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   2010| April-June  | Volume 20 | Issue 2  
    Online since May 6, 2010

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Pictorial essay: Breast USG
Geeta Shah, Bijal Jankharia
April-June 2010, 20(2):98-104
DOI:10.4103/0971-3026.63045  PMID:20607018
USG of the breast is now an established modality. It is used in the characterisation of focal breast lesions as well as in the primary evaluation of mammographically dense breasts. It helps guide biopsies as well. We present a pictorial essay on the role of USG in various breast pathologies
  21,514 2,692 -
Pictorial essay: Distal colostography
Mukund D Rahalkar, Anand M Rahalkar, Dilip M Phadke
April-June 2010, 20(2):122-125
DOI:10.4103/0971-3026.63054  PMID:20607024
Distal colostography (DC), also called distal colography or loopography, is an important step in the reparative management of anorectal malformations (ARMs) with imperforate anus, Hirschsprung's disease (occasionally) and colonic atresia (rarely) in children and obstructive disorders of the distal colon (colitis with stricture, carcinoma or complicated diverticulosis) in adults. It serves to identify/confirm the type of ARM, presence/absence of fistulae, leakage from anastomoses, or patency of the distal colon. We present a pictorial essay of DC in a variety of cases.
  10,156 1,075 -
Case report: Stercoral sigmoid colonic perforation with fecal peritonitis
Monika Sharma, Anjali Agrawal
April-June 2010, 20(2):126-128
DOI:10.4103/0971-3026.63051  PMID:20607025
Chronic constipation can lead to fecal impaction. It can also rarely lead to catastrophic complications like perforation, colonic obstruction, and fecal peritonitis. We report a rare case of stercoral sigmoid colonic perforation with fecal peritonitis and pneumoperitoneum, which was diagnosed on preoperative CT scan.
  10,013 387 9
Radiology websites: A few useful websites on chest radiology and imaging
IK Indrajit
April-June 2010, 20(2):158-159
  9,121 650 -
Objective structured clinical examination in radiology
Anurag Agarwal, Bipin Batra, AK Sood, Ravi Ramakantan, Satish K Bhargava, N Chidambaranathan, IK Indrajit
April-June 2010, 20(2):83-88
DOI:10.4103/0971-3026.63040  PMID:20607015
There is a growing need for introducing objective structured clinical examination (OSCE) as a part of radiology practical examinations in India. OSCE is an established, reliable, and effective multistation test for the assessment of practical professional skills in an objective and a transparent manner. In India, it has been successfully initiated and implemented in specialties like pediatrics, ophthalmology, and otolaryngology. Each OSCE station needs to have a pre-agreed "key-list" that contains a list of objective steps prepared for uniformly assessing the tasks given to students. Broadly, OSCE stations are classified as "manned" or "unmanned" stations. These stations may include procedure or pictorial or theory stations with clinical oriented contents. This article is one of a series of measures to initiate OSCE in radiology; it analyzes the attributes of OSCE stations and outlines the steps for implementing OSCE. Furthermore, important issues like the advantages of OSCE, its limitations, a strengths, weaknesses, opportunities, and threats (SWOT) analysis, and the timing of introduction of OSCE in radiology are also covered. The OSCE format in radiology and its stations needs to be validated, certified, and finalized before its use in examinations. This will need active participation and contribution from the academic radiology fraternity and inputs from faculty members of leading teaching institutions. Many workshops/meetings need to be conducted. Indeed, these collaborative measures will effectively sensitize universities, examiners, organizers, faculty, and students across India to OSCE and help successfully usher in this new format in radiology practical examinations.
  8,808 694 6
The diagnostic contribution of CT volumetric rendering techniques in routine practice
Simone Perandini, N Faccioli, A Zaccarella, TJ Re, R Pozzi Mucelli
April-June 2010, 20(2):92-97
DOI:10.4103/0971-3026.63043  PMID:20607017
Computed tomography (CT) volumetric rendering techniques such as maximum intensity projection (MIP), minimum intensity projection (MinIP), shaded surface display (SSD), volume rendering (VR), and virtual endoscopy (VE) provide added diagnostic capabilities. The diagnostic value of such reconstruction techniques is well documented in literature. These techniques permit the exploration of fine anatomical detail that would be difficult to evaluate using axial reconstructions alone. Although these techniques are now widely available, many radiologists are either unfamiliar with them or do not fully utilize their potential in daily clinical practice. This paper is intended to provide an overview of the most common CT volumetric rendering techniques and their practical use in everyday diagnostics.
  8,275 851 10
Pictorial essay: USG of lumps and bumps of the foot and ankle
Rajesh Botchu, Aman Khan, Raj Bhatt
April-June 2010, 20(2):105-108
DOI:10.4103/0971-3026.63048  PMID:20607019
USG is a cost-effective and dynamic way to interrogate superficial lumps and bumps. We present a pictorial review of the USG findings in various "lumps and bumps" of the foot and ankle.
  8,329 792 1
Isolated superior mesenteric artery dissection
Palle Lalitha, Balaji Reddy
April-June 2010, 20(2):132-134
DOI:10.4103/0971-3026.63047  PMID:20607027
Isolated superior mesenteric artery (SMA) dissection without involvement of the aorta and the SMA origin is unusual. We present a case of an elderly gentleman who had chronic abdominal pain, worse after meals. CT angiography, performed on a 64-slice CT scanner, revealed SMA dissection with a thrombus. A large artery of Drummond was also seen. The patient was managed conservatively.
  6,798 384 2
MRI in T staging of rectal cancer: How effective is it?
MG Mulla, R Deb, R Singh
April-June 2010, 20(2):118-121
DOI:10.4103/0971-3026.63055  PMID:20607023
Background: Rectal cancer constitutes about one-third of all gastrointestinal (GI) tract tumors. Because of the high recurrence rates (30%) in rectal cancer, it is vitally important to accurately stage these tumours preoperatively so that appropriate surgical resection can be undertaken. MRI is the ideal technique for the preoperative staging of these tumours. Aim: To determine the accuracy of local T staging of rectal cancer with MRI, using histopathological staging as the gold. Materials and Methods: Forty consecutive patients admitted with rectal cancer over a period of 18 months were included in this retrospective study. MRI scans were performed prior to surgery in all patients, on 1.5T scanners. Two radiologists, with a special interest in gastrointestinal imaging reported all images. Two dedicated histopathologists reported the histology slides. The accuracy of preoperative local MRI T staging was assessed by comparison with postoperative histopathological staging. Results: There was agreement between MRI and histopathology (TNM) staging in 12 patients (30%). The sensitivity and specificity of MRI for T staging was 89% and 67% respectively. The circumferential resection margin (CRM) status was accurately staged in 94.1% of the patients. Conclusions: Preoperative staging with MRI is sensitive in identifying CRM involvement, which is the main factor affecting the outcome of surgery.
  6,374 668 5
Elemental mercury poisoning caused by subcutaneous and intravenous injection: An unusual self-injury
Jaywant Wale, Pankaj K Yadav, Shairy Garg
April-June 2010, 20(2):147-149
DOI:10.4103/0971-3026.63056  PMID:20607031
Elemental mercury poisoning most commonly occurs through vapor inhalation as mercury is well absorbed through the lungs. Administering subcutaneous and intravenous elemental mercury is very uncommon but with only a few isolated case reports in the literature. We present an unusual case of elemental mercury poisoning in a 20-year-old young male who presented with chest pain, fever, and hemoptysis. He had injected himself subcutaneously with elemental mercury obtained from a sphygmomanometer. The typical radiographic findings in the chest, forearm, and abdomen are discussed, with a review of the literature.
  5,894 317 4
Accreditation standards for medical imaging services
Zainab Zaidi
April-June 2010, 20(2):89-91
DOI:10.4103/0971-3026.63042  PMID:20607016
The rapid changes in the healthcare system, with revolutionary advancements in imaging, along with the lack of any existing imaging standards in our country, have raised the need for an accreditation structure. The Quality Council of India (QCI) has therefore introduced standards for medical imaging services, focusing on the control of services, personnel, imaging processes and procedures, facility and environment, equipment, and documentation, as well as risk control and safety. This article deals briefly with the standards structured by the QCI for accreditation of imaging services.
  5,324 683 -
Case report: Short rib polydactyly syndrome - type 2 (Majewski syndrome)
Pramod Setty Jutur, Chandan Pramod Kumar, Shetteppa Goroshi
April-June 2010, 20(2):138-142
DOI:10.4103/0971-3026.63044  PMID:20607029
Short rib polydactyly syndrome (SRPS) type 2 (Majewski syndrome) is a rare inherited, autosomal recessive, lethal skeletal dysplasia characterized by horizontally located short ribs, pre- and postaxial polysyndactyly, and micromelia, with characteristic short ovoid tibiae. There may or may not be visceral involvement. We report a case of SRPS type 2 that was diagnosed by antenatal USG at 28 weeks of gestation; the diagnosis was subsequently confirmed by postnatal radiography, fetal autopsy, and histopathology.
  5,430 399 1
Intermittent torsion of accessory hepatic lobe: An unusual cause of recurrent right upper quadrant pain
Kedar Jambhekar, Tarun Pandey, Chhavi Kaushik, Hemendra R Shah
April-June 2010, 20(2):135-137
DOI:10.4103/0971-3026.63046  PMID:20607028
An accessory lobe of the liver is a rare congenital anomaly that can undergo torsion and present as an acute surgical emergency. It is rarely diagnosed preoperatively. We report the preoperative utility of CT scan and MRI in the diagnosis and surgical planning of a case of intermittent accessory hepatic lobe torsion.
  5,398 346 7
Retrorectal hamartoma: A 'tail' of two cysts!
Prasant Peter, Uttam George, Mark Peacock
April-June 2010, 20(2):129-131
DOI:10.4103/0971-3026.63049  PMID:20607026
Retrorectal hamartomas or tail gut cysts are rare congenital anomalies most commonly seen in a retrorectal location; most common in middle aged women. This article describes the radiological appearance in two cases of tail gut cysts in males, one a child with a visible perianal swelling since birth and the other, a 72-year-old man with symptoms for one week. In both, the tailgut cysts were in a right perirectal location. Presentation in such a location in males, at extremes of age, is unusual for tailgut cysts.
  5,141 377 1
Case series: CT scan in cardiac arrest and imminent cardiogenic shock
Manisha Jana, Shivanand Ramachandra Gamanagatti, Atin Kumar
April-June 2010, 20(2):150-153
DOI:10.4103/0971-3026.63037  PMID:20607032
Imaging a patient having a cardiac arrest on the examination table is not a common occurrence. Altered hemodynamics resulting from pump failure causes stasis of blood in the dependent organs of the body, which is manifested on imaging by dependent contrast pooling and layering. Often a patient with imminent cardiogenic shock also shows a similar dependent contrast pooling and layering, which is a marker of the worsening clinical condition. We report the contrast-enhanced CT scan features in four cases, two of whom had cardiac arrest during imaging, while the other two developed cardiogenic shock soon after the examination. Dependent contrast pooling and layering were found in all of them, with faint or no opacification of the left cardiac chambers. Contrast pooling was noted in the dependent lumbar veins, hepatic veins, hepatic parenchyma, and the right renal vein, as well as in the dependent part of the IVC and the right heart chambers.
  4,746 400 4
Radiation doses during chest examinations using dose modulation techniques in multislice CT scanner
Roshan S Livingstone, Joe Pradip, Paul M Dinakran, B Srikanth
April-June 2010, 20(2):154-157
DOI:10.4103/0971-3026.63036  PMID:20607033
Objective: To evaluate the radiation dose and image quality using a manual protocol and dose modulation techniques in a 6-slice CT scanner. Materials and Methods: Two hundred and twenty-one patients who underwent contrast-enhanced CT of the chest were included in the study. For the manual protocol settings, constant tube potential (kV) and tube current-time product (mAs) of 140 kV and 120 mAs, respectively, were used. The angular and z-axis dose modulation techniques utilized a constant tube potential of 140 kV; mAs values were automatically selected by the machine. Effective doses were calculated using dose-length product (DLP) values and the image quality was assessed using the signal-to-noise (SNR) ratio values. Results: Mean effective doses using manual protocol for patients of weights 40-60 kg, 61-80 kg, and 81 kg and above were 8.58 mSv, 8.54 mSv, and 9.07 mSv, respectively. Mean effective doses using z-axis dose modulation for patients of weights 40-60 kg, 61-80 kg, and 81 kg and above were 4.95 mSv, 6.87 mSv, and 10.24 mSv, respectively. The SNR at the region of the liver for patients of body weight of 40-60 kg was 5.1 H, 6.2 H, and 8.8 H for manual, angular, and z-axis dose modulation, respectively. Conclusion: Dose reduction of up to 15% was achieved using angular dose modulation and of up to 42% using z-axis dose modulation, with acceptable diagnostic image quality compared to the manual protocol.
  4,298 595 2
Case report: Antenatal MRI diagnosis of cloacal dysgenesis syndrome
P Gupta, S Kumar, Raju Sharma, A Gadodia
April-June 2010, 20(2):143-146
DOI:10.4103/0971-3026.63041  PMID:20607030
Cloacal dysgenesis sequence (CDS) is a lethal malformation with a highly variable presentation. CDS is characterized by direct communication between the gastrointestinal, urinary, and genital structures, resulting in a single perineal opening. Prenatal diagnosis of a cloacal anomaly is often difficult because of the highly variable imaging features. Here, we report a case in which a diagnosis of CDS was made with fetal MRI on the basis of a meconium-containing, bilobed, abdominopelvic cystic mass communicating with the ureters and the colon.
  4,403 386 4
Zygomatic air cell defect: A panoramic radiographic study of a south Indian population
HS Srikanth, Karthikeya Patil, VG Mahima
April-June 2010, 20(2):112-114
Aims: To determine the prevalence, patterns of occurrence and variations of zygomatic air cell defects (ZACDs) using panoramic radiographs. Methods and Materials: Dental panoramic radiographs of 600 outpatients were examined to evaluate the variations and characteristics of ZACDs. Results: ZACDs were identified in 15 subjects out of 600, giving an overall prevalence of 2.5%. Seven ZACDs were seen in males and eight in females. Among the 15 ZACDs, nine were unilateral and six were bilateral. Conclusion: The overall prevalence of ZACD is relatively low in south Indian population and careful radiographic evaluation is needed to detect these entities.
  3,870 463 4
Migratory intralaryngeal thyroglossal duct cyst
Pradeep D Karlatti, Swapnil Nagvekar, TP Lekshmi, Abhay S Kothari
April-June 2010, 20(2):115-117
DOI:10.4103/0971-3026.63053  PMID:20607022
Intralaryngeal thyroglossal duct cysts are rare; a migrating one, rarer still. Such a case may be a cause for confusion and it is important to understand this entity and its typical findings.
  3,859 311 2
Case report: Congenital absence of the dens
Manish Bajaj, Hemant Jangid, AK Vats, ML Meena
April-June 2010, 20(2):109-111
DOI:10.4103/0971-3026.63050  PMID:20607020
A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MRI revealed absence of the odontoid process of the C2 vertebral body, with resultant atlantoaxial dislocation along with myelomalacic changes involving the cervicomedullary junction.
  3,440 357 -
Some things change fast, other take their own sweet time
Bhavin Jankharia
April-June 2010, 20(2):79-79
DOI:10.4103/0971-3026.63038  PMID:20607013
  3,261 424 -
Presidential address: Ahmedabad, 23 rd January 2010
Kishor Taori
April-June 2010, 20(2):80-82
DOI:10.4103/0971-3026.63039  PMID:20607014
  3,062 252 -
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