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Fulltext The Growing Problem of Radiologist Shortage: Malaysia's Perspective

Ramli NM, Mohd Zain NR

Korean J Radiol, 2023 Oct;24(10):936-937.
PMID: 37793663 DOI: 10.3348/kjr.2023.0742
Matched MeSH terms: Radiologists*
Fulltext Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

Yaacob Y, Nguyen DV, Mohamed Z, Ralib AR, Zakaria R, Muda S

Indian J Radiol Imaging, 2013 Apr;23(2):121-5.
PMID: 24082475 DOI: 10.4103/0971-3026.116543

To report our early experience in image-guided chemoport insertions by interventional radiologists.

Matched MeSH terms: Radiologists
Fulltext A Review of Medical Doppler Ultrasonography of Blood Flow in General and Especially in Common Carotid Artery

Oglat AA, Matjafri MZ, Suardi N, Oqlat MA, Abdelrahman MA, Oqlat AA

J Med Ultrasound, 2018 03 28;26(1):3-13.
PMID: 30065507 DOI: 10.4103/JMU.JMU_11_17

Medical Doppler ultrasound is usually utilized in the clinical adjusting to evaluate and estimate blood flow in both the major (large) and the minor (tiny) vessels of the body. The normal and abnormal sign waveforms can be shown by spectral Doppler technique. The sign waveform is individual to each vessel. Thus, it is significant for the operator and the clinicians to understand the normal and abnormal diagnostic in a spectral Doppler show. The aim of this review is to explain the physical principles behind the medical Doppler ultrasound, also, to use some of the mathematical formulas utilized in the medical Doppler ultrasound examination. Furthermore, we discussed the color and spectral flow model of Doppler ultrasound. Finally, we explained spectral Doppler sign waveforms to show both the normal and abnormal signs waveforms that are individual to the common carotid artery, because these signs are important for both the radiologist and sonographer to perceive both the normal and abnormal in a spectral Doppler show.

Matched MeSH terms: Radiologists
"Anterior appendix": a boon for clinicians and radiologists

Nayak SB, Soumya KV

Surg Radiol Anat, 2019 Jun 18.
PMID: 31214757 DOI: 10.1007/s00276-019-02268-x

Vermiform appendix is considered as a vestigial organ, and it has minimal or no role to play in the digestion and absorption of food. It is an enigma to the clinicians due to its variable positions and symptoms caused by its inflammation. In the available literature, there are many reports on various positions, size and disease of appendix. However, there is no report on an anteriorly located appendicular attachment to the caecum. During dissection classes for medical undergraduates, an appendix with its base attached to the anterior wall of the caecum was noted. The entire appendix was attached to the ileum through a mesoappendix and was readily visible when the anterior abdominal wall was reflected. This position could be a boon to the clinicians and radiologists during diagnosis and surgery of the appendix.

Matched MeSH terms: Radiologists
Fulltext 3D CNN with Visual Insights for Early Detection of Lung Cancer Using Gradient-Weighted Class Activation

Neal Joshua ES, Bhattacharyya D, Chakkravarthy M, Byun YC

J Healthc Eng, 2021;2021:6695518.
PMID: 33777347 DOI: 10.1155/2021/6695518

The 3D convolutional neural network is able to make use of the full nonlinear 3D context information of lung nodule detection from the DICOM (Digital Imaging and Communications in Medicine) images, and the Gradient Class Activation has shown to be useful for tailoring classification tasks and localization interpretation for fine-grained features and visual explanation for the internal working. Gradient-weighted class activation plays a crucial role for clinicians and radiologists in terms of trusting and adopting the model. Practitioners not only rely on a model that can provide high precision but also really want to gain the respect of radiologists. So, in this paper, we explored the lung nodule classification using the improvised 3D AlexNet with lightweight architecture. Our network employed the full nature of the multiview network strategy. We have conducted the binary classification (benign and malignant) on computed tomography (CT) images from the LUNA 16 database conglomerate and database image resource initiative. The results obtained are through the 10-fold cross-validation. Experimental results have shown that the proposed lightweight architecture achieved a superior classification accuracy of 97.17% on LUNA 16 dataset when compared with existing classification algorithms and low-dose CT scan images as well.

Matched MeSH terms: Radiologists
Fulltext Computed Tomography (CT) of Blunt Abdominal Trauma: The Frequency of Incidental Findings, how it was Documented in Radiology Report and the Implication of These Findings to Acute Trauma Care

Radhiana H, Siti Kamariah CM, Mohd Nazli K, Azian AA

Med J Malaysia, 2014 Feb;69(1):46-8.
PMID: 24814633 MyJurnal

The wide use of computed tomography (CT) scanning for patients with blunt abdominal trauma can reveal incidental findings that vary in their importance. We evaluated these findings, how it was reported by radiologists and its implication on the trauma care. In 30 out of 154 patients, 32 incidental findings were discovered (19.5%). Out of these 32 findings, only 3 cases (9.4%) were considered significant and required immediate attention from the managing team. In all these 3 cases, the findings were described in the body of the report and highlighted in the conclusion section at the end of the radiology report. However, similar reporting style was used in only 58.4% of cases with moderate clinical concern and 23.5% of cases with little clinical concern. In 41.2% of cases with little concern, the incidental findings were not mentioned in the radiology report. In conclusion, incidental findings in CT scan performed for blunt abdominal trauma were common but many were clinically insignificant. There is little consistency in radiology reporting of these findings especially those with moderate and little clinical concern.

Matched MeSH terms: Radiologists
Fulltext Onyx in Brain Arteriovenous Malformation Embolisation

Hashim H, Muda AS, Abdul Aziz A, Abdul Hamid Z

Malays J Med Sci, 2016 Jul;23(4):59-64.
PMID: 27660546 MyJurnal DOI: 10.21315/mjms2016.23.4.8

Embolisation has long been used as an adjunct to surgical resection in the treatment of brain arteriovenous malformation (bAVM). The most commonly used embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for radiologists performing embolisation.

Matched MeSH terms: Radiologists
Automatic liver tumor segmentation on computed tomography for patient treatment planning and monitoring

Moghbel M, Mashohor S, Mahmud R, Saripan MI

EXCLI J, 2016;15:406-23.
PMID: 27540353 DOI: 10.17179/excli2016-402

Segmentation of liver tumors from Computed Tomography (CT) and tumor burden analysis play an important role in the choice of therapeutic strategies for liver diseases and treatment monitoring. In this paper, a new segmentation method for liver tumors from contrast-enhanced CT imaging is proposed. As manual segmentation of tumors for liver treatment planning is both labor intensive and time-consuming, a highly accurate automatic tumor segmentation is desired. The proposed framework is fully automatic requiring no user interaction. The proposed segmentation evaluated on real-world clinical data from patients is based on a hybrid method integrating cuckoo optimization and fuzzy c-means algorithm with random walkers algorithm. The accuracy of the proposed method was validated using a clinical liver dataset containing one of the highest numbers of tumors utilized for liver tumor segmentation containing 127 tumors in total with further validation of the results by a consultant radiologist. The proposed method was able to achieve one of the highest accuracies reported in the literature for liver tumor segmentation compared to other segmentation methods with a mean overlap error of 22.78 % and dice similarity coefficient of 0.75 in 3Dircadb dataset and a mean overlap error of 15.61 % and dice similarity coefficient of 0.81 in MIDAS dataset. The proposed method was able to outperform most other tumor segmentation methods reported in the literature while representing an overlap error improvement of 6 % compared to one of the best performing automatic methods in the literature. The proposed framework was able to provide consistently accurate results considering the number of tumors and the variations in tumor contrast enhancements and tumor appearances while the tumor burden was estimated with a mean error of 0.84 % in 3Dircadb dataset.

Matched MeSH terms: Radiologists
Fulltext Mylohyoid foramen of mandible: a rare exit point of intra-mandibular origin of nerve to mylohyoid

Nayak SB, Soumya KV

Anat Cell Biol, 2020 Mar;53(1):114-116.
PMID: 32274257 DOI: 10.5115/acb.19.186

Nerve to mylohyoid is a branch of inferior alveolar nerve. It arises in the infratemporal fossa and runs in the mylohyoid groove of mandible to reach the submandibular region, where it supplies the anterior belly of digastric and mylohyoid muscles. Though sensory distribution of this nerve have been described, it is predominantly a motor nerve. Here, a rare intra-mandibular origin of nerve to mylohyoid has been presented. This nerve arose from the inferior alveolar nerve inside the mandible and came out to the submandibular region by passing through a small foramen present on the medial surface of the body of the mandible. It ended by supplying the anterior belly of digastric and mylohyoid muscles. The knowledge of this variation could be of importance to maxillofacial surgeons and radiologists.

Matched MeSH terms: Radiologists
Fulltext Correlation between MRI characteristics of medulloblastoma with histopathological subtypes and 2-year survival

Hussain IZ, Mohd Zaki F, Mukari SA, Md Pauzi SH, Loh CK, Alias H

Indian J Radiol Imaging, 2020 03 30;30(1):46-51.
PMID: 32476749 DOI: 10.4103/ijri.IJRI_209_19

Objectives: The objective of this study is to describe the imaging features of medulloblastoma (MB) and correlate the MR characteristics with the different histological subtype of MB with 2-year survival.
Materials and Methods: This is a retrospective descriptive study. A total of 29 patients diagnosed with MB from January 2005 to December 2015 were included in this study. The MRI brain and spine studies of these patients were retrieved and reviewed by a pediatric radiologist and a neuroradiologist independently, both blinded from the histological type of the MB. The HPE slides were also retrieved and reviewed by a pathologist.
Results: 80% of desmoplastic MB showed the presence of intracranial leptomeningeal seeding and 57.1% of anaplastic MB showed the presence of necrosis. The presence of intracranial leptomeningeal seeding (P = 0.002) and necrosis (P = 0.019) was predictive of the histological subtypes. There is a significant correlation between the enhancement pattern and the 2-year outcome (P = 0.03) with 6 out of 8 patients whose tumors showed minimal enhancement having disease progression within 2 years. A significant correlation was also seen between the presence of necrosis with a poorer outcome (P = 0.03) and between the HPE subtype and 2-year outcome (P = 0.03) with anaplastic MB having the poorest prognosis.
Conclusion: MR imaging features of intracranial leptomeningeal seeding and the presence of necrosis were correlated with a specific histologic subtype of MB. The enhancement pattern as well as necrosis correlated with 2-year poorer outcome of the disease.

Matched MeSH terms: Radiologists
Fulltext Retrocaval ureter: the importance of intravenous urography

Hassan R, Aziz AA, Mohamed SK

Malays J Med Sci, 2011 Oct;18(4):84-7.
PMID: 22589677

Retrocaval ureter is a rare cause of hydronephrosis. Its rarity and non-specific presentation pose a challenge to surgeons and radiologists in making the correct diagnosis. Differentiation from other causes of urinary tract obstruction, especially the more common urolithiasis, is important for successful surgical management. Current practice has seen multislice computed tomography (MSCT) rapidly replaces intravenous urography (IVU) in the assessment of patients with hydronephrosis due to suspected urolithiasis, especially ureterolithiasis. However, MSCT, without adequate opacification of the entire ureter, may allow the physician to overlook a retrocaval ureter as the cause of hydronephrosis. High-resolution IVU images can demonstrate the typical appearance that leads to the accurate diagnosis of a retrocaval ureter. We reported a case that illustrates this scenario and highlights the importance of IVU in the assessment of a complex congenital disorder involving the urinary tract.

Matched MeSH terms: Radiologists
Fulltext Embolisation of a bronchial artery of anomalous origin in massive haemoptysis

Md Ralib AR, Han NT, Hin HS, Muda AS

Malays J Med Sci, 2010 Jul;17(3):55-60.
PMID: 22135550 MyJurnal

Massive haemoptysis is the most dreaded of all respiratory emergencies. Bronchial artery embolisation is known to be a safe and effective procedure in massive haemoptysis. Bronchial artery of anomalous origin presents a diagnostic challenge to interventional radiologists searching for the source of haemorrhage. Here, we report a case of massive haemoptysis secondary to a lung carcinoma with the bronchial artery originating directly from the right subclavian artery. This artery was not evident during the initial flush thoracic aortogram. The anomalous-origin bronchial artery was then embolised using 15% diluted glue with good results. An anomalous-origin bronchial artery should be suspected if the source of haemorrhage is not visualised in the normally expected bronchial artery location.

Matched MeSH terms: Radiologists
Guidelines for neuromuscular ultrasound training

Tawfik EA, Cartwright MS, Grimm A, Boon AJ, Kerasnoudis A, Preston DC, et al.

Muscle Nerve, 2019 10;60(4):361-366.
PMID: 31335971 DOI: 10.1002/mus.26642

Neuromuscular ultrasound has become an essential tool in the diagnostic evaluation of various neuromuscular disorders, and, as such, there is growing interest in neuromuscular ultrasound training. Effective training is critical in mastering this modality. Our aim was to develop consensus-based guidelines for neuromuscular ultrasound training courses. A total of 18 experts participated. Expert opinion was sought through the Delphi method using 4 consecutive electronic surveys. A high degree of consensus was achieved with regard to the general structure of neuromuscular ultrasound training; the categorization of training into basic, intermediate, and advanced levels; the learning objectives; and the curriculum for each level. In this study, a group of neuromuscular ultrasound experts established consensus-based guidelines for neuromuscular ultrasound training. These guidelines can be used in the development of the specialty and the standardization of neuromuscular ultrasound training courses and workshops.

Matched MeSH terms: Radiologists/education
Radiologists’ Performance at Reduced Recall Rates in Mammography: A Laboratory Study

Mohd Norsuddin N, Mello-Thoms C, Reed W, Lewis S

Asian Pac J Cancer Prev, 2019 Feb 26;20(2):537-543.
PMID: 30803217

Rationale and objectives: Target recall rates are often used as a performance indicator in mammography screening
programs with the intention of reducing false positive decisions, over diagnosis and anxiety for participants. However,
the relationship between target recall rates and cancer detection is unclear, especially when readers are directed to
adhere to a predetermined rate. The purpose of this study was to explore the effect of setting different recall rates on
radiologist’s performance. Materials and Methods: Institutional ethics approval was granted and informed consent
was obtained from each participating radiologist. Five experienced breast imaging radiologists read a single test set
of 200 mammographic cases (20 abnormal and 180 normal). The radiologists were asked to identify each case that
they required to be recalled in three different recall conditions; free recall, 15% and 10% and mark the location of any
suspicious lesions. Results: Wide variability in recall rates was observed when reading at free recall, ranging from
18.5% to 34.0%. Readers demonstrated significantly reduced performance when reading at prescribed recall rates,
with lower sensitivity (H=12.891, P=0.002), case location sensitivity (H=12.512, P=0.002) and ROC AUC (H=11.601,
P=0.003) albeit with an increased specificity (H=12.704, P=0.002). However, no significant changes were evident in
lesion location sensitivity (H=1.982, P=0.371) and JAFROC FOM (H=1.820, P=0.403). Conclusion: In this laboratory
study, reducing the number of recalled cases to 10% significantly reduced radiologists’ performance with lower detection
sensitivity, although a significant improvement in specificity was observed.

Matched MeSH terms: Radiologists/standards*
Fulltext Iatrogenic submandibular duct rupture complicating sialography: a case report

Sharouny H, Omar RB

Iran Red Crescent Med J, 2014 Sep;16(9):e7882.
PMID: 25593739 DOI: 10.5812/ircmj.7882

INTRODUCTION: Sialolithiasis is the most common disease of salivary glands. Sialography is particularly important for the assessment of the outflow tract and in diagnosing obstructive salivary gland lesions including calculi.
CASE PRESENTATION: We report on a 38-year-old female with sialolithiasis whom had Wharton's duct perforation, complicating the sialography. She was treated conservatively with a course of co-amoxiclav, oral prednisolone for three days and pain-killers. The patient was clinically well on follow-up reassessments at the end of the first week and three weeks post procedure.
CONCLUSIONS: Perforation of salivary duct complicating the sialography is rare. Awareness of this potential complication and utilizing a good sialography technique need to be advocated amongst radiologists. Response to treatment by conservative management is preferred as illustrated in this case.

Matched MeSH terms: Radiologists
Fulltext Insufficiency fractures related to low-dose adefovir dipivoxil treatment for chronic hepatitis B

Poh F, Sing WH, Mohan PC

Med J Malaysia, 2015 Feb;70(1):38-41.
PMID: 26032529

We present a case of a 53-year-old woman who developed multifocal insufficiency fractures associated with adefovir dipivoxil (ADV) induced osteomalacia, including recurring metatarsal insufficiency fractures and a subtrochanteric femoral insufficiency fracture requiring surgical fixation. She had received low-dose ADV treatment for 59 months for chronic hepatitis B viral infection at the time of presentation with subtrochanteric fracture. Imaging evidence of multifocal insufficiency fractures and metabolic disease on background of hypophosphatemia is attributed to hypophosphatemic osteomalacia from adefovir-induced renal proximal tubular dysfunction. Radiologists and clinicians should be aware of the possibility of insufficiency fractures in patients receiving ADV therapy to avoid delayed diagnosis and progression of high-risk proximal femoral fractures.

Matched MeSH terms: Radiologists
Fulltext Degenerated retained product of conception misdiagnosed as invasive trophoblastic disease

Tan AP

Med J Malaysia, 2015 Apr;70(2):100-1.
PMID: 26162386

Retained products of conception (POC) complicates nearly 1% of all pregnancies, occurring with greater frequency after termination of pregnancy than after vaginal or caesarean delivery. The presenting symptoms of retained products of conception are similar to those of gestational trophoblastic disease and hence accurate differentiation is difficult based on clinical history and physical examination alone. The distinction between these two entities is extremely important as the treatment differs dramatically. These patients often need to be further evaluated with either ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis. Hence, radiologists play a vital role in clinching the diagnosis although at times it may be challenging to differentiate between these two entities. Herein, we discuss a case of degenerated retained products of conception which was initially misdiagnosed as invasive trophoblastic disease in a 41-year-old woman whom last known pregnancy was 10 years ago.

Matched MeSH terms: Radiologists
Fulltext Triple right testicular veins and their variant termination and communications

Nayak SB, Kodimajalu Vasudeva S

Heliyon, 2020 Sep;6(9):e05014.
PMID: 32995649 DOI: 10.1016/j.heliyon.2020.e05014

Testicular veins are known to show many variations in their origin, course and termination. Some of their variations can lead to male sterility. We report a unique variation of right testicular vein here. Pampiniform plexus reduced to three testicular veins (medial, middle and lateral) at the deep inguinal ring on the right side. The medial vein terminated into the right renal vein, the middle vein terminated into the inferior vena cava above the level of right renal vein (close to the suprarenal gland) and the lateral vein terminated partly into the veins in the capsules of the kidney and partly into the veins under the diaphragm. The medial and middle testicular veins were connected through an oblique communicating vein. The middle and lateral testicular veins were also connected to each other through another oblique communicating vein. Knowledge of this case could be useful to radiologists, nephrologists and surgeons in general.

Matched MeSH terms: Radiologists
Role of contrast-enhanced spectral mammography in the post biopsy management of B3 lesions: Preliminary results

Bicchierai G, Nori J, De Benedetto D, Boeri C, Vanzi E, Bianchi S, et al.

Tumori, 2019 Oct;105(5):378-387.
PMID: 30558495 DOI: 10.1177/0300891618816212

PURPOSE: To evaluate the role of contrast-enhanced spectral mammography (CESM) in the post biopsy management of breast lesions classified as lesions of uncertain malignant potential (B3) by core needle biopsy and vacuum-assisted biopsy (VAB).
METHODS: The local ethics committee approved this retrospective study and for this type of study formal consent is not required. A total of 42 B3 lesions in 40 women aged 41-77 years were included in our study. All patients underwent CESM 2-3 weeks after the biopsy procedure and surgical excision was subsequently performed within 60 days of the CESM procedure. Three radiologists reviewed the images independently. The results were then compared with histologic findings.
RESULTS: The sensitivity, specificity, and positive and negative predictive values for confirmed demonstration of malignancy at CESM were 33.3%, 87.2%, 16.7%, and 94.4% for reader 1; 66.7%, 76.9%, 18.2%, and 96.7% for reader 2; 66.7%, 74.4%, 16.7%, and 96.7% for reader 3. Overall agreement on detection of malignant lesions using CESM among readers ranged from moderate to substantial (κ = .451-.696), for categorization of BPE from moderate to substantial (κ = .562-.711), and for evaluation of lesion intensity enhancement from fair to moderate (κ = .346-.459).
CONCLUSION: In cases of Breast Imaging Reporting and Data System (BI-RADS) 1, BI-RADS 2, or BI-RADS 3 results at CESM, follow-up or VAB rather than surgical biopsy might be performed.

Matched MeSH terms: Radiologists
Unusual contribution of the first jejunal vein in the formation of the portal vein

Nayak SB, Shetty SD, Packirisamy V, Vasudeva SK

Morphologie, 2021 May 05.
PMID: 33965324 DOI: 10.1016/j.morpho.2021.04.003

Jejunum is drained into superior mesenteric vein through a series of jejunal veins. The way in which the first jejunal vein terminates is of great importance in upper abdominal surgery and radiological procedures. Knowledge of its variations is particularly important in surgical procedures like orthotropic hepatic transplantation, hepatic vein reconstruction, pancreatic surgery and surgical procedures of duodenojejunal junction. We saw a first jejunal vein opening directly into the portal vein. Further, the inferior mesenteric vein drained into the first jejunal vein. This case could be useful to gastroenterologists, general surgeons and radiologists.

Matched MeSH terms: Radiologists

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