Carcinoma esophagus- a barium swallow showing irregular narrowing with "shouldered edges" suggestive of a malignant stricture!!
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MY BLOG ON TIMES OF INDIA!!!!

Docs bitten by the blog bug
VIVIDHA KAULTIMES NEWS NETWORK[ WEDNESDAY, DECEMBER 08, 2004 12:24:13 AM ]

NEW DELHI: From talking about dogs who can sniff out bladder cancer to solved AIIMS question papers, from cheap accommodation near Safdarjung Hospital to three exclusive 'from the bedside' opinions on the cause of Yasser Arafat's death — the medical community is warming up to the idea of sharing it all over blogs on the Net.For the uninitiated, blogs are short for web logs which are Internet journals or diaries. They differ from regular websites in being much more interactive, with the writers behind them updating the blogs frequently and inviting instant feedback. The idea seems to have gained ground amongst the members of the medical community in the past few months. Says Dr Sumer Kumar Sethi, a senior resident at the Lady Hardinge Medical College, who runs a blog on radiology, "I have had 2,000 visitors on my blog in the past three months. Starting with a lone visitor or two in September, I get as many as 30-40 visitors daily now." Sethi adds that one of the reasons behind the concept acquiring popularity is the fact that it is very difficult to get any work published in the medical community. "Authorities review your findings then check the evidence, and the process may take more than a year at times. Blogs are the easy way out," he says. For medical students like Manisha, "They are like small newspapers wherein you can share everything from what you felt when an infant passed away on Diwali morning to stuff on how to get that offending mole on your cheek removed." Interns aspiring for a post-graduate seat in their chosen specialisation also find blogs a good platform to share notes. "If someone from outside Delhi wants to take up MD here, all he has to do is to post a query on a blog and soon enough, doctors from here post their suggestions on where to stay, which specialisation is good at which hospital and what questions to expect," says Dr Ankit Verma, who works at a private hospital. Net-savvy patients, meanwhile, are the latest to join the blog bandwagon. "There are so many survival stories on the blogs about cancer patients, people who are living with AIDS and it's really inspiring," says Vidhi Chauhan (name changed), a teacher. "I suffer from polycystic ovarian syndrome, due to which I have a constant weight-gain problem. Awareness about the disease is low and there is no permanent cure. Getting onto blogs, learning from people's experiences on use of acupuncture and supplements really helped me out," she adds.
FROM TIMES OF INDIA, DELHI TIMES, 8/12/04

Barium study showing BEZOAR in the stomach!!
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JOURNAL WATCH

Comparison of MRI and CT for Detection of Acute Intracerebral Hemorrhage

Context Noncontrast computed tomography (CT) is the standard brain imaging study for the initial evaluation of patients with acute stroke symptoms. Multimodal magnetic resonance imaging (MRI) has been proposed as an alternative to CT in the emergency stroke setting. However, the accuracy of MRI relative to CT for the detection of hyperacute intracerebral hemorrhage has not been demonstrated.

Objective To compare the accuracy of MRI and CT for detection of acute intracerebral hemorrhage in patients presenting with acute focal stroke symptoms.
Design, Setting, and Patients A prospective, multicenter study was performed at 2 stroke centers (UCLA Medical Center and Suburban Hospital, Bethesda, Md), between October 2000 and February 2003. Patients presenting with focal stroke symptoms within 6 hours of onset underwent brain MRI followed by noncontrast CT.

Main Outcome Measures Acute intracerebral hemorrhage and any intracerebral hemorrhage diagnosed on gradient recalled echo (GRE) MRI and CT scans by a consensus of 4 blinded readers.

Results The study was stopped early, after 200 patients were enrolled, when it became apparent at the time of an unplanned interim analysis that MRI was detecting cases of hemorrhagic transformation not detected by CT. For the diagnosis of any hemorrhage, MRI was positive in 71 patients with CT positive in 29 (P<.001). For the diagnosis of acute hemorrhage, MRI and CT were equivalent (96% concordance). Acute hemorrhage was diagnosed in 25 patients on both MRI and CT. In 4 other patients, acute hemorrhage was present on MRI but not on the corresponding CT—each of these 4 cases was interpreted as hemorrhagic transformation of an ischemic infarct. In 3 patients, regions interpreted as acute hemorrhage on CT were interpreted as chronic hemorrhage on MRI. In 1 patient, subarachnoid hemorrhage was diagnosed on CT but not on MRI. In 49 patients, chronic hemorrhage, most often microbleeds, was visualized on MRI but not on CT.

Conclusion MRI may be as accurate as CT for the detection of acute hemorrhage in patients presenting with acute focal stroke symptoms and is more accurate than CT for the detection of chronic intracerebral hemorrhage.

JAMA. 2004;292:1823-1830.

The "classical air-crescent sign"
Diagnosis- fungal ball or Aspergilloma!!!
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classic appearance of a neurogenic bladder- known as "pine-tree appearance" also note the left Vesicoureteric reflux!!!
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journal watch

High resolution volume imaging of airways and lung parenchyma with multislice CT.
Chooi WK, Morcos SK.Department of Diagnostic Imaging, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield S5 7AU, UK.

The value of multislice CT (MSCT) in imaging the peripheral airways and lung parenchyma has not been widely investigated. In this article the authors' experience in the use of MSCT (4-slice scanner) in imaging patients with suspected parenchymal lung disease or airways abnormalities will be presented. The technique described should be modified with the more modern 8-slice or 16-slice scanners. The whole thorax is scanned contiguously using 4 x 1 mm collimation from the lung bases up to apices in end-inspiration while the patient is in the prone position. Collimation of 2 x 0.5 mm is used at 8-10 levels evenly spaced in expiratory scans and also in the breathless patient who is scanned during gentle breathing. High resolution images of the lungs (1 mm slice thickness) are reconstructed in the following planes: axial (10 mm apart from apices to bases), coronal (six evenly spaced through the chest) and sagittal (four images evenly spaced through each lung). Paddlewheel reconstruction is used if further assessment of the airways is required, and three-dimensional imaging is used mainly for assessment of the trachea and major bronchi. Contiguous axial images (10 mm slice thickness) of the whole lung and mediastinum are also produced and referred to as a screenogram. Axial images of 1 mm slice thickness are produced with expiratory scans and for breathless patients. All the images are produced independently by the radiographic staff and are provided as hard copies (20 frames/film) for reporting. However, if facilities are adequate, direct reporting from the workstation is more effective in reviewing large number of images. The technique is effective in assessment of infiltrative lung disease, emphysema, bronchiectasis and central airways. The screenogram offers comprehensive evaluation of the lung and mediastinum, but the radiation dose associated with high resolution volume imaging remains a source of concern.

Br J Radiol. 2004 Dec;77 Suppl 1:S98-S105.

radiology news

MR detects pancreatic islet inflammation in type 1 diabetes

CONTEXT: In type 1 diabetes, the body's immune system mistakenly launches an attack on insulin-producing beta cells, sending T cells to invade pancreatic islets. Until recently, physicians could track type 1 diabetes only by monitoring blood levels of antibodies directed against pancreatic islet proteins. The test, however, usually detected type 1 diabetes late in its progression, after most islet beta cells had been destroyed and autoimmune processes had been played out. Researchers at Massachusetts General Hospital and Boston's Joslin Diabetes Center are using magnetofluorescence contrast nanoparticles, monitored with high-field MR, to devise a better test. It measures the permeability of the small blood vessels surrounding and within the islets, an early marker of this inflammation.

RESULTS: The technique has been successfully tested on a mouse model. For imaging, long-circulating magnetofluorescent nanoparticles were used. They consist of a superparamagnetic iron oxide (SPIO) core, a crosslinked dextran coating, and amino groups to which Alexa-488 fluorochrome is attached. Transgenic mice were imaged with an 8.5T micro-MR scanner 24 hours after contrast injection. Contrast accumulation was monitored in vivo, and a positive correlation between probe accumulation and insulitis was documented.

IMAGE: Higher MR relativities were measured in the pancreas of normal mice compared with diabetic mice 24 hours after contrast injection. (Image reprinted with permission of Proceedings of the National Academy of Science)

IMPLICATIONS: This imaging strategy may prove invaluable in helping identify early insulitis and for monitoring therapeutic interventions aimed at stopping its progression. MGH has already safely used the method in human clinical trials to detect the spread of prostate cancers to the lymph nodes.

u get the latest on sumer's radiology site

AIIMS NOV 2004 FULLY SOLVED!!!

aiims nov 2004
cost-150/-
new concept-online support with mcq discussion board
www.sumerdoc.blogspot.com

highlights-extensive flowcharts and diagrams with special emphasis on protocols. beautiful explaination of the flow-volume curve with to the point diagrams.

features-fully solved and explained by sumer sethi and sidharth sethi is available in the market...highlights of the book are authentic references including harrisons 16th edition, diagrams and flowcharts, extensive coverage of topics so that all repeat questions are tackled...and first book of its kind to give extensive online support with an online discussion forum support by the author.. also by the same author "review of radiology" solving quite a few questions in this aiims!! and may 2004 aiims fully solved peepee publishers..one of the main features of this book is in the reference the author has not modified the exact language of the text taken from standard textbooks so that it is very reliable not biased by personal beliefs.. personal beliefs or fundas built without text basis are usually disastrous for mcq exams so emphasis has been kept on what the latest and most standard books say.. wherever possible and required multiple references have been given...
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Acute appendicitis. Ultrasound examination of the right lower quadrant demonstrates a tubular, hyporeflective, noncompressible structure with diameter of 8 mm. Hyporeflective aspect of adjacent fatty tissue is due to inflammatory oedema.

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journal watch

Pulmonary Nodules on Multi-Detector Row CT Scans: Performance Comparison of Radiologists and Computer-aided Detection.
Rubin GD, Lyo JK, Paik DS, Sherbondy AJ, Chow LC, Leung AN, Mindelzun R, Schraedley-Desmond PK, Zinck SE, Naidich DP, Napel S.Departments of Radiology and Electrical Engineering, Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105.
PURPOSE: To compare the performance of radiologists and of a computer-aided detection (CAD) algorithm for pulmonary nodule detection on thin-section thoracic computed tomographic (CT) scans.
MATERIALS AND METHODS: The study was approved by the institutional review board. The requirement of informed consent was waived. Twenty outpatients (age range, 15-91 years; mean, 64 years) were examined with chest CT (multi-detector row scanner, four detector rows, 1.25-mm section thickness, and 0.6-mm interval) for pulmonary nodules. Three radiologists independently analyzed CT scans, recorded the locus of each nodule candidate, and assigned each a confidence score. A CAD algorithm with parameters chosen by using cross validation was applied to the 20 scans. The reference standard was established by two experienced thoracic radiologists in consensus, with blind review of all nodule candidates and free search for additional nodules at a dedicated workstation for three-dimensional image analysis. True-positive (TP) and false-positive (FP) results and confidence levels were used to generate free-response receiver operating characteristic (ROC) plots. Double-reading performance was determined on the basis of TP detections by either reader.
RESULTS: The 20 scans showed 195 noncalcified nodules with a diameter of 3 mm or more (reference reading). Area under the alternative free-response ROC curve was 0.54, 0.48, 0.55, and 0.36 for CAD and readers 1-3, respectively. Differences between reader 3 and CAD and between readers 2 and 3 were significant (P < .05); those between CAD and readers 1 and 2 were not significant. Mean sensitivity for individual readings was 50% (range, 41%-60%); double reading resulted in increase to 63% (range, 56%-67%). With CAD used at a threshold allowing only three FP detections per CT scan, mean sensitivity was increased to 76% (range, 73%-78%). CAD complemented individual readers by detecting additional nodules more effectively than did a second reader; CAD-reader weighted kappa values were significantly lower than reader-reader weighted kappa values (Wilcoxon rank sum test, P < .05).
CONCLUSION: With CAD used at a level allowing only three FP detections per CT scan, sensitivity was substantially higher than with conventional double reading.


Radiology. 2004 Nov 10; [Epub ahead of print]

this is scary!!!!

Tuberculosis risk high among Indian resident physicians

Resident doctors in India have nearly nine times the risk of contracting tuberculosis from their patients than the general population has of contracting the disease, researchers from Chandigarh, India, report.
"Due to the exceptionally high burden of tuberculosis in the general population in India, it is expected that doctors caring for such patients have a high probability of acquiring the disease," Dr. KG Rao and colleagues write.
To assess this increased risk, Dr. KG Rao and colleagues from the Post Graduate Institute of Medical Education and Research evaluated 873 doctors in various stages of their residencies.
The resulting study population was divided into two groups: group one - comprised of 470 doctors who were already undergoing residency in January 2001 when the study began, and group two, comprising 231 residents who joined during 2001. Researchers administered a detailed questionnaire on their medical history, previous and present exposure to tuberculosis, and treatment to group one at the start of the study and to group two after completion one year of training.
Thirteen residents in both groups, including nine (1.9%) in group one and 4 (1.7%) in group two contacted tuberculosis during the course of residency, giving an overall risk of 17.3 per 1000, nearly nine times higher than the population risk in India, Dr. Rao and colleagues report in the November issue of International Journal of Tuberculosis and Lung Diseases.
Extrapulmonary tuberculosis was predominant, with six (67%) residents in group 1 and three (75%) from group 2 developing this severe form of the disease, the researchers add. The incidence of extrapulmonary tuberculosis was significantly higher in the general population, probably because of repeated contact and prior exposure to tuberculosis, they suggest.
As compared to a previous 40-year cohort study on tuberculosis risk in US physicians, the risk of tuberculosis among Indian residents was eight times higher, the authors note. This could be due to the low tuberculosis prevalence in the US, they postulate.
"The most appropriate method of preventing such transmission is effective treatment of smear-positive pulmonary tuberculosis patients with standard four-drug anti-tuberculosis therapy, as most patients become non-infectious after 2 weeks of treatment if the organism is drug-sensitive," the authors conclude.

Int J Tuberc Lung Dis 2004; 8:1392-1394.

MR, axial T2-weighted image, shows the absent vermis and hypoplasia of the cerebellar hemispheres and a large posterior fossa cyst!!
THE DANDY WALKER MALFORMATION!!!
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chondrodysplasia punctata!!!
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thumb printing-ISCAEMIC COLITIS!!!
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MRCP image annular pancreas showing typical ductal loop!!!
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biconvex extradural hematoma!!!
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