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Objective: To study the frequency of pneumothorax and intrapulmonary haemorrhage in computed tomography (CT) guided transthoracic needle lung biopsy (NLB) and the factors that affect the development of these complications in Pakistan through a representative limited data obtained from a tertiary care centre. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, from Jan 2018 to Feb 2019. Methodology: A total of 68 patients who underwent CT-guided transthoracic biopsy were evaluated for intra- and immediate (within 04 hours) post-procedural pneumothorax and pulmonary haemorrhage. The factors affecting the development of these complications were evaluated. Results: Complications developed in 30 patients with the frequency of pneumothorax at 26.5 % and frequency of pulmonary haemorrhage at 19.1%. Significant risk factors for the development of pneumothorax were small lesions less than 2.5 cm in diameter (p-value <0.05), increased needle track path within the lung tissue of more than 21 mm (p-value = 0.05), and presence of emphysema in the surrounding lung tissue (p-value <0.05). In addition, smaller lesion size (p-value <0.05) and increased traversed lung parenchyma (p-value <0.05) were also significant factors in the development of intrapulmonary haemorrhage. Conclusion: Significant risk factors for pneumothorax and intrapulmonary haemorrhage are smaller lesion size and length of puncture path. The presence of emphysema is related to the development of pneumothorax. [ABSTRACT FROM AUTHOR]

Objective: To assess chest x-ray appearance of patients with positive RT-PCR test for SARS-Cov-2 and utilize modified RALE score for severity assessment of chest x-ray findings for correlation with clinical spectrum of disease. Study Design: Prospective observational study. Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Pak Emirates Military Hospital, Rawalpindi, from Apr 2020 to May 2020. Methodology: First 1000 consecutive chest x-rays of COVID-19 patients with RT-PCR confirmation at our setup were analyzed. Positive chest x-rays were assessed for consolidation, ground glass opacities and location of involvement. A severity index using modified RALE score was calculated for each & both lungs. Results: Nine hundred and thirty two patients were males and 68 were females with an average age of 40.77 years ± 13.58. Out of 1000 patients, 759 (75.9%) had normal chest x-rays. Two hundred and forty one patients had positive findings, ground glass opacities being the most frequent feature 211 (87.6%) showing peripheral 219 (90.9%), bilateral 182 (75.5%) and lower zone predominance 221 (91.7%). The optimal modified RALE score threshold for recognizing severe disease was 4.5 (area under curve, 0.943), with 79.2% sensitivity and 96.3% specificity. Conclusion: COVID-19 patients with positive chest x-ray findings frequently showed ground glass opacities with bilateral lower zone involvement in peripheral distribution. Modified RALE score can be used for objective evaluation of clinically severe patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the spectrum of diseases on F-18 FDG PET/CT imaging at the Armed Forces Institute of Radiology and Imaging, Rawalpindi. Study Design: Cross-sectional study. Place and Duration of the Study: PET/CT and Cyclotron Department, Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Jul 2019 to Mar 2021. Methodology: The patients were scanned for staging, restaging, interim/response assessment and relapse/recurrence purposes. In addition, the frequency of various cancers and types of scans were determined. Scanning has been performed using GE Health care MiDR PET-CT Scanner. Results: A total of 1573 patients were included in the study. Male patients were 927(58.93%), and female patients were 646(41.06%). The most common diseases encountered were lymphoma 623(39.6%), breast cancer 193(12.2%), lung cancer 12(7.6%), colorectal cancer 88(5.5%) and unknown primary 84(5.3%). Amongst lymphoma, Non-Hodgkin's lymphoma was the most common 276(44.3%), followed by Hodgkin's lymphoma 267(42.8%). Conclusion: F-18 FDG PET/CT hybrid imaging is an important modality and can significantly alter patient management plans. Lymphomas were the most common disease in our spectrum, followed by cancers of the breast, lungs, colon-rectum and unknown primary cases, which can be managed well by PET/CT's routine utilization. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the patients' feedback for potential improvements in the patient management of PET-CT Department. Study Design: Cross-sectional survey. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep to Dec 2020. Methodology: A total of 350 participants were investigated in the study. Structured proforma was utilized for collecting patient feedback, and the ages ranged from 4 to 89 years. The collected data were arranged systematically to apply statistica l tests using Microsoft excel. Results: Explicitly, 14(4%) patients communicated their reservations about further development in PET-CT scan practice. In this regard, 4(1.14%) patients suggested overall improvement in the department. Further, 4(1.14%) and 3(0.86%) patientss' suggestions were towards staff behaviour and building of the department, respectively. Additionally, 2(0.57%) patients were not contented with the available prerequisite equipment, and 1(0.29%) patient suggested a reduction in scanning charges. Conclusion: More than 95% patients were satisfied with their experience. The studied data can be utilized to establish patient management protocols for similar PET-CT departments. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To find out the optimal timeline for the safe disposal of radioactive wastes generated at the end of normal and anomalous productions of 18FFluorodeoxyglucose for positron emission tomographycomputed tomography scans. Study Design: Quasiexperimental study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Aug to Dec 2020. Methodology: Wastes generated at the end of 18FFluorodeoxyglucose production were tested for residual radioactivity at 2, 12 and 24 hours after synthesis to ascertain the optimal timeline for discarding. The radiation dose at 5 cm from the surface of the container was also assessed. Results: Fifty productions were included in the study, of which 46(92%) were normal, and 4(8%) were anomalous productions. The mean activity at 2 and 24 hours after the end of synthesis was 4.102±0.831mCi and 0.0047±0.00116mCi, respectively, in normal productions and 45.125±2.332mCi and 0.005±0.00026mCi respectively in anomalous productions. The mean radiation dose at 5cm from the surface of the container at 2 and 24 hours after the end of synthesis was 8.2107±1.665mSv/h and 0.00000966±0.00000212mSv/h in normal productions and 90.32±4.66mSv/h and 0.00975±0.0005- mSv/h respectively in anomalous productions. Conclusion: The residual radioactivity in wastes was negligible 24 hours after the end of synthesis in both normal and anomalous productions. Radioactive wastes from 18FFluorodeoxyglucose production should, therefore, be conserved for at least 24 hours before their disposal to the environment. [ABSTRACT FROM AUTHOR]

Objective: To review all the patients of spinal dysraphism referred to our center over a three year period in order to identify the most typical neuro-radiological appearances on Magnetic Resonance Imaging. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi from Jan 2016 to Dec 2018. Methodology: MR spine reports of 144 patients of spinal dysraphism were retrospectively analyzed. Age, gender, indication for MRI, operative status, and neuro-radiological features (including site and type of lesion) were recorded for these patients. Results: Congenital spinal malformations were more frequent among females87 (60.4%) and between 0-20 years 135 (93.9%) of age. Tethered cord 97 (67.4%) was the most common congenital spinal abnormality followed by spina bifida, diastematomyelia, vertebral segmentation anomalies, myelomeningocele, menigocele. Lip-myelomeningocele, lipoma of filum terminale, and sacral agenesis. Frequently observed associated abnormalities included scoliosis 61 (42.4%), syrinx 47 (32.6%) and dural ectasia 40 (27.8%). Conclusion: Congenital spinal malformations are usually complex with variable radiological appearances. Modern high resolution MRI screening is the examination of choice for identification, preoperative evaluation, and long term follow up of such congenital anomalies. [ABSTRACT FROM AUTHOR]