The Logistics of Bringing Imaging to the World

The current issue of the Journal of Global Radiology (JGR) covers a range of topics that fall within the sub-specialty of global radiology. Original articles, country reports, and a conference report have attempted to paint an informative picture of the practice, research, and educational opportunities for voluntary contributions and profitable business. These papers contribute, in one way or another, to the vision of the Journal of Global Radiology: Ensuring medical imaging access for all

Evolving Role of Radiology in COVID-19 Pandemic: A Review

Background: This worldwide outbreak has disrupted a steady world of healthcare. Until now, diagnostic radiology and laboratory tests had been reasonably accurate in confirmed disease. Methods: The review article used data bases, published literature, radiological guidelines issued from societies related to COVID-19 and large number of research journals to find out the latest evidence for the evolving role of radiology in COVID-19 pandemic. Results: Computed Tomography scanning of the lungs demonstrated ground glass grounded opacities (34%) alone or in combination with consolidations (41%). In the first 5 days following exposure the false-negative rate of the RT-PCR testing is as much as 76 % dropping to 21% on day 8 after exposure and CT findings are non-specific, overlapping with other types of pneumonias. Pulmonary embolism has been reported in 23-30 % of hospitalized patients with COVID-19. Conclusions: This review attempts to clear the confusion about the application and imaging presentation of COVID-19 infection CT scanning of the lungs. Findings of glass grounded opacities and pulmonary embolism has been reported in patients with COVID-19. The evidence based practices required to deal with severity based clinical scenarios taking into account available resources in the high-, middle- and low income countries

Welcome to the Journal of Global Radiology

‘Global radiology’ is a new concept – a subspecialty of radiology that includes much more than diagnosticians and interventionists. It consists of an international community of individuals, groups and organizations working to improve access to and quality of medical imaging around the globe, and address universal shortages of equipment, infrastructure, trained personnel, education, and research opportunities in underdeveloped countries. Currently, articles on global radiology are scattered throughout various radiology journals. The Journal of Global Radiology (JGR), an open-access, peer-reviewed journal, seeks to counteract this fragmentation of information by publishing content pertaining exclusively to improving access to medical imaging on an international scale and addressing global health disparities. In addition to original research articles, JGR will invite book and literature reviews, commentary, state of radiology reports, technical notes, editorials and other articles that fit with the publication\u27s mission of encouraging communication, collaboration, education and advocacy. Additionally, JGR will facilitate collaboration on publications between researchers in developed and underdeveloped programs through a Scholar Twinning program

Radiology and Global Health: The Case for a New Subspecialty

In high- and medium-income countries, the use of radiology has grown substantially in the last several decades. But in the developing world, access to medical imaging remains a critical problem. Unlike more structured efforts in the field of global health, interventions in global radiology have been largely unplanned, fragmented and sometimes irrelevant to the needs of the recipient society, and have not resulted in any significant progress. Access to medical imaging around the world remains dismal. There is a therefore a clear and urgent need for the radiology community to develop a vision for global radiology, beginning with defining the scope of the subject and establishing measurable goals. Agreement must be reached to declare global radiology as a bona fide subspecialty of radiology. This should soon be followed by the establishment of divisions of Global Radiology in academic radiology departments. Resident and medical students should be taught how physicians in low -income countries practice medicine without access to adequate radiology. As part of training and electives, residents and medical students should accompany global health teams to countries where the need for radiology services is great. Global scholar exchange and sabbatical opportunities should be offered to staff radiologists. Successful implementation of a unified vision of global radiology has the potential to improve access to medical imaging on a large scale. Radiology journals dedicated to the promotion of global radiology can play an important role in providing forums of discussion, analyses and sharing of field experiences. In this discussion we have attempted to make a case for assigning global radiology a subspecialty status

Hepatitis B vaccination status of health care workers and their antiHBs titres - A cross sectional study

Back ground: The risk from occupational exposure to HBV infection is 2-4 times higher in HCW’s. A protective vaccine with a reported efficacy of 95% is available. Yet many HCW’s in developing countries remain non vaccinated, incompletely vaccinated or if vaccinated unaware of their post vaccination anti HBs status. Estimation of protective immune response following vaccination is essential to clear the misconceptions regarding booster dose of vaccine and non responder state which prevails among the HCW’s. Objective: The present study is designed to assess the hepatitis B vaccination rates in HCW’s and their antiHBs titres. Material and methods: A cross sectional study on 87 subjects was carried out at a tertiary care hospital by testing their sera for HBsAg & anti HBs levels. Results: None of the HCW’s were found to be HBsAg positive. Vaccination rate observed was 79%. Most vaccinated were the doctors and least the paramedics. Among doctors variation within the occupational groups was noticed. More number of males and young subjects were vaccinated and protected. Only 49% of the vaccinated HCW’s were vaccine compliant and 35% of these were protected. Factors like age, sex and time since last dose of vaccine influenced the anti HBs titres. None were aware of their anti HBs titres post vaccination. Conclusion: The study group involves only a small number of HCW’s but the findings are significant. Keeping in mind the annual global hepatitis B infection rates in HCW’s in developing countries we recommend the health care authorities to strengthen the existing educational programmes on Hepattis B infection which improves the awareness levels and thereby increases the vaccine rates. Further to make essential post vaccination assessment of antiHBs titres and its documentation to clear misconceptions regarding booster dose of vaccine

Temporal Bone Hyperpneumatization and Tinnitus: Clinico-Radiological Evaluation Using CT Scan

Purpose: We propose that there is increased incidence of subjective tinnitus (ST) in patients with temporal bone hyperpneumatization (TBHP). The secondary goal of this project is to assess the degrees of association of TBHP with paranasal sinus hyperpneumatization (PNSHP), chronic sinusitis (CS), otomastoiditis (OM) and concha bullosa (CB). Methods and Materials: A total of 196 patients, who had computed tomography (CT) of the head for various clinical indications, were included in this study. CT head scans of patients with TBHP (n=96) were correlated with control patients (n=100). These patients had no apparent TBHP, history of ST, PNSHP, CS, OM or CB. The TBHP was graded based upon the extent of pneumatization. Size of the maxillary and sphenoid sinuses were also measured, providing pneumatization grade. Results: Subjective tinnitus (ST) was present in 31 cases of TBHP and in 8 patients in the control group, which was statistically significant. Mean volume of maxillary sinus and the largest axial sphenoid sinus diameter were significantly larger in the cases of TBHP than in that of controls. Otomastoiditis was found in only 4 cases of TBHP (4%) and none of the controls; however, the difference was not statistically significant. Chronic sinusitis was present in 8 cases of TBHP and 5 of controls, and was also not statistically significant. Concha bullosa was significantly more frequent among cases of TBHP than controls. Conclusion: There is a significant (p \u3c 0.001) association between subjective tinnitus and increasing grade of temporal bone hyperpneumatization. There is a positive correlation between paranasal sinus hyperpneumatization and occurrence of concha bullosa, mimicking symptoms of sinusitis, with TBHP

Diagnostic Radiology in Liberia: A Country Report

Liberia is a tropical country located south of the Sahara Desert in coastal West Africa. It lies at 6 °30’ North Latitude and 9° 30’ West Longitude and is bordered by Guinea, Cote d’Ivoire, Sierra Leone and the Atlantic Ocean. Liberia has three distinct topographical areas: 1) coastal plain, creeks, lagoons and mangrove swamps; 2) rolling, forested hills with elevations up to 500 feet that cover most of the country; and 3) low mountains and plateaus in the Northern highlands with elevations reaching 4,748 feet (Nimba Mountains). Liberia is home to approximately four million people and is roughly the size of the US state of Tennessee. Named after former US President James Monroe, Liberia’s capital Monrovia is a coastal city with a population of one million (1). There are two major seasons in Liberia: dry and rainy. The dry season occurs between December and March, and is is characterized by warm days and cool nights, with risk of sand storms from the Sahara Desert (2). The rainy season occurs between mid-April and mid-November. The average annual rainfall is 200 inches on the coast and decreases to 80 inches in areas farthest inland, and the average temperature is 27 degrees Celsius (81 degrees Fahrenheit) (1). Liberia is a low-income country that relies heavily on foreign aid (3). Liberia is the seventh poorest nation in the world, ranking 31st among 46 sub-Sarahan African countries in national income. In 2013, Liberia’s per capita GDP was $900 US (3). Liberia’s economy depends heavily on natural resources, with mining and agriculture being the dominant industries. Iron exportation has grown and in 2013 overcame rubber as Liberia’s top export. According to the 2013 Central Bank of Liberia (CBL) Annual Report, iron ore and rubber represent 82% of Liberia’s total exports (4). Civil war destroyed much of Liberia’s economy, including critical infrastructure in and around Monrovia. Although conditions are favorable for agriculture, Liberia does not produce nearly enough food to meet the demands of its population. The country imports large quantities of food, with rice alone accounting for 10% of its overall imports (5)

Gestational Age Estimation Based on Fetal Pelvimetry on Fetal Ultrasound in Iraqi Women

Ultrasound is an integral part of obstetric practice, and assessment of gestational age (GA) is a central element of obstetric ultrasonography. Sonographic estimation of GA is derived from calculations based on fetal measurements. Numerous equations for GA calculation from fetal biometry have been adopted in routine practice. This study reports a new method of estimating GA in the second and third trimester using interischial distance (IID), the distance between the two ischial primary ossification centers, on fetal ultrasound. Four hundred women with uncomplicated normal singleton pregnancies from 16 weeks to term were examined. Standard fetal obstetric ultrasound was done measuring biparietal diameter (BPD) and femur length (FL) for each fetus. The IID, in millimeters, was correlated with the GA in weeks based upon the BPD and FL individually, and the BPD and FL together. Statistical analysis showed strong correlation between the IID and GA calculated from the FL with correlation coefficient (r =0.989, P \u3c 0.001). Strong linear correlation was also found between the IID and GA based upon BPD and BPD+FL. Further statistical analysis using regression equations also showed that the IID was slightly wider in female fetuses, but this difference was not statistically significant. Resulting from this analysis, we have arrived at an easy-to-use equation: GA Weeks = (IID mm + 8) ±1 week. We feel this method can be especially applicable in the developing world, where midwives may not have access to software for fetal biometry in their basic handheld ultrasound machines. Even more sophisticated machines may not come with loaded software for obstetrics analysis. There are several limitations to this study, discussed below. We recommend further studies correlating the IID with other biometric parameters