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Do the majority of Malaysian women have dense breasts on mammogram?

Biomedical Imaging and Intervention Journal.2011;7(2):1-6.

Purpose: To determine: (i) the mammographic parenchymal patterns in Malaysian women and whether the breasts are dense on mammogram; (ii) the effect of age on breast density; (iii) the effect of parity on breast density; (iv) the difference in breast parenchymal patterns among the major races of women in Malaysia. Methods: This was a descriptive cross-sectional study of 1,784 patients (981 Malays, 571 Chinese, 214 Indians and 18 others) who had undergone mammography during the 1-year study period. Majority of women (41.7%) were aged between 51 and 60 years and majority (43%) had 3–4 children. The Tabar classification (Pattern I - V) was used to evaluate breast parenchymal patterns on mammogram. Tabar Pattern I was further divided into 3 sub-groups (Pattern IA, IB, and IC). The different patterns were then grouped into dense (IB, IC, IV, V) and not dense (IA, II, III) breasts. The SPSS package was used for statistical analysis. Results: Majority (59%) of Malaysian women had dense breasts (Pattern IB 29%, IC 20%, IV 5%, and V 5%) and 41% did not have dense breasts (Pattern IA 28%, II 6%, and III 7%). Age and parity were inversely related to breast density (p < 0.0001). Chinese women (65.7%) had the highest percentage of dense breasts (p = 0.69, odds ratio = 1.22), followed by the Indians (57.2%) and the Malays (50.5%). Conclusion: Majority of women had dense breasts but Pattern IV, which has been associated with increased risk of breast cancer, was seen in only 5% of the women. The breast density reduced steadily with increasing age and parity. There was no statistically significant difference in breast density in the three main races.

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Reference Dosimetry according to the New German Protocol DIN 6800-2 and Comparison with IAEA TRS 398 and AAPM TG 51*

Zakaria A* ; Schuette W ; Younan C

Biomedical Imaging and Intervention Journal.2011;7(2):1-10.

The preceding DIN 6800-2 (1997) protocol has been revised by a German task group and its latest version was published in March 2008 as the national standard dosimetry protocol DIN 6800-2 (2008 March). Since then, in Germany the determination of absorbed dose to water for high-energy photon and electron beams has to be performed according to this new German dosimetry protocol. The IAEA Code of Practice TRS 398 (2000) and the AAPM TG-51 are the two main protocols applied internationally. The new German version has widely adapted the methodology and dosimetric data of TRS-398. This paper investigates systematically the DIN 6800-2 protocol and compares it with the procedures and results obtained by using the international protocols. The investigation was performed with 6 MV and 18 MV photon beams as well as with electron beams from 5 MeV to 21 MeV. While only cylindrical chambers were used for photon beams, the measurements of electron beams were performed by using cylindrical and plane-parallel chambers. It was found that the discrepancies in the determination of absorbed dose to water among the three protocols were 0.23% for photon beams and 1.2% for electron beams. The determination of water absorbed dose was also checked by a national audit procedure using TLDs. The comparison between the measurements following the DIN 6800-2 protocol and the TLD audit-procedure confirmed a difference of less than 2%. The advantage of the new German protocol DIN 6800-2 lies in the renouncement on the cross calibration procedure as well as its clear presentation of formulas and parameters. In the past, the different protocols evoluted differently from time to time. Fortunately today, a good convergence has been obtained in concepts and methods.

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Radiofrequency ablation of a misdiagnosed Brodie’s abscess

Chan RS* ; Abdullah BJJ ; Aik S ; Tok CH

Biomedical Imaging and Intervention Journal.2011;7(2):1-5.

Radiofrequency ablation (RFA) therapy is recognised as a safe and effective treatment option for osteoid osteoma. This case report describes a 27-year-old man who underwent computed tomography (CT)-guided percutaneous RFA for a femoral osteoid osteoma, which was diagnosed based on his clinical presentation and CT findings. The patient developed worsening symptoms complicated by osteomyelitis after the procedure. His clinical progression and subsequent MRI findings had led to a revised diagnosis of a Brodie’s abscess, which was further supported by the eventual resolution of his symptoms following a combination of antibiotics treatment and surgical irrigations. This case report illustrates the unusual MRI features of osteomyelitis mimicking soft tissue tumours following RFA of a misdiagnosed Brodie’s abscess and highlights the importance of a confirmatory histopathological diagnosis for an osteoid osteoma prior to treatment.

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Education and training of medical physicists in South East Asia: accomplishments and challenges

Thomas BJ

Biomedical Imaging and Intervention Journal.2011;7(3):1-3.

John Cameron has made significant contributions to the field of Medical Physics. His contributions encompassed research and development, technical developments and education. He had a particular interest in the education of medical physicists in developing countries. Structured clinical training is also an essential component of the professional development of a medical physicist. This paper considers aspects of the clinical training and education of medical physicists in South-East Asia and the challenges facing the profession in the region if it is to keep pace with the rapid increase in the amount and technical complexity of medical physics infrastructure in the region.

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Evaluating the clinical teaching of medical imaging students at Curtin University of Technology, Australia

Almohiy HM ; Davidson R

Biomedical Imaging and Intervention Journal.2011;7(3):1-5.

Purpose: To ascertain the effectiveness of the clinical, tutorial-based component of teaching and the clinical assessment method in the Bachelor of Medical Imaging Science at Curtin University of Technology (CUT), Perth, Western Australia. Materials and Methods: In mid-2006, second- and third-year students enrolled in CUT’s Medical Imaging Science degree were asked to complete a questionnaire assessing the Objective Structured Clinical Examination (OSCE) evaluation program and clinical teaching. Thirty-three of 57 students answered questions about demographics and their opinions of the laboratory sessions, clinical placements and the OSCEs. Results: Seventy-six per cent of students were satisfied with their laboratory sessions and clinical placements. Sixty-four per cent of respondents indicated that the OSCE was not an objective evaluation, but 82% of students felt the OSCE was an effective test of their radiography skills and knowledge, and believed that they were able to evaluate and care for a patient during the OSCE. Conclusion: Overall, the surveyed students believed that the practical skills explored in laboratory sessions helped improve clinical training outcomes; however, only 33% of the students were satisfied that the OSCE was an appropriate assessment of their clinical training in hospitals.

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A phase II study of oxaliplatin with 5-FU/folinic acid and concomitant radiotherapy as a preoperative treatment in patients with locally advanced rectal cancer

Chitapanarux I* ; Chitapanarux T ; Tharavichitkul E ; Mayurasakorn S ; Siriwittayakorn P ; Yamada S ; Lorvidhaya V

Biomedical Imaging and Intervention Journal.2011;7(4):1-8.

Objective: To evaluate the activity and safety of adding oxaliplatin to a standard chemoradiotherapy schema, including 5-fluorouracil (5-FU)/folinic acid (FA), in locally-advanced rectal cancer (LARC). Methods: Two cycles of oxaliplatin 130 mg/m2 plus FA 20 mg/m2 bolus for 5 days and 5-FU 350 mg/m2 continuous infusion for 5 days were given during week 1 and 4 of pelvic radiotherapy 46 Gy. Patients with a T3/4 and/or node-positive rectal tumour were eligible. Surgery was performed 4–6 weeks after radiotherapy. The primary endpoint was to determine the rate of pathological response. Secondary endpoints were to assess the rate of clinical response and the safety profile. Results: Between March 2005 and January 2009, a total of 35 patients were enrolled. The pathological downstaging rate was 79% with a pathological complete response rate of 17%. The overall clinical response rate (assessed by computed tomography or transrectal ultrasound) was 77%. Grade 3 diarrhoea and Grade 3 neutropaenia were reported in 14% and 11% of the patients, respectively. Eleven patients did not undergo surgery: four of them refused the operation, and seven patients were inoperable due to disease progression. In 24 patients who had surgery, a sphincter-preserving procedure could be performed in 29%. At the median follow-up time of 28.1 months, 25 patients (71%) survived with no evidence of disease. Conclusion: The promising results in terms of pathological response, and the associated good safety profile of a regimen of oxaliplatin plus 5-FU/FA with concomitant radiotherapy, suggest that the regimen could be used in LARC.

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Pelvic aneurysmal bone cyst

Sharifah MIA* ; Nor Hazla MH ; Suraya A ; Tan SP

Biomedical Imaging and Intervention Journal.2011;7(4):1-3.

This paper describes an extremely rare case of a huge aneurysmal bone cyst (ABC) in the pelvis, occurring in the patient’s 5th decade of life. The patient presented with a history of painless huge pelvic mass for 10 years. Plain radiograph and computed tomography showed huge expansile lytic lesion arising from the right iliac bone. A biopsy was performed and histology confirmed diagnosis of aneurysmal bone cyst. Unfortunately, the patient succumbed to profuse bleeding from the tumour.

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Epidural haemorrhage during embolisation: a rare complication of intra-arterial embolisation of vertebral metastases

Hashim H* ; Abdul Kadir KA

Biomedical Imaging and Intervention Journal.2011;7(4):1-4.

Pre-operative embolisation of vertebral metastases has been known to effectively devascularise hypervascular vertebral tumours and to reduce intra-operative bleeding. However, the complications that occur during the procedure are rarely reported. This case study attempts to highlight one rare complication, which is epidural tumoural haemorrhage intra-procedure. It may occur due to the fragility of the tumour and presence of neovascularisation. A small arterial dissection may also have occurred due to a slightly higher pressure exerted during injection of embolising agent. Haemostasis was secured via injection of Histoacryl into the area of haemorrhage. The patient was able to undergo the decompression surgery and suffered no direct complication from the haemorrhage.

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Ultrasound evaluation of penile fractures

Kachewar SG* ; Kulkarni DS

Biomedical Imaging and Intervention Journal.2011;7(4):1-3.

This short case report discusses the various aspects of penile fracture, which is a rare entity. Nevertheless, the incidence of penile fractures is on the rise due to the increased use of performance-enhancing drugs. An individual with a penile fracture should seek immediate medical referral. Prompt diagnosis and management is necessary to prevent undesirable after-effects as discussed. Emphasis is made on how imaging with ultrasound enables a quick and complete assessment of this mishap.

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Modified teaching approach for an enhanced medical physics graduate education experience

Rutel IB

Biomedical Imaging and Intervention Journal.2011;7(4):1-6.

Lecture-based teaching promotes a passive interaction with students. Opportunities to modify this format are available to enhance the overall learning experience for both students and instructors. The description for a discussion- based learning format is presented as it applies to a graduate curriculum with technical (formal mathematical derivation) topics. The presented hybrid method involves several techniques, including problem-based learning, modeling, and online lectures, eliminating didactic lectures. The results from an end-of-course evaluation show that the students appear to prefer the modified format over the more traditional methodology of “lecture only” contact time. These results are motivation for further refinement and continued implementation of the described methodology in the current course and potentially other courses within the department graduate curriculum.

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