Hamzaini Abdul Hamid

Treatment of drooling in children with cerebral palsy using ultrasound guided intraglandular injections of botulinum toxin A

The aim of this study was to determine whether botulinum toxin A (BTX-A), injected into both parotid and sub- mandibular salivary glands of children with cerebral palsy and sialorrhea, could decrease their drooling and improve their quality of life. Twenty-one children aged 4 to 12 years (mean age 8.4 years) received 60-80 units BTX-A (mean dose 3.6 U/kg) under sedation using ultrasound guidance. Response was assessed by several methods (drool frequency and severity score, drool quo- tient, number of bib changes per day and a visual analogue score) at baseline, 2, 8 and 16 weeks post-injection. A questionnaire related to quality of life and caregiver satisfaction was administered at baseline and week 8. Adverse events were recorded at each visit. Drool frequency and severity scores were significantly reduced at weeks 2, 8 and 16 compared to baseline ( P< 0.001). Significant reductions were also seen for the visual analogue scale, number of bibs changed daily and drool quotient ( P< 0.001). Mean quality of life scores dropped from 35 ± 4.8 at baseline to 29 ± 5.2) at week 8 ( P< 0.001). Caregiver satisfaction was high at weeks 2, 8 and 16. Pain or swelling (19%), excessively thick saliva (9.5%), fever (9.5%) and chewing difficulties (4.8%) were transient and subsided within 2 weeks of the injection. Eighteen (87.5%) caregivers indicated they wanted repeat injections in the future. In conclusion, percutaneous intraglandular injection of BTX-A was safe and had a sustained effect for up to 16 weeks, with a concomitant improvement in their quality of life and caregiver satisfaction.

Design and development of a content-based medical image retrieval system for spine vertebrae irregularity

BackgroundContent-based medical image retrieval (CBMIR) system enables medical practitioners to perform fast diagnosis through quantitative assessment of the visual information of various modalities.MethodsIn this paper, a more robust CBMIR system that deals with both cervical and lumbar vertebrae irregularity is afforded. It comprises three main phases, namely modelling, indexing and retrieval of the vertebrae image. The main tasks in the modelling phase are to improve and enhance the visibility of the x-ray image for better segmentation results using active shape model (ASM). The segmented vertebral fractures are then characterized in the indexing phase using region-based fracture characterization (RB-FC) and contour-based fracture characterization (CB-FC). Upon a query, the characterized features are compared to the query image. Effectiveness of the retrieval phase is determined by its retrieval, thus, we propose an integration of the predictor model based cross validation neural network (PMCVNN) and similarity matching (SM) in this stage. The PMCVNN task is to identify the correct vertebral irregularity class through classification allowing the SM process to be more efficient. Retrieval performance between the proposed and the standard retrieval architectures are then compared using retrieval precision (Pr@M) and average group score (AGS) measures.ResultsExperimental results show that the new integrated retrieval architecture performs better than those of the standard CBMIR architecture with retrieval results of cervical (AGS > 87%) and lumbar (AGS > 82%) datasets.ConclusionsThe proposed CBMIR architecture shows encouraging results with high Pr@M accuracy. As a result, images from the same visualization class are returned for further used by the medical personnel.

Development of Total Knee Replacement Digital Templating Software

In this study, by taking full advantage of digital X-ray and computer technology, we have developed a semi-automated procedure to template knee implants, by making use of digital templating method. Using this approach, a software system called OrthoKneeTMhas been designed and developed. The system is to be utilities as a study in the Department of Orthopaedic and Traumatology in medical faculty, UKM (FPUKM). OrthoKneeTMtemplating process employs uses a technique similar to those used by many surgeons, using acetate templates over X-ray films. Using template technique makes it easy to template various implant from every Implant manufacturers who have with a comprehensive database of templates. The templating functionality includes, template (knee) and manufactures templates (Smith & Nephew; and Zimmer). From an image of patient x-ray OrthoKneeTMtemplates help in quickly and easily reads to the approximate template size needed. The visual templating features then allow us quickly review multiple template sizes against the X-ray and thus obtain the nearly precise view of the implant size required. The system can assist by templating on one patient image and will generate reports that can accompany patient notes. The software system was implemented in Visual basic 6.0 Pro using the object-oriented techniques to manage the graphics and objects. The approaches for image scaling will be discussed. Several of measurement in orthopedic diagnosis process have been studied and added in this software as measurement tools features using mathematic theorem and equations. The study compared the results of the semi-automated (using digital templating) method to the conventional method to demonstrate the accuracy of the system.

Automatic Vertebral Fracture Assessment System (AVFAS) for Spinal Pathologies Diagnosis Based on Radiograph X-Ray Images

Nowadays, medical imaging has become a major tool in many clinical trials. This is because the technology enables rapid diagnosis with visualization and quantitative assessment that facilitate health practitioners or professionals. Since the medical and healthcare sector is a vast industry that is very much related to every citizen`s quality of life, the image based medical diagnosis has become one of the important service areas in this sector. As such, a medical diagnostic imaging (MDI) software tool for assessing vertebral fracture is being developed which we have named as AVFAS short for Automatic Vertebral Fracture Assessment System. The developed software system is capable of indexing, detecting and classifying vertebral fractures by measuring the shape and appearance of vertebrae of radiograph x-ray images of the spine. This paper describes the MDI software tool which consists of three main sub-systems known as Medical Image Training & Verification System (MITVS), Medical Image and Measurement & Decision System (MIMDS) and Medical Image Registration System (MIRS) in term of its functionality, performance, ongoing research and outstanding technical issues.

DURAL METASTASIS MIMICKING MENINGIOMA: AN INTERESTING CASE

Dural metastasis is a rare entity in clinical practice. We report a case of dural metastasis secondary to thyroid carcinoma, which on both preoperative CT and MRI and at surgery had the typical appearance of a meningioma. Histopathological findings confirmed metastatic follicular thyroid carcinoma as a primary site. Although rare, dural metastases can mimic a meningioma. Our experience in this case has led us to consider metastasis as a differential diagnosis even when a meningioma is suspected. We believe that reporting of the case of dural metastasis mimicking a meningioma may help clinicians in future.

Pedunculated Parietal Pleural Lesion: A Rare Presentation of Bronchogenic Cyst

We present a 35-year-old man with a preoperative diagnosis of a right lower lobe cystic mass. Misled by a radiological suggestion of an intraparenchymal lesion, he had a thoracotomy and right lower lobectomy. An intraoperative finding of a pedunculated cyst arising from the parietal pleural with subsequent histopathology confirmation of a benign bronchogenic cyst, however, would have made a less invasive surgical excision more appropriate.

Anterior osteoporosis classification in cervical vertebrae using fuzzy decision tree

Anterior Osteoporosis (AOs) in the cervical vertebrae is an osteoporosis complication and a common condition of vertebral irregularity caused by a decrease in bone density and strength, which can lead to fragile bone and fractures. Consequently, it is crucial to detect the AOs irregularity early so that appropriate pharmacological intervention can be done to reduce further complications. To do so via a computer approach, an efficient method that can provide high classification rate is required. Basing on the fuzzy logic theory, this article affords a new method for AOs (classes and severity) classification of the cervical radiography by designing a fuzzy decision tree (FDT) model. The method involves two main processed, namely i) segmentation process which employs the active shape model (ASM) based on the 9-anatomical points representation (9-APR) to segment the cervical vertebra shape boundary (C-VSB) and ii) fuzzy based feature extraction and classifier development, known as FDT method. The fuzzy set along with its membership functions are derived from the resulting C-VSB segment. It operates by extracting a specific angle descriptor (horizontal, vertical, and corner) as crisp input to the fuzzification inter-face to produce reasonable key indexing to the fuzzy interface system. Then, the defuzzification interface converts it into a crisp output that adequately represents the degree of AOs class and severity as appraisal values. The resulting fuzzy then acts as input to a basic concept of if-then rules called FDT to recognise and distinguish between vertebrae presented with/without AOs. Receiver operating characteristic (ROC) and area under curve (AUC) index evaluation methods are examined to offer quantitative evaluation between the medical ground truth versus FDT classifier predicted results. Results obtained on a set of 400 cervical vertebrae images indicate superb classification rate (R > 90 %) which suggest that the proposed FDT as an appropriate solution to AOs classification process for reliable vertebral fracture diagnosis. In summary, the findings confirmed the effectiveness of FDT as an excellent classifier to recognize and differentiate AOs classes and severity thus, able to provide important basis for pathology.

Simple multifunctional angle measurement method in orthopaedic

Few types of angle measurementin orthopedic diagnosis process have been studied (Cobb’s Angle, Q-Angle, Bohler’s Angle and Intermetatarsal Angle). A standard and simple multifunctional angle measurement method was identified to help diagnosis and analysis work in orthopedic radiology. Some basic mathematic theorems and equations have been applied to make sure the reliability of the method. The angle measurement method was then tested in an application named OrthokneeTMwith successful results.

Computed Tomography Dose in Paediatric Care: Simple Dose Estimation Using Dose Length Product Conversion Coefficients

Background The use of multislice computed tomography (MSCT) is increasing worldwide; at the same time, there is a growing awareness of the future risk of cancer associated with greater exposure to radiation. Therefore, there is a need for an accessible method of effective dose estimation. This study aims to estimate the effective doses (EDs) of a variety of paediatric computed tomography (CT) examinations in five age groups using recently published age- and region-specific dose length products (DLPs) as effective dose conversion coefficients. Methods A retrospective review was performed over a 12-month period. Patients were assigned to one of five age groups: neonatal, 1-, 5-, 10- and 15-years-old. Age- and region-specific conversion coefficients were applied to the DLP data displayed on the CT console in order to estimate the ED. Results Over the 12-month period, there were a total of 283 CT scans, 211 of which were selected for study. The ED estimates for plain CT brain scans in neonatal, 1-, 5-, 10- and 15-yearolds were 2.5, 1.5, 1.4, 1.3 and 0.8 mSv, respectively. For the corresponding CT abdominal scans, the results were 18.8, 12.9, 7.8, 8.6 and 7.5 mSv; these were the highest values recorded. High-resolution CT (HRCT) temporal scans showed EDs of 2.9, 1.8, 1.5 and 1.1 mSv in 1-, 5-, 10- and 15-years-old, respectively. CT scans of the helical thorax had an estimated ED of 4.8, 4.2 and 7.0 mSv in 5-, 10- and 15-years-old, respectively. Conclusion An inverse relationship between age and effective dose was demonstrated in CT scans of the brain and abdomen/pelvis. In general, our study showed lower overall EDs compared to other centres.

Semi-automated vertebral segmentation of human spine in MRI images

Image segmentation is an important task in medical image processing to assist physicians or radiologists in making faster and effective diagnosis and treatment. However, there is still lack of effective segmentation methods to extract human spine in Magnetic resonance imaging (MRI) images. In this study, we propose a segmentation method using 12-anatomical point representation (12-APR) method for human spine vertebra. The proposed method is a semi-automatic segmentation in which 12-points will be manually annotated on the region of interest (ROI) before the ROI can be extracted automatically. The performance of this segmentation is evaluated using six performance metrics and the results show that the proposed method gives the highest accuracy (99.87%), specificity (99.89%), Dice similarity coefficient (94.04%), Jaccard similarity coefficient (88.81%) and Cosine similarity coefficient (94.14%).