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Introduction Measuring the effectiveness of a dental curriculum as reflected by the competencies of the graduates is paramount in ensuring the curriculum remains relevant in the rapidly evolving field of dentistry. We aimed to assess the competencies of dental graduates of Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM) as perceived by the graduates and their employers, based on the core competencies listed in the UKM undergraduate dental curriculum. Methods A self-administered questionnaire consisting of 43 questions based on eight domains of competencies were sent to all UKM dental graduates of years 2012 to 2015 as well as senior dental officers who represented their employers. Findings 132 out of 177 graduates (75%) and 18 out of 33 employers (55%) responded. Most graduates felt competent in gathering information and all employers agreed that the graduates were competent with this skill. Out of the eight domains, only community based domain was collectively rated ‘poor’ by the employers while the rest of the domains had an ‘excellent’ rating by both the graduates and their employers. However, based on the individual skill, basic life support skill was rated very low for both groups (38.6% graduates and 23.5% employers). The employers underrated the graduates in the domain of treatment and prevention, community-based, management and administrative, and communication. Significance The findings of this study allow an evaluation of the curriculum in a myriad of angles. Although the graduates reported a good level of competency in most domains, the employers were reserved on the community-based skills. This needs to be addressed in order to improve the undergraduate program. DOI : http://dx.doi.org/10.17576/JSKM-2021-1901-09

Introduction Chest radiographs (CXR) are widely used for the screening and management of the coronavirus disease 2019 (COVID-19). This paper determinates the radiographic features of COVID-19 based on an initial national cohort of patients. Methods This is a retrospective review of swab-positive COVID-19 patients admitted to four different hospitals in Singapore between 22 January and 9 March 2020. Initial and follow-up CXR were reviewed by three experienced radiologists to identify the predominant pattern and distribution of lung parenchymal abnormalities. Results In total, 347 CXR of 96 patients were reviewed. Initial CXR were abnormal in 41 out of 96 patients (42.7%). The mean time from onset of symptoms to CXR abnormality was 5.3 (range 1-21) days. The predominant pattern of lung abnormality was ground-glass opacity on initial CXR (51.2%) and consolidation on follow-up CXR (51.0%). Multifocal bilateral abnormalities in mixed central and peripheral distribution were seen in 63.4% and 59.2% of abnormal initial and follow-up CXR, respectively. The lower zones were involved in 90.2% of the initial CXR and 93.9% of the follow-up CXR. Conclusion In a cohort of swab-positive patients, including those identified from contact tracing, we found the incidence of CXR abnormality to be lower than previously reported. The most common pattern was ground-glass opacity or consolidation, but mixed central and peripheral involvement was more common than peripheral involvement alone.

Purpose: Surgical delay due to the wait for advanced cross-sectional imaging in occult fragility hip fracture management is not well studied. Our study aims to investigate computed tomography (CT) as an alternative to the gold standard magnetic resonance imaging (MRI) in occult hip fracture workup to decrease surgical delay. Methods: We conducted a retrospective review of all CTs and MRIs performed between 2015 and 2017 for patients with clinically suspected fragility hip fractures and negative plain radiographs to investigate surgical delay resulting from the wait for advanced imaging and representations due to missed fractures. Results: A total of 243 scans (42 CTs and 201 MRIs) were performed for occult hip fracture workup over the study timeframe, of which 49 patients (20%) had occult hip fractures [CT: 6 (14%), MRI: 43 (21%), p = 0.296)]. There were no readmissions for fracture in the 12 months following a negative scan. The CT group had shorter waiting times (CT: 29 ± 24 h, MRI: 44 ± 32 h, p = 0.004) without significantly reducing surgical delay (CT: 82 ± 36 h, MRI: 128 ± 58 h, p = 0.196). The MRI group had a higher number of patients with a cancer history ( p = 0.036), reflective of the practice for workup of possible metastases as a secondary intention. Conclusion: Advanced cross-sectional imaging wait times in occult hip fracture workup contribute significantly to surgical delay. Modern CT techniques are not inferior to MRI in detecting occult fractures and may be a suitable alternative in the absence of a cancer history if MRI cannot be obtained in a timely fashion or is contraindicated. Clinicians should utilize the more readily available imaging modality to reduce surgical delay.

Studies show that up to 80% of all radiology errors are due to errors in perception. Early detection is critical for good outcomes in patients with primary lung cancer and lung metastasis. However, pulmonary nodules can be easily missed due to their small size. We prospectively applied a machine vision algorithm to CT studies containing lung parenchyma to detect pulmonary nodules, as well as a natural language processing algorithm to the text of the report to identify documentation of pulmonary nodules. Apparent discrepancies in perception – instances where a pulmonary nodule was not reported – were flagged for a secondary review by a radiologist. Four thousand and nine hundred studies were prospectively processed, of which 450 cases with potential discrepancies were detected. Preliminary manual analysis was performed to analyze the base error rate and to optimize thresholds for the machine vision and natural language processing algorithms, and 104 cases were flagged for final review. Of these 104 cases, 50 cases contained undocumented pulmonary nodules. Among these cases, 7 cases were classified as likely to be significant, where report addendums were done and the clinicians notified. We have successfully implemented an automated double read system to detect pulmonary nodule discrepancies, with minimal disruption to the radiology workflow and while keeping personal health information on-premises. This successful implementation demonstrates the viability of using an automated and secure radiology double-read system to improve patient safety in radiology workflows, either at a health system or an independent radiology practice.

OBJECTIVE. Nosocomial transmission of coronavirus disease (COVID-19) to frontline health care workers is well known, and health care workers may inadvertently become vectors for onward transmission. Ultrasound (US) service providers are at significant risk because scanning usually requires prolonged close patient contact. The bulky US equipment may also facilitate fomite transmission of disease. With increasing use of point-of-care and portable diagnostic US services, the risk is substantial. CONCLUSION. Our experience and protocols may help service providers with their own effective response against COVID-19.

The coronavirus 2019 (COVID-19) outbreak poses a serious public health risk. To date, the disease has affected almost all countries in the world. The enormous scale of the outbreak and the relative lack of knowledge and information regarding a new virus, as well as the unpredictability of events, make it challenging for leadership teams to respond. This paper shares how we have reconfigured our radiology leadership team into a smaller disease outbreak task force (DOTF) to respond and coordinate all related efforts during this ongoing COVID-19 pandemic. The DOTF format is modelled after the military with domain groups looking at manpower, intelligence, operations, and logistics matters on a daily basis so that timely decisions can be made and action plans executed promptly. In managing the DOTF, discipline, flexibility, and teamwork are key principles, and these are built upon a strong foundation of focus on infection prevention and control, and patient and staff safety as well as staff well-being. The DOTF has positioned us well to confront the many challenges to date. We believe it will also help us navigate the complex issues that will arise with future surges in cases and in formulating strategies to manage exit from the present and future lockdowns. Key Points • In a pandemic, regular and directed meetings by a smaller leadership core group are required, for prompt decision making and execution of action plans. • The military format, with domain groups to look at manpower, intelligence, operations, and logistics matters, is useful in managing a pandemic. • Discipline, flexibility, and teamwork with strong focus on infection prevention and control, and patient and staff safety as well as staff well-being are key principles for leadership teams managing a pandemic.

• Radiology services encountering the coronavirus disease-19 pandemic will need to modify their daily operational practices. • Leadership, patient risk stratification, adequate manpower, operational workflow clarity, and workplace/social responsibility will help Radiology services safely and sustainably deal with the current disease outbreak.

Background To determine the utility of chest radiography (CXR) for assessing and prognosticating COVID-19 disease with an objective radiographic scoring system.Methods A multicenter, prospective study was conducted, forty patients were included. Seventy-eight CXR’s were performed on the first derivation cohort of twenty patients with COVID-19 (median age 47.5 years, 10 females and four with comorbidities) admitted between 22 January 2020 and 1 February 2020. Each CXR was scored by three radiologists in consensus and graded on a 72-point COVID-19 Radiographic Score (CRS). This was correlated with supplemental oxygen requirement, C-reactive protein (CRP), lactate dehydrogenase (LDH) and lymphocyte count. To validate our findings, the parameters of another validation cohort of twenty patients with 65 CXRs were analysed.Results In the derivation cohort, seven patients needed supplemental oxygen and one was intubated for mechanical ventilation with no death. The maximum CRS was significantly different between patients on and not on supplemental oxygen (p=Conclusion Using an objective scoring system (CRS), the degree of abnormalities on CXR correlates closely with known markers of disease severity. CRS may further be applied to predict patients who require oxygen supplementation during the course of their disease.

The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented challenge to the health care systems of the world. In Singapore, early experiences of the radiology community on managing this pandemic was shaped by lessons learned from the severe acute respiratory syndrome outbreak in 2003. This article surveys the operational responses of radiology departments from six public hospitals in Singapore. © RSNA, 2020.

OBJECTIVE. This article shares the ground operational perspective of how a tertiary hospital radiology department in Singapore is responding to the coronavirus disease (COVID-19) epidemic. This same department was also deeply impacted by the severe acute respiratory syndrome (SARS) outbreak in 2003. CONCLUSION. Though similar to SARS, the COVID-19 outbreak has several differences. We share how lessons from 2003 are applied and modified in our ongoing operational response to this evolving novel pathogen.

Objective Dynamic Computed Tomography (CT) promises insights into the pathophysiology of carpal instability by recording images of the carpus while it is in motion. The purpose of this study was to investigate the effect of motion velocity on image quality for dynamic carpal imaging applications using a clinical dual-source CT (DSCT) scanner. Methods A phantom with targets in the axial, coronal and sagittal planes was attached to a motion simulator and imaged using a 64-slice DSCT scanner. Data was acquired when the phantom was stationary and during periodic linear motion. Spatial resolution, motion artifacts and banding artifacts were assessed. Results Mean spatial resolution was 0.82 mm at 36 mm/s and 0.79 mm at 18 mm/s. Banding artifacts were mild at 36 mm/s and minimal at 18 mm/s. Motion artifacts were minimal at motion velocity of up to 36 mm/s in both the coronal and sagittal planes. Axial plane motion artifacts were moderate at 36 mm/s and mild at 18 mm/s. Discussion Sub-millimeter resolution is achievable with commercially available DSCT scanners with mild to moderate amounts of motion artifacts at velocities of 18 mm/s and 36 mm/s respectively.

Purpose To ascertain the suitability of vertebrae adjacent to spinal bone lesions as a signal intensity reference on MRI, and compare the MR spectroscopic appearance of vertebral body compression fractures due to malignant tumor infiltration, bone weakening (e.g., osteoporosis), and/or minor trauma. Materials and Methods Twenty-five patients with spinal compression fractures underwent routine spinal MRI with an additional 1H MRS study protocol to assess the percent fat fraction of the compressed vertebrae as well as the adjacent bony environment. Peak areas for water and total lipid were calculated from short-TE single-voxel 1H MR spectra using the LCModel analyzing tool. Results There were consistent water-only patterns in the fractured vertebra suggesting either near complete marrow replacement by malignant tissue or local edematous fluid/hemorrhage within the marrow spaces. However, the adjacent vertebrae showed a wide range of patterns from a dominant lipid signal to the inverse of a pronounced water level. These results far exceed the normal variation expected based on age and sex. Conclusion The results suggest that the adjacent vertebrae may not be an accurate reference, especially in diffusion-weighted imaging (DWI), because of the large difference between the two compartments. Furthermore, in the case of gradient-echo measurements, the in-phase vs. opposed-phase effects are significant. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc.

OBJECTIVE. We describe five cases of biopsy-proven fat necrosis and review the imaging with an emphasis on MRI.CONCLUSION. MRI showed the classically reported finding of central globular high signal intensity with a low-signal-intensity rim in only two of the five cases. We noted peripheral contrast enhancement, which to our knowledge has not been reported previously, in three of our five cases. Other patterns such as amorphous, cloudlike stranding and a serpentine appearance were also encountered. In reviewing the literature, we found that the MRI appearance of fat necrosis is more varied than previously thought.

(2002). An intraventricular brain tumour in a young woman. Pathology: Vol. 34, No. 2, pp. 185-188.

11069 Background: Guidelines recommend routine surveillance imaging in patients (pts) following curative resection of STS. However the benefit of such an approach is unclear. We sought to evaluate the utility of a surveillance imaging strategy in pts with localized STS treated with curative intent. Methods: Pts with localized non-indolent STS, seen between 2010 – 2016, who had undergone surgery with R0/R1 surgical margins were included. Epidemiology, treatment and relapse data were collected as was the mode of detection. We defined optimal surveillance as CT/ MRI performed at least 6-mthly following surgery; suboptimal surveillance was defined as CT/ MRI imaging performed less frequently than 6mthly. Results: Of 294 pts included, 31% (n = 92) vs 34% (n = 100) vs 35% (n = 102) had optimal, suboptimal and no routine CT/MRI surveillance imaging respectively. At a median follow-up of 27mths (range 0-79), 36% (n = 105) experienced a relapse; 43% (n = 45) local and 57% (n = 60) had metastatic relapse. More relapses were noted in the optimal surveillance group, 57% (n = 52) vs 28% (n = 28) and 25% (n = 25) in the suboptimal and no surveillance groups respectively (p < 0.001). Within each cohort, relapses detected directly by routine surveillance imaging vs outside of surveillance imaging were as follows: 35% (n = 32) / 22% (n = 20) in the optimal, 17% (n = 17) / 11% (n = 11) in the suboptimal and 0 / 25% (n = 25) in the no surveillance arms respectively. Comparing the 3 strategies, the proportion of pts who then went on to receive curative resection/ metastacectomy was not significantly different, 38% (n = 20), 57% (n = 16) and 32% (n = 8) of relapses, in the optimal vs suboptimal vs no surveillance cohorts respectively (p = 0.1). Notably, routine surveillance imaging directly leading to curative resection occurred only in 15% (n = 14) of pts in the optimal and 9% (n = 9) in the suboptimal surveillance groups. Conclusions: While an intensive routine CT/MRI surveillance imaging strategy detected more recurrences, the impact it has on subsequent resection is less certain. Optimal frequency of surveillance imaging remains unclear.

Aim We studied the usefulness of magnetic resonance imaging (MRI) in detecting subclinical inflammation in patients with asymptomatic RA and tested the hypothesis of interleukin (IL)-18 as a marker of disease activity. Methods Thirteen RA patients with Disease Activity Score of 28 joints (DAS28)

Airlines can minimize the chances of flights arriving at airports with failed components and no replacements by positioning spare components at strategically selected airports. In this paper, we describe a high-fidelity simulation system that can simulate component failures, replace-and-repair cycles, and inventory re-balancing policies in global commercial passenger flights. This simulation system is used together with other modules such as a user interface and an optimizer to provide inventory management and decision support for airlines or maintenance, repair, and overhaul (MRO) service providers. We present some results from simulating failures of critical and non-critical spare components and show how they can be of use for decision support in the inventory management.

We developed a simulation tool that simulates rotable failures in commercial flights, a replace-and-repair cycle, and an inventory re-balancing policy (Virtual Warehouse concept). With this tool, we are able to determine the percentages of instances where flights arriving at their destination airports with failed components can get replacements. This tool was developed using a commercial simulation software ProModel. The time taken to run a typical scenario is in the order of hours, which makes this tool unsuitable for use in a real-life decision support system. Using our proprietary parallel and distributed simulation (PADS) platform, the tool was re-engineered. The time taken by the new simulation tool takes just a few seconds for the same scenario, an improvement of several thousand times. In this paper we describe our simulation tool and discuss the results from running some realistic scenarios. The analysis revealed that using the Virtual Warehouse concept, up to 50% less inventory is required compared to conventional policies (IATP pooling).

A multilevel training procedure is proposed for automatic speech recognition in noise. In the multilevel training procedure, six levels of Gaussian noise, corresponding to six signal‐to‐noise ratios (SNR), were added to the training samples. The procedure was tested in three speech recognizers implemented, respectively, on the basis of the following three speech recognition techniques: dynamic time warping (DTW), discrete hidden Markov modeling (DHMM), and neural network (NN). The tests on the three recognizers were conducted using a common database for isolated word recognition of the ten digits. The results of the first series of the tests showed that when the recognizers were trained using clean training samples without noise and tested with noisy test samples with additive Gaussian noise, the performance of the three recognizers degraded significantly as the SNR decreased. In the second series of tests, the multilevel training procedure was applied. The results showed that, when the recognizers were trained with noisy training samples and tested with noisy test samples, the three recognizers were, in contrast to the first series, much better able to maintain their performance as the SNR decreased. The multilevel procedure is therefore effective in improving the performance of recognizers for automatic recognition in noise.