Striving for Excellence: Multicentre Quality Improvement Project to Optimize CT KUB Technique in Renal Colic Patients.

OBJECTIVE: To perform audit of imaging practice in different hospitals to assess their adherence to guidelines on optimizing computerized tomography of kidneys, ureter and bladder (CT KUB) technique in order to reduce unnecessary scan length. To assess improvement in adherence to guidelines after intervention, following education of the technologists. MATERIAL AND METHODS: There were 12 participant radiology departments in eight cities of Islamic Republic of Pakistan. Findings of first audit round were presented in respective departmental meetings and technologists were educated. Second round was performed after 12 weeks. Our target was to achieve 100% compliance to standards. Comparison of adherence to guidelines before and after intervention was done. Total number of axial slices of KUB CT scan, images above upper pole of highest kidney (overscan/unnecessary slices) and percentage of unnecessary images were recorded. To calculate statistical significance of difference, Fischer exact and Chi-square tests were applied. RESULTS: Percentage of patients with appropriate CT KUB technique according to RCR guidelines was far less in first round (0-64%). It significantly improved after educating the technologists (35.57- 90.90%). CONCLUSION: By following standard practice of CT KUB scan, significant radiation dose reduction is achievable without compromising diagnostic details. ADVANCES IN KNOWLEDGE: Standardization of CT KUB examination technique can valuably contribute to reduction in unessential radiation exposure.

Optociliary shunt vessels in multiple sclerosis.

BACKGROUND/INTRODUCTION: Optociliary shunt vessels develop as a result of chronic retinal venous obstruction. Optic neuritis has never been reported as a causative influence. OBJECTIVE: To determine whether optic neuritis predisposes to the development of optociliary shunts in patients with multiple sclerosis. CASES: This case series follows two patients with multiple sclerosis from August 1st, 2019 to April 24th, 2024, who developed optociliary shunt vessels after attacks of optic neuritis. A 43-year-old female presented with left visual loss and bilateral superior optociliary shunt vessels. Perimetry showed bilateral peripheral visual field loss. Optical coherence tomography showed bilateral retinal thinning and ganglion cell complex loss. Optical coherence tomography angiography showed reduced capillary density bilaterally. We investigated her and eventually diagnosed her with multiple sclerosis. The second, a 49-year-old female, developed right-sided optociliary shunt vessels after an episode of neuroretinitis. Perimetry revealed bilateral central scotomata; optical coherence tomography showed disc and retinal nerve fiber layer edema, and serous retinal detachment; later, ganglion cell complex loss; and reduced capillary density on optical coherence tomography angiography. Neuroimaging revealed demyelination in both, leading to a diagnosis of multiple sclerosis, and therapy was instituted. CONCLUSIONS: We hypothesize, that demyelinating optic neuritis due to multiple sclerosis causes chronic retinal hypoperfusion, leading to subsequent optociliary shunt development in affected eyes. Our case series reveals that eyes with optic neuritis, both previous episodes and fresh cases, can contribute to sufficient retinal vein hypoperfusion to cause the development of optociliary shunts, which should be reported in the literature.

Does optic neuritis in multiple sclerosis cause optociliary shunt vessels? Our case study shows that optociliary shunt vessels have developed in eyes having previous as well as fresh optic neuritis in two multiple sclerosis patients, as demonstrated by examination and investigations. We hypothesize that multiple sclerosis causes decreased retinal perfusion predisposing to the development of optociliary shunts. This will guide neurologists and ophthalmologists in diagnosing this debilitating condition upon the visualization of optociliary shunts; heralding previous or recurrent attacks of optic neuritis. @SanaNadeemS.

Unilateral Optic Neuropathy due to a Sphenoid Mucocoele.

Isolated sphenoid sinus mucocoeles are rare; whereas, benign lesions usually discovered incidentally. These may present with headache, diplopia, visual loss or ocular motor nerve palsies, due to slow expansion and mass effects. Prompt endoscopic removal is the key to prevent permanent sequelae. We present the case of a 63-year femele, who presented with sudden loss of vision of the left eye, along with periorbital and retrobulbar pain for the last one month. She was found to have "no light perception" vision in the left eye and optic atrophy. Neuroimaging was performed, which revealed a sphenoid sinus mucocoele, impinging on the left optic nerve. Our ENT Department performed endoscopic sinus surgery and removed it, but her vision did not return at 6-month follow-up. Although very rare, sphenoid sinus mucocoeles should be considered in the differential diagnosis of any patient, who presents with sudden visual loss. Key Words: Sphenoid sinus, Mucocoele, Optic neuropathy, Visual loss.

Monocular elevation deficiency with associated dextrocardia and situs inversus.

A patient having monocular elevation deficiency with associated dextrocardia and situs inversus is reported. Review of the literature regarding ocular features described in association with dextrocardia is also presented.

Factors associated with breast arterial calcification on mammography.

OBJECTIVE: To determine the frequency of breast arterial calcifications (BAC) as seen on mammographic examination and to determine the association between BAC and hypertension, age, parity and weight of the person. STUDY DESIGN: Cross-sectional analytic study. PLACE AND DURATION OF STUDY: Department of Diagnostic Radiology, Military Hospital, Rawalpindi, from January 2006 to January 2007. METHODOLOGY: Two hundred patients undergoing mammography were studied to evaluate the association of BAC with raised blood pressure, age and parity. Previous history of lactation and the patients' weight were also recorded. Proportions of classes were compared using chi-square test. RESULTS: 13.5% of the subjects (n = 200) were positive for BAC on mammograms. Mean age of the BAC positive subjects was higher than their counterparts found negative for BAC. Women bearing 5 - 6 children showed the highest frequency of BAC. Seventy seven (10.38%) of the BAC positive cases had previous history of lactation, whereas 15.44% (n = 123) had not breast fed their children and showed BAC. No significant association of presence of BAC was noted with the weight of the subjects. CONCLUSION: The frequency of presence of BAC on mammography was associated with systemic hypertension and higher age. It also increased with the reproductive parameters of a woman.