Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 2nd World Congress on Medical Imaging and Clinical Research Paris, France.

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Scientific Program Day 1
Scientific Program Day 2

Day 1 :

Keynote Forum

Sanjay Gandhi

Southmead Hospital, UK

Keynote: The role of computer-assisted detection (CAD), artificial intelligence and machine learning in the medical imaging data overload problem: Current practice, limitations and new developments

Time : 09:45-10:35

Conference Series Medical Imaging and Clinical Research 2017 International Conference Keynote Speaker Sanjay Gandhi photo
Biography:

Sanjay Gandhi in his 30-year career spanning over the UK, India and the USA, has won several outstanding awards for his contributions to the Healthcare Innovations and Education. Times TV Network honoured him as a Global Academic Icon and the British Medical Association honoured him as a Highly Commended Editor. He has published 8 textbooks and written several papers on the use of cutting-edge technology to improve patient care. He has expertise in innovative Telehealth products including CAD, Diagnostic & Assessment Tools, PACS, etc. and has been an advisor to multinational organisations. He has also been involved in numerous research projects and collaborative trials. He has regularly published accomplished articles, rare medical conditions and research papers in reputable indexed international journals such as British Journal of Radiology (BJR), British Journal of Hospital Medicine (BJHM) and British Medical Journal (BMJ). He is on the Editorial Boards of four peer-reviewed medical journals. His current research areas are Computer-Assisted Detection (CAD) to find polyps on CT colonography and he is supervising PhD Research on the use of Artificial Intelligence and Machine Learning.

Abstract:

The demand for diagnostic imaging has continued to increase dramatically over the past few decades. More than 5 billion diagnostic tests are performed globally each year. Replacement of older modalities such as Barium enema with CT colonoscopy and isotopeVQ-scans with CT pulmonary angiography has also massively contributed to increased image datasets per examination. As a result, the majority of Radiologists and other healthcare professionals have to review tens of thousands of images every day. Fortunately, technologies such as Computer Aided Detection (CAD), 3D processing and automated image analysis have also continued to develop. These are becoming increasingly more reliable and affordable. Computer-assisted polyps and cancers detection on virtual-colonography, nodules on lung cancer screening and analysis of breast lumps on MR mammography are just a few of the examples. We will discuss the accuracy and use of different CAD programmes. Our research has shown that a large variation exists in sensitivity and PPV of commercially available software. Some programmes suffer from very long analysis times. Hence, companies producing CAD tools need to address these issues. The role and potential of new technologies such as Artificial Intelligence (AI) and machine learning in coping with the massive increase in the medical imaging workload will be explored. This talk will cover the pitfalls and provide practical tips on the use of these techniques. Such information is useful for Radiologists and Radiographers/Technicians. In addition, CAD developers and other healthcare sector’s entrepreneurs might find this discussion useful in order to develop future products.

 

Keynote Forum

Vikas Leelavati Balasaheb Jadhav

Dr.D.Y.Patil University, India

Keynote: Trans abdominal sonography of the stomach & duodenum

Time : 10:55-11:45

Conference Series Medical Imaging and Clinical Research 2017 International Conference Keynote Speaker Vikas Leelavati Balasaheb Jadhav photo
Biography:

Vikas Leelavati Balasaheb Jadhav has completed Post-graduation in Radiology in 1994. He has 23 years of experience in the field of Gastro-intestinal tract ultrasound and diagnostic as well as therapeutic interventional sonography. He has four Indian patents and an international patent in the field of Gastro-intestinal tract sonography and Radiology, since 2008. He has delivered many lectures in Indian as well as international conferences in nearly 27 countries as an Invited Guest Faculty, since 2000. He is a Consultant Radiologist and Specialist in Unconventional Gastro-Intestinal Tract Ultrasound and Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.

Abstract:

Trans-abdominal sonography of the stomach and duodenum can reveal following diseases: gastritis, duodenitis, and acid gastritis. An ulcer, whether it is superficial, deep with risk of impending perforation, perforated, sealed perforation, chronic ulcer and post-healing fibrosis and stricture, polyps and diverticulum, benign intra-mural tumors, intra-mural haematoma, duodenal outlet obstruction due to annular pancreas, gastro-duodenal ascariasis, pancreatic or biliary stents, foreign body, necrotizing gastro-duodenitis, tuberculosis, lesions of ampulla of vater like prolapsed, benign and infiltrating mass lesions. Neoplastic lesion is usually a segment involvement, and shows irregularly thickened, hypoechoic and aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture and has eccentric irregular luminal narrowing. It shows loss of normal gut signature, enlargement of the involved segment seen, and shouldering effect at the ends of stricture is most common feature. Enlarged lymph-nodes around may be seen. Primary arising from wall itself and secondary are invasion from peri-ampullary malignancy or distant metastasis. All these cases are compared and proved with gold standards like surgery and endoscopy. Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign and malignant gastro-intestinal tract lesions, so should be the investigation of choice.

 

  • Radiography | Image Proceesing | Imaging Technology
Location: Sunset -1
Speaker

Chair

Abdulrahman A. S. Alsayyari

Qassim University, Saudi Arabia

Session Introduction

Abdulrahman A. S. Alsayyari

Qassim University, Saudi Arabia

Title: Study of common requested radiographs and relative exposure dose in Qassim province
Speaker
Biography:

Abdulrahman Alsayyari, is a vice dean of the college of applied medical sciences at Qassim university. He obtained his PhD degree from university of Queensland at Australia. He worked in both sector clinical and educational where he developed his experience and knowledge to improve the healthcare services for the Saudi population.    

Abstract:

The objective of the article was to study the common requested radiographs and relative exposure dose in Qassim province in Kingdom of Saudi Arabia. The method was retrospective and analytical study for collected variables as radiographs, relative entrance surface dose (ESD) and the effective dose, patient age, gender and causative factors. The doses have been derived from the product of system output, mAs, back scatter factor BSF, focal detector distance FDD and focus – skin- distance FSD based on the equation stated by ICRU, (2005) and  Davies et al, (1997):

The objective of the article was to study the common requested radiographs and relative exposure dose in Qassim province in Kingdom of Saudi Arabia. The method was retrospective and analytical study for collected variables as radiographs, relative entrance surface dose (ESD) and the effective dose, patient age, gender and causative factors. The doses have been derived from the product of system output, mAs, back scatter factor BSF, focal detector distance FDD and focus – skin- distance FSD based on the equation stated by ICRU, (2005) and  Davies et al, (1997):

Dose (mGy) = (Output(mGy⁄mAs)×(mAs)×(BSF)×〖(FDD)〗^2)/〖(FSD)〗^2

Then the effective dose in mSv has been derived from the equation stated by ICRP, 2007 report 103.

EffD=  ∑(W_T [H_T (female)+ H_T (male)])/2

Where WT refers to weighting factor for organ or tissue and HT refers to equivalent dose to organ or tissue.

The analysis with excel software revealed that: the common requested radiographs were skull, abdomen and chest with male incidence as 75%, 72.2% and 64% respectively relative to whole sample. Traffic accident (71%) and fall-down (45%) were the most causative factors among male, female respectively, with injuries as skull fissure fracture (77%), and intracranial hemorrhage (23%). The skull radiographs noted among the age group of 11-21 years and peaking at 36% among the age group of 22-32 years. The requested abdominal radiographs appeared among the age group of 13-21 years; with frequency of (19%) and peaking at 30% among the age group of 22-30 years; with injuries as spleen ruptures (42%) and liver (27%). The chest radiographs observed among age group of 3-13 years; with frequency of 4% and peaking among age groups of 14-24 & 25-35 years old with frequencies of 19% and 21% respectively, and injuries as ribs fracture (55%), ribs dislocation (15%), pierced lung (20%) hemorrhage (10%). The average ESD for abdomen, skull and the chest radiographs were 1.93±0.8, 1.53±0.6 and 0.21±0.2 mGy, which were increase linearly following the aging, and the average effective doses were 0.24±0.1, 0.1±0.1 and 0.4±0.2 mSv respectively.

Image :

Figure 1: shows distribution of requested radiographic based on gender

 

Figure 2: shows the distribution of requested radiographic cases based on causes

Figure 3: shows the average ESD in mGy & EffD in mSv received by common anatomical site radiography

Recent Publications

1.      Kristin B Lysdah and BjÙ‘rn M Hofmann. (2009). What causes increasing and unnecessary use of radiological investigations? A survey of radiologists' perceptions. BMC Health Services Research, 9:155. doi: 10.1186/1472-6963-9-155.

2.      United Nations Scientific Committee on the Effects of Atomic Radiation. (2000). Sources and effects of ionizing radiation: report to the General Assembly, annex D, medical radiation

3.      ICRP. (1991). Recommendations of the ICRP publication 60, Annals of ICRP, Pergamon Press, Oxford.

 

Abdulrahman A. S. Alsayyari

Qassim University, Saudi Arabia

Title: Study of common requested radiographs and relative exposure dose in Qassim province
Speaker
Biography:

Abdulrahman Alsayyari, is a vice dean of the college of applied medical sciences at Qassim university. He obtained his PhD degree from university of Queensland at Australia. He worked in both sector clinical and educational where he developed his experience and knowledge to improve the healthcare services for the Saudi population.    

Abstract:

The objective of the article was to study the common requested radiographs and relative exposure dose in Qassim province in Kingdom of Saudi Arabia. The method was retrospective and analytical study for collected variables as radiographs, relative entrance surface dose (ESD) and the effective dose, patient age, gender and causative factors. The doses have been derived from the product of system output, mAs, back scatter factor BSF, focal detector distance FDD and focus – skin- distance FSD based on the equation stated by ICRU, (2005) and  Davies et al, (1997):

Dose (mGy) = (Output(mGy⁄mAs)×(mAs)×(BSF)×〖(FDD)〗^2)/〖(FSD)〗^2

Then the effective dose in mSv has been derived from the equation stated by ICRP, 2007 report 103.

EffD=  ∑(W_T [H_T (female)+ H_T (male)])/2

Where WT refers to weighting factor for organ or tissue and HT refers to equivalent dose to organ or tissue.

The analysis with excel software revealed that: the common requested radiographs were skull, abdomen and chest with male incidence as 75%, 72.2% and 64% respectively relative to whole sample. Traffic accident (71%) and fall-down (45%) were the most causative factors among male, female respectively, with injuries as skull fissure fracture (77%), and intracranial hemorrhage (23%). The skull radiographs noted among the age group of 11-21 years and peaking at 36% among the age group of 22-32 years. The requested abdominal radiographs appeared among the age group of 13-21 years; with frequency of (19%) and peaking at 30% among the age group of 22-30 years; with injuries as spleen ruptures (42%) and liver (27%). The chest radiographs observed among age group of 3-13 years; with frequency of 4% and peaking among age groups of 14-24 & 25-35 years old with frequencies of 19% and 21% respectively, and injuries as ribs fracture (55%), ribs dislocation (15%), pierced lung (20%) hemorrhage (10%). The average ESD for abdomen, skull and the chest radiographs were 1.93±0.8, 1.53±0.6 and 0.21±0.2 mGy, which were increase linearly following the aging, and the average effective doses were 0.24±0.1, 0.1±0.1 and 0.4±0.2 mSv respectively.

Image :

https://d2cax41o7ahm5l.cloudfront.net/cs/upload-images/imaging2017-33417.png

 

Figure 1: shows distribution of requested radiographic based on gender

 

https://d2cax41o7ahm5l.cloudfront.net/cs/upload-images/imaging2017-17136.JPG

 

Figure 2: shows the distribution of requested radiographic cases based on causes

 

 

https://d2cax41o7ahm5l.cloudfront.net/cs/upload-images/imaging2017-17136.JPG

 

Figure 3: shows the average ESD in mGy & EffD in mSv received by common anatomical site radiography

Recent Publications

1.      Kristin B Lysdah and BjÙ‘rn M Hofmann. (2009). What causes increasing and unnecessary use of radiological investigations? A survey of radiologists' perceptions. BMC Health Services Research, 9:155. doi: 10.1186/1472-6963-9-155.

2.      United Nations Scientific Committee on the Effects of Atomic Radiation. (2000). Sources and effects of ionizing radiation: report to the General Assembly, annex D, medical radiation

3.      ICRP. (1991). Recommendations of the ICRP publication 60, Annals of ICRP, Pergamon Press, Oxford.

 

Masoud Hashemi

Shahid Beheshti University of Medical Sciences, Iran

Title: Ultrasound guidance for interventional pain management of lumbar facet joint pain: An anatomical and clinical study
Speaker
Biography:

Masoud Hashemi MD, Anesthesiologist fellow in pain management has his expertise in pain management procedures in improving the health and wellbeing of chronic pain patients. He is known as the founder of the modern pain clinic in both educational and practical fields. His ten years of experience in teaching and training of physicians and so many patients who found less painful lives, prove his capacities in the field. As an associate professor and director of pain fellowship program and member of International Association for the Study of Pain (IASP) (Branch of Iran) he has a number of publications. Besides he organized and managed a number of congresses and workshops bringing out the latest and newest science based data as well as techniques in pain medicine in Iran.

Abstract:

There is a growing trend in ultrasound use in interventional pain management. Recently, the ease of use and clinical benefits of lumbar medial branch nerve block under ultrasound guidance have been identified. In this study, we assessed the relevant anatomy and sonoanatomy of these specific interventional techniques. We also evaluated the feasibility and success rates of ultrasound guided lumbar medial branch nerve block. Patients and Methods: Selected patients with facet joint pain who were referred to the Akhtar hospital pain clinics were evaluated.
Ultrasound-guided lumbar medial branch nerve blocks were performed. The target point for the lumbar nerve block was the cephalad margin of the transverse process groove in the vicinity of the superior articular process. C-arm fluoroscopy was performed to confirm the needle location. Pain levels were measured by a visual analog scale (0 - 10 scale), the Oswestry disability index (0 - 5 scale), and patient satisfaction scores (0 - 3 scale). The patients were followed for 6 weeks.
Results: The success rate was 98%, which was due to our use of ultrasound guided needle placement for the correct positioning of the needles. The mean procedural time was 5.9 ± 1 minutes. The average time of needle insertion was 4 ± 1 minutes. The pain intensity significantly improved from an initial value of 5 to 2.8 in the final follow-up (P = 0.0001). The oswestry disability index score significantly improved from 33.9 to 18.3 in the final follow-up (P = 0.0001). Patient satisfaction significantly improved from poor satisfaction immediately after the medial branch nerve block to excellent satisfaction in the final follow-up (P = 0. 0001). Analgesic requirements were also significantly reduced after 6 weeks of follow-up (P = 0.046).
Conclusion: Lumbar medial branch nerve block under ultrasound guidance was associated with high rates of treatment success and excellent treatment outcomes for facet joint pain. It is also feasible and administers no radiation. Thus, ultrasound-guided procedures can be used instead of conventional methods.

Hissa Mohammed

National center for Cancer Care and Research, Qatar

Title: The efficiency of good communication between radiographer and autism pediatric patient in reduction of radiation dose to patient
Biography:

 I completed my three-year diploma in medical radiography from Health Science School–College of North Atlantic–Qatar in 2008. Subsequently, I worked as a radiology technologist for Hamad Medical Corporation, Qatar, for two years. In 2010, I went to Edinburgh to continue my studies and obtain a bachelor’s in medical radiography from Queen Margaret University,Edinburgh. In 2014, I completed my bachelor’s and returned to Qatar, where I worked as a technologist. In 2016, I was promoted to technical supervisor at the National Center of Cancer Care and Research. I am always taking an active part in improving and developing my imaging skills, especially in pediatric imaging. In turn, I am sharing this knowledge as I train my colleagues and new staff in the department.

Abstract:

Autism Spectrum Disorder (ASD) characterizes as a mental disorder. According to Johnson et al., ASD is a developmental disorder of the brain that associates with impairments in social interaction, communication, and repetitive patterns of behavior; controlling their behaviors in usually challenging especially in hospitals. Johnson et al. show that children may become anxious in health care setup because of new faces of HCPs making them uncontrollable. Attending to such children would, therefore, need an experienced staff with good communication skills. Radiographers have a responsibility of ensuring smooth and effective communication with their patients to obtain a successful imaging. Mettler et al. present a research done in 2007 indicating that the amount of patients exposed to radiation has increased to a similar level to that of background radiation. It means that radiographers have failed in their responsibility hence putting the ASD children at more risk.
 
The objective of the research herein is to evaluate the efficiency of effective communication between radiographers and autism pediatric patient as a tool to reduction of radiation exposure.The study involves a qualitative research with two groups (n=10, five radiographers and five mothers to ASD children). The questionnaires were analysed by data analysis software, STRATA.
In results, mothers disclosed how their children behaved in different environments and what makes the children calm while radiologists expressed the challenges they face especially during imaging and gained strategies from mother's experiences. Good communication leads to easy and effective imaging procedure and thus, reduction in radiation dose in ASD patients.

Chih-Jen Hung

Taichung Veterans General Hospital, Taiwan

Title: MR myelography for postoperative orthostatic headache
Biography:

Chih-Jen Hung has his expertise in evaluation and passion in improving the health and wellbeing. He has worked both as Anesthesiologist and Pain Physician for a couple of decades. Based on the clinical experience of thoracic epidural analgesia for postoperative pain management, he tries to improve the practice of postoperative care and promote the education on the postoperative pain management.

Abstract:

We report the case of a man who presented with orthostatic headache postoperatively. The procedure of mid-thoracic epidural catheterization for posthoracotomy pain management was performed before induction of anesthesia. Unfortunately, theprocedure was abandoned due to some fluid aspirated from the epidural catheter. After operation, the patient complained of a severe headache for the first time when he was in the upright position. However, the findings of magnetic resonance (MR) myelography were characteristic of spontaneous intracranial hypotension (SIH), and the patient was successfully treated by an epidural blood patch at T1 level. Some reports implied that epidural anesthesia/analgesia might be a possible triggering factor of SIH in patients with an underlying structural weakness of spinal meninges. MR myelography can detect the pooling of CSF leakage. The T2-weighed MR image of our patient revealed dural sinus engorgement with contrast enhancement along bilateral nerve root sleeves of 5 levels from C7-T1 toT5-6 and left nerve root sleeve of C6-7 which indicated the presence of multiple simultaneous leaks at different spinal levels. The present case suggests that MR myelography could be carried out in patients with postoperative orthostatic headache when accidental dural puncture was not confirmed.

Image

Figure 1: T2-weighed MRI revealed contrast enhancement along neural sleeves of C7-T1.

Figure 2: Many CSF leak lesions along multiple nerve root sleeves.

  • Medical Imaging | Radiology Trends and Technology | X-Ray and PET
Location: Sunset -1

Chair

M. A. Alnafea

King Saud University, Saudi Arabia

Session Introduction

M. A. Alnafea

King Saud University, Saudi Arabia

Title: Non-monte carlo methods for investigating the application of coded aperture breast tumour imaging
Biography:

M A Alnafea is presently working as an Assistant professor in King Saud University, Saudi Arabia. He attended several International and National conferences. He published several article in different journals as well.

Abstract:

This paper describes two non-Monte Carlo methods for investigating the possible application of Coded Aperture (CA) in breast tumor imaging. The first one based on a simple approach called Binary Mask Shift (BMS) representing the action of a distributed source in the projective CA imaging geometry. The second method based on Pseudo-Ray Tracing (PRT) that obtained by purely calculating the angle of incidence of each point in the object that successfully strikes an open aperture element and then hits the detector element. These methods particularly used for CA imaging investigations. Interestingly, these non-Monte Carlo methods yields similar results of a similar CA pattern but takes less computing power, than using a full MCS approach.

Monica Kansal

Jaypee Hospital, India

Title: Dynamics of folliculogenesis – sonographic assessment and applications in infertility management
Biography:

Monica Kansal has been practising Radiology at eminent hospital and educational institutions from last nine years with special interest in Women’s imaging.

Abstract:

 Trans-vaginal sonography along with colour Doppler is the gold standard investigation in assessment of gynaecological and reproductive disorders in females. Besides exclusion of uterine, endometrial and tubal causes, sonography provides noninvasive tool for monitoring individual follicles during menstrual cycle and response to ovarian stimulation. This paper describes various uses of ultrasound in assisted reproductive techniques as the principal non-invasive modality for evaluation of key process of ovarian function – the process of folliculogenesis. Folliculogenesis refers to all phases that a primordial germ cell should pass to become mature healthy oocyte that is subsequently fertilized. It is a constant process that starts in embryogenic period and ends with the disappearance of last functional follicle in the period of menopause. Recognising the quality of follicle, its growth pattern and vascularity has a prognostic value for outcome of assisted reproduction techniques.

Figure 1: Folliculogenesis - Process of follicle recruitment and development.

Recent Publications

1.      V Vlaisavljevic and M Dosen (2007) Clinical applications of ultrasound in assessment of follicle development and growth. Donald School Journal of Ultrasound in Obstetrics and Gynaecology 1(2):50–63.

2.      Nanette Santoro, Barbara Isaac, Genevieve Neal – Perry, Tovaghol Adel, Laura Weingart and Aimee Nussbaum (2011) Impaired folliculogenesis and ovulation in older reproductive aged women. Journal of clinical endocrinology and metabolism: 88(11):5502–5509.

3.      Angela Baerwald, Gregg P Adams and Roger A Pierson (2012) Ovarian antral folliculogenesis during human menstrual cycle: A review. Human Reproduction Update, 18(1):73-91.

David Sipos

University of Pecs Faculty of Health Sciences, Hungary

Title: Radiographer prospects in Hungary
Biography:

David Sipos is a lecturer at the University of Pecs Faculty of Health Sciences Department of Diagnostical Imaging. According to my Bsc. degree I’m a radiographer,and I’ve done my Msc. from Healthcare Management. From September 2017 I’m going to attend the Phd. course at the University of Pecs. Next to my duties I’m also an application specialist for Medipixel Ltd., we are distributors of Samsung DR systems in Hungary and Slovakia as well. I can speak 4 languages (Hungarian,Slovak, Czech, English) and I’m highly interested in developing international relationships into the way of education and research.

Abstract:

Our aim was to identify the possible reasons behind the migration and attrition behaviour among Hungarian radiograhers. We were interested wether the dedicated professional staff has concrete ideas across borders which can be connected with attrition.For data collection we used one self made questionnaire and the Effort-Reward Imbalance (ERI) Questionnaire’s shortened version according to international practise. Our target group were workers with diploma of diagnostic analysis. Our sample counted 216
radiographers (n=216). For data analysis we used the 13.0 verison of SPSS. We applied analysis of variance, paired sample T-test, Chisquare test, linear regression and descriptive statistics with the performed probability of 95% (p=0.05). 30,6% of respondents (n=66) were concerned about the idea of working abroad, 40,3% (n=87) of respondents is staying in Hungary just because of their current life situation. At the group of 20-30 age we can espy significant relationship between the working opportunity abroad (p=0,001). The migration tendency was specific for radiograhers with no children (n=54). We found a significant relationship between the working ability abroad and the radiographers years spent in health care system (p=0,008). 41,7% of respondents (n=90) think that it will be favorable option if they change career. We found significant relationship between possible working opportunity abroad and the desire for higher wages and the lack of moving up in the radiographer hierarchy (p=0,001; p=0,001). Our research provides a broad view of the migration and attrition tendency among Hungarian radiographers. According to our study serious changes should be involved in the Hungarian system to keep the younger radiographers home.

Vikas Leelavati Balasaheb Jadhav

Dr.D.Y.Patil University, India

Title: TransAbdominal sonography of the small & large intestines
Speaker
Biography:

Vikas Leelavati Balasaheb Jadhav has completed Post-graduation in Radiology in 1994. He has 23 years of experience in the field of Gastro-intestinal tract ultrasound and diagnostic as well as therapeutic interventional sonography. He has four Indian patents and an international patent in the field of Gastro-intestinal tract sonography and Radiology, since 2008. He has delivered many lectures in Indian as well as international conferences in nearly 27 countries as an Invited Guest Faculty, since 2000. He is a Consultant Radiologist and Specialist in Unconventional Gastro-Intestinal Tract Ultrasound and Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.

Abstract:

Trans-abdominal sonography of the stomach and duodenum can reveal following diseases: gastritis, duodenitis, and acid gastritis. An ulcer, whether it is superficial, deep with risk of impending perforation, perforated, sealed perforation, chronic ulcer and post-healing fibrosis and stricture, polyps and diverticulum, benign intra-mural tumors, intra-mural haematoma,duodenal outlet obstruction due to annular pancreas, gastro-duodenal ascariasis, pancreatic or biliary stents, foreign body, necrotizing gastro-duodenitis, tuberculosis, lesions of ampulla of vater like prolapsed, benign and infiltrating mass lesions. Neoplastic lesion is usually a segment involvement, and shows irregularly thickened, hypoechoic and aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture and has eccentric irregular luminal narrowing. It shows loss of normal gut signature, enlargement of the involved segment seen, and shouldering effect at the ends of stricture is most common feature. Enlarged lymph-nodes around may be seen. Primary arising from wall itself and secondary are invasion from peri-ampullary malignancy or distant metastasis.
All these cases are compared and proved with gold standards like surgery and endoscopy. Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective noninvasive method to diagnose primarily hitherto unsuspected benign and malignant gastro-intestinal tract lesions, so should be the investigation of choice.

Amjed Eljaili

Ysbyty Gwynedd, UK

Title: The use of abdominal X-rays film in the emergency department of Ysbyty Gwynedd NHS Hospital
Biography:

Amjed Eljaili, MBBS, October 2010, University of Al-Zaiem Al-Azhari, Sudan, currently practicing in UK, Ysbyty Gwynedd, BCUHB, Intensive care unit, Surgical department Dr Eljaili has attended several academic meetings regionally and nationally also he has participated in various national work-shops, congress.
participation and membership with British institute of Radiology, United Kingdom.

Abstract:

The audit was carried out to exercise the compliance of the emergency department at Ysbyty Gwynedd, in relation to the standards guidelines of I-Refer and the royal college of radiologist (RCR), in order to ensure that the plain abdominal films are performed appropriately since it was noted that a significant numbers of abdominal X-rays are not clinically indicated or justified. Adherence to the recommended guidelines surely helps reducing the unnecessary radiation dose exposure directly toward sensitive and soft
abdominal organs and genitalia, also that will facilitate accessing more relevant imaging quicker into the way of establishing the diagnosis of the patient’s clinical problem. Abdominal X-rays is considered as high radiation dose study, and below is highlighting’s of few examples in comparison to the abdominal radiograph radiation dose,
1. Chest X-Ray: 0.1mSv (10 days background radiation).
2. CT head 2.0mSv (8 months background radiation).
3. Abdominal X ray 8.0mSv (3 years background radiation).
4. CT Abdomen and Pelvis 10mSv (3 years background of radiation).
5. CT chest 7mSv (2 years background of radiation).
The audit has also covered few other aspects in terms of film quality and request form adequacy as beside proper indication of the abdominal radiograph. The breakdown of the abnormal results illustrated by the radiology reports also has been mentioned, generally speaking, faecal loading represents the majority of that.
I-Refer/ RCR Standards guideline
The indications for requesting abdominal X-rays film, including:
1. Clinical suspicion of perforation or obstruction
2. Acute exacerbation of inflammatory bowel disease
3. Palpable mass (specific circumstances)
4. Constipation (specific circumstances)
5. Acute and chronic pancreatitis
6. Sharp/poisonous foreign body
7. Smooth and small foreign body, e.g., coin (specific circumstances)
8. Blunt or stab abdominal injury
Abdominal radiograph is not indicated routinely in the following conditions unless otherwise in very specific circumstances by specialist, pancreatitis, biliary Colic, constipation and GI Bleed.
Aim of the Audit: To audit our compliance in Ysbyty Gwynedd Hospital, emergency department, in adherence to the RCR/I-Refer standards guidelines and to increase the awareness of the healthcare staff in Ysbyty Gwynedd in relation to correct and appropriate indications of abdominal X-ray films, in so doing that will reduce to unnecessary radiation dose the patient will expose to. 2- To improve ‘the optimization of abdominal radiographic imaging in the emergency department in order to allow easy and correct interpretation of the radiograph film.
Methodology: This was a retrospective study involved data collection of 60 patients that were audited over period of two-monthsfor each cycle (Nov/December 2016 to March and April2017) to assess the compliance with the I-refer/RCR guidelines and also to optimise the film quality and the adequacy. The 60 consecutive abdominal X-rays requested in the emergency department where looked at their indication, radiology report, request form adequacy, radiograph quality and the clinical question need to be answered.
The patient’s information was obtained via using radiology information system for radiology reports/requests form and emergency department admission case cards.
Discussion and recommendations of the audit: It was noted that during the first the study, some abdominal radiographs were requested inappropriately for the following conditions, constipation, hemorrhoid, PR bleed, Upper GI bleed, ascites, bladder symptoms and UTIs, scrotal pain, appendicitis, gastroenteritis and acute cholecystitis, however majority of the films were requested by the most junior doctors particularly those who had recently completed a surgical placement. The junior doctors who newly started emergency medicine placement were educated and advised always not to hesitate to ask for senior opinion regarding requesting abdominal films when not sure whether or not indicated, also the majority of cases where bowels obstruction suspected have not had direct rectal examination performed as part for the NICE guideline for patients presenting with abdomenal pain.
Conclusion: Abdominal radiograph is of high radiation dose and usually has low diagnostic value in the majority of the cases, direct rectal examination is good practice and part of the recommended NICE guideline in the context of abdominal pain and bowel obstruction. Abdominal X-rays are not indicated for non-specific abdominal pain.

Shahriari Mozhgan

Tehran University, Iran

Title: Evaluation of diagnostic efficacy of vessel specific coronary calcium score in detection of coronary artery stenosis with usage of invasive angiography as gold standard
Biography:

Shahriari Mozhgan completed her study from Babol University, Iran. She has worked as a Researcher in the Radiology Research Center of Tehran University for six months and now she is working as a General Practitioner at her office.

Abstract:

Coronary computed tomography angiography (CCTA) is a beneficial method for detection of coronary artery disease. In this study,we investigated diagnostic accuracy and predictive value of vessel specific calcium scoring in detection of coronary stenosis by using 128-slice computed tomographic angiography (CTA) scanner. We used invasive angiography (IA) as the gold standard. 71 patients who had undergone both 128-slice CTA and IA were enrolled in the study. Three threshold for stenosis were considered (normal versus any kind of stenosis, stenosis<50% vs. >50%, stenosis<70% vs. >70%) in four major epicardial coronary arteries. Mean calcium score and p-values were compared between these three groups of stenosis by T-test and Mann-Whitney test. ROC analysis was done for evaluation of sensitivity/specificity, positive predictive value (PPV) and negative predictive value (NPV) of vessel specific calcium scoring method. There was a significant positive correlation between calcium score and coronary artery stenosis in our study.
The p value of this correlation for LAD in normal versus any kind of stenosis, stenosis<50% vs. >50%, stenosis<70% vs. >70% was 0.004, 0.005 and 0.001 respectively. For RCA, it was 0.001, 0.001 and 0.00 respectively and for LCX 0.02, 0.003 and 0.017 respectively.
In ROC analysis, we detected that by increasing in stenosis from normal to >70%, we had higher sensitivity, specificity and NPV in LAD, RCA and LCX arteries. Coronary artery calcification score is a good predictive and diagnostic method for coronary stenosis evaluation; however, it’s not enough in the case of high risk patients because it does not achieve 100% NPV.