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Different dental post designs and materials affect the stability of restoration of a tooth. This study aimed to analyse and compare the stability of two shapes of dental posts (parallel-sided and tapered) made of five different materials (titanium, zirconia, carbon fibre and glass fibre) by investigating their stress transfer through the finite element (FE) method. Ten three-dimensional (3D) FE models of a maxillary central incisor restored with two different designs and five different materials were constructed. An oblique loading of 100 N was applied to each 3D model. Analyses along the centre of the post, the crown-cement/core and the post-cement/dentine interfaces were computed, and the means were calculated. One-way ANOVAs followed by post hoc tests were used to evaluate the effectiveness of the post materials and designs (p = 0.05). For post designs, the tapered posts introduced significantly higher stress compared with the parallel-sided post (p < 0.05), especially along the centre of the post. Of the materials, the highest level of stress was found for stainless steel, followed by zirconia, titanium, glass fibre and carbon fibre posts (p < 0.05). The carbon and glass fibre posts reduced the stress distribution at the middle and apical part of the posts compared with the stainless steel, zirconia and titanium posts. The opposite results were observed at the crown-cement/core interface.

The performance of a digital mammography system (Siemens Mammomat Novation) using different target/filter combinations and tube voltage has been assessed. The objective of this study is to optimize beam quality selection based on contrast-to-noise ratio (CNR) and mean glandular dose (MGD). Three composition of breast were studied with composition of glandular/adipose of 30/70, 50/50, and 70/30. CNR was measured using 2, 4 and 6 cm-thick simulated breast phantoms with an aluminium sheet of 0.1 mm thickness placed on top of the phantom. Three target/filter combinations, namely molybdenum/molybdenum (Mo/Mo), molybdenum/rhodium (Mo/Rh) and tungsten/rhodium (W/Rh) with various tube voltage and mAs were tested. MGD was measured for each exposure. For 50/50 breast composition, Mo/Rh combination with tube voltage 26 kVp is optimal for 2 cm-thick breast. W/Rh combination with tube voltage 27 and 28 kVp are optimal for 4 and 6 cm-thick breast, respectively. For both 30/70 and 70/30 breast composition, W/Rh combination is optimal with tube voltage 25, 26 and 27 kVp, respectively. From our study it was shown that there are potential of dose reduction up to 11% for a set CNR of 3.0 by using beam quality other than that are determined by AEC selection. Under the constraint of lowest MGD, for a particular breast composition, calcification detection is optimized by using a softer X-ray beam for thin breast and harder X-ray beam for thick breast. These experimental results also indicate that for breast with high fibroglandular tissues (70/30), the use of higher beam quality does not always increase calcification detection due to additional structured noise caused by the fibroglandular tissues itself.

The International Atomic Energy Agency (IAEA) has a mandate to assist member states in areas of human health and particularly in the use of radiation for diagnosis and treatment. Clinical audit is seen as an essential tool to assist in assuring the quality of radiation medicine, particularly in the instance of multidisciplinary audit of diagnostic radiology. Consequently, an external clinical audit programme has been developed by the IAEA to examine the structure and processes existent at a clinical site, with the basic objectives of: (1) improvement in the quality of patient care; (2) promotion of the effective use of resources; (3) enhancement of the provision and organisation of clinical services; (4) further professional education and training. These objectives apply in four general areas of service delivery, namely quality management and infrastructure, patient procedures, technical procedures and education, training and research. In the IAEA approach, the audit process is initiated by a request from the centre seeking the audit. A three-member team, comprising a radiologist, medical physicist and radiographer, subsequently undertakes a 5-d audit visit to the clinical site to perform the audit and write the formal audit report. Preparation for the audit visit is crucial and involves the local clinical centre completing a form, which provides the audit team with information on the clinical centre. While all main aspects of clinical structure and process are examined, particular attention is paid to radiation-related activities as described in the relevant documents such as the IAEA Basic Safety Standards, the Code of Practice for Dosimetry in Diagnostic Radiology and related equipment and quality assurance documentation. It should be stressed, however, that the clinical audit does not have any regulatory function. The main purpose of the IAEA approach to clinical audit is one of promoting quality improvement and learning. This paper describes the background to the clinical audit programme and the IAEA clinical audit protocol.

Shear wave elastography (SWE) is an imaging technique using ultrafast ultrasound (20k fps) to measure tissue elasticity. This study aimed to verify the accuracy of SWE measurement compared to the gold standard and inves-tigate the effects of size, depth, stiffness and overlapping of lesions on SWE measurements. A tissue-mimicking phantom with acoustic and shear elasticity properties similar to human breast was developed. The masses’ elasticity was measured using a commercial SWE scanner and an electromechanical microtester (gold standard). Statistically significant difference (p

Samarium-153 (153Sm) is widely used in radiation synovectomy and pain management of bone metastases. It emits 103 keV gamma radiation suitable for imaging, providing an alternative for therapy with pure beta emitter, especially liver radioembolization using Yttrium-90 (90Y). This study investigated 153Sm theranostics (therapy plus diagnostic) properties for unresectable liver tumor. The cation-exchange resin, Amberlite IR-120H + (Sigma-Aldrich, USA) commercially available as beads (620-830 μm), was crushed and sieved to 20- 40 μm, and labelled with 152SmCl3 prior to neutron activation. 3 GBq 153Sm activity was aimed based on 90Y SIR-Spheres standard activity. The samples were irradiated in 1.494 x 1012 n.cm− 2.s− 1 neutron flux for 6 h. Microparticles characterization, gamma spectroscopy, and in-vitro radiolabelling studies were carried out and compared to Fractogel EMD SO3- (S) (Merck, Germany), commercially made in 20-40 μm. Fourier Transform Infrared (FTIR) spectroscopy of Sm-Amberlite showed unaffected functional groups, following size reduction of the beads. However, as shown by the electron microscope, the microparticles were irregular in shape. The radioactivity achieved after 6 h neutron activation was 3.104 ± 0.029 GBq. The specific activity per microparticle for 153Sm-Amberlite and 153Sm-Fractogel were 55 Bq and 49 Bq, respectively. Gamma spectroscopy showed no radioactive impurities in 153Sm- Amberlite but there was a detectable amount of 24Na in 153Sm- Fractogel. Energy-dispersive X-ray (EDX) spectroscopy of 153Sm-Fractogel showed presence of chlorine (Cl) impurity but no significant impurities were observed in 153Sm-Amberlite. Radiolabeling efficiency of 153Sm-Amberlite in distilled water and blood plasma over 48 h were excellent and better than 153Sm-Fractogel. 153Sm-Amberlite is suitable as alternative to 90Y, with advantage of post-procedure imaging.

The objective of this study was to prospectively determine the incidence of venous thrombosis (VT) in the upper limbs in patients with peripherally inserted central catheters (PICC). We prospectively investigated the incidence of VT in the upper limbs of 26 patients who had PICC inserted. The inclusion criteria were all patients who had a PICC inserted, whilst the exclusion criterion was the inability to perform a venogram (allergies, previous contrast medium reaction and inability of gaining venous access). Both valved and non-valved catheters were evaluated. Prior to removal of the PICC, an upper limb venogram was performed. The number of segments involved with VT were determined. The duration of central venous catheterization was classified as; less than 6 days, between 6 days and 14 days and more than 14 days. VT was confirmed in 38.5% (10/26) of the patients. The majority 85.7% (12/14) were complete occlusive thrombi and the majority of VT only involved one segment. There was no statistical correlation between the site of insertion of the PICC and the location of VT. Neither was there any observed correlation between the occurrence of VT with the patient's history of hypertension, hypercholesterolaemia, coronary artery disease, diabetes mellitus, cardiac insufficiency, smoking or cancer. There was also no statistical correlation with the size of the catheter. In conclusion, PICCs are associated with a significant risk of upper extremity deep vein thrombosis (UEVT).

The medical radiation usage for diagnostic radiology in Malaysia (a Level II country) for 1990-1994 is reported, enabling a comparison to be made for the first time with the United Nations Scientific Committee on the Effects of Atomic Radiation Report. In 1994, the number of physicians, radiologists, x-ray units, and x-ray examinations per 1,000 population was 0.45, 0.005, 0.065, and 183, respectively. (Level I countries had averages of 2.6, 0.072, 0.35, and 860, respectively). In 1994, a total of 3.6 million x-ray examinations were performed; the annual effective dose per capita to the population was 0.05 mSv, and the collective effective dose was 1,000 person-Sv. Chest examinations contributed 63% of the total. Almost all examinations experienced increasing frequency from 1990 to 1994 except for barium studies, cholecystography, and intravenous urography (-23%, -36%, -51%). These decreases are related to the increasing use of ultrasound and greater availability of fiberoptic endoscopy. Notable increases during the same period were observed in computed tomography (161%), cardiac procedures (190%), and mammography (240%). In order to progress from Level II to Level I status Malaysia needs to expand and upgrade radiological service in tandem with the health care development of the country.

Splinter or foreign body removal from the hand and foot is a common occurrence. Usually only the deep seated, broken or missed splinters are referred to the surgeon for removal. Unless the object is radio-opaque, plain radiograph will not give any useful information, hence removal can sometimes be very difficult and traumatic. We are reporting a case where a radiolucent splinter was removed with the aid of ultrasonography. This modality can help to localize a splinter at the pre and intra-operative period, minimizing amount of exploration and time of operation.

So how is biij different from other scientific online journals? biij’s objectives are: • to provide free online access to all our scientific materials in accordance with the Budapest Open Access Initiative. biij plans to remove unnecessary barriers that inhibit the sharing of scientific knowledge and information to accelerate research, enrich education and share the learning of the rich with the poor and vice-versa. biij lays the foundation to unite humanity in a common intellectual discussion and to fulfil the quest for knowledge in a costeffective manner. • to expand the scope of disseminating scientific information through the Internet by making available a large stock of teaching materials in the form of audio-video files from presentations made at scientific meetings. • through shared ownership by the scholarly community and individuals involved in the field to shape the future direction of the journal including ‘radiological’ and allied organizations in the region that do not have their own journals to share their research publications, guidelines, etc. with others.

Neutron activation of Sm-152 offers a method of radiolabeling for the in vivo study of oral dose formulations by gamma scintigraphy. Reproducibility measurements are needed to ensure the robustness of clinical studies. 204 enteric-coated guaifenesin core tablets (10 mg of Sm(2)O(3)) were irradiated by thermal neutrons to achieve 1 MBq at 48 h. Administered activities were 0.86 +/- 0.03 MBq. Good reproducibility (CV=3.5) was observed over 24 weeks ensuring that volunteer doses were within the dose reference level of 0.8 mSv.

Background: Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic fibroids has been performed in several centres in the United States, Western Europe and Asia with promising results. This study reports the authors' experience with UAE at the University Malaya Medical Centre. Method: Fifty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via patientcontrolled analgesic pump. The patients were followed up at an interval of 6/12 clinically and with MRI. Results: Transcatheter UAE was performed on all 50 patients with no major complications. 49 patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery due to previous myomectomy. The mean hospital stay was 3.5 days (range, 2 to 7). At a mean follow-up of 24/52, all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on MRI. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) after 6 months and subsequent endometrial sampling revealed cystic glandular hyperplasia for which total abdominal hysterectomy was performed. Two other patients had no change in symptoms and after hysterectomy, the pathology revealed concurrent adenomyosis. Another 2 patients with cervical fibroids were treated with hysterectomy as there was no gross reduction in the size of fibroid following UAE. Overall, 90% of the patients had dramatic improvement of anaemia and symptoms at 1 year follow-up. Conclusion: Out of the 50 patients, 17 patients had total disappearance of their fibroids and 28 patients had more than 50% reduction in the size of fibroids after 1 year. 5 patients ended up with total abdominal hysterectomy. These results suggest that UAE is an appealing alternative to hysterectomy or myomectomy for many women with symptomatic fibroids. © 2010 Biomedical Imaging and Intervention Journal. All rights reserved.

Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

Computed tomography (CT) fluoroscopy is able to give real time images to a physician undertaking minimally invasive procedures such as biopsies, percutaneous drainage, and radio frequency ablation (RFA). Both operators executing the procedure and patients too, are thus at risk of radiation exposure during a CT fluoroscopy. This study focuses on the radiation exposure present during a series of radio frequency ablation (RFA) procedures, and used Gafchromic film (Type XR-QA; International Specialty Products, USA) and thermoluminescent dosimeters (TLD-100H; Bicron, USA) to measure the radiation received by patients undergoing treatment, and also operators subject to scatter radiation. The voltage was held constant at 120 kVp and the current 70mA, with 5mm thickness. The duration of irradiation was between 150-638 seconds. Ultimately, from a sample of 30 liver that have undergone RFA, the study revealed that the operator received the highest dose at the hands, which was followed by the eyes and thyroid, while secondary staff dosage was moderately uniform across all parts of the body that were measured.

Purpose This is a retrospective study to evaluate the results of our early experience of using doxorubicin eluting beads (DEB) to treat patients with early and intermediate hepatocellular carcinoma (HCC). Material and methods A cohort of 19 patients (84.2% male; 15.8% female; mean age 59.2 years ± 11.0; range, 32-80 years) with documented HCC of size 1.8-10cm (mean, 4.0cm ± 1.8 ) undergoing DEB transarterial chembolisation (TACE) was reviewed. All patients had at least one image examination (multiphase computed tomography or magnetic resonance imaging) after embolisation. Results A total of 32 procedures were performed. The objective response according to the European Association for the Study of the Liver criteria was 57.9% at 1-month, 42.8% at 6-month and 50.0% at 1-year follow up. There were 4 (21.1%) treatment-related complications (1 liver abscess, 2 pancreatitis and 1 tumour rupture) which resulted in 2 deaths. One death occurred 3 weeks after second embolisation, due to ruptured pancreatic pseudocyst, giving a 5.3% 30-day mortality rate. Another patient died 2 months after embolisation caused by tumour rupture. Eight patients received radiofrequency ablation after embolisation for residual or recurrent tumours. The 1-year survival rate in the DEB TACE only group was 80% while the 1- and 2-year survival rate in the group that received radiofrequency after DEB TACE was 85.7% and 100% respectively. Conclusion DEB TACE is safe and effective in select group of patients. Survival may be improved when combined with other treatment modality.

Neutron activation of non-radioactive Sm-152 to Sm-153 offers a valuable method of radiolabeling for the in vivo study of the behavior of oral dosage formulations. In particular this methodology allows the manufacture of a pharmaceutical formulation without the need for radioactive laboratory facilities. During manufacturing a small amount of Sm-152 is added to the formulation. This is then irradiated with neutrons to produce the Sm-153 that can be used for in vivo imaging of formulation transit and release using a standard gamma camera. Prior to clinical investigation it is essential to validate the manufacturing procedure to ensure that the activated material is within accepted limits. In particular the amount of radioactivity administered should be within a specified tolerance level. This will be required as part of the condition of ethical approval for human study. The final activity produced and hence the radiation effective dose to patients or healthy subjects is dependent on a number of factors including the amount of incorporated Sm2O3 (mg), the reactor neutron flux (cm− 2s− 1) and the irradiation period (s). We have investigated the reproducibility of the activated activity as part of the validation process for in vivo clinical studies. 96 placebo tablets each containing 10 mg of Sm2O3 were irradiated using a thermal neutron flux of 5 x 1012 cm− 2s− 1 for 70 s to achieve the radioactivity of 1 MBq at the time of administration. This corresponded to 0.8 mSv effective dose per administration. The tablets were assayed prior to the administration to the volunteer subjects using the radionuclide assay calibrator. The range of activities obtained prior to dosing was 0.82 - 0.95 MBq (mean ± SD: 0.887 ± 0.026). This was considered acceptable since it was below the 1 MBq Dose Reference Level and within the permitted radiation dose granted by the ethical study review. This study demonstrates the factors affecting the activity produced by neutron activation of oral formulations containing Sm-152 and the data confirm the reproducibility of the activity produced over an extended period of 10 weeks.

The case report, which has a long history in medicine, has seen its fortune wax and wane with time. We discuss the challenges facing the continued survival of the case report, including the inability of journals to cope with the increased load and increased cost of publication, ethical issues, the impact factor and the rise of evidence-based medicine. We highlight the important role that the case report will continue to play in medical research and education, as a means of sharing information and detecting novelty through observations. Most importantly, the case report serves as a stepping stone for young physicians and practitioners into the world of medical writing. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

Hepatocellular carcinoma is the most common primary tumour of the liver. The most common extrahepatic metastatic sites are the lung, lymph nodes, bones and adrenal glands. All forms of HCC demonstrate a tendency for vascular invasion, producing extensive intrahepatic metastases and, occasionally, portal vein or inferior vena cava extension with spread into the right atrium in extreme cases. Tumour spread of abdominal diseases via hepatic ligaments has also been previously reported. We report a rare case of hepatocellular carcinoma with extension into the falciform ligament, overlying rectus sheath and adjacent diaphragm with concomitant infiltration into the recanalised paraumbilical vein.

To date, the College of Radiology (CoR) does not see any clear benefit in performing whole body screening computed tomography (CT) examinations in healthy asymptomatic individuals. There are radiation risk issues in CT and principles of screening should be adhered to. There may be a role for targeted cardiac screening CT that derives calcium score, especially for asymptomatic medium-risk individuals and CT colonography when used as part of a strategic programme for colorectal cancer screening in those 50 years and older. However, population based screening CT examinations may become appropriate when evidence emerges regarding a clear benefit for the patient outweighing the associated radiation risks.

Percutaneous image-guided needle biopsy is typically performed in highly vascular organs or in tumours with rich macroscopic and microscopic blood supply. The main risks related to this procedure are haemorrhage and implantation of tumour cells in the needle tract after the biopsy needle is withdrawn. From numerous conducted studies, it was found that heating the needle tract using alternating current in radiofrequency (RF) range has a potential to minimize these effects. However, this solution requires the use of specially designed needles, which would make the procedure relatively expensive and complicated. Thus, we propose a simple solution by using readily available coaxial core biopsy needles connected to a radiofrequency ablation (RFA) generator. In order to do so, we have designed and developed an adapter to interface between these two devices. For evaluation purpose, we used a bovine liver as a sample tissue. The experimental procedure was done to study the effect of different parameter settings on the size of coagulation necrosis caused by the RF current heating on the subject. The delivery of the RF energy was varied by changing the values for delivered power, power delivery duration, and insertion depth. The results showed that the size of the coagulation necrosis is affected by all of the parameters tested. In general, the size of the region is enlarged with higher delivery of RF power, longer duration of power delivery, and shallower needle insertion and become relatively constant after a certain value. We also found that the solution proposed provides a low cost and practical way to minimizes unwanted post-biopsy effects.

Primary bone lymphoma is an uncommon tumour accounting for approximately 4-5% of extra nodal lymphoma and less than 1% of all Non-Hodgkin's lymphoma. The radiographic appearance of primary bone lymphoma is variable. As lesions frequently resemble other disease processes namely chronic osteomyelitis and metastases, further imaging evaluation and histopathological examination allow early identification for appropriate treatment. The authors present a case of anaplastic large cell lymphoma of bone presenting with multifocal osseus involvement.

To write what is worth publishing, to find honest people to publish it, and get sensible people to read it, are the three great difficulties in being an author (Charles Caleb Colton, English sportsman and writer, 1780-1832). Scholarly journals have been the basic tool for scientific communication for over three centuries, since the Flemish itinerant craftsman William Caxton and his assistant Wynkyn de Worde set up his heavy wood and metal German designed printing press in the shadow of St Paul’s Cathedral in 1476. Scientific societies publish and distribute these journals to their members as a part of their subscription. With the huge investments in basic scientific research which occurred after the Second World War, the scientific societies had great difficulty in keeping pace with the phenomenal growth in the number of publications that sprouted. Journals catering to new disciplines arose when researchers in these specialised areas found it difficult to get their works published in the journals which kept to traditional views of the boundaries of disciplines [1]. Publishers, in general, ceased to be their own booksellers in the 18

Teratomas are neoplasms characterised by an abnormal growth of tissues derived from the three germinal layers. The term ‘teratoma’ is derived from the Greek root ‘teratos’, meaning monster. Germ cells develop in the embryo and subsequently become the cells that make up the reproductive system. During fetal development, these cells follow a midline path and descend into the pelvis as ovarian cells or the scrotal sac as testicular cells. The presence of germ cells in extragonadal sites is because of the failure of these cells to migrate along the urogenital ridge. Therefore, teratomas occur in order of decreasing frequency in the ovaries, testes, anterior mediastinum, retroperitoneum, sacrococcygeal region and cranium. Liver teratomas are very rare; of the 25 hepatic teratomas described in the literature, only five have occurred in adults. The majority of the cases were in female children below the age of three, mostly arising in the right lobe of liver. We report a case of an adult male with benign mature teratoma arising in the left lobe of liver, compressing the common bile duct and causing obstructive jaundice.

Chronic wounds and scar tissues are prone to skin cancer. In 1828, Jean-Nicholas Marjolin described the occurrence of tumours in post-traumatic scar tissue. He did not, however, identify the warty ulcers he described as malignant. It was Dupuytren, who about two years later, noted that these lesions were cancerous. The eponym was bestowed by Da Costa in 1903. Marjolin’s ulcer no longer refers only to carcinomas secondary to burns and is classified as a malignancy that arises from previously traumatised, chronically inflamed, or scarred skin. It has been reported in relation to osteomyelitis, venous stasis ulcer, tropical ulcers, chronic decubitus ulcer, frostbite, pilonidal sinus, vaccination site, urinary fistula, hidradenitis suppurativa, skin graft donor site, gunshot wounds, puncture wounds, dog bites, and lupus rash. Early arising Marjolin’s ulcer has rarely been described in literature. In this case report, we present the CT appearances of Marjolin’s ulcer in the left gluteal region of a young man.

The accuracy and the efficacy of radiological diagnosis depend, to a large extent, on the conditions under which radiographs and images are viewed. This mainly involves the luminance of the display devices and the ambient room illumination. We report a perceptual study to investigate the relationship between detectability and monitor luminance as well as ambient illuminance. A statistical test pattern was used in this study, and the test pattern was developed using Microsoft® Visual Basic 6. The test pattern contained a set of randomised contrast detail objects, that is, disks of different diameters (0.7, 1.0, 1.4, and 2.0 mm) and contrasts against a black background (2.7, 3.9, 5.5, and 7.8%), simulating lesions in digital images. The receiver operating characteristic (ROC) analysis was used in this study. The results indicated that a set of optimal viewing conditions exists and that it has a significant effect on detectability performance.

Acquired intra-abdominal arteriovenous fistulas (AVFs) are a rare disorder where the communication most commonly occurs between abdominal aorta and inferior vena cava. Ilio-iliac AVF has been reported previously, but is exceedingly rare. We present a case of spontaneous ilio-iliac AVF in an elderly woman who presented with symptoms of right heart failure where the diagnosis was not considered. The computed tomographic (CT) and angiographic features are described. The current status of management as well as a review of the literature is also presented.

As stated in the first issue, biij as an open access multidisciplinary online journal, “was set up to meet the challenges of biomedical imaging and intervention facing the allied sciences community by providing a new avenue for discussion and exchange of viewpoints.” The Biomedical Imaging and Intervention Journal (biij) was born on July 16th 2005 during the opening ceremony of the ‘Second International University of Malaya Research Imaging Symposium: Fundamentals of Molecular Imaging’. The multimedia launch was accompanied by Gustav Holst’s Jupiter, the Bringer of Jollity. This is most fitting as applying advanced imaging and interventional techniques to improve the quality of health heralds joy to the world. We are especially interested in exploiting electronic publishing: online submission, online review, and online publication. Although numerous online journals have been published very few have taken advantage of the multimedia capabilities such as audio, video, animation, and simulation (Figures 1-3). We are convinced that this is the way journal publications will have to advance in the near future. Feature-rich html papers will appear in the biij. The abstracts of two international meetings have been archived in the first issue of the biij, namely Asian Breast Diseases Association (ABDA) Third Teaching Course: Advances in the Management of Breast Diseases, Kuantan, Malaysia (28-30 May 2005) and the 2nd International University of Malaya Research Imaging Symposium: Fundamentals of Molecular Imaging, Kuala Lumpur, Malaysia (16-17 July 2005).

AIM The primary objective of this study was to evaluate the specificity and sensitivity of diffusion weighted MR imaging (DWI) in the differentiation and characterisation between benign and malignant vertebral compression fractures compared with conventional T1 WI, T2 WI and fat suppressed contrast enhanced T1 WI in the Malaysian population. MATERIALS AND METHODS Thirty five patients with 68 vertebral compression fractures were imaged using the conventional T1 WI, T2 WI, fat suppressed contrast enhanced T1-weighted, and steady state free precession diffusion-weighted (SSFP DWI) sequences on a 1.5 T MR scanner. Signal intensities were analysed qualitatively for all the sequences by comparison to adjacent normal marrow. A quantitative assessment of the signal intensity in the SSFP DWI was also performed. RESULTS T1 WI and T2 WI images are of limited diagnostic value because of the variability in signal intensities. Contrast enhanced images had sensitivity and specificity of 93% and 71%, respectively with a negative predictive value (NPV) of 93%. On diffusion-weighted MR imaging, sensitivity was 87% with specificity of 92%. The positive predicative value (PPV) and NPV were both 90%. The quantitative assessment of ratio revealed a statistical significant difference between the benign (0.96) and the malignant (1.73) group of lesion (Mann-Whitney U-test, p=0.0001). CONCLUSIONS We found that absence of contrast enhancement has a high NPV (90%) while SSFP DWI has both a high PPV (90%) and high NPV (90%) in detecting malignant vertebral compression fractures. Furthermore, in our study the ratio of lesion intensity technique offers an excellent criterion to differentiate between the benign and malignant lesions, and the presence of iso- or hypointensity of the collapsed vertebral bodies is suggestive of a benign lesion while hyperintensity is highly suggestive of malignancy. We also found that using the NLMR showed a statistical significant difference between the malignant and benign groups (p

AIM The single emulsion or single screen system is usually reserved for mammography since its use in general radiography is limited. The purpose of this study is to compare the mammographic film-screen combination (MFC) and the standard film-screen combination (SFC) in terms of fracture and soft tissue injuries detection. PATIENTS, METHODS AND MATERIALS: In this prospective study, 41 patients from Accident and Emergency suspected of having injury in the hands, wrists, ankles and feet regions were radiographed using both MFC and SFC. These were compared in terms of image quality, presence of fractures and soft tissue injuries. The two different film-screen combinations were also compared in terms of detection of bony fragments, film characteristics such as film speed, contrast and spatial resolution, dose and cost. RESULTS The MFC gives statistically better image quality compared to SFC. In 10% of patients, fractures were detected only in the MFC, which also detects tiny bone fragments that may not be resolved by the SFC. The spatial resolution of the MFC is greater than the SFC. The film speed and contrast of the MFC are lower than that of the SFC. The doses of MFC were higher compared to SFC. CONCLUSIONS The MFC detects fractures better compared with SFC. However, the entrance skin dose for the mammographic film-screen combination was about 35% to 55% higher than the standard film-screen combination.

Development of computer-based medical inference systems is always confronted with some difficulties. In this paper, difficulties of designing an inference system for the diagnosis of arthritic diseases are described, including variations of disease manifestations under various situations and conditions. Furthermore, the need for a huge knowledge base would result in low efficiency of the inference system. We proposed a hierarchical model of the fuzzy inference system as a possible solution. With such a model, the diagnostic process is divided into two levels. The first level of the diagnosis reduces the scope of diagnosis to be processed by the second level. This will reduce the amount of input and mapping for the whole diagnostic process. Fuzzy relational theory is the core of this system and it is used in both levels to improve the accuracy.

We present a rare indirect nontraumatic cerebrospinal fluid (CSF) fistula secondary to a fourth ventricle ependymoma. The fistula resulted from rupture of the left temporal horn, distant from the tumour. The fistula was well demonstrated by MRI. High-resolution CT demonstrated a defect in the roof of the sphenoid sinus, but no leakage of CSF was seen on CT cisternography. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

A recognized cause of incomplete or cancelled MRI examinations is anxiety and claustrophobic symptoms in patients undergoing MR scanning. This appears to be a problem in many MRI centres in Western Europe and North America, where it is said to be costly in terms of loss of valuable scan time, and has led to researchers suggesting several anxiety-reducing approaches for MRI. To determine the incidence of failed MRI examination among our patients and if there are any associations with a patient's sex, age and education level, we studied claustrophobia that led to premature termination of the MRI examination in the University Malaya Medical Centre (UMMC) in 3324 patients over 28 months. The incidence of failed MRI examinations due to claustrophobia in the UMMC was found to be only 0.54%. There are associations between claustrophobia in MRI with the patients' sex, age and level of education. The majority of those affected were male patients and young patients in the 25-45-years age group. The patients' education level appears to be the strongest association with failed MRI examinations due to claustrophobia, where the majority of the affected were highly educated individuals. Claustrophobia in MRI is more of a problem among the educated individuals or patients from a higher socio-economic group, which may explain the higher incidence in Western European and North American patients.

Nosocomial infections are posing an increasingly serious problem in the hospital setting. With the increasing use of ultrasound in medical diagnosis, there is the potential for transmission of nosocomial infections via the ultrasound transducer and coupling gel. We evaluated the use of different membranes (three types of commercially available household cling film, condom, surgical glove and Opsite) applied over the ultrasound probe to determine if these were safe, convenient, cost-effective and did not impair the performance parameters of the ultrasound probe. None of the membranes impaired the physical scanning parameters using a Multi-Purpose Tissue/Cyst Phantom. The cling film was ideal for general use in terms of cost and convenience as well as safety. For sterile use the Opsite was better overall compared to the surgical glove, though it costs significantly more. The condom and surgical glove, though safe, were not very convenient to use for scanning.

Lipoma of the parapharyngeal space is very rare, only three cases having been reported in the literature. A parapharyngeal space lipoma causing obstructive sleep apnoea has not been reported before. A 60-year-old man presented at the ear, nose and throat (ENT) clinic with a history of loud snoring associated with sleep apnoea secondary to a right parapharyngeal space lipoma. The causes of sleep apnoea and the radiological features of a parapharyngeal space lipoma are discussed.

Today, imaging is at the heart of the health care system. Accuracy of diagnosis and ultimately the efficacy of radiological diagnosis greatly depend on the conditions under which radiographs and images are viewed. These conditions include the luminance of the display devices (view boxes and display monitors) as well as the ambient room illumination or the amount of light falling on the viewing surface. Extensive psychophysical and clinical research has established the fact that lesion detectability declines when viewing conditions are not optimized. Sad to say, although viewing of radiographic images is a vital link in the imaging chain, it is not accorded much importance and the radiology community has given it scant attention. The fact that there is no one apparent internationally agreed standard for clinical practice underscores the lack of focus on this issue, although attempts have been made to establish standards and guidelines. Quality control of view boxes has been recommended in the UK, and a luminance uniformity standard is given in ‘‘Practical guide to quality assurance in medical imaging’’ [1]. This standard stipulates that the brightness levels of the centre and in each quadrant of the view box should be within 10% of the mean value. It is also recommended that the level of illumination in the room under normal clinical film viewing conditions should not exceed 100 lux. One of the viewing conditions stated by the European guidelines [2] is that ‘‘The light intensity incident on the viewer’s eye should be about 100 cdm. To achieve this, the brightness of the film illuminator should be between 2000 and 4000 cdm for films in the density range 0.5 to 2.2.’’ However, these recommendations have not been generally adopted as part of the routine quality assurance programme of radiology departments. Both the Royal College of Radiologists [3] and the American College of Radiology (ACR) [4] guidelines and standard for teleradiology recommend monitor luminance of at least 50 ft-L (171.3 cdm). However, the ACR merely suggest that ‘‘Care should be taken to control lighting in the reading room to eliminate reflections in the monitor and to lower the ambient light as much as is feasible.’’ The most comprehensive guidelines on view box and viewing conditions is the mammography quality control established by the ACR and the American Cancer Society [5]. They recommend that ‘‘The luminance of a mammographic viewbox should be at least 3,000 to 3,500 nit (cdm). The room ambient illumination level should be 50 lux or less.’’ A summary of all international regulations and guidelines has been compiled by Smartlight Inc. [6]. Perhaps it is pertinent to mention a new generation of digital view boxes that meet these requirements and promise to improve diagnostic efficacy [6]. Even though there is a trend towards increased utilization of soft copy viewing, the vast majority of facilities worldwide, especially those in less developed countries, still rely on view boxes to display and read films. As computed radiography, picture archiving and communication systems (PACS) and teleradiology gain popularity, the luminance of display monitors and the quality of soft copy reporting become important quality issues. In the past, the number, location and size of rooms were important considerations. Today, soft copy requires additional considerations, for example lighting and ergonomics. These considerations have an impact on the radiologist’s comfort, accuracy and speed in soft copy interpretation [7]. As ambient room illuminance levels Received 20 October 2000 and in revised form 24 January 2001, accepted 7 March 2001. The British Journal of Radiology, 74 (2001), 675–676 E 2001 The British Institute of Radiology

A 35 year-old Chinese female patient with Hereditary Hemorrhagic Telengiectasia (HHT) and a prior history of 2 uneventful pregnancies, had undergone an emergent caesarian section at 36 weeks gestation, due to the development of high-output cardiac failure. Post-partum she developed drowsiness and required intensive care support. Radiological imaging of the brain (CT and MRI) excluded meningoencephalitis, intracranial haemorrhage and arteriovenous malformations (AVMs).The patient subsequently developed active pulmonary haemorrhage and gastrointestinal (GI) bleeding. CT imaging of the thorax and abdomen demonstrated multiple AVMs in the lung bases and the liver (Figure 1). Bronchoscopy showed bleedingAVMs in the left lingular branch and an emergent embolisation of the feeding vessel was performed successfully. A duodenal ulcer with a clean base was diagnosed as well (via endoscopy) but further GI bleeding prompted a CT mesenteric angiogram which demonstrated air-fluid levels in the posterior aspect of the large bowel loops indicative of ruptured AVMs (White arrow, Figure 2). Embolisation was not performed due to concerns about bowel infarction. Despite maximal supportive therapy, she deteriorated into disseminated intravascular coagulation. Prior to her demise, she developed a sudden, tense abdominal distension with subsequent hypovolaemic shock and cardio-respiratory arrest. A post-mortem revealed massive haemorrhage in the intra-peritoneal cavity with multiple AVMs in the gastrointestinal tract. Massive intraperitoneal haemorrhage associated with HHT is seen in 25‐30% of patients. During pregnancy, the plasma volume expands 30‐50% and thus the cardiac output increases and peripheral vascular resistance reduces. This leads to ‘softening’ of the connective tissues in the vascular walls and hence enlargement of AVMs during pregnancy with potential risk of rupture. Although arterial embolisation of pulmonary and hepatic AVMs have been successfully described before, the widespread distribution of AVMs and rapid systemic deterioration in our patient precluded any chance of successful haemostasis.Although rare, women with HHT should be screened for AVMs and monitored closely during pregnancy.

Photodynamic therapy (PDT) has emerged as a capable therapeutic modality for the treatment of cancer. PDT is a targeted cancer therapy that reportedly leads to tumor cell apoptosis and/or necrosis by facilitating the secretion of certain pro-inflammatory cytokines and expression of multiple apoptotic mediators in the tumor microenvironment. In addition, PDT also triggers oxidative stress that directs tumor cell killing and activation of inflammatory responses. However, the cellular and molecular mechanisms underlying the role of PDT in facilitating tumor cell apoptosis remain ambiguous. Here, we investigated the ability of PDT in association with hypericin (HY) to induce tumor cell apoptosis by facilitating the induction of reactive oxygen species (ROS) and secretion of Th1/Th2/Th17 cytokines in human hepatocellular liver carcinoma cell line (HepG2) cells. To discover if any apoptotic mediators were implicated in the enhancement of cell death of HY-PDT-treated tumor cells, selected gene profiling in response to HY-PDT treatment was implemented. Experimental results showed that interleukin (IL)-6 was significantly increased in all HY-PDT-treated cells, especially in 1 μg/ml HY-PDT, resulting in cell death. In addition, quantitative real-time PCR analysis revealed that the expression of apoptotic genes, such as BH3-interacting-domain death agonist (BID), cytochrome complex (CYT-C) and caspases (CASP3, 6, 7, 8 and 9) was remarkably higher in HY-PDT-treated HepG2 cells than the untreated HepG2 cells, entailing that tumor destruction of immune-mediated cell death occurs only in PDT-treated tumor cells. Hence, we showed that HY-PDT treatment induces apoptosis in HepG2 cells by facilitating cytotoxic ROS, and potentially recruits IL-6 and apoptosis mediators, providing additional hints for the existence of alternative mechanisms of anti-tumor immunity in hepatocellular carcinoma, which contribute to long-term suppression of tumor growth following PDT.