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Objective: To determine the correlation of renal ultrasonographic parameters with serum creatinine levels in patients with chronic kidney disease. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep 2020 to April 2021. Methodology: One hundred thirteen patients with chronic kidney disease (Stages 1 to 4) were enrolled in a cross-sectional study. Detailed history and examination were carried out. Serum creatinine levels were carried out, and findings were noted. All patients underwent renal ultrasonography evaluation, kidney parameters were assessed, findings were noted, and statistical analysis was performed. Results: The mean age of the patients was 42.96±12.71 years, the duration of Chronic kidney disease was 30.38±14.59 months, the length of the kidneys was 7.15±1.84 cm, the volume of the kidneys was 59.4±12.7 ml, the thickness of the renal cortex was 3.78±1.41 cm, thickness of renal parenchyma was 8.33±1.71 mm and serum creatinine levels were 5.36±2.63. Renal ultrasound parameters negatively correlated for length of kidneys r=-0.187 (p=0.047), for volume r=-0.133 (p=0.161), for cortical thickness r=-0.285 (p=0.002) and parenchymal thickness r=-0.083 (0.382) with serum creatinine level and only cortical thickness and length of kidneys had significant correlation with it.Conclusion: Ultrasound assessment is an easy and reliable tool. Measurement of cortical thickness and length of kidneys must be routinely incorporated in the ultrasonographical assessment of patients with Chronic kidney disease.

Objective: To evaluate the patients' feedback for potential improvements in the patient management of PET-CT Department. Study Design: Cross-sectional survey. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep to Dec 2020. Methodology: A total of 350 participants were investigated in the study. Structured proforma was utilized for collecting patient feedback, and the ages ranged from 4 to 89 years. The collected data were arranged systematically to apply statistical tests using Microsoft excel. Results: Explicitly, 14(4%) patients communicated their reservations about further development in PET-CT scan practice. In this regard, 4(1.14%) patients suggested overall improvement in the department. Further, 4(1.14%) and 3(0.86%) patientss’ suggestions were towards staff behaviour and building of the department, respectively. Additionally, 2(0.57%) patients were not contented with the available prerequisite equipment, and 1(0.29%) patient suggested a reduction in scanning charges. Conclusion: More than 95% patients were satisfied with their experience. The studied data can be utilized to establish patient management protocols for similar PET-CT departments.

Objective: To compare and observe the differences of 18F-FDG produced using FDG citrate and FDG duo citrate cassette on the GE Healthcare FASTlab2 Synthesizer system following standard operating parameters. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep 2020 to Aug 2021. Methodology: Comparison of 18F-FDG produced using FDG citrate and FDG duo citrate cassette on FASTlab2 consists of evaluating the estimated yield uncorrected (EYUC), estimated yield decay corrected (EYDC), radiochemical purity (RCP), synthesis duration and tracer volume in both cassettes. Sixty Batches of each FDG citrate and duo citrate cassettes were utilized to obtain the required results. Results: Results acquired by comparing the mean yield of FDG citrate and FDG duo citrate cassette were 74.98±8.92% for EYUC and 86.35±10.26% for EYDC for the FDG citrate cassette. At the same time, the mean RCP turned out to be 99.58±1.06% for the citrate cassette and 99.9±0.35 for the duo citrate cassette. The mean synthesis duration of FDG was 24.21±0.76min and 24.75±0.43min for the citrate cassette and duo citrate cassette correspondingly, and the volume of the tracer was 3.5ml for both cassettes. Conclusion: The results obtained by comparing these two cassettes were within the range of acceptable limits as claimed by the manufacturer, with a single cassette offering more yield as compared to a duo cassette, while the radiochemical purity, pH and volume of the tracer were found to be identical in both cassettes.

Objective: To find out the optimal timeline for the safe disposal of radioactive wastes generated at the end of normal and anomalous productions of 18F-Fluorodeoxyglucose for positron emission tomography-computed tomography scans. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Aug to Dec 2020. Methodology: Wastes generated at the end of 18F-Fluorodeoxyglucose production were tested for residual radioactivity at 2, 12 and 24 hours after synthesis to ascertain the optimal timeline for discarding. The radiation dose at 5 cm from the surface of the container was also assessed. Results: Fifty productions were included in the study, of which 46(92%) were normal, and 4(8%) were anomalous productions. The mean activity at 2 and 24 hours after the end of synthesis was 4.102±0.831mCi and 0.0047±0.00116mCi, respectively, in normal productions and 45.125±2.332mCi and 0.005±0.00026mCi respectively in anomalous productions. The mean radiation dose at 5cm from the surface of the container at 2 and 24 hours after the end of synthesis was 8.2107±1.665mSv/h and 0.00000966±0.00000212mSv/h in normal productions and 90.32±4.66mSv/h and 0.00975±0.0005-mSv/h respectively in anomalous productions. Conclusion: The residual radioactivity in wastes was negligible 24 hours after the end of synthesis in both normal and anomalous productions. Radioactive wastes from 18F-Fluorodeoxyglucose production should, therefore, be conserved for at least 24 hours before their disposal to the environment.

Objective: To determine the spectrum of diseases on F-18 FDG PET/CT imaging at the Armed Forces Institute of Radiology and Imaging, Rawalpindi. Study Design: Cross-sectional study. Place and Duration of the Study: PET/CT and Cyclotron Department, Armed Forces Institute of Radiology and Imaging,Rawalpindi Pakistan, from Jul 2019 to Mar 2021. Methodology: The patients were scanned for staging, restaging, interim/response assessment and relapse/recurrence purposes. In addition, the frequency of various cancers and types of scans were determined. Scanning has been performe using GE Health care MiDR PET-CT Scanner. Results: A total of 1573 patients were included in the study. Male patients were 927(58.93%), and female patients were 646(41.06%). The most common diseases encountered were lymphoma 623(39.6%), breast cancer 193(12.2%), lung cancer 12(7.6%), colorectal cancer 88(5.5%) and unknown primary 84(5.3%). Amongst lymphoma, Non-Hodgkin’s lymphoma was the most common 276(44.3%), followed by Hodgkin’s lymphoma 267(42.8%). Conclusion: F-18 FDG PET/CT hybrid imaging is an important modality and can significantly alter patient management plans. Lymphomas were the most common disease in our spectrum, followed by cancers of the breast, lungs, colon-rectum and unknown primary cases, which can be managed well by PET/CT’s routine utilization.

Objective: Present study conducted for the measurement of radiation doses received by the radiation workers due to their direct involvement in handling of unsealed radionuclides for the PET/CT scanning. Study Design: Quasi Experimental Study. Place and Duration of Study: PET-CT and Cyclotron Department, Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Aug 2020 to Jul 2021. Methodology: TLD film badges and ring dosimeters, based on LiF:Mg:Ti material, were used for the detection and measurement of radioactivity. The measurements were performed for both whole body and extremity (fingers) dose measurements. Results: The measured radiation doses were in the range of 362.75 mSv/y to 409.74 mSv/y and 0.08 mSv/y to 4.35 mSv/y for extremities and whole body, respectively. Number of injections was calculated for extremity workers and found to be 720±27 injections per worker per year. Conclusion: The measured results clearly show that the annual doses for whole body (20 mSv/y) and extremity (500 mSv/y) of radiation workers are under the recommended limits. However, radiation workers with direct access to radioisotopes were more exposed to radiation. The results of present study were also in good correspondence with the published data.

Objective: To compare the sites of extra-nodal involvement by Contrast-Enhanced Computed Tomography (CECT) and Positron Emission Tomography-Computed Tomography (PET-CT) in lymphoma patients Study Design: Cross-sectional study Place and Duration of Study: Armed Forces Institute of Radiology & Imaging, Military Hospital, Rawalpindi Pakistan, from Aug to Dec 2021. Methodology: A total of 216 patients were included in the study who were diagnosed with lymphoma and presented with suspicion of extra-nodal metastasis. CECT and PET CT were performed in these patients, and a comparison of CECT and PET CT was made in the detection of sites of extra-nodal involvement. Results: A total of 216 patients were included in the study, and the ability of CECT and PET CT was compared to detect the sites of extra-nodal involvement. The sensitivity, specificity, PPV, and NPV for 18-FDG PET-CT were calculated as 92.7%, 100.0%, 100.0% and 95.7% respectively, which was significantly more than CECT.  Conclusion: PET CT has proven to be a superior diagnostic tool for identifying sites of extra-nodal involvement as compared to CECT. It plays a significant role in guiding effective disease management.

Objective: To compare the roles of MRI and HRCT-Temporal bone as a part of preoperative evaluation of candidates selected for cochlear implant before surgery. Study Design: Comparative cross-sectional study. Place and Duration of Study: ENT Departments of the Combined Military Hospital and Pakistan Emirates Military Hospital Rawalpindi, Pakistan from Nov 2022 to May 2023. Methodology: Patients having bilateral sensorineural hearing loss (SNHL), which ranged in severity from mild to severe, were referred from the ENT departments of the Combined Military Hospital and Pakistan Emirates Military Hospital Rawalpindi. Their Cochlear status was evaluated using HRCT and MRI of the temporal bone before giving the cochlear implant. The anatomical abnormalities of each temporal bone were listed and noted for analysis. Results: Of the 100 patients, 48% were male, and 52% were female. The most common disorders were abnormalities of the cochlea (45/100) and semicircular canal (20/100). The most frequent cochlear abnormality (10/100) was Mondini's deformity. In 12 cases, MRI was more effective than HRCT at identifying hypoplastic or aplastic vestibulocochlear nerves. Conclusion: For the diagnosis of membranous labyrinth and nerve abnormalities, MRI of the temporal bone was superior to HRCT. However, neither HRCT nor MRI temporal bone is the only imaging modality of choice for cochlear implant assessment; rather they perform best in combination  

Objective: To determine the correlation between transabdominal ultrasound prostatic volume and International Prostatic Symptom Score in patients with benign prostatic hyperplasia. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep 2020 to Apr 2021. Methodology: Forty five patients were enrolled after taking informed consent. Detailed history was taken and all patients were assessed using the International Prostate Symptom Score. Findings were noted on a predesigned proforma after which all patients were prepared for transabdominal ultrasound in order to achieve bladder volume of at least 50 to 99 ml. Subsequently, transabdominal ultrasound was carried out for determining the volume of the prostate and all findings were subjected to statistical analysis. Results: Mean age of patients was 66.6±9.91 years, with the mean International Prostate Symptom Score being 20.53±9.84 and volume of prostate being 59.56±27.18 cc. Five patients (11.1%) had mild symptoms, 15(33.6%) had moderate and 25(55.6%) had severe symptoms. With regards to volume of prostate, Grade I, II, III and IV was seen in 6(13.3%), 7(15.6%), 20(44.4%) and 12(26.7%) patients respectively. Significant positive correlation was seen between prostatic volume and International Prostate Symptom Score as indicated by an r=0.437 and p=0.003. Conclusion: Transabdominal prostatic volume was found to be significantly correlated with International Prostate Symptom Score, and can be used as an objective assessment of symptoms severity.