Radiology Commons^™

An Implantable Mosfet Dosimeter Modified To Act As A Fiducial Marker, Joseph S. Dick

Dissertations and Theses (Open Access)

In external beam radiation therapy, it is imperative that the prescribed dose is administered to the correct location and in the correct amount. Though several ex vivo methods of quality assurance are currently employed to achieve this goal, verifying that the correct dose is received within the patient in situ is impossible without the capability of measuring dose inside the patient. Recently, a method of measuring dose delivered within the patient has been developed, an implantable MOSFET dosimeter. This dosimeter is implanted within the patient and records the dose received. Since the dosimeter is implanted in the patient, it could …

Effect Of Acute Administration Of Angiopoietin-1 In Experimental Traumatic Spinal Cord Injury: Magnetic Resonance Imaging And Neurobehavioral Studies, Chirag B. Patel

Dissertations and Theses (Open Access)

Spinal cord injury (SCI) is a devastating condition that affects people in the prime of their lives. A myriad of vascular events occur after SCI, each of which contributes to the evolving pathology. The primary trauma causes mechanical damage to blood vessels, resulting in hemorrhage. The blood-spinal cord barrier (BSCB), a neurovascular unit that limits passage of most agents from systemic circulation to the central nervous system, breaks down, resulting in inflammation, scar formation, and other sequelae. Protracted BSCB disruption may exacerbate cellular injury and hinder neurobehavioral recovery in SCI.

In these studies, angiopoietin-1 (Ang1), an agent known to reduce …

Dynamic Chemical Shift Imaging For Image-Guided Thermal Therapy, Brian A. Taylor

Dissertations and Theses (Open Access)

Magnetic resonance temperature imaging (MRTI) is recognized as a noninvasive means to provide temperature imaging for guidance in thermal therapies. The most common method of estimating temperature changes in the body using MR is by measuring the water proton resonant frequency (PRF) shift. Calculation of the complex phase difference (CPD) is the method of choice for measuring the PRF indirectly since it facilitates temperature mapping with high spatiotemporal resolution. Chemical shift imaging (CSI) techniques can provide the PRF directly with high sensitivity to temperature changes while minimizing artifacts commonly seen in CPD techniques. However, CSI techniques are currently limited by …

Craniocerebral Aspergillosis: A Review Of Advances In Diagnosis And Management, Muhammad Shahzad Shamim, Ather Enam, Rushna Ali, Saleha Anwar

Section of Neurosurgery

Craniocerebral aspergillosis is a rare but dangerous central nervous system infection. The infection has a spectrum of presenting features, mostly affecting immunocompromised individuals. The incidence appears to be on the rise that has been especially observed in the immunocompetent population. A high index of suspicion, a comprehensive understanding of the infectious process and advanced laboratory and radiological diagnostic techniques, allow early diagnosis. Surgery, followed by systemic antifungal medications, remains the cornerstone of management. Early administration of empirical anti-fungal agents along with immunomodulators may further improve prognosis. Immunocompetent patients tend to have better outcomes as compared to those who are immunocompromised. …

Birth Weight Estimation--A Sonographic Model For Pakistani Population, Waseem Akhtar, Arif Ali, Mubashir Aslam, Farah Saeed, Salman, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To develop a sonographic birth weight estimation model for Pakistani population and to validate the published models in the same population.

METHODS: Data was collected for pregnant women who presented to Radiology Department of Aga Khan University Hospital Karachi from January 2007 to July 2008 and had undergone ultrasound estimation of foetal weight within 4 days prior to a term delivery (37-42 weeks gestation). The neonate's actual birth weight was used to validate the published foetal weight estimation models and modified sonographic birth weight estimation model was derived for our population by using linear regression.

RESULTS: Modified sonographic birth …

Department Of Radiology-Annual Executive Summary Report-July 1, 2009 To June 30, 2010, Vijay M. Rao, Md

Department of Radiology Administrative Documents and Reports

86 page Annual Executive Summary Report from Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States

Table of Contents:

Department of Radiology

Chairman, Vice Chairmen 1

Divisions and Directors 1

Committees and Chairmen 1

Radiology Department Faculty Rank 2

Faculty with Secondary Appointments 3

Clinical Divisions 4

Radiology Residents and Fellows 5

Department Organizational Chart 6

Department Administration Chart 7

State of the Department 8

Appendix I: Publications Journal Articles 21

Books and Book Chapters 28

Abstracts 30

Appendix II: Formal Scientific Presentations 39

Appendix III: Honors, Editorial Activities, Service to Regional or National Organizations 59

Appendix IV: …

Optimizing Radiology Peer Review: A Mathematical Model For Selecting Future Cases Based On Prior Errors, Yun Robert Sheu, Elie Feder, Igor Balsim, Victor F. Levin, Andrew G. Bleicher, Barton F. Branstetter Iv

Publications and Research

Introduction: Peer review is an essential process for physicians because it facilitates improved quality of patient care and continuing physician learning and improvement. However, peer review often is not well received by radiologists, who note that it is time intensive, subjective, and lacks demonstrable impact on patient care. Current advances in peer review include the RADPEER system with its standardization of discrepancies and incorporation of the peer review process into the PACS itself. Our purpose was to build on RADPEER and similar systems by using a mathematical model to optimally select the types of cases to be reviewed, for each …

Post Traumatic Avulsion Of Lumbar Artery: A Rare Cause Of Retroperitoneal Haemorrhage Treated By Glue Embolization, Rana Shoaib Hamid, Haq Tanveer Ul Ul, Ishtiaq Chishti, Muhammad Azeemuddin

Department of Radiology

Lumbar arterial injury after trauma is a rare cause of significant retroperitoneal haemorrhage. Early diagnosis followed by endovascular transcatheter embolization is a very effective treatment to control bleeding in patients who do not respond to conservative management. We present a case of post traumatic avulsion of left fourth lumbar artery which was successfully treated with percutaneous transcatheter arterial embolization with glue.

Labrad : Vol 35, Issue 2 - June 2010, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• The Atypical Lymphocytes
• High Performance Liquid Chromatography (HPLC): An Effective Tool for the Diagnosis of Various Hemoglobinopathies
• Platelet Transfusions: What We Need to Know
• Measuring Homocysteine Levels
• Parathyroid Hormone: A Marker of Vitamin D Deficiency and Insufficiency
• Surrogate Measures of Insulin Sensitivity
• Foetal Autopsy
• Laboratory Diagnosis of Vaginitis due to Trichomonas Vaginalis
• AKU Clinical Laboratory Continuing Medical Education Seminars

Comparison Of Multi-Detector Ct Venography And Venous Sonography For Detecting Lower Limb Deep Venous Thrombosis In Patients With Suspected Pulmonary Embolism, Ruth Wanjohi

Master of Medicine in Imaging and Diagnostic Radiology

Objective: This was a prospective analytic study that aimed to compare the agreement between CT pulmonary angiography (CTPA/CTV) and ultrasonography (US) for diagnosis of thromboembolic disease and determine the sensitivity, specificity, positive and negative predictive values of the 2 tests using the presence of thromboembolic disease as a reference standard. Methods: 76 consecutive patients who were referred for CTPA at the Radiology department of Aga Khan University Hospital over an 8 month period between December 2008 and July 2009 were included in the study. All the patients underwent combined CTPA/CTV according to the usual departmental protocol. They subsequently had bilateral …

Bone Density Measurement Via Radiographic Calibration, Amber Jean Bowen

Master's Theses

Musculoskeletal injuries are the most common injuries sustained by athletes and military recruits and can result in decreased performance and lifelong disability. So common and costly are these injuries that the American Academy of Orthopedic Surgeons has provided guidelines for future research, including recommendations for the development of a large animal model of bone injury (USDA 2001). In human and veterinary medicine, digital radiography represents the primary diagnostic tool the physician uses to diagnose skeletal injury. Advances in digital radiography have provided the veterinarian with opportunities to make both simple and complex radiographic assessments. We investigated a simple quantitative measurement …

Splenic Infarction: An Update On William Osler's Observations., Yaacov R Lawrence, Ma Mbbs Mrcp, Russell Pokroy, Mb Bch, Daniel Berlowitz, Mb Bch, Dvora Aharoni, Md, Daniel Hain, Md, Gabriel S Breuer, Md

Department of Radiation Oncology Faculty Papers

BACKGROUND: Osler taught that splenic infarction presents with left upper abdominal quadrant pain, tenderness and swelling accompanied by a peritoneal friction rub. Splenic infarction is classically associated with bacterial endocarditis and sickle cell disease.

OBJECTIVES: To describe the contemporary experience of splenic infarction.

METHODS: We conducted a chart review of inpatients diagnosed with splenic infarction in a Jerusalem hospital between 1990 and 2003.

RESULTS: We identified 26 cases with a mean age of 52 years. Common causes were hematologic malignancy (six cases) and intracardiac thrombus (five cases). Only three cases were associated with bacterial endocarditis. In 21 cases the splenic …

Rational Use Of Radiology Services, Saba Sohail

Department of Radiology

No abstract provided.

Posterior Reversible Encephalopathy Syndrome: A Case Series In Patients With Eclampsia, Rohana Naqi, Humera Ahsan, Muhammad Azeemuddin

Department of Radiology

Posterior Reversible Encephalopathy Syndrome (PRES) refers to a clinicoradiologic entity with characteristic features on neuro-imaging and non-specific symptoms comprising headache, confusion, visual disturbances and seizures. The lesions in PRES are thought to be due to vasogenic oedema, predominantly in the posterior cerebral hemispheres, and are reversible with appropriate management. We report 3 cases of acute PRES who had eclampsia and presented with recurrent episodes of seizures and hypertension. Their MRI scan showed diffuse abnormal signal intensities involving predominantly deep white matter of the occipital lobes. Based on the findings the most probable diagnosis of PRES was suggested. They were started …

Thoracic Radiotherapy Treatment Planning With Cine Pet/Ct, Adam C. Riegel

Dissertations and Theses (Open Access)

Purpose: Respiratory motion causes substantial uncertainty in radiotherapy treatment planning. Four-dimensional computed tomography (4D-CT) is a useful tool to image tumor motion during normal respiration. Treatment margins can be reduced by targeting the motion path of the tumor. The expense and complexity of 4D-CT, however, may be cost-prohibitive at some facilities. We developed an image processing technique to produce images from cine CT that contain significant motion information without 4D-CT. The purpose of this work was to compare cine CT and 4D-CT for the purposes of target delineation and dose calculation, and to explore the role of PET in target …

Decision Analytic Model For Evaluation Of Suspected Coronary Disease With Stress Testing And Coronary Ct Angiography., Ethan J Halpern, David Fischman, Michael P Savage, Anish R Koka, Matthew Decaro, David C Levin

Department of Radiology Faculty Papers

RATIONALE AND OBJECTIVES: The aim of this study was to apply a decision analytic model for the evaluation of coronary artery disease (CAD) to define the optimal utilization of coronary computed tomographic angiography (cCTA) and stress testing.

MATERIALS AND METHODS: The model tested in this study assumes that CAD is evaluated with a stress test and/or cCTA and that a patient with positive evaluation results undergoes cardiac catheterization. On the basis of values of sensitivity, specificity, and radiation dose from the published literature and test costs from the Medicare fee schedule, a decision tree model was constructed as a function …

Cerebral Toxoplasmosis In A Patient With Acquired Immunodeficiency Syndrome, Rohana Naqi, Muhammad Azeemuddin, Humera Ahsan

Department of Radiology

Cerebral toxoplasmosis commonly affects patients with advanced HIV immunodeficiency. Toxoplasmosis in patients who are immunocompromised can be severe and debilitating in patients with Central Nervous System (CNS) involvement and the condition may be fatal. We report the case of a 40-year-old man who was a known case of HIV and presented with cerebral toxoplasmosis. His Magnetic Resonance Imaging (MRI) scan showed multiple ring enhancing lesions with extensive surrounding oedema in supratentorial as well as infratentorial region. Lesions were mainly located in the periventricular region as well as at the grey-white matter junction and showed enhancement in the periphery as well …

Development Of A Functional Mri Olfactory Protocol, Jeremy Mangum

UNLV Theses, Dissertations, Professional Papers, and Capstones

Many people can spend a few days with an acute form of sinusitis, a stuffy nose, or sinus congestion that inhibits their ability to smell, but there are fourteen million Americans over the age of fifty that suffer from some form of chronic olfactory dysfunction. Some neurological disorders such as Parkinson's disease and Alzheimer's disease have demonstrated that olfactory dysfunction is a frequent and early sign. While these diseases have no known cure, there are medicines that exist to slow the progression of such debilitating illnesses. By identifying such diseases in their early stages, we can improve the quality of …

Ewing's Sarcoma/Pnet Of Kidney In 13-Year-Old Girl, Quratulain Badar, Nasir Ali, Nadeem Abbasi, Shamvil Ashraf, Farrok Karsan, Raheel Hashmi

Department of Radiology

Ewing's sarcoma is the second most common primary tumour of bone in childhood. Less frequently it occurs in soft tissues. Ewing's sarcoma/primitive neuroectodermal tumour (ES/PNET) is an extra ordinarily rare primary tumour in the kidney. Only very few cases of primary renal Ewing's sarcoma have been reported in the literature to date. We present a case of primary right renal Ewing's sarcoma in a 13-year-old girl who was diagnosed as a case of stage IV ES/PNET of kidney with metastases to lung and liver. Right nephrectomy was done followed by adjuvant radiotherapy and chemotherapy with complete response to local and …

Ureteroscopic Laser Treatment Of Upper Urinary Tract Neoplasms., Demetrius H. Bagley, Michael Grasso

Department of Radiology Faculty Papers

BACKGROUND: Endoscopic management of upper urinary tract transitional cell carcinoma has assumed an important role in diagnosis and treatment. The introduction of small diameter rigid and flexible ureteroscopes has permitted access to the upper tract. Biopsy techniques have been developed for accurate diagnosis, and the addition of lasers has given the urologists an excellent tool for treatment. METHODS: Medical literature available relative to the endoscopic laser treatment of upper tract neoplasms has been reviewed. RESULTS: Ureteroscopic treatment has been characterized by good success with high recurrence rates, both in the upper tract and in the bladder. Bladder recurrence rates are …

Hydatid Disease Of The Breast, Imrana Masroor, M. Azeemuddin, S. Khan, A. Barakzai

Department of Radiology

Cystic hydatid disease is caused by the parasite Echinococcus granulosus. Humans are the accidental intermediate hosts of this organism. Hydatid disease is endemic in countries in which raising sheep and cattle constitutes an important means of livelihood. The most commonly affected organs are the liver and lungs. Involvement of the kidney, bone, brain and other organs is rare. Breast involvement in this disease is also very rare. A case of isolated hydatid cyst of the breast is presented, along with a review of the literature and a discussion on the pertinent clinical and radiological aspects of the disease.

Simple Linear Measurements Of The Normal Liver: Interobserver Agreement And Correlation With Hepatic Volume On Mri, Sachit K. Verma, Kristen Mcclure, Laurence Parker, Donald G. Mitchell, Manisha Verma, Diane Bergin

Department of Radiology Faculty Papers

OBJECTIVE. To retrospectively evaluate interobserver agreement for 4 manually determined linear hepatic measurements on magnetic resonance imaging (MRI) and correlation of these linear measurements with hepatic volume.

MATERIALS AND METHODS. Hepatic linear measurements: midhepatic point craniocaudad (MHP CC), maximum CC to liver tip (Max CC), maximum transverse and MHP anteroposterior (AP) dimensions were performed on 116 patients without liver disease who had 1.5 T MR imaging of the abdomen.Linear measurements: MHP CC, Max CC, maximum transverse, MHP AP dimensions and products of CC with MHP AP dimension were correlated with hepatic volumes. Correlation analysis (Pearson product moment correlation), Student t …

Comparison Of A New Opposed Phase Imaging Protocol To The Standard Conventional Mri Protocol In Demonstration Of Lumbar Degenerative Disc Disease At 1.5t., Peter C. Magabe

Master of Medicine in Imaging and Diagnostic Radiology

Purpose: The purpose of the study was to compare diagnostic yield of a new Opposed Phase Imaging protocol [OPI] to the standard conventional MRI protocol [CONV] in demonstration of lumbar degenerative disc disease at 1.5T. Materials and Methods: A total of 102 patients suspected of lumbar disc disease were examined using the two protocols. Images from both protocols were then analyzed independently by two radiologists. Category of disc disease[normal, bulge ,protrusion, extrusion] and anatomic clarity of spinal structures related to disc disease[nerve roots, osteophytes, modic changes and hemangiomas ] were assessed using a standard 4 point scoring scale [1=inadequate,2 =adequate,3=normal …

Tips And Tricks For The Trauma Patient., Anthony D Goei, Brian H Ching, Mark W Meyermann, Timothy Nunez, David Sacks

Reading Hospital Interventional Radiology

Interventions on the trauma patient are an essential component of the complete scope of care that is provided to the multiply injured patient today. The active participation by the interventional radiologist along the entire spectrum of clinical care is very important to optimize patient outcomes. Suggestions on how to establish a clinical presence are presented. A few of the newer concepts and terminology applicable to trauma care are reviewed. Tips useful in the trauma room, in the interventional radiology suite, and during the postprocedural period are discussed.

Neovascularity Patterns In Breast Carcinoma: Correlation Of Doppler Ultrasound Features With Sonographic Tumour Morphology, Riffat Shaheen, Saba Sohail, Kauser Jahan Siddiqui

Department of Radiology

Objective: To determine the association and correlation between morphologic features of breast cancer on gray scale ultrasound, and vascularity patterns and indices on color and spectral Doppler ultrasound.
Study design: Cross-sectional, analytical study.
Place and duration of study: Department of Radiology, Dow University of Health Sciences and Civil Hospital, Karachi, from August 2006 to June 2007.
Methodology: Fifty adult female patients with histopathological proven breast cancer underwent ultrasound for evaluation of morphologic features on gray scale mode; vascularity patterns on color Doppler scan and flow indices measurement on spectral Doppler ultrasound. Regression analysis was conducted to determine correlation between the …

Magnetic Resonance Imaging Findings In Patients With Schizophrenia, Waseem Akhtar, Haider A Naqvi, Sajjad Hussain, Arif Ali, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging (MRI).

STUDY DESIGN: Comparative study.

PLACE AND DURATION OF STUDY: The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008.

METHODOLOGY: Thirty-three cases of schizophrenia (n=33) and thirty-three age-matched controls, (n=33) were enrolled for this study. Screening Magnetic Resonance Imaging (MRI) of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p < 0.05.

RESULTS: Among the total of 66 (n=66) …

Evaluation Of Solid Breast Masses Using Sonographic Acr Bi-Rads Lexicon Descriptors, Brian N. Bwombuna

Master of Medicine in Imaging and Diagnostic Radiology

Purpose of the study: To which of the ACR sonographic BIRADS lexicon descriptors can be used reliably to differentiate benign from malignant solid breast masses. Objectives: 1.Main Objective: To determine the association of sonographic ACR BI-RADS descriptors and solid breast masses 2. Specific Objective: To determine the predictive probabilities of sonographic BI-RADS lexicon descriptors Methodology: This was a 15 months prospective cross sectional study in which 125 consecutive patients who met the inclusion criteria were enrolled. The study was carried out at theAga KhanUniversity hospitalradiology department between October 2008 and December 2009 inclusive. The scans were performed in ourradiology department …

Ct And Mri Features Following Uterine Fibroid Embolization, Sachit Verma Md, Carin F. Gonsalves Md, Oksana H. Baltarowich Md, Donald G. Mitchell Md, Anna Lev-Toaff Md, Diane Bergin Md

Department of Radiology Faculty Papers

Uterine artery embolization (UAE) is an effective treatment for symptomaticuterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a …

A Review Of Autoimmune Diseases Associated With Cancer, Patricia Tai, Edward Yu, Kurian Joseph, Thomas Miale

Oncology Publications

The focus of this review is on the relationships between autoimmune diseases and cancer from two closely related perspectives: 1.Those autoimmune diseases which are often associated with malignancies. 2.Those prevalent cancers which may increase the risks of developing autoimmune disorders. The review concludes with a brief discussion of some selected innovative approaches to cancer immunotherapy.

Biological Impact Of Geometric Uncertainties: What Margin Is Needed For Intra-Hepatic Tumors?, Hsiang-Chi Kuo, Wen-Shan Liu, Andrew Wu, Dennis Mah, Keh-Shih Chuang, Linda Hong, Ravi Yaparpalvi, Chandan Guha, Shalom Kalnicki

Department of Radiologic Sciences Faculty Papers

BACKGROUND: To evaluate and compare the biological impact on different proposed margin recipes for the same geometric uncertainties for intra-hepatic tumors with different tumor cell types or clinical stages. METHOD: Three different margin recipes based on tumor motion were applied to sixteen IMRT plans with a total of twenty two intra-hepatic tumors. One recipe used the full amplitude of motion measured from patients to generate margins. A second used 70% of the full amplitude of motion, while the third had no margin for motion. The biological effects of geometric uncertainty in these three situations were evaluated with Equivalent Uniform Doses …