, Eric Wickstrom, Mathew L. Thakur

Department of Radiology Faculty Papers

OBJECTIVE: The authors have conjugated chelating agents (DOTA and NODAGA) with a peptide (pituitary adenylate cyclase-activating peptide [PACAP] analogue) that has a high affinity for VPAC1 receptors expressed on cancer cells. To determine a suitable chelating agent for labeling with (68)Ga, they have compared the labeling kinetics and stability of these peptide conjugates.

METHODS: For labeling, (68)GaCl3 was eluted in 0.1 M HCl from a [(68)Ge-(68)Ga] generator. The influences of peptide concentration, pH, and temperature on the radiolabeling efficiency were studied. The stability was evaluated in saline, human serum, DTPA, transferrin, and metallic ions (FeCl3, CaCl2, and ZnCl2). Cell binding …

Optimization Of Chest Wall Hyperthermia Treatment Using A Virtual Human Chest Model, Dario B. Rodrigues, Mark D. Hurwitz, Paolo F. Maccarini, Paul R. Stauffer

Department of Radiation Oncology Faculty Papers

This work explores different coupling configurations (direct contact, air and water coupling) between a single 915 MHz waveguide applicator and human tissue in the setting of chest wall recurrence (CWR) of breast cancer. The objective is to treat chest wall tumours with microwave hyperthermia, while avoiding hot spots in critical areas such as scars and ribs. The best coupling configuration was a customized 24×29 cm water bolus developed by our team. It helps the applicator deliver an effective field size of 268 cm2 at 1 cm depth and a penetration depth of 2-3 cm. Water bolus thickness can be adjusted …

Outcome And Cost Effectiveness Of Autobiographically Guided Surgical Clip Placement For Tumor Localization In Patients Undergoing Neo-Adjuvant Chemotherapy For Breast Cancer., Imrana Masroor, Sana Zeeshan, Shaista Afzal Saeed, Saira Naz, Madeeha Ali, Khabir Ahmad, Shaista Khan

Department of Surgery

Abstract

BACKGROUND:

To determine the outcome and cost saving by placing ultrasound guided surgical clips for tumor localization in patientsundergoing neo-adjuvant chemotherapy for breast cancer.

MATERIALS AND METHODS:

This retrospective cross sectional analytical study was conducted at the Department of Diagnostic Radiology, Aga Khan University Hospital, Karachi, Pakistan from January to December 2014. A sample of 25 women fulfilling our selection criteria was taken. All patients came to our department for ultrasound guided core biopsy of suspicious breast lesions and clip placement in the index lesion prior to neo-adjuvant chemotherapy. All the selected patients had biopsy proven breast cancer.

RESULTS: …

Stay Beautiful -- Stay Alive: Assessing The Receptivity Of African American Beauty Salon Owners To The Integration Of Breast Cancer Intervention Programs Into Salon Operations, Funmi Apantaku-Onayemi

Ed.D. Dissertations

The lower incidence rate of breast cancer in African American women is dwarfed by the excessive number of deaths due to late diagnosis and treatment. Lack of screening, socioeconomic factors, fatalistic beliefs and inequality of care are major contributing factors. Studies have suggested that those who had more knowledge about breast cancer are more likely to have reduced fatalistic attitudes and engage in screening behaviors. This study investigated beauty salons as sustainable and viable venues to reach women with health intervention programs because they fit the prescriptions of the principles of adult learning. In a mixed-method, descriptive study involving 115 …

Usefulness Of Hook Wire Localization Biopsy Under Imaging Guidance For Nonpalpable Breast Lesions Detected Radiologically, Imrana Masroor, Shaista Afzal, Gulnaz Shafqat, Hasan Rehman

Department of Radiology

Background: The purpose of this study was to evaluate the usefulness of hook wire localization biopsy under imaging guidance for nonpalpable breast lesions detected radiologically.Methods: This was a descriptive study conducted at the Department of Radiology, Aga Khan University Hospital, Karachi. All patients undergoing needle localization biopsy of a nonpalpable breast lesion under mammographic or ultrasound guidance between January 2009 to December 2010 were included in the study. Patients with incomplete medical records were excluded. All patients' mammograms or ultrasound were categorized using BI-RADS() assessment categories. The percentages of benign and malignant lesions were determined by pathological examination of surgically …

Determining Efficacy Of Breast Cancer Therapy By Pet Imaging Of Her2 Mrna, Bishnuhari Paudyal, Kaijun Zhang, Changpo Chen, Neil Mehta, Eric Wickstrom, Brian Gray, Jeffrey Mattis, Koon Pak, Mathew L Thakur

Department of Radiology Faculty Papers

No abstract provided.

Breast Imaging Reports For Malignant Lesions: Are We Maintaining Recommended Bi-Rads® Lexicon Standards, Imrana Masroor, Muhammad Azeemuddin, Saima Sakhawat, Madiha Hashmi, Saba Sohail, Rashid Ahmed, M Irfan Ul Haq, Javed Mehboob

Department of Radiology

Background: The purpose of this study was to evaluate mammography reports for diagnosed breast cancer cases in major government and private centers in Karachi, Pakistan, with respect to concordance with the Breast Imaging Reports And Data System (BI-RADS®) lexicon.
Methods: A prospective, descriptive, multicenter study was conducted in the radiology sections of the Aga Khan University Hospital, Pakistan Naval Station Shifa Hospital, Advanced Radiology Clinic, Karachi Institute of Radiotherapy and Nuclear Medicine, and Civil Hospital Karachi between May and October 2010 after approval from the ethical review committee of Aga Khan University. Mammograms reported as BI-RADS category 4 and 5 …

Dynamic Contrast Enhanced Mri Breast For Lesion Detection And Characterization With Histopathological Co Relation: Preliminary Experience At Tertiary Care Hospital, Gulnaz Shafqat, Ajmal Agha, Imrana Masror, Mahwash Rehan, Shaista Afzal

Department of Radiology

OBJECTIVE: To determine the morphological and enhancement characteristics significantly associated with malignant breast lesions on dynamic contrast enhanced MRI by considering the histopathological findings as a gold standard.

METHODS: A retrospective analysis was performed on 70 patients who underwent MRI breast during the study period because of suspicious mammographic abnormalities. MR imaging was performed on 1.5 tesla machine with dynamic contrast enhancement by using dedicated breast coil. MR Images of breast were evaluated on a workstation and reported on the basis of morphological appearance of lesion and time activity curves. Histopathological analysis of the lesion was done either after mastectomy …

Application Of X-Ray Diffraction To Material Analysis And Medical Imaging, Wei Zhou

Legacy Theses & Dissertations (2009 - 2024)

Powder diffraction is commonly used to determine the structures of both inorganic and organic materials. The angle and intensity of the diffraction (also called coherent scatter) peak depends on the nanostructure of the material. When no x-ray optic is used, the peak width broadens, and hence the resolution worsens, as the sample area is increased. However, a small sample area gives low diffracted signal intensity, particularly for thin films and for organic materials, which have low diffraction cross sections. X-ray optics can be used in x-ray powder diffraction to increase the diffraction intensity, thus decreasing exposure times. For a small …

Knowledge, Attitude And Preventive Practices For Breast Cancer Among Health Care Professionals At Aga Khan Hospital Karachi, Shiyam Kumar, Ayesha Mallick Imam, Nauman Fazal Manzoor, Nehal Masood

Department of Radiation Oncology

OBJECTIVE: To assess the knowledge and practice of risk factors, symptoms and screening for breast cancer among health care professionals.

METHODS: A cross sectional study was carried out at The Aga Khan University Hospital from January 2008 to March 2008. A total of 336 health care workers including consultants (48), fellows (17), residents (76), medical officers (14), interns (37), nurses (94) and fourth and final year medical students (50) were requested to fill a questionnaire designed to assess the knowledge about the risk factors, signs and symptoms, screening tools, breast self examination (BSE) and treatment.

RESULTS: More than two third …

Factors Influencing Early Detection Of Breast Cancer In African American Women, Tamrah Joy Parker

Nursing Theses and Capstone Projects

Background. African American women are more likely to have breast cancer diagnosed at a later stage than Caucasian women and with a five year death rate 1.5 times greater than Caucasian women. Mammography screening detects breast cancer in its early stages and can reduce mortality.

Objective. To examine factors influencing early detection of breast cancer for African American women.

Methods. A convenience sample of 39 African American women 50 years of age and older was selected from two local Baptist churches in eastern North Carolina. Eligibility criteria included ability to read and write in English with no prior or present …

Breast Cancer In Pakistan - Awareness And Early Detection, Saba Sohail, Shams Nadeem Alam

Department of Radiology

No abstract provided.