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Background and Purpose: Size-specific dose estimates (SSDE) have been introduced into computed tomography (CT) dosimetry to tailor patients’ unique sizes to facilitate accurate CT radiation dose quantification and optimization. The purpose of this study was to develop and validate an automated algorithm for the determination of patient size (effective diameter) and SSDE. Materials and Methods: A MATLAB platform was used to develop software of algorithms based on image segmentation techniques to automate the calculation of patient size and SSDE. The algorithm was used to automatically estimate the individual size and SSDE of four CT dose index phantoms and 80 CT images of pediatric patients comprising head, thorax, and abdomen scans. For validation, the American Association of Physicists in Medicine (AAPM) manual methods were used to determine the patient’s size and SSDE for the same subjects. The accuracy of the proposed algorithm in size and SSDE calculation was evaluated for agreement with the AAPM’s estimations (manual) using Bland–Altman’s agreement and Pearson’s correlation coefficient. The normalized error, system bias, and limits of agreement (LOA) between methods were derived. Results: The results demonstrated good agreement and accuracy between the automated and AAPM’s patient size estimations with an error rate of 1.9% and 0.27% on the patient and phantoms study, respectively. A 1% percentage difference was found between the automated and manual (AAPM) SSDE estimates. A strong degree of correlation was seen with a narrow LOA between methods for clinical study (r > 0.9771) and phantom study (r > 0.9999). Conclusion: The proposed automated algorithm provides an accurate estimation of patient size and SSDE with negligible error after validation.

Extramedullary Haematopoiesis (EMH) is a compensatory response occurring secondary to inadequate bone marrow function and is observed in many haematological conditions. EMH can occur in many haemoglobinopathies. Extramedullary haemopoiesis favours certain sites such as the liver, the spleen, and the paraspinal regions of the thorax. However, in addition to these common sites of extramedullary haemopoiesis, the process can involve virtually any organ or tissue and can often manifest as a mass mimicking a neoplasm. Although EMH is usually asymptomatic, clinical symptoms can appear due to mass effect. Radiological evaluation can be done using Ultrasonography (USG), Computed Tomography (CT) scan, and T2, T1 weighted Magnetic Resonance Imaging (MRI). Both conservative and surgical treatments are practiced depending on the organ involvement. Here, is a rare case of a young female in her mid-20s, who was a known case of beta thalassaemia major. She presented with a mass insidiously growing in left flank region, which on radiological imaging was found to be focal mass in the spleen. The pathological diagnosis after elective splenectomy was EMH of spleen. Due to chronic transfusions in patients of beta thalassaemia major, EMH is rarely seen. In-fact, the incidence of EMH in beta-thalassaemia major is thought to be less than 1%, which makes the present case a rare entity.

Teratomas are the most prevalent type of germ cell tumors and usually display benign characteristics. Mature cystic teratomas consist of a varied mixture of mature tissue types that originate from squamous epithelium and skin adnexal structures. It is most commonly found in female gonads. A mature teratoma located in the abdomen of an adult male patient is exceptionally uncommon. In this case, we report a rare case of intra-abdominal mature cystic teratoma in an adult male.

Intracranial epidermoid cysts are benign, slow-growing congenital tumors of ectodermal origin. They are rare embryonal benign cystic masses with an incidence rate of approximately 0.04%-0.6% of intracranial tumors. Computed tomography (CT) and magnetic resonance imaging (MRI) are fundamental diagnostic tools providing valuable information for surgical management. We reported a 59-year-old male patient with right limb weakness twelve hours prior to admission, slurred speech, and paresis of the facial nerve. Based on history taking, physical examination, and radiology examinations, we concluded a diagnosis of non-communicated hydrocephalus due to a right cerebellar intra-axial tumor with a suspicion of low-grade glioma (Pylocitic Astrocytoma). CT and MRI in intracranial epidermoid cysts are fundamental diagnostic tools for diagnosing and obtaining helpful information for surgical planning. Intracranial epidermoid cysts appear as lobulated lesions filling and expanding CSF spaces and exerting a gradual mass effect, insinuating between structures and encasing adjacent nerves and vessels. In this case, we noted a hypodense lesion with irregular calcifications and well-defined on the right cerebellar region measuring 6.15 × 5.47 × 5.7 cm, surrounded by a hypodense image suggesting an intra-axial mass suspected of low-grade glioma with a differential diagnosis of brain abscess. The hypointense lesion on the T1WI sequence found in the MRI examination, with no significant contrast enhancement and restricted diffusion area on DWI, was one of the notable features described in the epidermoid cyst. Intracranial epidermoid cyst rarely occurs in the intracranial, resulting in many symptoms in this case, which should be diagnosed and treated promptly. Imaging aids in proper diagnosis and provides more valuable information for further treatment.

Abstract Objectives Blunt abdominal trauma is a common cause of emergency department admission. Computed tomography (CT) scanning is the gold standard method for identifying intra-abdominal injuries in patients experiencing blunt trauma, especially those with high-energy trauma. Although the diagnostic accuracy of this imaging technique is very high, patient admission and prolonged observation protocols are still common practices worldwide. We aimed to evaluate the incidence of intra-abdominal injury in hemodynamically stable patients with high-energy blunt trauma and a normal abdominal CT scan at a Level-1 Trauma Center in Colombia, South America, to assess the relevance of a prolonged observation period. Methods We performed a retrospective study of patients admitted to the emergency department for blunt trauma between 2021 and 2022. All consecutive patients with high-energy mechanisms of trauma and a normal CT scan at admission were included. Our primary outcomes were the incidence of intra-abdominal injury identified during a 24-hour observation period or hospital stay, ICU admission, and death. Results We included 480 patients who met the inclusion criteria. The median age was 33 (IQR 25.5, 47), and 74.2% were male. The most common mechanisms of injury were motor vehicle accidents (64.2%), falls from height (26%), and falls from bikes (3.1%). A total of 99.2% of patients had a Revised Trauma Score of 8. Only 1 patient (0.2%) (95% CI: 0.01–1.16) presented with an abdominal injury during the observation period. No ICU admissions or deaths were reported. Conclusion The incidence of intra-abdominal injury in patients with hemodynamically stable blunt trauma and a negative abdominal CT scan is extremely low, and prolonged observation may not be justified in these patients.

Sternal tuberculosis is a rare and challenging diagnosis. We present a case of a 63-year-old woman who presented with a progressively enlarging anterior chest wall mass and nonspecific symptoms. Imaging studies revealed a destructive sternal lesion. A biopsy confirmed the tuberculosis diagnosis. The patient responded well to anti-tuberculosis treatment. This case highlights the importance of considering tuberculosis when making a differential diagnosis of sternal masses and emphasizes the need for early diagnosis and treatment.

Background and Objectives: SARS-CoV-2 is a newly discovered viral infection. It’s still unclear how antibodies react in infected individuals, and there is not enough evidence to support the clinical use of antibody examination. This study evaluates the diagnostic value of serologic tests for diagnosing COVID-19. Materials and Methods: 32 patients for whom serologic testing was performed within 7 to 21 days from symptom onset and whether they were diagnosed with COVID-19 by both PCR and lung HRCT as gold standard tests at the same time, were included in the study. Results: Serologic tests (IgM / IgG) compared to PCR and lung HRCT scan to diagnose COVID-19, were 89.3% specific and 59.6% sensitive. Positive predictive value (PPV) was 95% and negative predictive value (NPV) was 37%. The diagnostic accuracy index of the serologic test was 0.745 (CI 0.651-0.838) (p-value

Emphysematous cholecystitis is a potentially life-threatening variant of acute cholecystitis, characterized by the presence of gas in the gallbladder wall/lumen due to the proliferation of gas-producing bacteria. Symptoms include upper right quadrant pain, fever, nausea, and vomiting. Laboratory tests may show nonspecific indications of systemic infection, and radiological assessment, especially CT scanning, is crucial for diagnosis. This case underscores the significance of early diagnosis and intervention in managing emphysematous cholecystitis to prevent serious complications and reduce the higher mortality rate compared to acute cholecystitis.

During the COVID-19 pandemic, it was crucial for the healthcare sector to detect and classify the virus using X-ray and CT scans. This has underlined the need for advanced Deep Learning and Machine Learning approaches to effectively spot and manage the virus's spread. Indeed, researchers worldwide have dynamically participated in the field by publishing an important number of papers across various databases. In this context, we present a bibliometric analysis focused on the detection and classification of COVID-19 using Deep Learning and Machine Learning techniques, based on X-Ray and CT images. We analyzed published documents of the six prominent databases (IEEE Xplore, ACM, MDPI, PubMed, Springer, and ScienceDirect) during the period between 2019 and November 2023. Our results showed that rising forces in economy and technology, especially India, China, Turkey, and Pakistan, began to compete with the great powers in the field of scientific research, which could be seen from their number of publications. Moreover, researchers contributed to Deep Learning techniques more than the use of Machine Learning techniques or the use of both together and preferred to submit their works to Springer Database. An important result was that more than 57% documents were published as Journal Articles, which was an important portion compared to other publication types (conference papers and book chapters). Moreover, the PubMed journal "Multimedia Tools and Applications" tops the list of journals with a total of 29 published articles.

Eosinophilic gastroenteritis (EoGE) is a group of infrequent conditions that arise from the accumulation of eosinophils in the gastrointestinal (GI) tract without any secondary causes of eosinophilia. Most cases of EoGE cases show involvement of different parts of the GI tract. Herein, we report a case of EoGE with the sole involvement of Jejunum. A 57-year-old male patient presented to our center with a chief complaint of acute abdominal pain. The patient had experienced chronic abdominal pain and intermittent diarrhea for several years, but he presented to the emergency department with severe acute flank pain. The patient was first diagnosed with renal stone and treated accordingly. However, the computed tomography (CT) scan also showed other incidental findings related to his chronic abdominal pain from several years ago, including mesenteric infiltration which shows fluid appearance in some areas, mild wall thickening, and mucosal edema of the duodenum and jejunal loops with normal appearance of the ileum. Complete blood count (CBC) showed increased eosinophil (15.5%) and decreased lymphocytes (13.1%) percent. Pathological examination of enteroscopy samples of jejunum showed a mild increase in the number of eosinophils in lamina propria. Neither parasites nor granuloma was detected. However, no such changes were found in other parts of the GI tracts. Based on pathological examination, the patient was diagnosed with eosinophilic enteritis of the jejunum. EoGE does not typically involve a specific part of the GI and generally affects both the stomach and intestine. This study reported the first case of EoGE where only the jejunal part of the intestine was involved and other parts of the GI tract were spared.

Abstract COVID-19 had a huge impact on patients and medical systems all around the world. Computed tomography (CT) images can effectively complement the reverse transcription-polymerase chain reaction testing (RT-PCR) and offer results much faster than RT-PCR test which assists to prevent spread of COVID-19. Various deep learning models have been recently proposed for COVID-19 screening in CT scans as a tool to automate and help the diagnosis, but consisting of some benefits and limitations. Some of the reasons for this are: (i) training the data with largely unbalanced dataset and (ii) training the models with datasets having all similar CT images which leads to overfitting. In this work, we proposed a method to use multiple models to classify COVID-19 positive or negative which are trained using transfer learning techniques. In addition to classifying, if a person is COVID-19 positive or negative, we have also calculated the high-resolution computed tomography (HRCT) score or CT score to find the severity of infection with the help of image segmentation techniques, which assist in identifying the preliminary prognosis of the patient, and take necessary preventive measures.

Lymphangiomas are benign lesions of vascular origin with lymphatic differentiation, most commonly found in the head and neck. Generalized lymphangiomatosis is a very rare condition in adults, which is characterized by a diffuse proliferation of lymphatic vessels. The lymphangioma is composed of lymphatic endothelium-lined cystic spaces. This condition can be histologically differentiated from other vascular disorders such as cavernous or capillary hemangioma. However, many cases of lymphangioma can be confused with other vascular disorders, because of overlapping histologic findings. radiologic examinations, such as CT scan and MR imaging, are useful for assessing the morphologic feature and also the extent of disease, it is important to know the radiologic findings of generalized lymphangiomatosis. In this paper, we report a case of generalized lymphangiomatosis in a 42-year-old male who presented with left flank pain and hematuria. The first differential diagnosis was renal colic; hence he underwent an abdominopelvic computed tomography scan (CT scan). In the performed CT scan multiple cystic lesions were seen in the liver and spleen. Also, lytic lesions were seen in bones. CT-guided biopsy was performed and the result was compatible with generalized lymphangiomatosis, confirmed by cytology. Generalized lymphangiomatosis is a rarely reported disease in children and young adults. Delayed diagnosis in older patients or misdiagnosis is common due to its rarity and nonspecific clinical presentation. Different imaging modalities can incidentally diagnose the disease in asymptomatic patients. So radiologists should be aware of the disease manifestations in imaging modalities to diagnose the disease sooner and help the clinician start the therapy if needed.

Abstract The global economy has been dramatically impacted by COVID‐19, which has spread to be a pandemic. COVID‐19 virus affects the respiratory system, causing difficulty breathing in the patient. It is crucial to identify and treat infections as soon as possible. Traditional diagnostic reverse transcription‐polymerase chain reaction (RT‐PCR) methods require more time to find the infection. A high infection rate, slow laboratory analysis, and delayed test results caused the widespread and uncontrolled spread of the disease. This study aims to diagnose the COVID‐19 epidemic by leveraging a modified convolutional neural network (CNN) to quickly and safely predict the disease's appearance from computed tomography (CT) scan images and a laboratory and physiological parameters dataset. A dataset representing 500 patients was used to train, test, and validate the CNN model with results in detecting COVID‐19 having an accuracy, sensitivity, specificity, and F1‐score of 99.33%, 99.09%, 99.52%, and 99.24%, respectively. These experimental results suggest that our strategy performs better than previously published approaches.

Background: Neck swellings are common in clinical practice and are of various types – congenital, acquired, inflammatory, neoplastic, and miscellaneous. The workup of a neck mass is different in children and adults, as the etiologies are different. Only 2–15% are malignant. Aims and Objectives: To estimate the burden of neck mass in pediatric age group clinicopathological. Materials and Methods: This prospective observational study was conducted in the Otorhinolaryngology Department of Burdwan Medical College and Hospital, Burdwan, a rural-based tertiary care hospital in Burdwan for 18 months from April 2021 to September 2022, and 50 patients in pediatric age group presented with neck swelling were included in this study after through history taking and meticulous clinical examination and after getting institutional ethics committee clearance. Results: It was found that most of the patients presented with swelling over the right side (26 [52.0%]), but this was not statistically significant (P=68916) (Z=0.4). Few patients had (11 [22.0%]) 5 months of duration of symptoms, but it was not statistically significant (P=63836) (Z=0.4683). Some of the patients had fever and cough (13 [26.0%]) which was statistically significant (P

Background: Epstein-Barr virus (EBV) is a common human Herpesvirus with worldwide distribution. Primary EBV infection usually occurs early in life and typically presents as infectious mononucleosis consisting of fever, pharyngitis, hepatosplenomegaly, and lymphadenopathy. Usually, the disease course is benign and most patients recover uneventfully without any consequent sequel. Method and results: We present a case of an immunologically normal young male in whom an acute EBV infection caused severe pneumonitis. He was treated empirically with Paracetamol, intravenous Ceftriaxone 1 gr/day plus Azithromycin 500 mg/day. Conclusion: EBV-associated pneumonitis is rare, and treatment is usually supportive, whether antiviral agents (such as acyclovir) or steroids would be beneficial remains to be determined.

Objective: To determine the diagnostic accuracy of a CT scan for detecting ongoing internal bleeding following torso injury, keeping operative findings as the gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Radiology Department, Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jul 2021 to Oct 2021. Methodology: Contrast-enhanced CT was carried out for 100 patients with torso injury to detect the incidence of extravasated contrast material, an outcome that signifies any active haemorrhages present. The findings were then compared with the peroperative findings of the patient. Results: We detected active haemorrhages in 48 out of 100 patients on Computed Tomography. A total of 83 injury sites were recorded. Active haemorrhages were mostly visible through the spill of contrast agents in a jet stream in 61(73.4%) out of 83 injury sites. Immediate surgical intervention was performed on all the patients who were detected with active haemorrhages on CT, which confirmed the findings. In 3 patients out of 100, CT did not detect active haemorrhage, but surgical intervention showed active haemorrhage on intra-peritoneal sites. Computed Tomography had a high diagnostic accuracy for torso injuries (97.0 %) with a sensitivity of 94. 11 % and a specificity of 100 %. Conclusion: Instantaneous surgical intervention is obligatory whenever contrast extravasation is identified on Computed Tomography (CT).

Background: The primary goal in treating craniocerebral trauma due to any cause is to preserve the patient’s life and remaining neurological function. It has also made the neuroradiologist an indispensable element of the trauma treatment team. The purpose of this study is to evaluate the efficacy of computed tomography (CT) in the diagnosis, treatment, and prognosis of patients with brain trauma. Aims and Objectives: The objectives of this study were to evaluate the efficacy of CT in the diagnosis, treatment, and prognosis of patients with brain trauma. Materials and Methods: The present study was conducted on patients with head injuries who were referred to the Department of Radiodiagnosis over a 2 years. Details were noted down on pro forma either immediately before or after the procedure was carried out, depending on the status of the patient. Few of the patients underwent plain radiography of the skull before conducting the CT scan. Results: In the present study, the most common lesion observed by CT was edema (49%) followed by contusion (48%), whereas least lesion was observed as intraventricular hemorrhage (4%) and intracerebral hemorrhage (8%). In the present study, the patient with low scores (3–5) showed early deterioration as compared to those with higher scores. This could be attributable to the severity of the primary injury. Late deterioration was more common than early deterioration in scores of >8 where mortality within 48 h was virtually nil and the recovery rate was much higher. Conclusion: This simple, affordable, highly successful, and safe imaging modality should be regarded the initial imaging modality of choice in acute head injury, as it serves as the foundation for cornerstone for rapid and effective diagnosis.

Background: Squamous cell carcinoma is the most prevalent kind of tumor of the buccal mucosa. For the purpose of planning surgery and radiotherapy for tumors of the tongue, floor of the mouth, and oropharyx, imaging to locate the size and extent of the original tumor is essential. Therefore, it is beneficial to determine the radiation field, to ensure adequate tumor margin excision, and overall to improve the patient’s prognosis. Aims and Objectives: The aim of the study was to evaluate the role of computed tomography (CT) scan in diagnosis of buccal mucosal malignancies and its characteristics. Materials and Methods: Total 50 patients suspecting buccal mucosa cancer were referred to Radiology Department. They were subjected for CT scan examination on 16 slice CT scanner. CT scan evaluation was made for size and extent of primary mass lesion. The staging of disease was performed with TNM classification. Results: In our study, out of 50 patients, the fourth decade (30%) and fifth decade (26%) saw the highest incidence of buccal mucosa cancer. The majority of the patients were suffering from severe disease; 44% had T4 stage and 58% had Stage IV. Conclusion: CT plays a very important role in staging of buccal mucosa malignancy and effectively detects bone erosion (98% sensitive) and invasion to infratemporal fossa. However, during the early stages of cancer, a CT scan might not be very helpful.

Background: Computed tomography (CT) imaging has a large portion in the dose of patients from radiological procedures; therefore, accurate calculation of radiation risk estimation in this modality is inevitable. In this study, a method for determining the patient-specific effective dose using the dose–length product (DLP) index in lung CT scan using Monte Carlo (MC) simulation is introduced. Methods: EGSnrc/BEAMnrc MC code was used to simulate a CT scanner. The DOSxyznrc simulation code was used to simulate a specific voxelized phantom from the patient’s lungs and irradiate it according to X-ray parameter of routing lung CT scan, and dose delivered to thorax organs was calculated. Three types of phantoms were simulated according to three different body habits (slim, standard, and fat patients) in two groups of men and women. A factor was used to convert the relative dose per particle in MC code to the absolute dose. The dose was calculated in all lung organs, and the effective dose was calculated for all three groups of patient body habits. DLP index and volume CT dose index (CTDIvol) were extracted from the patient’s dose report in the CT scanner. The DLP to effective dose conversion factor (k-factor) for patients with different body habitus was calculated. Results: Lung radiation dose in slim, standard, and fat patients in men was 0.164, 0.103, and 0.078 mGy/mAs and in women was 0.164, 0.105, and 0.079 mGy/mAs, respectively. The k-factor in the group of slim patients, especially in women, was higher than in other groups. Conclusions: CT scan dose indexes for slim patients are reported to be underestimated in studies. The dose report in CT scan systems should be modified in proportion to the patient’s body habitus, to accurately estimate the radiation risk.

Noise pollution is a major threat to the health and well-being of the entire world; this issue forces researchers to find new sound absorption and insulating material. In this paper, the sound absorption coefficient and vibration damping factor of panels manufactured from Cyperus pangorei rottb and ramie fiber reinforced with epoxy resin are explored. Cyperus pangorei rottb grass fiber and ramie fiber are widely available natural fibers. Cyperus pangorei rottb grass fiber is used in mat manufacturing, whereas ramie is widely used as a fabric. Using both of these fibers, six variant panels using a vacuum resin infusion process (VRIP) were fabricated. The panels were named C, R, CR, RCR-Flat, RCR-Curved, and RCR-Perforated. All the panels were tested for the sound absorption coefficient using an impedance tube with a frequency ranging up to 6300 Hz. Modal analysis was carried out by using the impulse hammer excitation method. A micro X-ray computed tomography (CT) scan was used to study the voids present in the panels. The results were compared among the six variants. The results show that the RCR-curved panel had the highest sound-absorbing coefficient of 0.976 at a frequency range between 4500 Hz to 5000 Hz. These panels also showed better natural frequency and damping factors. The presence of internal voids in these panels enhances sound absorption properties. These panels can be used at higher frequencies.

Pancreatic adenocarcinoma is often discovered at an advanced stage due to a lack of early symptomology, resulting in this being the fourth leading cause of cancer-related death in the USA. The relationship between diabetes mellitus and pancreatic cancer has been known for many years; however, it is not well understood. Studies have suggested that long-standing type 2 diabetes mellitus can increase the risk of pancreatic cancer by 1.5–2.0-fold. However, patients with new-onset diabetes over 50 years of age have an 8-fold higher risk of pancreatic cancer. Evidence has shown that pancreatic cancer causes diabetes, with the majority being new onset. Diabetic ketoacidosis, which occurs in long-term hyperglycemia, as an initial presentation of pancreatic adenocarcinoma is rare, and only a few cases have been reported. It is postulated that pancreatic cancer prevents insulin-producing cells of the pancreas from responding to insulin resistance. The enriching new-onset diabetes for pancreatic cancer (ENDPAC) score may be utilized as a screening tool for pancreatic carcinomas as an early diagnosis may lead to cure by surgery instead of the grave prognosis associated with it. In this case report, we discuss a 52-year-old female presenting with symptoms of diabetic ketoacidosis who was then subsequently found to have stage-4 pancreatic adenocarcinoma. We concluded that if a patient presents with new-onset diabetes, abdominal imaging with CT scans and endoscopic ultrasound may be warranted to rule out pancreatic carcinoma.

A retained drainage tube after surgery is rare and patients may be asymptomatic if it occurs. The presence of a retained drainage tube may be first recognized on imaging and this requires a high index of suspicion by radiologists. In this case report, we described an incidental finding of an asymptomatic retained fractured drainage tube in the pelvis of a 32-year-old female on ultrasonography for renal evaluation. This highlighted the need for radiologists to have a high index of suspicion when performing ultrasonography on postoperative patients and surgeons should be meticulous when removing drainage tubes postsurgery. The possibility of a foreign body should be considered when unfamiliar findings are encountered on imaging. Surgeons should inspect drainage tubes after removal to ensure the full length of the tube is removed.

(1) Background: Currently, multisystem inflammatory syndrome in children (MIS-C) is diagnosed based on clinical symptoms and laboratory findings of inflammation in the body. Once MIS-C is diagnosed, children will need to be followed over time. The imaging modalities most commonly used in the evaluation of patients with MIS-C include radiographs, ultrasound (US), and computed tomography (CT). Our study aims to summarise the literature data for the main gastrointestinal and pulmonary imaging features in children diagnosed with MIS-C and to share a single-centre experience. (2) Methods: We present the imaging findings in a cohort of 51 children diagnosed with MIS-C, admitted between December 2020 and February 2022. Imaging studies include chest and abdominal radiographs, thoracic, abdominal, and neck US and echocardiography (ECHO), and CT of the chest, abdomen, and pelvis. (3) Results: In accordance with the results in other studies, our observations show predominantly gastrointestinal involvement (GI) with ascites (33/51, 65%) and lymphadenopathy (19/51, 37%), ileitis or colitis (18/51, 35%), some cases of splenomegaly (9/51, 18%), hepatomegaly (8/51, 16%), and a few cases of renal enlargement (3/51, 6%) and gallbladder fossa oedema/wall thickening (2/51, 4%). Most common among the thoracic findings are posterior–basal consolidations (16/51, 31%), pleural effusion (14/51, 27%), and ground-glass opacities (12/51, 24%). We also register the significant involvement of the cardiovascular system with pericarditis (30/51, 58%), pericardial effusion (16/51, 31%), and myocarditis (6/51, 12%). (4) Conclusions: Radiologists should be aware of those imaging findings in order to take an important and active role not only in applying an accurate diagnosis, but also in the subsequent management of children with MIS-C. Radiological findings are not the primary diagnostic tool, but can assist in the evaluation of the affected systems and guide treatment.

Background: Oxygenation indices are used to assess the condition of patients with pneumonia and ARDS. These indexes determine the status of patients as well as the mortality rate of respiratory diseases and the need for intubation. The aim of this study was to determine and compare oxygenation indices and the extent of radiographic findings in patients with COVID-19 in ICU at Shariati Hospital. Methods: The present study was a cross-sectional study that was performed prospectively in the intensive care units of Shariati Hospital in Tehran. Patients admitted to the intensive care unit were examined if they met the inclusion criteria. Data were analysed by SPSS software version 26. Results: In this study, 39 patients were evaluated. Of these, 35.9% were men and 64.1% were women. The mean age of the population was 62 ±17. On average, SpO2 and PaO2 were not significantly different based on pulmonary involvement, severity of pulmonary involvement and also the pattern of pulmonary involvement (p> 0.05). No significant relationship was found between the severity of ARDS and the parameters of pulmonary involvement severity on CT scan (p> 0.05). Conclusion: It seems that there is no significant relationship between oxygenation indices and the extent of radiographic findings in hospitalized patients with COVID-19. Also, the severity of ARDS has no significant relationship with the extent of radiographic findings (CT scan). Oxygen saturation should be used as an adjunct when considering a CT scan of the lung, but should not be used as the sole means of diagnosis.

Objective: To associate the findings of CT scan with the Glasgow coma scale (GCS) of cases presenting with head trauma in the Emergency Department. Study Design: Cross-sectional study. Place and Duration of Study: Emergency Department, Combined Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2021. Methodology: Ninty head injury cases of either gender, aged 12-60 years were included using non-probability consecutive sampling. The severity of the head injury was determined via GCS. CT scan findings were noted. Results: The mean age was 22.21±11.10 years. The highest frequency of patients was noted in the age group of (13-29 years).The most common cause of head injury in men was road traffic accidents n=39/58(67.24%). As per GCS scoring, 63.3% of patients had mild brain injury. A strong association was observed between GCS and CT scan findings in cases with brain oedema (p=0.002), skull fracture (0.018) and no findings on CT scan (p-value≤0.001). No association between findings on CT scan and GCS scoring was noted in cases with epidural, subdural hematoma, cerebral contusions, intracranial and subarachnoid haemorrhage. Conclusions: There is a lack of association between brain injury based on GCS scoring and CT scan findings. Using GCS scoring only for assessing the degree of brain injury is insufficient. Keywords: Computed tomography (CT) scan, Glasgow coma scales (GDS), Head injury.

Background: Novel methods of bone density assessment using computed tomography (CT) and magnetic resonance imaging (MRI) have been increasingly reported in the spine surgery literature. Correlations between these newer measurements and traditional Dual-Energy X-ray Absorptiometry (DEXA) is not well known. The purpose of this study is to perform an updated systematic review of correlations between bone mineral density (BMD) from CT or MRI and DEXA. Methods: Articles published between 2011 and 2021 that reported correlations between the CT-HU or MRI measurements to DEXA t-scores or BMD of lumbar spine or hip were included in this systematic review. Results: A total of 25 studies (15 CT, 10 MRI) met the inclusion criteria with a total number of 2,745 patients. The pooled correlation coefficient of spine CT-HU versus spine DEXA, spine CT-HU versus hip DEXA and spine CT-HU versus lowest t-score were 0.60, 0.50 and 0.60 respectively. Regarding spine DEXA parameters, the pooled r2 for spine CT-HU versus spine t-score was 0.684 and spine CT-HU versus spine BMD was 0.598. Furthermore, in patients undergoing spine surgery in four studies, the pooled correlation between spine CT and spine DEXA was (r2: 0.64). In MRI studies, the pooled r2 of spine MRI versus spine DEXA and spine MRI versus hip DEXA were -0.41 and -0.44 respectively. Conclusions: CT-HU has stronger correlations with DEXA than MRI measurements. Lumbar CT-HU has the highest pooled correlation (r2 = 0.6) with both spine DEXA and lowest skeletal t-score followed by lumbar CT-HU with hip DEXA (r2 = 0.5) and lumbar MRI with hip (r2 = 0.44) and spine (r2 = 0.41) DEXA. Both imaging modalities achieved only a moderate correlation with DEXA. Few studies in both modalities have investigated the correlation in spine surgery populations and the available data shows that the correlations are worse in the degenerative spine population. A careful interruption of CT HU and MRI measurement when evaluation of BMD as they only moderately correlated with DEXA scores. At this time, it is unclear which modality is a better predictor of mechanical complications and clinical outcomes in spine surgery patients.

Introduction: Damage to the axons in neural brain tracts, corpus callosum, and brainstem, known as Diffuse Axonal Injury (DAI), can result in considerable morbidity and mortality in patients with head injuries. This type of injury involves microscopic damage and can have severe consequences. Aim: To investigate the incidence, clinical features, and radiological findings of DAI on Magnetic Resonance Imaging (MRI) and to associate MRI grading with neurological outcome using the Glasgow Outcome Scale (GOS). Materials and Methods: A longitudinal study was conducted in the Department of Neurosurgery, Jayarogya group of Hospitals, Gajra Raja Medical College, Gwalior,Madhya Pradesh, India, from December 2017 to November 2019. All the patients with Glasgow coma scores of eight or less with Computed Tomography (CT) and MRI brain findings consistent with DAI were included. The study collected data on patients including sociodemographic information, clinical variables related to trauma, details of hospital admission and stay, and variables related to the severity and consequences of DAI. Glasgow Coma Scale (GCS) was noted after resuscitation, MRI brain was done in stable patients. The neurological outcome was assessed after six months using the GOS and associated with MRI brain grading. The analyses were done using Statistical Package for Social Sciences (SPSS) version 26.0 and the frequencies were reported as percentages. Results: Total patients with head injury were N=694 and out of which patients with DAI n=94. The mean age was 33.97 years with a male:female ratio of 4.33:1. Grade 1, grade 2, and grade 3 MRI brain findings were present in 50% (N=50), 31.25% (N=20), and 18.75% (N=12) of cases. Most common site for contusions was parietal-temporo-occipital region found in 85.93% cases. Regarding functional outcome, poor outcome was observed in 26.67% (n=4) of grade II DAI and 75% (n=9) of patients of grade III DAI. Conclusion: DAI is major mechanism involved in Traumatic Brain Injury (TBI). In affected patients, long term hospitalisation is necessary. Patients with MRI grade I and II had a good outcome.

Thoracic empyema, defined as the accumulation of pus in the pleural space, is a rare cause of respiratory distress in neonates. Its occurrence in neonate patients has been only described in few literatures, as opposed to cases in older children. Even though the diagnosis of thoracic empyema is confirmed by histopathological examination of pleural fluid, radiographic examinations have important roles in helping clinicians narrowing down the differential diagnoses. This case report describes a neonatal patient who exhibited symptoms of respiratory distress and imaging modalities revealed multiloculated thoracic empyema.

Abstract Background Ordering of computed tomography (CT) scans needs to consideration of diagnostic utility as well as resource utilisation and radiation exposure. Several factors influence ordering decisions, including evidence-based clinical decision support tools to rule out serious disease. The aim of this qualitative study was to explore factors influencing Emergency Department (ED) doctors’ decisions to order CT of the head or cervical spine. Methods In-depth semi-structured interviews were conducted with purposively selected ED doctors from two affiliated public hospitals. An interview tool with 10 questions, including three hypothetical scenarios, was developed and validated to guide discussions. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo Release 1.3 to facilitate coding and thematic analysis. Results In total 21 doctors participated in semi-structured interviews between February and December 2020; mean interview duration was 35 min. Data saturation was reached. Participants ranged from first-year interns to experienced consultants. Five overarching emerging themes were: 1) health system and local context, 2) work structure and support, 3) professional practices and responsibility, 4) reliable patient information, and 5) holistic patient-centred care. Mapping of themes and sub-themes against a behaviour change model provided a basis for future interventions. Conclusions CT ordering is complex and multifaceted. Multiple factors are considered by ED doctors during decisions to order CT scans for head or c-spine injuries. Increased education on the use of clinical decision support tools and an overall strategy to improve awareness of low-value care is needed. Strategies to reduce low-yield CT ordering will need to be sustainable, sophisticated and supportive to achieve lasting change.

Introduction: Renal Cell Carcinoma (RCC) is a group of neoplastic lesions with unique cytogenetic characteristics and histopathological features. The majority of studies till date on RCC have been focusing on tissue histology to plan neoadjuvant treatment in clinical settings. An accurate forecast of the histopathological subtype has clinical implications in management and response to newer treatment strategies. It is pertinent to preoperatively distinguish a solid renal masses histologically but, there are currently no well-established imaging criteria to classify these tumors on the basis of radiographic evaluation. Aim: To evaluate the differences in imaging characteristics of different histological subtypes of RCC by Power Doppler Ultrasound and Multi-Detector Computed Tomography (MDCT) scan. Materials and Methods: This cross-sectional study was conducted in the Department of Urology, Gauhati Medical College and Hospital, Guwahati, Assam, from March 2016 to December 2017. The study population consisted of 61 patients of RCC who were evaluated with MDCT and Doppler ultrasound prior to surgery and findings were correlated with histopathological forms of tumour. The Pearson Chi-square test and ANOVA test was used to statistically analyse the data. Results: Histopathology revealed clear cell Renal Cell Carcinoma (ccRCC), chromophobe Renal Cell Carcinoma (chRCC) and papillary Renal Cell Carcinoma (pRCC) in 52, 4 and 5 patients, respectively. Heterogenous enhancement was found in 51 cases and among these 90.4% were ccRCC. Absolute attenuation values in Corticomedullary Phase (CMP) and Nephrographic Phase (NP) for clear cell and chromophobe subtype were higher than papillary subtype, i.e., 88.04±30.40 Hounsfield Unit (HU) and 72.41±20.17 HU for clear cell, 60.75±22.54 HU and 88±16.06 HU for chromophobe; 22.40±12.52 HU and 58.00±4.41 HU for papillary subtype, respectively. Papillary RCC (pRCC) showed a unique enhancement pattern, with a low peak enhancement (average peak of 55.40 HU) and greatest enhancement during the NP. In this study population ccRCC, ChRCC RCC and pRCC had mean Resistive Index (RI) of 0.63±0.06, 0.58±0.0 and 0.67±0.11, respectively. Conclusion: Power doppler flow imaging is not useful in discriminating subtypes of RCC while multiphasic Computed Tomography (CT) imaging may be useful, particularly the phasic enhancement pattern to distinguish common RCC subtypes which may facilitate treatment planning and choosing appropriate tyrosine kinase inhibitors.

Purpose: Evaluating organ radiation doses and also lifetime risk (LAR) of breast cancer from lung CT scans of 735 female patients from the age of 20-50 with Covid19 surveyed by four Corona center hospitals in Tehran, Iran. Patients’ data and exposure information were extracted from dose report pages in picture archiving and communication systems. Materials and methods: Patients were divided into six age groups 20-25; 25-30; 30-35; 35–40; 40-45 and 45–50 years. Breast, thyroid, lung and heart doses were calculated by NCICT, and LAR of breast cancer incidence has been evaluated by BEIR VII report. Results: The average dose of breast, thyroid, lung and heart were 3.97, 4.75, 4.10 and 3.37 mGy and also the average of the effective dose was 2.56 mSv. Also, the average LAR of breast cancer in female patients was 7.45 per 100,000 exposures and it decreased with age. Conclusion: Although CT scan is a useful instrument in the diagnosis and treatment of Corona disease, but it should be recommended with caution due to the increased risk of breast cancer, especially in younger women.

ObjectiveTo analyze the CT findings of hepatoid adenocarcinoma of the stomach (HAS) and improve the diagnosis accuracy of this condition.MethodsThe CT images of 22 pathologically confirmed HAS patients were analyzed retrospectively. We investigated the location of lesions, morphology, enhancement features, area of invasion into surrounding organs, lymph node metastasis, and venous tumor thrombus.ResultsAmong the 22 patients (17 men and 5 women, the mean age was 61.41 ± 9.83 years ranging from 36 to 80 years) with HAS; the morphology of tumors included mass (n = 5), focal ulcer (n = 7), and infiltrating ulcer (n = 10). Extraserous fat was invaded in 12 cases. Enhancement scans showed continuous enhancement in all cases. The CT values of unenhanced scan, the arterial phase, and the portal venous phase are 30.36 ± 6.46, 60.91 ± 17.80, and 75.64 ± 22.09 (Hounsfield Unit, HU), respectively. In six cases, the tumor infiltrated the surrounding organs: liver (n = 1), pancreas (n = 2), and both liver and pancreas (n = 3). In 16 out of 22 patients (72.3%), suspicious lymph node metastasis at CT imaging has then been confirmed by pathological specimens. Intrahepatic metastasis was found in 14 cases. Seven patients had venous tumor thrombus: three patients developed tumor thrombus in the main trunk and intrahepatic branches of the portal vein and two patients in the portal vein, splenic vein, and superior mesenteric vein simultaneously.ConclusionThe CT scans of HAS often show a thickened gastric wall and infiltrating ulceration. Infiltration into extraserosal fat is often seen. Enhancement scans show a continuous and progressive enhancement of lesions. Lymph node metastasis, intrahepatic metastasis, and portal vein tumor thrombus are common in HAS patients.

Dear Editor Traumatic brain injury (TBI) is a harmful condition that permanently or temporarily damages brain functions and imposes enormous costs on health systems. Computed tomography (CT) scan is the preferred modality to detect injuries and determine TBI patients' prognoses in emergency departments. Thus far, some scoring systems have been introduced for grading TBI based on CT scan findings, including the Marshal,[1] Rotterdam,[2] Helsinki,[3] Stockholm,[4] and NeuroImaging Radiological Interpretation System (NIRIS) [Table 1].[5] This letter aims to briefly raise issues regarding the scoring of epidural hematoma (EDH) in CT scan-based scoring systems of TBI.Epidural hematoma is the gathering of blood between the dura mater and the skull. This intracranial hematoma usually occurs following the bleeding from the middle meningeal artery and, less commonly, from the dural venous sinuses.[6] Some studies have shown that EDH positively affects the outcome, so patients with EDH would have a better overall prognosis.[2] A typical EDH's prognosis is good if diagnosed early and managed before deterioration. Gennarelli et al., showed that the EDH death rate is approximately one-tenth of subdural hematoma.[7] Bricolo et al., reported that mortality should be zero in uncomplicated EDH.[8]On the other hand, EDH can be potentially life-threatening. EDH of venous origin can gradually spread, and its findings may appear late, leading to a delayed diagnosis and treatment. Consequently, EDH expansion can lead to herniation, permanent neurological damage, and death.[9] EDH with a size greater than 30 ml or a midline shift of more than 10 mm does not have a good prognosis.[9] The swirl sign indicating active bleeding also worsens the prognosis.[10]The presence or absence of EDH is evaluated in four CT scan-based scoring systems of TBI [Table 1]. Three scoring systems, including Rotterdam, Helsinki, and Stockholm, consider the presence of EDH as a favorable prognostic factor, i.e., patients with EDH on their brain CT scans get a lower score. However, in the NIRIS, EDH is scored as an adverse prognostic factor based on its volume, leading to a higher score.Hence, EDH cannot always be a favorable prognostic indicator. For instance, the presence of EDH along with diffuse axonal injury (DAI) worsens the outcome.[11] However, according to Rotterdam, Helsinki, and Stockholm systems, the association of EDH with DAI would have a lower score than DAI alone. Besides, high-volume EDH can worsen the situation by causing a midline shift and brain herniation.[9] Nonetheless, the specific size of EDH is not checked in any of these three systems.The scoring systems have been developed from the statistical weighting of variables. However, it is necessary to look at the issue more dynamically and comprehensively for a more accurate outcome prediction. Adjusting CT scoring systems with clinical characteristics and scales such as the Glasgow Coma Scale (GCS) and head injury biomechanics may also be helpful.

Background: The purpose of this study is to evaluate the effective dose (ED) for computed tomography (CT) examination in different age groups and medical exposure in pediatric imaging centers in Tehran, Iran. Methods: Imaging data were collected from 532 pediatric patients from four age groups subjected to three prevalent procedures. National Cancer Institute CT (NCICT) software was used to calculate the ED value. Results: The mean ED values were 1.60, 4.16, and 10.56 mSv for patients' procedures of head, chest, and abdomen–pelvis, respectively. This study showed a significant difference of ED value among five pediatric medical imaging centers (P < 0.05). In head, chest, and abdomen–pelvis exams, a reduction in ED was evident with decreasing patients' age. Conclusion: As there were significant differences among ED values in five pediatric medical imaging centers, optimizing this value is necessary to decrease this variation. For head CT in infants and also abdomen–pelvis, further reduction in radiation exposure is required.

Ganglioneuroma is a rare, differentiated, and benign neurogenic tumor that could grow into a huge size with minimal or no symptoms at all. Ganglioneuroma is typically found in older children or adults and is commonly detected within the posterior mediastinum (other than retroperitoneal). Here, we present a case of a 3-year-old patient with shortness of breath, and radiological examination showed a giant mediastinal tumor which proved to be a ganglioneuroma after histopathological examination. This study highlights the possibility of ganglioneuroma occurring in younger children and the role of imaging in assessing ganglioneuroma as a posterior mediastinal tumor.

Automatic detection of pulmonary nodules is critical for the early diagnosis and prevention of lung cancer. Computed tomography (CT) is an effective and economical lung cancer detection method. In CT images, the size and shape of pulmonary nodules appear different, and some nodules appear similar to the surrounding tissues. Therefore, the automatic localization of pulmonary nodules in CT images is a challenging task. An attention-embedded three-dimensional convolutional neural network is proposed for pulmonary nodule detection in the current study. Specifically, 1) channel-spatial attention guides 3D ResNet to down sample the input 3D CT patch. The channel pays attention to important features and the space to the region of interest. The two form a complementary feature extraction mechanism to effectively help the global flow of information in the network and refine the feature mapping to extract the nodule context features. 2) The channel-spatial attention module changes the fusion model of the feature pyramid, adaptively adjusts the pixel-level weight between features and extracts multi-scale representative node features. 3) The deep separable convolution is used to replace the standard convolution of ResNet, reducing the time cost and improving the efficiency of model training on the premise of ensuring the model’s performance. 4) To adapt the distribution of nodule scale, different characteristic layers correspond to two sizes of anchors. Under the condition of ensuring the detection rate of nodules, the number of anchor frames is reduced, and the network sensitivity is improved. Finally, several ablation experiments are carried out using the LUNA16 dataset. The results revealed that the attention-guided network could extract the multi-scale representative features of nodules, and the average sensitivity was 97.7%. Additionally, the CMP score reached 0.912. The extensive experiments demonstrate that the proposed approach can effectively improve the detection sensitivity and control the number of false positive nodules, which has clinical application value and a certain reference value.

Adel Abdelhadi,1 Abeer Kassem2 1Department of Critical Care Medicine, Saqr Hospital, MOH, Ras Al-Khaimah, Ras Al-Khaimah, United Arab Emirates; 2Department of Pulmonary Medicine, IBHOA Hospital, MOH, Ras Al-Khaimah, Ras Al-Khaimah, United Arab EmiratesCorrespondence: Adel AbdelhadiDepartment of Critical Care Medicine, Saqr Hospital, MOH, Ras Al-Khaimah, Ras Al-Khaimah, United Arab EmiratesTel +97172049868Fax +97142574933Email adeltaha72@gmail.comAbstract: A South Asian male patient in his mid-forties presented with symptoms of severe 2019-nCoV (COVID-19) and recent brain infarction. Subsequently, he was found to have evidence of sepsis, underlying undetected diabetes mellitus (DM) and oral candida mucositis, possibly leading to the rare occurrence of direct spread to the lung, manifesting as a necrotizing candida lung abscess. We describe the diagnosis, clinical course, and management of the unique complication in this case that occurred during his admission, hospitalization, and eventual successful discharge from the hospital. This case highlights the importance of early identification and treatment of suspected COVID-19 infection based on clinical and radiological assessments before the confirmation of COVID-19 by real-time polymerase chain reaction (rtPCR) test result, especially in patients with hyperglycemia. It also indicates the complications that can occur due to COVID-19 such as arteriovenous manifestations and the rare occurrence of pulmonary candida lung abscess. Early detection and prompt management by interdisciplinary teams in the emergency room, followed by close monitoring of complications in the intensive care unit (ICU), can lead to successful outcomes in severe/critical COVID-19 infection.Keywords: Candida albicans, management, computed tomography scan, remdesivir therapy

Abstract Objective To explore short‐term changes after left bundle branch pacing (LBBP) using echocardiography and computed tomography (CT), especially for postoperative ventricular septal perforation. Methods Between January and September 2019, 33 patients with atrioventricular block underwent LBBP at Beijing Anzhen Hospital. All the patients were evaluated using electrocardiography, pacing, parameters and echocardiographic measurements, including for major complications, during the 1, 3, 6, 12 and 24‐month follow‐up. Interval perforations were examined during a 1‐month follow‐up echocardiogram and CT. Results Left bundle branch pacing was successfully performed in 100% (33/33) of patients. The mean seizure threshold was stable and unchanged postoperatively at the 1, 3, 6, 12 and 24‐month follow‐up. The paced QRS duration of the LBBP was 119.72 ± 2.53 ms and .05). No ventricular thrombus or stroke was detected. Conclusion Permanent LBBP is safe and feasible in patients with bradycardia. Echocardiography and/or CT can more accurately evaluate changes in cardiac structure and function after LBBP.

Solitary fibrous tumor is a rare mesenchymal tumor originating from fibroblasts. It was first reported in the pleura. In recent years, more and more cases of solitary fibroma in the extra pleural area have been reported. It has been reported that the tumor can occur in almost all sites. The structure and function of the lacrimal drainage system has its particularity, and there are still few reports about solitary fibroma of the lacrimal drainage system. Therefore, this article summarizes the existing reports of solitary fibroma of the lacrimal drainage system to analyse its clinical characteristics and treatment.

Objective: To examine the GFAP and S100B ability in prevention unnecessary brain CT scan in mTBI and compare them with the single extremity fracture in orthopedic patients. Methods: In this prospective cohort study, two orthopedics patients’ groups and mTBI patients were studied to assess the biomarkers’ ability in prevention unnecessary brain CT scan at the emergency setting. There were 40 orthopedics’ patients with single extremity fracture and 41 mTBI patients. Brain CT scans were done for all mTBI patients. Results: Brain CT scans showed no intracranial traumatic lesions. The median levels for S100B in the mTBI group was 14.8 (4.4-335.9) ng/L, and in orthopedic patients’ group was 13.3 (5-353.10) ng/L. Statistically significant differences were observed between both groups in S100B levels (p=0.006). The median Glial Fibrillary Acidic Protein (GFAP) levels in the mTBI patients’ group were 600 (400-16300) and in the orthopedic patients’ groups was 60 ng/L (300-14900). Statistically significant differences were observed between groups in GFAP (p=0.041). Conclusion: Our results showed that S100B and GFAP serum levels were significantly higher in patients with mTBI than in patients with a single limb fracture.

This study compared the predictive utility of Marshall, Rotterdam, Stockholm, Helsinki, and NeuroImaging Radiological Interpretation System (NIRIS) scorings based on early non-contrast brain computed tomography (CT) scans in patients with traumatic brain injury (TBI). The area under a receiver operating characteristic curve (AUROC) was used to determine the predictive utility of scoring systems. Subgroup analyses were performed among patients with head AIS scores > 1. A total of 996 patients were included, of whom 786 (78.9%) were males. In-hospital mortality, ICU admission, neurosurgical intervention, and prolonged total hospital length of stay (THLOS) were recorded for 27 (2.7%), 207 (20.8%), 82 (8.2%), and 205 (20.6%) patients, respectively. For predicting in-hospital mortality, all scoring systems had AUROC point estimates above 0.9 and 0.75 among all included patients and patients with head AIS > 1, respectively, without any significant differences. The Marshall and NIRIS scoring systems had higher AUROCs for predicting ICU admission and neurosurgery than the other scoring systems. For predicting THLOS ≥ seven days, although the NIRIS and Marshall scoring systems seemed to have higher AUROC point estimates when all patients were analyzed, five scoring systems performed roughly the same in the head AIS > 1 subgroup.

Even though a small number of published single patient reports have more recently reported pulmonary cavitation in COVID-19 disease, it is still considered a rare radiology feature. We report a 45-year-old man with COVID 19 disease and a pulmonary cavity.

Abstract Myositis ossificans circumscripta (MOC) is a benign and self‐limiting heterotopic ossification in the subcutaneous fat, tendons, muscles, and nerves. It is commonly due to trauma and is frequently encountered in the arm, shoulder, thigh, and hand which are prone to trauma. Non‐traumatic MOC arising from the abdominal muscles is extremely rare. We report a case of 7‐year‐old male child with a three‐year history of progressive painless abdominal swelling in the left hypochondria region with no history of associated trauma. CT scan of the abdomen showed a well‐defined hyperdense mass in the left external oblique muscle. Histological diagnosis confirmed myositis ossificans of the external oblique muscle. The mass was removed surgically with no immediate or late complications.

Purpose: The use of ionizing radiation in medical research, treatment, and diagnosis is inevitable and expanding day by day. Meanwhile, in two modes of Computed Tomography (CT) and Single Photon Emission Computed Tomography (SPECT) imaging, the dose received by the organs is featured with limitations and problems, which are often referred to as the CT Dose Index volume (CTDIvol.) and the Dose Length Product (DLP). This study aimed to estimate the average dose of organs and compare them in each of these two modalities. Materials and Methods: Using the GATE code to simulate the SPECT-CT system and the ICRP voxelized phantom as the patient was investigated. The mean dose distribution in three groups of children, adults, and obese people with different body thicknesses was estimated. The dose received by each of the two systems was evaluated separately and results were discussed and analyzed comparatively. Results: In the kidney, bladder, intestine, colon, liver, and gallbladder, the dose received in CT is at least 10% more than nuclear medicine. For example, the ratio of the dose received in CT to the dose received in nuclear medicine in the lung was about 1.08 and in the esophagus was about 1.24. Subsequently, the ratio increased to 0.25 in the bladder and 0.19 in the colon and intestine. Moreover, the major organs that received the maximum dose, result in CT at least 10% more than nuclear medicine. Conclusion: The dose received in organs such as the esophagus, breast, and lung during CT imaging protocol and also maximum dose were at least ten percent more than nuclear medicine.

Background and Objectives: Bacterial involvement in chronic rhinosinusitis (CRS) condition made it difficult to treat using available antibiotic therapy. Therapeutic ultrasound was investigated here to evaluate bacterial diversity and quantity before and after continuous/pulsed ultrasound strategy compared to control patients. Materials and Methods: Totally, 34 CRS patients were studied in three groups, including continuous ultrasound, pulsed ultrasound and control. Bacterial culture and identification were done before and after treatment. Computed tomography scan (CT scan) and questionnaire scores were recorded two times before and after intervention. Results: The most prevalent bacterial isolates were non-hemolytic Streptococci (34 patients), coagulase-negative Staphylococcus (33 patients), Gram-negative cocci (26 patients), Staphylococcus aureus (19 patients), Streptococcus pneumoniae (five patients) and Streptococcus pyogenes (five patients). Both continuous and pulsed ultrasound could significantly reduce the quantity of bacterial isolates after treatment. CT scan and questionnaire results support the effectiveness of therapeutic ultrasound. Conclusion: The quantity of clinically important bacteria was significantly reduced using ultrasound treatment and recovery of patients was supported by CT scan and questionnaire scores. Alternative therapeutic ultrasound could be an effective procedure in CRS patients.

ABSTRACT Choriocarcinoma is a rare highly malignant tumor. We report a case of 35-year-old woman, with a history of four months menstrual irregularity and human chorionic gonadotropin persistently positive that presented transvaginal ultrasound normal and the computed tomography scan of the chest showed three nodules and abdominal scan evinced a hypervascularized solid nodular lesion on left kidney. An ultrasound-guided biopsy of left kidney was performed with a pathologic diagnosis of renal choriocarcinoma. After chemotherapy the human chorionic gonadotropin was negative and the patient returned to normal menstrual cicles.

Background and Objectives: Interstitial lung diseases have always been an issue for pulmonary and rheumatology physicians. Computed tomography scans with a high-resolution protocol and bronchoalveolar lavage have been used along with biochemical blood tests to reach a diagnosis. Materials and Methods: We included 80 patients in total. First, all patients had their diagnosis with computed tomography of the thorax, serological/ immunological blood tests and bronchoalveolar lavage. However; after 3 months, all were divided into 2 groups: those who had bronchoalveolar lavage again and those who had cryobiopsy instead of bronchoalveolar lavage (40/40). Positron emission-computed tomography was also performed upon the first and second diagnosis. The patients’ follow-up was 4 years from diagnosis. Results: Patients suffered most from chronic obstructive pulmonary disease (56, 70%), while lung cancer was rarely encountered in the sample (7, 9.75%). Age distribution ranged between 53 and 68 years with a mean value of 60 years. The computed tomography findings revealed 25 patients with typical diagnosis (35.2%), 17 with interstitial pulmonary fibrosis (23.9%) and 11 with probable diagnosis (11%). The cryobiopsy technique led to a new diagnosis in 28 patients (35% of the total sample). Patients who had a new diagnosis with cryobiopsy had a mean survival time of 710 days (Conclusions: Cryobiopsy is a safe tool for patients with interstitial lung disease and can assist in the diagnosis of interstitial lung diseases. The survival of patients was increased in the cryobiopsy group versus only bronchoalveolar lavage for disease diagnosis.

Lung transplantation (LT) can be considered a definite treatment for end-stage pulmonary disease in appropriate patients. Depending upon various clinical factors, LT can be performed either as a single LT, bilateral LT, or heart LT. Although LT is a well-established procedure now, it is not without its own complications. In post-LT patients, several complications can have overlapping clinical and imaging features; therefore, early and accurate diagnosis can be challenging. Due to this difficulty, an interdisciplinary approach is imperative. Bronchoscopy, bronchoalveolar lavage, and transbronchial biopsy may be required in this approach, in addition to the routine investigations. The treating team should be aware of the possible complications after LT and the associated imaging features that may occur at varying time points following transplantation to provide prompt management. This article describes our experience and reviews the utility of radiological imaging in LT in relation to complications that may occur following LT.