Kanaga Kumari Chelliah

Breast Imaging Using Electrical Impedance Tomography: Correlation of Quantitative Assessment with Visual Interpretation

BACKGROUND Electrical impedance tomography (EIT) is a new non-invasive, mobile screening method which does not use ionizing radiation to the human breast; allows conducting quantitative assessment of the images besides the visual interpretation. The aim of this study was to correlate the quantitative assessment and visual interpretation of breast electrical impedance tomographs and associated factors. MATERIALS AND METHODS One hundred and fifty mammography patients above 40 years and undergoing EIT were chosen using convenient sampling. Visual interpretation of the images was carried out by a radiologist with minimum of three years experience using the breast imaging - electrical impedance (BI-EIM) classification for detection of abnormalities. A set of thirty blinded EIT images were reinterpreted to determine the intra-rater reliability using kappa. Quantitative assessment was by comparison of the breast average electric conductivity with the norm and correlations with visual interpretation of the images were determined using Chi-square. One-way ANOVA was used to compare the mean electrical conductivity between groups and t-test was used for comparisons with pre-existing Caucasians statistics. Independent t-tests were applied to compare the mean electrical conductivity of women with factors like exogenous hormone use and family history of breast cancer. RESULTS The mean electrical conductivity of Malaysian women was significantly lower than that of Caucasians (p<0.05). Quantitative assessment of electrical impedance tomography was significantly related with visual interpretation of images of the breast (p<0.05). CONCLUSIONS Quantitative assessment of electrical impedance tomography images was significantly related with visual interpretation.

A peek into oneself: reflective writing amongst undergraduate Medical Imaging students

Reflection is thinking about, pondering upon something that we have learnt. It is something that one consciously looks at in great depth – contemplating, analyzing in order to learn from it. Reflection aids everyday life in formal learning and informal learning. Reflection is used widely in the field of education, especially healthcare curricula throughout the world in which clinical practice is a huge component. This study aims to identify whether there is an improvement in students’ clinical grades with the use of a reflective journal. Before students were exposed to clinical posting, they underwent a Workshop on Reflective Writing to teach them how to write a reflective journal. They were introduced to Kolb’s four-stage model of reflection: concrete experience, reflective observation, abstract conceptualization and active experimentation. The students were asked to write a minimum of three journal entries each week, but they were encouraged to write as much as possible. Students were then sent on clinical placement. A one-to one interview with each student revealed that students felt that writing reflective journals improved their clinical practice. Findings revealed that there was improvement in their clinical practice. Hence knowledge of reflective writing is fundamental to healthcare educators, and they themselves need to be reflective practitioners.

Association of bone mineral density and mammographic breast density in premenopausal and postmenopausal Malaysian women: Study on women with and without breast cancer

High mammographic breast density is an established risk factor for breast cancer whilst bone mineral density is a marker of estrogen cumulative exposure. This study was conducted to compare bone mineral density in Malaysian premenopausal and postmenopausal women; with and without breast cancer. Besides, it was to determine the relationship between bone mineral density and mammographic breast density in these groups. A cross-sectional study on 50 women above 40 years old who underwent mammogram and Dual Energy X-ray Absorptiometry was conducted at the General Hospital Kuala Lumpur for a year. Respondents were chosen using purposive sampling and women who had commenced cancer treatment were excluded from the study. The mean of selected characteristics were compared between groups using independent-t and Mann-Whitney U for continuous and categorical data respectively whilst Chi-square analysis was used to determine the association of bone mineral density and mammographic breast density. A total of 31 and 19 pre- and postmenopausal women respectively. Women with scattered fibroglandular breasts were the most affected by cancer, although, there was no statistical difference (p=0.298). There was no significant difference in women with contraceptive and/or hormone replacement therapy usage with breast density based on the classification of bone mineral density (p=0.214), cancer (p=0.344) and menstrual status (p=0.298). In conclusion, there was an adverse association between bone mineral density and mammographic breast density in both premenopausal and postmenopausal women; with and without breast cancer.

A comparative study of computed radiography-based mammography using digital phosphor storage plate and full field digital mammography

BACKGROUND Two digital mammography systems, based on different physical concepts, have been introduced in the last few years namely the full-field digital mammography (FFDM) system and computed radiography-based mammography using digital storage phosphor plate (DSPM). AIMS The objective of this study was to compare the image quality for DSPM and FFDM using a grading scale based on previously published articles. MATERIALS AND METHODS This comparative diagnostic study was done for 5-month duration at the Breast Clinic. The system used was the Lorad Selenia FFDM system and the Mammomat 3000 Nova DSPM system. The craniocaudal and mediolateral oblique projections were done on both breast on 58 asymptomatic women using both DSPM and FFDM. The mammograms were evaluated for eight criteria of image quality: Tissue coverage, compression, exposure, contrast, resolution, noise, artifact, and sharpness by two independent radiologists. STATISTICAL ANALYSIS Wilcoxon Signed Rank Test and Weighted Kappa. RESULTS FFDM was rated significantly better (P < 0.05) for five aspects: Tissue coverage, compression, contrast, exposure, and resolution and equal to DSPM for sharpness, noise, and artifact. CONCLUSION FFDM was superior in five aspects and equal to DSPM for three aspects of image quality.

Perbandingan dos sinaran antara prosedur urografi intravena (IVU) dan tomografi berkomputer helikal tanpa kontras (UHCT) urografi

ABSTRAK Urografi intravena (IVU) dan tomografi berkomputer helikal tanpa kontras (UHCT) urografi adalah dua prosedur utama yang akan dijalankan semasa penyiasatan radiologi bagi pengesanan urolitiasis (batu karang) pada sistem genitourinari. Dedahan terhadap sinaran radiasi merupakan faktor kebimbangan utama dalam kedua-dua prosedur. Oleh itu, satu kajian perbandingan dos sinaran telah dijalankan antara prosedur IVU dan UHCT urografi di samping menentukan faktor dedahan optimum bagi kedua-dua prosedur tersebut. Kajian ini telah dijalankan ke atas fantom antropomorfi k seluruh tubuh mengikut protokol sebenar bagi prosedur UHCT urografi dan penghasilan radiografi bersiri berserta dengan pemberian media berkontras bagi prosedur IVU. Sebanyak tiga parameter dedahan voltan tiub digunakan iaitu 75 kVp, 80 kVp dan 85 kVp bagi prosedur IVU dan 100 kVp, 120 kVp dan 140 kVp bagi prosedur UHCT urografi . Hasil dos sinaran bagi prosedur IVU yang diperolehi adalah 1.40 mSv, 2.10 mSv dan 2.79 mSv bagi 75 kVp, 80 kVp dan 85 kVp. Manakala bagi prosedur UHCT urografi , sebanyak 0.76 mSv, 1.32 mSv dan 1.82 mSv dos sinaran direkodkan bagi 100 kVp, 120 kVp dan 140 kVp. Hasil kualiti imej optimum adalah menggunakan dedahan sebanyak 85 kVp bagi prosedur IVU dan 120 kVp bagi prosedur UHCT urografi . Kesimpulannya, walaupun tidak terdapat perbezaan signifi kan, dos sinaran yang terhasil daripada prosedur IVU adalah kekal lebih tinggi daripada prosedur UHCT urografi . Kata kunci: Urografi intravena; tomografi berkomputer helikal tanpa kontras urografi ; dos sinaran; kualiti imej

Transition from Uniprofessional Towards Interprofessional Education: The Malaysian Experience of a Pragmatic Model

Changing from conventional uniprofessional education to interprofessional education (IPE) in health professions education requires strategic planning, especially in developing countries where resources are limited. Successful implementation of IPE is an important way to establish a foundation for interprofessional collaborative care that will improve the quality of health care. Although providing best quality of care is paramount, defining what is ‘best’ is contextual and is highly dependent on a national agenda (The WHO Framework for Action, 2010). Therefore, stakeholders and funders from developing countries need convincing data, particularly local data, before investing in an IPE approach. Piloting such initiatives on a smaller scale provides room for fine-tuning before it is implemented on a national or regional level. In this chapter, pilot projects for IPE initiatives in Malaysia are described. How interprofessional practices can pave the way for national policy change in IPE is also discussed. The framework for action on IPE and collaborative practice (CP) proposed by the World Health Organization (WHO) (The WHO Framework for Action, 2010) was used to guide the project. A brief account of Malaysian health care is given, followed by our experience of developing IPE and finally a leadership model is offered.

Validation of Electrical Impedance Tomography Qualitative and Quantitative Values and Comparison of the Numeric Pain Distress Score against Mammography

Electrical impedance tomography (EIT) is a potential supplement for mammogram screening. This study aimed to evaluate and feasibility of EIT as opposed to mammography and to determine pain perception with both imaging methods. Women undergoing screening mammography at the Radiology Department of National University of Malaysia Medical Centre were randomly selected for EIT imaging. All women were requested to give a pain score after each imaging session. Two independent raters were chosen to define the image findings of EIT. A total of 164 women in the age range from 40 to 65-year-old participated and were divided into two groups; normal and abnormal. EIT sensitivity and specificity for rater 1 were 69.4% and 63.3, whereas for rater 2 they were 55.3% and 57.0% respectively. The reliability for each rater ranged between good to very good (p<0.05). Quantitative values of EIT showed there were significant differences in all values between groups (ANCOVA, p<0.05). Interestingly, EIT scored a median pain score of 1.51±0.75 whereas mammography scored 4.15±0.87 (Mann Whitney U test, p<0.05). From these quantitative values, EIT has the potential as a health discriminating index. Its ability to replace image findings from mammography needs further investigation.