Imaging Shows Bird Flu Characteristics

Jul 26, 2013

With the help of medical imaging, researchers have identified unique characteristics in patients infected with the newest strain of bird flu, according to a study published in Radiology.

Chest radiographs and computed tomography scans revealed common radiologic findings that may help physicians diagnose H7N9, a subtype of bird flu. The first human outbreak of the deadly, pneumonia-causing virus was reported in China in March 2013.  

Two radiologists reviewed clinical data and medical imaging scans from nine male and three female patients who presented with pneumonia symptoms like a fever, cough, shortness of breath, white phlegm and loss of strength. All patients underwent chest radiography and thin-section CT as an initial exam, with chest x-rays taken every one or two days to monitor disease progression and treatment response.

The study revealed that H7N9 is characterized by ground-glass opacities, air bronchograms, interlobular septal thickening with right lower lobe predominance, and rapidly progressive changes in the lungs and pulmonary connective tissues. Less commonly occurring patterns included centrilobular nodules, reticulations, cystic changes, bronchial dilation and subpleural linear opacities.

According to researchers, the severity of medical imaging findings mirrored the severity of the virus. Researchers suggest that medical imaging could be a crucial aid in the early diagnosis of H7N9

Source:http://www.asrt.org

Radiation dose optimization is crucial in pediatric imaging.

Radiation dose optimization is crucial in pediatric imaging.

                                                            K.M Chapagain(RT)

Pediatric radiography is highly dedicated speciality.  For state-of-the-art pediatric radiology highest level of medical expertise and the newest imaging techniques are required for  limiting exposure to ionizing radiation. Child friendly environment is also very important for their proper  co-operation. Specialty education in field of pediatric radiography is essential in order to better understand pediatric diseases and pathologies and to develop advanced imaging techniques tailored to the specific needs of children. 
Plain film radiography ,fluoroscopy ,Computerized tomography ,magnetic resonance imaging and ultrasonography are  the radiological modalities of choice for pediatric imaging.Magnetic resonance imaging and ultrasonography uses non ionic EM radiation and sound wave respectively   for imaging . Plain film radiography and computerized tomography contribute most of pediatric examination and they uses ionizing radiation .Protection from ionizing radiation is more important for rapidly growing pediatric age group because they are in  the most sensitive stage of human life from radiation. So dose optimization is very- very important for imaging of children. Learning of suitable protection method and mechanism for pediatric examination is essential for imaging specialist. Here I am trying to explore some of possible mechanism to reduce radiation dose without significant compromising the image quality.
choices of modalities
We should try to use  modality with non ionizing radiation  whenever possible, for pediatric patient ultrasonography and magnetic resonance imaging are the first line of choice. Pediatric patient are firstly evaluated by such modalities. Doppler ultrasound can be used as vascular imaging modality.
Ultra low dose radiography.
Low dose high quality radiography is essential for pediatric radiography setting.Initially Calcium tungstate screen were used which are latter replaced by rare earth phosphor e.g Gd –oxysulphide which yield greater X-ray absorption and X-ray to light conversion efficiency than CaWo4.Cassette  front with carbon fiber attenuate very minimally and helpful for dose reduction,  but are quite expensive and brittle. Cassette with Du pont Kevlar front are durable and cost effective. Erbium rare elements with atomic number 68 can be used as effective filter to reduce low energy beam.( which only contribute for more entrance skin exposure).Portable and dedicated NICU machine are appropriate for such filter.
  Proper restraining of small and uncooperative child to minimize film retake due to patient motion and  malpositioning is very important. velcro strap are one of example .Radiation beam should be  tightly collimated. and shielding to gonadal region is important for high radiation exam and procedure with repeating exam. Use of  grid and phototiming is discouraged in pediatric radiology setting. Use of  digital radiography with direct image capture device like FPD are the latest modality of choice which have lower radiation dose than computer radiography system.
Ultra low dose fluoroscopy.
Routine fluoroscopy equipment has one of the site where highest radiation dose is exposed. Fluroscopy procedure should be restricted only for those having strong indication otherwise alternative modality should be used. For pediatric suite pulsed fluoroscopy is used to decrease radiation exposure rate. Digital fluoroscopy with low exposure rate is the modern choice for pediatric fluoroscopy.
D. Low dose computed tomaography .
Keeping radiation dose as low as reasonably achievable is important in computer tomography, it remains the most important strategy for decreasing radiation induced potential risk.Dose reduction in  pediatric CT examinations is of particular importance because the risk to children due to radiation exposure is two- to three-times greater than the risk to adults . This is because children’s organs are more sensitive to radiation exposure and they have a much longer life expectancy relative to adults, thereby allowing more time for a potential radiation-induced cancer to develop. To reduce radiation dose in pediatric CT, the most important first step is to carefully assess the risk and benefit of CT for each patient. When alternative imaging modalities with less or no radiation exposure are readily available and that can adequately answer the clinical question, these methods should be considered for use instead of the CT. Multiphase examinations should be avoided if the information obtained from a single-phase scan is already sufficient.When a CT examination is deemed necessary for a pediatric patient, scanning protocols specifically designed for children must be used. 
Adapting the dose level to different patient size is very important in pediatric cases. Patient size-dependent scanning techniques include the use of AEC, manual technique charts and size-dependent bowtie filters. In AEC, the tube current is automatically modulated according to the patient size. The adjustment is based on target noise levels for different patient sizes. For head CT, the mAs reduction from an adult to a newborn of approximately a factor of 2–2.5 is appropriate.
The use of lower tube potentials in pediatric patients to reduce radiation dose has been actively investigated. Pediatric patients are less attenuating than adults, so the lower tube potential settings usually give better iodine contrast without significantly increasing the noise for the same radiation dose. Conversely, we could reduce the radiation dose and achieve the same or improved iodine CNR relative to 120 kV.
Fast rotation time and a high helical pitch are desirable in pediatric CT in order to reduce motion artifacts. Because of tube current limitations, the maximum achievable dose level (determined by maximum mAs/pitch) can also be limited, especially for lower tube potential settings. Therefore, a higher tube potential may still be necessary for bigger children, which demands a weightor size-based kV/mAs technique chart. Third, lower tube potential tends to generate more artifacts than higher tube potential in the presence of high attenuating object such as bright iodine contrast and bone owing to the more significant beam-hardening effect. In addition, lower tube potential may lead to increased noise and deceased contrast of soft tissues and other structures without iodine uptake. Thus, lower tube potential may not be appropriate for every examination and has to be carefully evaluated before its use.

Conclusion-:
To sum up, medical  radiation protection is very important for pediatric imaging. Radiation exposure can be reduced by the help of TDS principle. Imaging expert in the field of pediatric radiology  knows all the principle of dose optimization and limitation in during imaging. Justification for the investigation is also important in such imaging. Dedicated pediatric imaging suite having different dose optimization option and dedicated digital radiography suite specially designed for pediatric imaging  are using widely nowdays.The specialization in pediatric radiography and computed tomography is essential. Due to dose consideration and technological advancement the future  of pediatric imaging will be surely shifted  towards non ionizing modality.
Refrences-
Thomas KE, Owens CM, Britto J, Nadel S, Habibi P, Nicholson R. Efficacy of chest CT in a pediatric ICU: a prospective study.
Kamel IR, Hernandez RJ, Martin JE, Schlesinger AE, Niklason LT, Guire KE. Radiation dose reduction in CT of the pediatric pelvis. Radiology 1994;
Bushberg JT, Seibert JA, Leidholdt EM, Boone JM. Essential physics of medical imaging 2nd ed Philadelphia, Pa: Lippincott, Williams & Wilkins.
American journal of  roentgenology.

Medical Vacancy in KDC.....

Detailed Job Description / Requirements

KANTIPUR DENTAL COLLEGE TEACHING HOSPITAL & RESEARCH CENTRE (KDCH) was established in the year 2007. lt has been recognized by the Nepal Medical Council and the Government of Nepal Ministry of Education / Health and Population and affiliated to Kathmandu University. Since last 7 year, we proved ourselves as pioneer institution in the field of Oral health and Dental education. Now we are extending our service in the field of General Hospital. KDC -General Hospital a 100 beded multi speciality Hospital invites application from qualified candidates for the following position.

1. ECG Technician
2. Dietician
3. Radiographer - 02
4. Assistance radiographer

Submit your application with complete documentation at human resource department Kantipur dental college and hospital Bashundhara Kathmandu Nepal before 15th August 2013.

Shortlisted candidates will be contacted for interview will be contacted for interview process.

Kantipur Dental College

Teaching Hospital & Research Center

Basundhara Ring Road, Kathmandu - 3,

Phone: (977)1 4385910/4385911

Fax: (977) 1 4385912

Email: kdch@wsn.com.np

Note: Published in Kantipur Daily Newspaper

Date: 04/08/2013

एमबिबिएस अध्ययनरत २० बिद्यार्थी कलेजबाट निस्कासित

एमबिबिएस अध्ययनरत २० बिद्यार्थी कलेजबाट निस्कासित

चिकित्शा शास्त्र अध्ययन संस्थान (आइओएम)ले त्रिभुवन विश्वबिद्यालय अन्तर्गतका मेडिकल कलेजमा एमबिबिएस अध्ययनरत २० जना विद्यार्थीको भर्ना रद्ध गरी कलेजबाट निस्कासन गरेको छ । बोर्डले एमबिबिएस पहिलो बर्षको दास्रो सेमेस्टरमा ४ पटक सम्म फेल भएपछि भर्नारद्ध गर्ने गर्छ । आइओएम परीक्षा बोर्डको ५०१ औं बैठकले भर्ना रद्ध गर्ने निर्णय गरेको हो ।  भर्ना रद्ध गरेको जानकारी आइओएमले २०७० साउन ८ गते पत्रलेखि कलेजलाई जानकारी गराएको छ । बोर्डले जानकि मेडिकल कलेजका १८, चितवन मेडिकल कलेजका एक र आइओएमको एक गरी २० जनाको भर्ना रद्ध गरेको हो । भर्ना रद्ध गरेका बिद्यार्थीले पढ्न पाउदैनन् । एकैपटक एउटै कलेजमा अध्यनरत १८ जना बिद्यार्थीको भर्ना रद्ध गरेको यो पहिलो पटक हो ।

भर्ना रद्ध हुने विद्यार्थीको संख्या बढ्दै गएपछि यसवर्ष देखि आइओएमले विद्यार्थीलाई २ पटक सम्मका लागि अवसर दिने फ्याकल्टि बोर्डले निर्णय गरेको आइओएमका सहायक डिन डा. शरद वन्तले बताए । उनका अनुसार बिद्यार्थीले परीक्षा फराम नभरी परिक्षा नदिने लिखित निबेदन दिएमा वा कलेजले आग्रह गरेमा २ पटक सम्म परीक्षा नदिन पाउने छन् । यो कमजोर बिद्यार्थीलाई दिइएको अवसर हो । तर परीक्षा फाराम भरेर परीक्षामा सहभागी नभए फेल सरहनै परीक्षा काउन्ट हुन्छ ।

भर्ना रद्ध गरेका १८ बिद्यार्थीले गत बुधबार देखि जानकि मेडिकल कलेजमा आन्दोलन गरेका छन् । जानकिका रद्धमा परेका सबै बिद्यार्थी भारतीय नागरीक हुन् ।  जानकि कलेज स्रोतका अनुसार कलेजका सञ्चालक वाइपी पाण्डेले कुरा मिलाउछु भन्दै बिद्यार्थीलाई आश्वासन दिएका थिए । उनले कुरा मिलाउन नसकेपछि बिद्यार्थी आक्रोसित भएर आन्दोलनमा लागेका हुन् । (source: swasthey khabar patrika)

Vacancy......

X-ray Technician - Radiographer

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I. MSF INTERNATIONAL

Médecins Sans Frontières (MSF) is an international, independent, medical humanitarian
organisation that delivers emergency aid to people affected by armed conflict, epidemics,
 healthcare exclusion and natural disasters. MSF offers assistance to people based only on
 need and irrespective of race, religion, gender or political affiliation.

MSF International is the legal entity that binds MSF’s 19 sections, 23 associations and other
offices together. Based in Geneva, MSF International provides coordination, information
and support to the MSF Movement, as well as implements international projects and
initiatives as requested. MSF International also provides administrative support to the MSF
 Access Campaign

II. BACKGROUND OF THE POSITION

In 2007, an MSF intersectional working group on diagnostics was formed including a subgroup
 focusing on Diagnostic Imaging (DI). The working group determined key recommendations
 and is currently seeking an MSF intersectional radiographer who can support in the
implementation of the following key recommendations:

• Ultrasound for diagnosis in hospitals where MSF supports obstetrics/gynaecology and/or 
• surgical programs
• X-ray access in TB/HIV programs
• X-ray access in all surgical programs with orthopaedic focus

III. PLACE IN THE ORGANISATION

• Reports to the Diagnostic Network (DN) leader who in turn works under the
•  International Medical Coordinator
• While in the field is accountable to the relevant Medical Coordinator

IV. OBJECTIVE OF THE POSITION

• Support the translation of the DI recommendations into actions
• Increase DI capacity, quality and availability in MSF’s field programs
• Act as diagnostic imaging advisor for medical/public health departments and field staff
•  for all MSF sections
• Stimulate debate within MSF (Operational Centers and field) by discussing key issues/
• questions raised regarding DI
• Collaborate with the team of biomedical engineers for the selection and follow-up of
•  use/performance of DI equipment.

Specific tasks

• Report regularly to the DN leader on progress and activities and upon request to Medical
•  Directors and relevant WGs
• Attend and contribute in internal platforms as MSF radiographer (e.g. diagnostic imaging,
•  surgical, reproductive health, TB working groups)
• Motivate and support health advisors/medical department staff and field teams on the 
• implementation of the diagnostic strategy and DI recommendations
• Promote and ‘market’ the role of diagnostic imaging in MSF to Operations and Medical 
• Departments
• Establish and maintain contacts/networks between MSF and international health 
• authorities (e.g. World Health Organization),
•  industry and other relevant stakeholders for technical issues linked with DI
• Undertake field trips to evaluate the planning, use and quality of ultrasound and 
• radiography in MSF projects and provide on-site training to field teams
• Support and train field staff on safe use of radiology equipment and production of high
•  quality images
• Provide updated overview on international research and development on diagnostic 
• imaging progress relevant to MSF programs
• Identify key research priorities in diagnostic imaging for MSF together with the disease
•  specific working groups and propose to the Medical Directors operational research
•  protocols to address these priorities.
• Act as radiation protection focal point for MSF: liaise with health advisors (HA)/
• polyvalent and Medical Coordinators 
• regarding adherence to local radiation law in countries where MSF operates and 
• develop guidelines for all aspects of radiation protection relevant to MSF
• Develop and implement a training strategy to address radiographic and radiologic 
• training needs in DI
• Continue the development and implementation of quality assurance systems for DI in MSF
• Participate with the intersectional group for the selection, availability, and best price
•  of quality equipment and advise procurement as needed in collaboration with 
• International Catalogue (ITC) and biomedical engineers
• Extend and coordinate a well functioning network of volunteer radiologists and
•  radiographers to undertake field trips for training and providing teleradiology services
• Develop and identify resource materials available for field and headquarters
• Promote and facilitate the use of teleradiology in MSF field sites

V. PROFILE

Professional Training

• Radiographer/Medical Imaging Technologist

Work experience

• 5 years working experience
• Experience in radiography (i.e. x-rays) of both children and adults
• Experience in ultrasound; particularly in obstetrics
• Experience in training and coaching
• Familiar with Quality Assurance systems in radiography
• Ideally experienced in working in resource-limited settings

Specific skills

• Excellent networking and communication skills including proven report writing ability
• Ability to motivate and lead medical colleagues
• Ability to translate strategy and policy into operational practice in the field
• Proven strategic and analytical skills in order to provide strong leadership and vision
•  in DI
• Flexibility to travel and to spend up to 30% of time on work related travel to field sites 
• or European headquarters
• Enthusiastic, motivated and independent; able to work with minimal supervision
• Knowledge of the humanitarian world; commitment and passion for the goals and work
•  of MSF
• Computer literacy: Microsoft Office is essential
• Fluent in English and optimally in French (reading and writing)
• Prior research experience is desirable

Starting date: As soon as possible

Contract: 100% - Fixed term 24 months with possible extension

Location: Amsterdam, Brussels, Paris, Geneva or Barcelona

Salary: Salary equivalent to a health specialist / senior health expert in the section
where the position is based

Deadline for applications: 31 August 2013 

Please submit all applications only by email to: IO-recruitment.gva@msf.org stating
 “X-ray Technician-Radiographer” in the title

Please submit only one zip file containing your CV and cover letter and name in ONE file
 with your last name.

Only short-listed candidates will be contacted.

Bachelor entrance open .....................notice!

Bachelor entrance open .....................notice!

example questions for LOK SEWA AAYOG

1. The specially designed port in x-ray tube through which useful x-ray beam emmited is called:
a. Collimator b. Window
c.Filter d. Cone
2. Phase voltage is that voltage is that voltage which exists:
a. between one phase and neutral wire b. between two phases
c. both a. and b. d. none of the above
3. The tube current is the current which flows in the:
a. Filament b. Transformer
c. X-ray tube cathode to anode d. Rectifier
4.The expansion bellows are generally made up of:
a. Rubber b. Plastic
c. Neoprene d. Any of the above material
5. Timer is the device which is responsible to :
a. Initiate an exposure b. Time the exposure
c. Terminate the exposure d. All of the above
6. The most effective device for reducing the amount of scattered radiation , reaching to the film is:
a. Cone b. Diaphragm
c. Stationary Grid d. Filter
7. The performance of Grid can be assessed by:
a. thickness of lead strips b. Lead contents of grid
c. Nature of interspace material d. All of the above
8. The brightness of fluoroscopic material is measured in:
a. Milli-lamberts b. Lamberts
c. Lumen d. None
9. Visual aquity is defined as:
a. photopic vision b. Scotopic vision
c. Mesopic vision d. Telescopic vision
10. The illumination range of conventional fluoroscopic vision is between:
a. 10-1000 mLamberts b. 0.01 to 0.0001 mLamberts
c. 0.00001 to 0.000001 mLamberts d. 100 to 100000 mLamberts
11. The image intensifier tube is complex electronic device and consists of :
a. input phosphor b. Photocathode
c. Output phosphor d. All of the above
12.In modern image intensifier tube, the input phosphor has the  layer of:
a. ZnCdS b. CsI
c. Calcium Tungstate d. All of the above
13.The body section of radiography is also known as:
a. Tomography b. Straitography
c. Laminography d. All of the Above
14.Name the physicist associated with computed tomograhy:
a. GN Hounsfield b. Potter
c. Twinning d. Bucky
15. The main components of CT Scanner is/are:
a. Gantry b. Console
c. Computer d. All of the above
16. Detectors used in CT Sanners are:
a. NaI crystals b. Scintillation Detectors
c. Gas Detectors d. All of the above
17. The CT Number of dense tissue like bone is:
a. 10HU b. 100HU
c. 1000HU d. 10000HU
18. For designing MRI room one should use:
a. Poluvenyl Chloride reinforcing rods b. Iron reinforcing bars
c. Magnetic material d. All of the above
19. The parameters for MR imaging are :
a. Spin density b. Spin lattice relaxation time, T1
c. Spin Spin relaxation time, T2 d. All of the above
20. The gantry for MR imaging system consists of:
a. Enormous magnet & xray tube b. Enormous magnet, Shim coils, Gradient coils, RF transreceiver coils
c. Enormous magnet and high  currentpower     d.None of the above
supply