A Detailed Assessment of Variations of Ethmoid Roof, Olfactory Fossa, and Anterior Ethmoidal Artery on CT Scan of Paranasal Sinuses of 200 Patients.

To study and analyse the variations in ethmoid roof anatomy and estimate the anatomical location and variations of AEA on CT scans. The study is conducted on 200 patients for detailed analysis of the olfactory fossa (OF) depth, supraorbital pneumatisation, and AEA location and distance from the skull base. In our study, Keros type II was predominant type seen followed by type I. Asymmetry was noted in 32/200 subjects (16%). The anterior ethmoidal artery (AEA) canal was seen in 341/400 sides (85.2%). We found Keros type II was the most common type in our study. We also found grade I anterior ethmoidal artery as the most common variant and the dangerous grade III anterior ethmoidal artery was least common type found in this study, and there was a significant association of Keros type II with increasing anterior ethmoidal artery grading.

Interobserver reproducibility of RENAL nephrometry score in comparison to simplified PADUA Renal nephrometry score.

Introduction: Nephron-sparing surgery (NSS) is the standard of care for renal tumors, especially in the early stages. RENAL Nephrometry scores provide a comprehensive presurgical predictive module for the choice of NSS or Radical Nephrectomy. The validity and reliability of Nephrometry scores is being tested continuously with advancement in the surgical techniques. The Simplified PADUA Nephrometry score (SPARE NS) is a newer proposed score which aims to better the reproducibility of the previously established nephrometry scores. Materials and Methods: The retrospective observational study studied the comparative inter-observer reliability of RENAL (RENAL NS) and SPARE nephrometry scoring systems amongst two radiologists while assessing solid renal tumors in contrast-enhanced computed tomography scans of 42 patients. Interobserver reliability for all components of both scores, final scores and risk grading was done by Kendall's Concordance Coefficient (Tau). Results: Both RENAL NS and SPARE NS showed strong to excellent agreement (RENAL NS = 78.57% and SPARE NS = 88.09%) among observers with comparable correlation co-efficient (RENAL NS = 0.944 and SPARE NS = 0.935). Lesion radius and exophytic/endophytic properties were the most reproducible components of RENAL NS with 97.61% and 92.85% agreement, respectively. Location across polar lines was the least reproducible component with 85.71% agreement among observers. Exophytic rate (97.61%) and Rim location were the most reproducible components of SPARE NS. The final lesion risk stratification by both observers for both was concordant in 92.85% of cases. Conclusion: The SPARE system of scoring matches up to the RENAL NS in total score and risk stratification reproducibility. However, the individual components of the SPARE score are more reproducible than those of RENAL NS, bringing about better compliance among radiology consultants. Comparable reproducibility with the RENAL NS, lesser number of variables, and ease of doing make SPARE NS a plausible option for the customary preoperative assessment of renal tumors.

Role of Endovascular Treatment in Dysfunctional Hemodialysis Fistulae: A Single Center Experience.

Introduction: Arteriovenous fistulas (AVFs) are the preferred route of hemodialysis in end-stage renal disease. However, recurrent patency loss is an obstacle in long-term maintenance. Endovascular treatments may provide a durable option for prolongation of patency in AVFs. Methods: Retrospective observational study was done on 46 patients with AVF for hemodialysis in the Department of Diagnostic and Interventional Radiology for a period of 1 year from September 2020 to August 2021. The characters of dysfunctional fistulas and results of various interventional procedures were assessed for technical and clinical success rates. Short-term follow-up records of patients were assessed for post-intervention primary patency (PIPP) and post-intervention assisted primary patency (PIAPP) of various procedures. Results: The most successful outcomes post intervention were seen in radio-cephalic fistulas formed more than 1 year ago with juxta-anastomotic narrowing. The overall technical success rate was 89.13% with a PIPP of 78.26% and a PIAPP of 82.60% at 3 months. PTA had better technical success rates (88.23%) as compared to dysfunctional segments with thrombosis that underwent angioplasty and thromboaspiration (84.2%). Central venous stenosis undergoing PTA and stenting had a 100% success rate. At 3 months follow-up, PIPP was better among the angioplasty plus thromboaspiration group (73.7%), while PIAPP rate was better in the angioplasty subgroup at 82.35%. Conclusion: Endovascular intervention is the first-line treatment in dysfunctional AVFs attributable to the multitude of options available, all of which have comparable outcomes, high success rates, and notable short-term patency.

Impact of COVID-19 on postgraduate medical education: Cross sectional survey from an Indian Medical College.

BACKGROUND: The corona virus disease (COVID-19) pandemic has caused widespread effect on the lives of health care professionals. The postgraduate medical students, who are the major pillars of medical institutions had to bear multitude of setbacks due to the pandemic involving academic, research and well-being issues. MATERIALS AND METHODS: This was a cross sectional feedback based online survey done in the month of October 2021 to study the effect of COVID-19 pandemic induced changes in the postgraduate medical education; amongst 78 students pursuing MD/MS degree in all departments of a tertiary medical institute in Himalayan foothills of North India. The questionnaire consisted of ten questions; each of which needed to be answered on a five point Likert scale ranging from strongly disagree to strongly agree. Results were assessed for the most common answers of each question (represented by mode) and association between various components of the questionnaire analyzed by Spearman's rho correlation coefficient. RESULTS: The internal consistency of the questionnaire as tested by Cronbach's Alpha (0.82) was good. Most number or respondents were from surgical branches (n = 31, 39.74%). There was a generalized agreement towards preference of resumption of onsite education (75.64%), the lack of variety of cases causing hampering of thesis work (88.46%) and increased mental stress during the pandemic (58.9%). While more time for self-study was seen as the only consensual positive aspect of online teaching (64%), most students opined that technical glitches are a major roadblock in online education (80.76%). Significant positive correlation was seen between disciplinary ease and punctuality in online teaching (R = 0.543, P < 0.001), lack of interaction and its effect on learning and mental health (R = 0.471; P < 0.001) and the lack of diversity in cases and difficulties in dissertation work (R = 0.351; P < 0.05). Negative correlation was observed between the satisfaction from overall learning through online teaching and the desire of resumption of offline classes (R = -0.491; P < 0.001). CONCLUSION: COVID-19 pandemic and its effects on medical education are long lasting. A comprehensive approach is required to rebuild the medical education curriculum, inculcating both traditional and newer virtual methods of education. A consistent support in academics and overall growth needs to be provided to medical postgraduate residents who have been the first line fighters in face of the massive disaster compromising their basic needs and education.

Effect of vaccination on the HRCT profile of COVID-19 patients - A single-center experience.

Introduction: Vaccination against the global pandemic coronavirus disease 2019 (COVID-19) is a promising way out of the havoc caused by the disease. The clinico-radiological profile of COVID-19 patients in relation to the vaccination status is depicted in the present study. Materials and Methods: This is a retrospective observational imaging and hospital data-based study performed on 214 confirmed and clinically suspicious patients of COVID-19 who underwent high-resolution computed tomography (HRCT) scan of the thorax at the Department of Radio-Diagnosis of a tertiary medical center in the Himalayan foothills. The present study aims to evaluate the effect of vaccination on HRCT findings of COVID-19 populations. Results: Forty-three percent of the non-vaccinated population presented with severe HRCT scores (19-25) in comparison to only 11.5% of the study population who had taken both doses of vaccine (P = 0.018). Two doses of vaccination had a negative Pearson correlation coefficient with severe HRCT scores (-0.146). Co-morbidities had a significant correlation with HRCT severity score, with 61.5% diabetics and 63.33% of hypertensive patients showing scores >19 on HRCT. Conclusion: Vaccination proves to be a game changer in the pandemic with two doses of vaccination having a significant negative correlation with COVID-19-induced severe pneumonitis on HRCT of the thorax.

Pneumomediastinum: Radiological profile and associations of uncommon complication of COVID-19.

Introduction: Spontaneous pneumomediastinum is an uncommon complication of Corona Virus Disease (COVID)-19 presenting mostly in moderate to severe cases. Materials and Methods: This is a retrospective observational imaging and hospital data-based study done on 15 confirmed patients of COVID-19 who underwent high resolution computed tomography (HRCT) thorax at the Department of Radio-Diagnosis of a tertiary medical center in the Himalayan foothills. The clinico-radiological profile of the study group was assessed and it was aimed at finding the association of pneumomediastinum with the severity of lung changes. Results: A strong association of pneumomediastinum was observed with severe lung changes on HRCT thorax (n = 13, 87%, P < 0.00001). Dyspnea was the most common presenting factor. The mortality rate is high in mechanically intubated patients of pneumomediastinum with COVID-19 (75%). Conclusion: Pneumomediastinum is a complication of a severe COVID-19 disease spectrum. Along with severe lung parenchymal disease, systemic inflammation, systemic steroid therapy, comorbid state, and mechanical intubation, it is a part of the pool of poor prognostic factors. HRCT is essential for making a quick and comprehensive diagnosis, thereby, guiding the clinician for further management.

'Phenytoin: Shepherd or Wolf in Disguise? Phenytoin-Induced Neurotoxicity: A Case Series.

Phenytoin is a commonly used antiepileptic drug for various types of seizure disorders except for absent seizures. Long-term dose-dependent neurological side effects of phenytoin therapy include cerebellar atrophy, cerebral atrophy, and brain stem atrophy. Skull hyperostosis, gum hypertrophy, and megaloblastic anemia are other known effects of long-term therapy. We present four cases depicting clinical and neuroimaging findings of phenytoin-induced toxicity.

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center.

INTRODUCTION: An organization's transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. AIM: To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. MATERIALS AND METHODS: To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP's), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. RESULTS: A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. CONCLUSION: Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety.

MRI in Chemotherapy induced Leukoencephalopathy: Report of Two Cases and Radiologist's Perspective.

Leukoencephalopathy is a progressive white matter disease primarily caused due to myelin damage by a variety of factors. Chemotherapy for oncological treatment is an uncommon but important cause of potentially reversible leukoencephalopathy. In current radiological setting, conventional and diffusion weighted MRI play a significant role in early and accurate detection of this entity. We are hereby presenting MRI evaluation of two cases of methotrexate and 5-fluorouracil induced toxic leukoencephalopathy.