Radiology Commons^™

A Sonographer’S Step-By-Step Approach For Preventing Transmission Of Covid-19, Corinne Wessner, Joann Nelson, Sarah Mott, Maria Francesco, Laurence Needleman

Department of Radiology Faculty Papers

The 2019 novel coronavirus, known as COVID-19, has greatly affected the way sonographers care for their patients. Sonography can be a useful imaging tool for surveillance and diagnosis of various conditions associated with COVID-19 patients or patients under investigation (PUIs). Currently, there are limited resources and protocols for preventing the transmission of COVID-19 from ultrasound equipment. Our institution has created a detailed protocol for scanning COVID-19 patients or PUIs to address this important issue.

Localizing An Occult Insulinoma By Selective Calcium Arterial Stimulation Test: First Ever Experience And A New Dimension To Diagnosis In Pakistan, Muhammad Owais Rashid, Sumerah Jabeen, Zareen Kiran,, Khurram Minhas, Muhammad Azeemuddin, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Insulinomas are rare, usually benign, solitary tumours accounting for 60% of islet cell tumours. These tumours can be difficult to localize preoperatively due to their small size. We present a challenging case of a 40 year old male with frequent hypoglycaemic spells and endogenous hypoglycaemia who presented as a diagnostic dilemma. Patient had an occult insulinoma with inconclusive CT Abdomen, MRI Abdomen and Octreotide scan. The final localization of the tumour was made by selective arterial calcium stimulation testing (SCAT), done for the first time in Pakistan at Aga Khan University Hospital. This was followed by successful distal pancreatectomy as …

Ultrasonographic Risk Stratification Of Indeterminate Thyroid Nodules; A Comparison Of An Artificial Intelligence Algorithm With Radiologist Performance, Aylin Tahmasebi, Shuo Wang, Kelly Daniels, Elizabeth Cottrill, Ji-Bin Liu, Jiajun Xu, Andrej Lyshchik, John R. Eisenbrey

Department of Radiology Faculty Papers

Background, Motivation and Objective: Thyroid nodules with indeterminate or suspicious cytology are commonly encountered in clinical practice and their clinical management is controversial. Recently, genetical analysis of thyroid fine needle aspiration (FNAs) was implemented at some institutions to differentiate thyroid nodules as high and low risk based on the presence of certain oncogenes commonly associated with aggressive tumor behavior and poor patient outcomes. Our group recently detailed the performance of a machine-learning model based on ultrasonography images of thyroid nodules for the prediction of high and low risk mutations. This study evaluated the performance of a second-generation machine-learning algorithm incorporating …

Quantitative Magnetic Resonance Imaging Of Knee Articular Cartilage And Effusion-Synovitis: The Structural Response To Changes In Joint Loading, Hayden F. Atkinson

Electronic Thesis and Dissertation Repository

Knee osteoarthritis (OA) is a progressive degenerative condition that can affect all tissues within the joint. Methods to measure early changes in joint structures and the effect of interventions are required. The purpose of this thesis was to investigate aspects of quantitative magnetic resonance imaging (MRI) as outcome measures in knee OA studies. Specifically, changes in articular cartilage composition and/or effusion-synovitis were examined in people with or at risk for knee OA and healthy controls, and after altering joint loads.

Chapter 2 is a systematic review that studied articular cartilage composition using MRI T2 and T1ρ relaxation in patients at …

Pathophysiology And Proteogenomics Of Post-Infectious And Post-Hemorrhagic Hydrocephalus In Infants, Albert M. Isaacs

Arts & Sciences Electronic Theses and Dissertations

Post-infectious (PIH) and post-hemorrhagic (PHH) hydrocephalus occur as sequalae of neonatal sepsis or intraventricular hemorrhage (IVH) of prematurity, respectively. Together, PIH and PHH represent the most common form of infantile hydrocephalus, the most common indication for neurosurgery in children globally, and the leading cause of neurological morbidity and mortality worldwide. The lack of understanding of the pathophysiology of PIH and PHH, particularly with regards to the host central nervous system response to the antecedent infection and hemorrhage, perturbation of differentiating neural stems in the ventricular (VZ) and subventricular (SVZ) zones, and damage to periventricular white matter (PVWM) tracts carrying sensorimotor …

Detection Of Left Ventricular Thrombi On Cardiac Magnetic Resonance Viability Studies, Donya Ahmed Alhassan, Khawaja Bilal Waheed, Muhammad Nasim Sharif, Muhammad Zia Ulhassan, Fazal Ghaffar, Khaled Saleh Saleem, Emad Fouad Mahmoud Said, Bayan Mohammed Altalaq, Zechariah Jebakumar Arulanantham, Ahmad Omar Qarmash

Journal of the Saudi Heart Association

Objective: To highlight detection of left ventricular thrombi on cardiac magnetic resonance (CMR) viability studies.

Method: This retrospective observational study was conducted in the Radiology Department at our Hospital in Dhahran, from April 2015-2019. All recently re-perfused (post-percutaneous coronary intervention/ PCI) patients with ST-segment elevation myocardial infarctions (STEMI), having low ejection fractions (

Results: Of the 125 patients, most were men (71.2%) with a mean age of 56.78 years. Eleven patients had left ventricular thrombi (8.8%), and most of these were anterior wall infarctions with low ejection fractions (

Conclusion: Left ventricular thrombi can be detected on cardiac viability studies …

Digital Breast Tomosynthesis Versus Additional Diagnostic Mammographic Views For The Evaluation Of Asymmetric Mammographic Densities, Hira Waheed, Imrana Masroor, Shaista Afzal Saeed, Muhammad Ismail Alvi, Syed Jahanzeb

Department of Radiology

Introduction: Many young females present with an advanced stage of breast cancer, which has a negative effect on the prognosis. Digital breast tomosynthesis is a new emerging imaging technique that aids in improving the specificity of mammography with subsequent early detection of breast cancer, especially in women with radiographically dense breasts. Tomosynthesis is subjectively preferred to conventional mammography and may offer superior diagnostic accuracy for the evaluation of breast lesions.
Method: Two breast radiologists retrospectively reviewed asymmetric densities using protocols that were institutional review board-approved in 185 patients aged 18 - 70 years (mean: 48 years) who underwent diagnostic mammography …

Contemporary Interventional Radiology Employment: Analysis Of The American College Of Radiology And The Society Of Interventional Radiology Occupational Portals, Anthony N Hage, Vibhor Wadhwa, Eric J Monroe, David S Shin, Jeffrey Forris Beecham Chick

Department of Radiology Faculty Papers

No abstract provided.

Lc-Ms Based Stability-Indicating Method For Studying The Degradation Of Lonidamine Under Physical And Chemical Stress Conditions, Ankit K. Rochani, Margaret A. Wheatley, Brian Oeffinger, John R. Eisenbrey, Gagan Kaushal

College of Pharmacy Faculty Papers

Background and purpose: Lonidamine is a hexokinase II inhibitor, works as an anticancer molecule, and is extensively explored in clinical trials. Limited information prevails about the stability-indicating methods which could determine the forced degradation of lonidamine under stressed conditions. Hence, we report the use of a rapid, sensitive, reproducible, and highly accurate liquid chromatography and mass spectrometry method to analyze lonidamine degradation. Experimental approach: The Xbridge BEH shield reverse phase C18 column (2.5 μm, 4.6 × 75 mm) using isocratic 50:50 water: acetonitrile with 0.1% formic acid can detect lonidamine with help of mass spectrometer in tandem with an ultraviolet …

Investigating The Metabolic Progression Of Glioblastoma With Hyperpolarized Magnetic Resonance, Travis Salzillo

Dissertations & Theses (Open Access)

Rapid diagnosis and therapeutic monitoring of aggressive diseases such as glioblastoma (GBM) can improve patient survival by providing physicians the time to optimally deliver treatment. This includes early in development, while the tumor is still manageable, or following initial therapy, when alternative treatments should be considered. The main goal of this project was to determine whether metabolic imaging with hyperpolarized magnetic resonance spectroscopy (MRS) could detect changes in tumor progression more rapidly than conventional anatomic magnetic resonance imaging (MRI) in patient-derived GBM murine models. To comprehensively capture the dynamic nature of cancer metabolism, in vivo pyruvate-to-lactate conversion with hyperpolarized MRI, …

Development Of A Ct Metal Artifact Management Algorithm For Proton Therapy Planning (Ampp) For Head And Neck Cancer Patients, Daniela Branco

Dissertations & Theses (Open Access)

Purpose: Dental amalgams (high Z materials) are common sources of artifacts in Head and Neck (HN) images. Commercial artifact reduction techniques have been offered, but many are impractical, produce inaccurate CT images or are not clinically available, thus not widely implemented. The goal of this work is to use CT gantry tilts to develop and evaluate a stereoscopic HN metal artifact management algorithm and investigate its improvement in proton treatment planning.

Methods: The in-house CT metal artifact management method for proton planning (AMPP) uses two angled CT scans to generate a single image set with no metal artifacts posterior …

Dual X-Ray Absorptiometry Has Limited Utility In Detecting Bone Pathology In Children With Hypophosphatasia: A Pooled Post Hoc Analysis Of Asfotase Alfa Clinical Trial Data., Jill H. Simmons, Eric T. Rush, Anna Petryk, Shanggen Zhou, Gabriel Á. Martos-Moreno

Manuscripts, Articles, Book Chapters and Other Papers

Asfotase alfa is an enzyme replacement therapy approved for treatment of patients with pediatric-onset hypophosphatasia (HPP), a rare, inherited, systemic disease causing impaired skeletal mineralization, short stature, and reduced physical function in children. The role of dual X-ray absorptiometry (DXA) in the assessment of children with HPP has been insufficiently explored. This post hoc analysis included pooled DXA data from 2 open-label, multicenter studies in 19 children with HPP. The study population was aged ≥5 to≤6.6 years at enrollment (male: 79%; median age at enrollment: 10.4 y [range: 5.9-16.7]; treatment duration: 6.3 y [range: 0.1-6.6]. Baseline height Z-scores indicated short …

A Case Series On Uterine Arteriovenous Malformations: A Life-Threatening Emergency In Young Women, Rabia Hammad, Sidrah Nausheen, Mumtaz Malik

Department of Obstetrics & Gynaecology

Uterine arteriovenous malformation (AVM) is a rare condition, with few cases reported in the literature. Despite being rare, it is a potentially life-threatening condition in women of child-bearing age. It should be considered in the differential diagnosis of prolonged or irregular vaginal bleeding, which, otherwise, can lead to critical complications ending up in severe morbidity and mortality. This case series describes four cases of young Asian women aged between 33 and 38 years who presented with irregular vaginal bleeding. Trans-abdominal ultrasound of the pelvis showed increased vascularity with multi-directional blood flow in the uterus. Magnetic resonance imaging (MRI) confirmed an …

Can Contrast Enhanced Ultrasound Differentiate Intrahepatic Cholangiocarcinoma From Hepatocellular Carcinoma?, Jia-Yan Huang, Jia-Wu Li, Wen-Wu Ling, Tao Li, Yan Luo, Ji-Bin Liu, Qiang Lu

Department of Radiology Faculty Papers

BACKGROUND: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) differ in treatment and prognosis, warranting an effective differential diagnosis between them. The LR-M category in the contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) was set up for lesions that are malignant but not specific to HCC. However, a substantial number of HCC cases in this category elevated the diagnostic challenge.

AIM: To investigate the possibility and efficacy of differentiating ICC from HCC classified in the LR-M category according to the CEUS LI-RADS.

METHODS: Patients with complete CEUS records together with pathologically confirmed ICC and LR-M HCC (HCC classified …

The Impact Of Temporal Resolution On Clinical Decision-Making For Individuals With Dysphagia, Shauna Corinne Murray

Speech and Hearing Sciences ETDs

INTRODUCTION: Dysphagia, or a disordered swallow, affects up to 1 in 25 individuals in the United States. The gold standard for assessing dysphagia is the videofluoroscopic evaluation of swallowing (VFES). This allows the clinician to observe the swallow anatomy in motion via an X-ray movie, which historically was recorded at 30 frames per second. In recent years VFES have been performed at less frames per second due to radiation concern. This project investigates the effect of using lower temporal resolutions on assessment of video-fluoroscopic swallow studies.

METHODS: In this investigation, 30 swallow studies, all acquired at 30 frames per second, …

Perfusion-Guided Sonopermeation Of Neuroblastoma: A Novel Strategy For Monitoring And Predicting Liposomal Doxorubicin Uptake, Aditi Bellary, Arelly Villarreal, Rojin Eslami, Quincy J Undseth, Bianca Lec, Ann M Defnet, Naina Bagrodia, Jessica J Kandel, Mark A Borden, Sumbul Shaikh, Rajiv Chopra, Theodore W Laetsch, Lauren J. Delaney, Colette Shaw, Md, John R. Eisenbrey, Sonia L Hernandez, Shashank R Sirsi

Department of Radiology Faculty Papers

Neuroblastoma (NB) is the most common extracranial solid tumor in infants and children, and imposes significant morbidity and mortality in this population. The aggressive chemoradiotherapy required to treat high-risk NB results in survival of less than 50%, yet is associated with significant long-term adverse effects in survivors. Boosting efficacy and reducing morbidity are therefore key goals of treatment for affected children. We hypothesize that these may be achieved by developing strategies that both focus and limit toxic therapies to the region of the tumor. One such strategy is the use of targeted image-guided drug delivery (IGDD), which is growing in …

Mapping Gadolinium Contrast In A Complex Ionic And Photosynthesis Environment Of Pineapple By Near-Infrared And X-Ray Imaging, Subhendra Sarkar, Zoya Vinokur, Chen Xu, Tetiana Soloviova, Amina Shahbaz, Aldona Gjoni

Publications and Research

This work explores the diffusivity of a lanthanide complex, Eovist (Gadolinium-Ethoxy Benzyl Diethylenetriamine pentaacetate) that is stable in neutral media but is not in acidic environment. In the current work an acidic fruit model like pineapple that is rich in transition metals was used and a possible transmetallation reaction among Eovist and transition metal complexes was tested using X-ray imaging. Another goal of this work was to perturb the usual and the unusual photosynthesis systems that pineapple has maintained for millions of years during the evolution of circadian genes for efficient water conservation by dark photosynthesis. To detect such photosynthesis …

The Pulmonary Venous Ridge Length To Stratify Stroke Risk In Atrial Fibrillation, Varun Singh, Joy Li, Mark Keroles, Daniel Frisch, Behzad B. Pavri, Baskaran Sundaram, Md, Jason Jacobson, Rajiv Kabadi

Department of Radiology Faculty Papers

Purpose of Study: To evaluate the left superior pulmonary venous ridge length (RL) and the left atrial appendage fractal dimension (LAA FD) as predictors of cardioembolic ischemic stroke (CVA) and transient ischemic attack (TIA) in patients with atrial fibrillation (AF).

Materials, Methods and Procedures: A multicenter, retrospective multicenter study was conducted on patients with AF who underwent cardiac CT prior to catheter ablation between 01/01/2010 and 12/31/2015. Patients were grouped by the presence or absence of prior CVA/TIA. Patients with mitral stenosis, prior mechanical aortic valve replacement, ascending aortic arch atheroma, highrisk patent foramen ovale, history of atrial septal repair …

Coronary Artery Aneurysm In Kawasaki Disease., Achala Donuru, Maansi Parekh, Vinay V R Kandula, Sharon Gould

Department of Radiology Faculty Papers

A 3-year-old male presents to the emergency department with chief complaints of fever and vomiting. He had a positive rapid streptococcus throat test with cervical lymphadenopathy. The patient was started on antibiotics. On examination, there was diffuse erythematous macular rash on the chest. Laboratory tests revealed elevated white cell count and C-reactive protein. Electrocardiogram was notable for prolonged PR interval indicating 1^st degree atrioventricular block. Echocardiogram revealed ectasia of the right coronary artery (RCA). A presumptive diagnosis of Kawasaki disease was made and the patient was started on high-dose aspirin and intravenous immunoglobulins. Cardiac computed tomography angiography (CTA) showed …

Diagnostic Value Of Mean Elasticity Index As A Quantitative Shear Wave Elastography Parameter For Prediction Of Malignancy In Small Suspicious Solid Thyroid Nodules, Saba Sohail, Sameera Kaliq Uz Zaman

Department of Radiology

Objective: To determine the diagnostic accuracy of mean elasticity index (Emean) on quantitative shear wave elastography (SWE) in detection of malignancy in small solid suspected malignant thyroid nodules on ultrasound, taking histopathology as the gold standard.
Study design: Analytical study.
Place and duration of study: Department of Radiology, Dow Medical College, Dow University of Health Sciences (DUHS) and Dr. Ruth K. M. Pfau Civil Hospital, Karachi from September 2017 to March 2018.
Methodology: Adult patients of either gender with suspected malignant thyroid nodules (solid, ≤10 mm) were subjected to SWE examination. All patients underwent thyroid surgery later. Histopathological findings were …

Dosimetric Effect When Treating Multiple Lesion Srs Using Vmat With And Without Jaw Tracking, Mindy Bui

Culminating Experience Projects

The main purpose of this study was to determine if jaw tracking or non-jaw tracking is the superior technique for patients with multiple brain metastasis that are treated with Volumetric Modulated Radiation Therapy (VMAT) Stereotactic Radiosurgery (SRS). Doses to the organs at risk (OAR) and the target volumes were analyzed using the dose volume histogram (DVH) and dose statistics for each plan. The goal of this study included analyzing the dosimetric effect on the organs at risk and the normal tissue when using jaw tracking versus non jaw tracking. The pros and cons for each technique were identified as well …

Dosimetric Comparison Of Hypofractionated Prostate Radiation With Simultaneous Integrated Boost And Conventional Fractionation With Sequential Boost, Kristina Sammon

Culminating Experience Projects

Introduction: Hypofractionated treatment delivery regimens are associated with better overall long-term disease control for prostate cancer. For patients with high-risk disease, there may be an indication for treatment of the surrounding pelvic lymph nodes for better over-all disease control. In order to achieve a hypofractionated regimen with treatment to the surrounding pelvic lymph nodes a simultaneous integrated boost technique is employed. There are concerns regarding achievability of target dose coverage and limitation of dose to the surrounding organs at risk with this fractionation.

Methods: This study is a retrospective dosimetric analysis of 7 randomly selected patients with high-risk prostate cancer. …

The Air Gap Effect Between A Bolus And The Skin Surface For Chest Wall Irradiation, Marisa Clark

Culminating Experience Projects

Planning technique and bolus choice are important aspects in planning chest wall irradiation (CWI). Many previous studies have tested various combinations of photon energies, electron energies, bolus types and sizes, air gaps sizes, and treatment methods. This study aims to assess the effect of smaller, clinically relevant air gap sizes on specific chest wall treatments using a variety of common bolus types. Due to the Covid-19 pandemic, no data was able to be collected and was instead fabricated by the researcher. Four different treatment plans were created on a phantom patient using various energies of photons (6MV and 10MV) and …

A Comparison Between Rectal Dose In Prostate Radiotherapy Patients Treated With Spaceoar Hydrogel Present Versus Patients Treated Without Spaceoar Hydrogel., David Desano

Culminating Experience Projects

Introduction: External beam radiation therapy is a common treatment option for prostate cancer patients with localized disease. Radiation-induced side effects associated with the rectum can impact a patient’s ability to complete treatment or affect the quality of life years after radiation treatment. Spaceoar hydrogel has been developed to reduce radiation dose to nearby pelvis structures, and therefore decreasing potential side effects.

Methods: A total of 20 patients who received definitive radiation therapy to the prostate and seminal vesicles were selected and placed into 2 groups (10 spaceoar, 10 non-spaceoar). The individuals’ age ranged from 60 to 79 years old with …

Myocardial Echinococcosis: Rare Manifestation Of A Common Parasitic Disease In Northern Tanzania, Ahmed Jusabani, Clement F. Kalambo, Mubashir Jusabani, Salim Surani

Imaging & Diagnostic Radiology, East Africa

Hydatid (Echinococcal) disease often involves the liver and lungs but in sporadic cases, it can involve cardiac structures. A 24-year-old male was referred with symptoms of cough and shortness of breath and a provisional diagnosis of metastatic disease of unknown primary to the lung, which was based on a chest X-ray (CXR). Incidentally, on echocardiogram, he was found to have right ventricular (RV) and myocardial multiseptated cysts, which were compatible with cardiac echinococcosis, as the patient had multiple bilateral lung cysts as well. Imaging with ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI) has ameliorated the diagnosis of …

Effectiveness Of High-Fidelity Simulation In Training Emergency Medicine Physicians In Point Of Care Ultrasonography In Pakistan: A Quasi-Experimental Study, Kiran Azizi, Madiha Ismail, Umaira Aftab, Badar Afzal Khan, Asad Mian

Department of Emergency Medicine

Background: Point-of-care ultrasound (PoCUS) is frequently utilized in emergency medicine (EM), with an extended-focused assessment with sonography in trauma (e-FAST) being the most widely used PoCUS modality. This modality is not only time- and cost-efficient, but it is highly accurate in the diagnosis and management of surgical patients in the emergency department, as well as being highly predictive of patient outcomes. Targeted training is essential to ensure a learner's confidence in image acquisition, interpretation, and translation of knowledge to making clinical decisions. High-fidelity simulation offers a uniquely safe and "mistake-forgiving" environment to teach and train medical professionals. The present study …

Discrimination Of Benign From Malignant Breast Lesions In Dense Breasts With Model-Based Analysis Of Regions-Of-Interest Using Directional Diffusion-Weighted Images., Alan I Penn, Milica Medved, Vandana Dialani, Etta D Pisano, Elodia B Cole, David Brousseau, Gregory S Karczmar, Guimin Gao, Barry D Reich, Hiroyuki Abe

Articles, Abstracts, and Reports

BACKGROUND: There is an increasing interest in non-contrast-enhanced magnetic resonance imaging (MRI) for detecting and evaluating breast lesions. We present a methodology utilizing lesion core and periphery region of interest (ROI) features derived from directional diffusion-weighted imaging (DWI) data to evaluate performance in discriminating benign from malignant lesions in dense breasts.

METHODS: We accrued 55 dense-breast cases with 69 lesions (31 benign; 38 cancer) at a single institution in a prospective study; cases with ROIs exceeding 7.50 cm

RESULTS: The region-growing algorithm for 3D lesion model generation improved inter-observer variability over hand drawn ROIs (DSC: 0.66 vs 0.56 (p < 0.001) with substantial agreement (DSC > 0.8) …

Labrad : Vol 46, Issue 2 - June 2020, Aga Khan University Hospital, Karachi

LABRAD

• Pathophysiology of Lung Injury in Context with Novel Coronavirus 2019
• Imaging in COVID-19 Pandemic: Salient Features
• Qualitative Real-Time RT-PCR For Detection of SARS-Cov-2 RNA
• Coagulopathy and Anticoagulants in COVID-19
• AKUH Blood Bank During SARS-COV-2 Outbreak
• Significance of COVID-19 Whole Genome Sequencing
• Convalescent Plasma Therapy for COVID-19
• COVID-19: An Alarm Bell for Healthcare System in Pakistan!
• Emergency Online Undergraduate Medial Education During COVID 19
• Adopting Virtual Teaching During the Pandemic-An Overview of the Utility of ‘Microsoft Teams’ from an Educator’s Perspectiv
• The Best of the Recent Past
• Polaroid

Internal Hernia As A Late Complication Of Roux-En-Y Gastric Bypass Procedure, Samantha Purton, Gabriel Meshekow, My Myers, Edgar Mercado, Allan Katz

West Florida Division Virtual Research Day 2020

As the prevalence of obesity continues to rise, so does the popularity of bariatric surgery. Previously the Roux-en-Y gastric bypass was the most common bariatric procedure, but now falls second to the gastric sleeve. It remains a relevant procedure, however, accounting for 17% of bariatric procedures in 2018. Due to its prevalence, it is important that the radiologist be familiar with the procedure and its complications such as leak, obstruction, stricture, or, as in this case, internal herniation through a mesenteric defect. Internal hernias are more commonly associated with the laparoscopic approach versus open. This is likely due to fewer …

Tumor Boards During Covid-19 Pandemic, Ahmed Nadeem Abbasi

Department of Radiation Oncology

No abstract provided.