Search results for: Raveinal Masri

Authors: Dwitya Elvira, Raveinal Masri, Rohayat Bilmahdi

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Human Immunodeficiency Virus (HIV) pandemic increased significantly worldwide. The rise in cases of HIV/AIDS was also followed by an increase in the incidence of opportunistic infection, with tuberculosis being the most opportunistic infection found in HIV/AIDS and the main cause of mortality in HIV/AIDS patients. Diagnosis of tuberculosis in HIV/AIDS patients is often difficult because of the uncommon symptom in HIV/AIDS patients compared to those without the disease. Thus, diagnostic tools are required that are more effective and efficient to diagnose tuberculosis in HIV/AIDS. CXCL-10/IP-10 is a chemokine that binds to the CXCR3 receptor found in HIV/AIDS patients with a weakened immune system. Tuberculosis infection in HIV/AIDS activates chemokine IP-10 in urine, which is used as a marker for diagnosis of infection. The aim of this study was to prove whether IP-10 urine can be a biomarker diagnosis of active lung tuberculosis in HIV-AIDS patients. Design of this study is a cross sectional study involving HIV/AIDS patients with lung tuberculosis as the subject of this study. Forty-seven HIV/AIDS patients with tuberculosis based on clinical and biochemical laboratory were asked to collect urine samples and IP-10/CXCL-10 urine being measured using ELISA method with 18 healthy human urine samples as control. Forty-seven patients diagnosed as HIV/AIDS were included as a subject of this study. HIV/AIDS were more common in male than in women with the percentage in male 85.1% vs. 14.5% of women. In this study, most diagnosed patients were aged 31-40 years old, followed by those 21-30 years, and > 40 years old, with one case diagnosed at age less than 20 years of age. From the result of the urine IP-10 using ELISA method, there was significant increase of the mean value of IP-10 urine in patients with TB-HIV/AIDS co-infection compared to the healthy control with mean 61.05 pg/mL ± 78.01 pg/mL vs. mean 17.2 pg/mL. Based on this research, there was significant increase of urine IP-10/CXCL-10 in active lung tuberculosis with HIV/AIDS compared to the healthy control. From this finding, it is necessary to conduct further research into whether urine IP-10/CXCL-10 plays a significant role in TB-HIV/AIDS co-infection, which can also be used as a biomarker in the early diagnosis of TB-HIV.

Keywords: chemokine, HIV/AIDS, IP-10 urine, tuberculosis

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Authors: Taliah Foudah, Sana Masri, Jana Al Ghamdi, Rimaz Alzaaqi

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This research project explores the creative works of the app Metui, which allows consumers to edit their photos and use the new and popular AI feature, which turns any photo into a cartoon-like animated image with beautified enhancements. Studying this AI app demonstrates the significance of the ability in which AI can develop intricate designs which verily replicate the human mind. Our goal was to investigate the Metui app by asking our audience certain questions about its functionality and their personal feelings about its credibility as well as their beliefs as to how this app will add to the future of the AI generation, both positively and negatively. Their responses were further explored by analyzing the questions and responses thoroughly and calculating the results through pie charts. Overall, it was concluded that the Metui app is a powerful step forward for AI by replicating the intelligence of humans and its creativity to either benefit society or do the opposite.

Keywords: AI Art, Meitu, application, photo editing

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Authors: Masri Baharom

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The purpose of the study is to identify the age group of children 9 who have experienced delays in gross motor development. Instrument used in this study is Test Gross Motor Development / TGMD-2 (Ulrich, 2000) which was adopted at the international level. Gross motor development data were obtained by video recording (Sony (DRC-SR42 with a 40x optical zoom capability, and software Ultimate Studio 14) on locomotor and manipulative skills. A total n = 192 persons, children of 9 years (9.30 ± .431) at Sekolah Kebangsaan Mutiara Perdana, Bayan Lepas, Penang were involved as subjects. Children age 9 years experienced delays AELS (4.61 ± .69), AEMS (5:52 ± .62) and GMDQ (7.26 ± .2.14). The findings based on descriptive rating indicated that the performance of children age 9 years acquired low levels of AELS, MSS, AEMS and very low in LSS and GMDS.

Keywords: gross motor development score, locomotor standard score, age equivalent locomotor score, manipulative standard score, age equivalent manipulative score

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Authors: Ahmad Hashim, Masri Baharom

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The purpose of the study is to identify the age group of children 9 who have experienced delays in gross motor development. Instrument used in this study is Test Gross Motor Development / TGMD-2 (Ulrich, 2000) which was adopted at the international level. Gross motor development data were obtained by video recording (Sony (DRC-SR42 with a 40x optical zoom capability, and software Ultimate Studio 14) on locomotor and manipulative skills. A total n = 192 persons, children of 9 years (9.30 ± .431) at Sekolah Kebangsaan Mutiara Perdana, Bayan Lepas, Penang were involved as subjects. Children age 9 years experienced delays AELS (4.61 ± .69), AEMS (5:52 ± .62) and GMDQ (7.26 ± .2.14). The findings based on descriptive rating indicated that the performance of children age 9 years acquired low levels of AELS, MSS, AEMS and very low in LSS and GMDS.

Keywords: gross motor development score, locomotor standard score, age equivalent locomotor score, manipulative standard score, age equivalent manipulative score

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Authors: Camille A. Issa, Omar Masri

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In the study, the commercial finite element software Abaqus was used to develop a three-dimensional nonlinear finite element model capable of simulating the pull-out test of reinforcing bars from underwater concrete. The results of thirty-two pull-out tests that have different parameters were implemented in the software to study the effect of the concrete cover, the bar size, the use of stirrups, and the compressive strength of concrete. The interaction properties used in the model provided accurate results in comparison with the experimental bond-slip results, thus the model has successfully simulated the pull-out test. The results of the finite element model are used to better understand and visualize the distribution of stresses in each component of the model, and to study the effect of the various parameters used in this study including the role of the stirrups in preventing the stress from reaching to the sides of the specimens.

Keywords: pull-out test, bond strength, underwater concrete, nonlinear finite element analysis, abaqus

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Authors: Safoin Aktaou, Aya Al Masri, Kamel Guerchouche, Malorie Martin, Fouad Maaloul

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Introduction: In the ‘Magnetic Resonance Imaging (MRI)’ department, all workers involved in preparing the patient, setting it up, tunnel cleaning, etc. are likely to be exposed to ‘ElectroMagnetic fields (EMF)’ emitted by the MRI device. Exposure to EMF can cause adverse radio-biological effects to workers. The purpose of this study is to propose an organizational process to manage and control EMF risks. Materials and methods: The study was conducted at seven MRI departments using machines with 1.5 and 3 Tesla magnetic fields. We assessed the exposure of each one by measuring the two electromagnetic fields (static and dynamic) at different distances from the MRI machine both inside and around the examination room. Measurement values were compared with British and American references (those of the UK's ‘Medicines and Healthcare Regulatory Agency (MHRA)’ and the ‘American Radiology Society (ACR)’). Results: Following the results of EMF measurements and their comparison with the recommendations of learned societies, a zoning system that adapts to needs of different MRI services across the country has been proposed. In effect, three risk areas have been identified within the MRI services. This has led to the development of a good practice guide related to the magnetic protection of MRI workers. Conclusion: The guide established by our study is a standard that allows MRI workers to protect themselves against the risk of electromagnetic fields.

Keywords: comparison with international references, measurement of electromagnetic fields, magnetic protection of workers, magnetic resonance imaging

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Authors: Musatafa Abbas Abbood Albadr, Masri Ayob, Sabrina Tiun, Fahad Taha Al-Dhief, Mohammad Kamrul Hasan

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Breast Cancer (BC) is considered one of the most frequent reasons of cancer death in women between 40 to 55 ages. The BC is diagnosed by using digital images of the FNA (Fine Needle Aspirate) for both benign and malignant tumors of the breast mass. Therefore, this work proposes the Online Sequential Extreme Learning Machine (OSELM) algorithm for diagnosing BC by using the tumor features of the breast mass. The current work has used the Wisconsin Diagnosis Breast Cancer (WDBC) dataset, which contains 569 samples (i.e., 357 samples for benign class and 212 samples for malignant class). Further, numerous measurements of assessment were used in order to evaluate the proposed OSELM algorithm, such as specificity, precision, F-measure, accuracy, G-mean, MCC, and recall. According to the outcomes of the experiment, the highest performance of the proposed OSELM was accomplished with 97.66% accuracy, 98.39% recall, 95.31% precision, 97.25% specificity, 96.83% F-measure, 95.00% MCC, and 96.84% G-Mean. The proposed OSELM algorithm demonstrates promising results in diagnosing BC. Besides, the performance of the proposed OSELM algorithm was superior to all its comparatives with respect to the rate of classification.

Keywords: breast cancer, machine learning, online sequential extreme learning machine, artificial intelligence

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Authors: Maher El-Masri, Jamie Crawley, Judy Bornais, Abeer Omar

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Background: Misuse of Emergency Department (ED) for non-urgent healthcare results in unnecessary crowdedness that can result in long ED waits and delays in treatment, diversion of ambulances to other hospitals, poor health outcomes for patients, and increased risk of death Objectives: The main purpose of this study was to explore the independent predictors of non-urgent ED visits in Erie St. Clair LHIN. Secondary purposes of the study include comparison of the rates of non-urgent ED visits between urban and rural hospitals Design: A secondary analysis of archived population-based data on 597,373 ED visits in southwestern Ontario Results The results suggest that older (OR = .992; 95% CI .992 – .993) and female patients (OR = .940; 95% CI .929 - .950) were less likely to visit ED for non-urgent causes. Non-urgent ED visits during the winter, spring, and fall were 13%, 5.8%, and 7.5%, respectively, lesser than they were during the summer time. The data further suggest that non-urgent visits were 19.6% and 21.3% less likely to occur in evening and overnight shifts compared to the day shift. Non-urgent visits were 2.76 times more likely to present to small community hospitals than large community hospitals. Health care providers were 1.92 times more likely to refer patients with non-urgent health problem to the ED than the decision taken by patients, family member or caretakers. Conclusion: In conclusion, our study highlights a number of important factors that are associated with inappropriate use of ED visits for non-urgent health problems. Knowledge of these factors could be used to address the issue of unnecessary ED crowdedness.

Keywords: emergency department, non-urgent visits, predictors, logistic regression

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Authors: Mohd Bahroddin Badri, Ridzuan Masri

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Despite the existence of large volume of waqf assets, it is argued that the potential of these assets not fully unleashed. There are many waqf assets especially in the form of land waqf that are idle and undeveloped mainly because of the insufficient fund and lack of investment expertise. This paper attempts to explore few cases on the innovation of waqf development in Malaysia and some countries that demonstrate synergistic collaboration between stakeholders, e.g., the government, nazir, Islamic religious councils, corporate entities and Islamic financial institutions for waqf development. This paper shows that cash waqf, corporate waqf, Build-Operate-Transfer (BOT) and Sukuk are found to be contemporary mechanisms within Islamic finance ecosystem that drive and rejuvenate the development of waqf to the next level. It further highlights few samples of waqf Sukuk that were successfully issued in selected countries. This paper also demonstrates that the benefit of waqf is beyond religious matters, which may also include education, healthcare, social care, infrastructure and corporate social responsibility (CSR) activities. This research is qualitative in nature, whereby the researcher employs descriptive method on the collected data. The researcher applies case study and library research method to collect and analyse data from journal articles, research papers, conference paper and annual reports. In a nutshell, the potential of contemporary models as demonstrated in this paper is very promising, in which the practical application of those instruments should be expanded for the rejuvenation of waqf asset.

Keywords: cash waqf, corporate waqf, Sukuk waqf, build-operate-transfer

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Authors: Sawsan Saridar masri, Hisham Arnaouty

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Architecture both defines and is defined by social, cultural, political and financial constraints: this is where the discipline and the profession of architecture meet. This mutual sway evolves wherever interferences in the built environment are thought-out and can be strengthened or weakened by the many ways in which the practice of architecture can be undertaken. The more familiar we are about the concerns and factors that control what can be made, the greater the opportunities to propose and make appropriate architectures. Apparently, the criteria in any qualification policy should permit flexibility of approach and will – for reasons including cultural choice, political issues, and son on – vary significantly from country to country. However the weighting of the various criteria have to ensure adequate standards both in educational system as in the professional training. This paper develops, deepens and questions about the regulatory entry routes to the professional practice of architecture in the Arab world. It is also intended to provide an informed basis about strategies for conventional and unconventional models of practice in preparation for the next stages of architect’s work experience and professional experience. With the objective of promoting the implementation of adequate built environment in the practice of architecture, a comprehensive analysis of various pathways of access to the profession are selected as case studies, encompassing examples from across the world. The review of such case studies allows the creation of a comprehensive picture in relation to the conditions for qualification of practitioners of the built environment at the level of the Middle Eastern countries and the Arab World. Such investigation considers the following aspects: professional title and domain of practice, accreditation of courses, internship and professional training, professional examination and continuing professional development.

Keywords: architecture, internship, mobility, professional practice

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Authors: Hasmadi Mamat, Noorfarahzilah Masri

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The search for lesser known and underutilized crops, many of which are potentially valuable as human and animal foods has been the focus of research in recent years. Tarap (Artocarpus odoratisimmus) is one of the most delicious tropical fruit and can be found extensively in Borneo, particularly in Sabah and Sarawak. This study was conducted in order to determine the proximate composition, mineral contents as well as to study the effect of the seed flour on the quality of bread produced. Tarap seed powder (TSP) was incorporated (up to 20%) with wheat flour and used to produce bread. The moisture content, ash, protein, fat, ash, carbohydrates, and dietary fiber were measured using AOAC methods while the mineral content was determined using AAS. The effect of substitution of wheat flour with Tarap seed flour on the quality of dough and bread was investigated using various techniques. Farinograph tests were applied to determine the effect of seaweed powder on the rheological properties of wheat flour dough, while texture profile analysis (TPA) was used to measure the textural properties of the final product. Besides that sensory evaluations were also conducted. On a dry weight basis, the TSP was composed of 12.50% moisture, 8.78% protein, 15.60% fat, 1.17% ash, 49.65% carbohydrate and 12.30% of crude fiber. The highest mineral found were Mg, followed by K, Ca, Fe and Na respectively. Farinograh results found that as TSP percentage increased, dough consistency, water absorption capacity and development time of dough decreased. Sensory analysis results showed that bread with 10% of TSP was the most accepted by panelists where the highest acceptability score were found for aroma, taste, colour, crumb texture as well as overall acceptance. The breads with more than 10% of TSP obtained lower acceptability score in most of attributes tested.

Keywords: tarap seed, proximate analysis, bread, sensory evaluation

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Authors: Muhammad A. Ashraf, Scott Steinmetz, Matthew J. Dunn, Assaad R. Masri

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This study focuses on the evolution of soot and soot precursors in three different piloted diffusion turbulent flames. The fuel composition is as follow flame A (ethylene/nitrogen, 2:3 by volume), flame B (ethylene/air, 2:3 by volume), and flame C (pure methane). These flames are stabilized using a 4mm diameter jet surrounded by a pilot annulus with an outer diameter of 15 mm. The pilot issues combustion products from stoichiometric premixed flames of hydrogen, acetylene, and air. In all cases, the jet Reynolds number is 10,000, and air flows in the coflow stream at a velocity of 5 m/s. Time-resolved laser-induced fluorescence (LIF) is collected at two wavelength bands in the visible (445 nm) and UV regions (266 nm) along with laser-induced incandescence (LII). The combined results are employed to study concentration, size, and growth of soot and precursors. A set of four fast photo-multiplier tubes are used to record emission data in temporal domain. A 266nm laser pulse preferentially excites smaller nanoparticles which emit a fluorescence spectrum which is analysed to track the presence, evolution, and destruction of nanoparticles. A 1064nm laser pulse excites sufficiently large soot particles, and the resulting incandescence is collected at 1064nm. At downstream and outer radial locations, intermittency becomes a relevant factor. Therefore, data collected in turbulent flames is conditioned to account for intermittency so that the resulting mean profiles for scattering, fluorescence, and incandescence are shown for the events that contain traces of soot. It is found that in the upstream regions of the ethylene-air and ethylene-nitrogen flames, the presence of soot precursors is rather similar. However, further downstream, soot concentration grows larger in the ethylene-air flames.

Keywords: laser induced incandescence, laser induced fluorescence, soot, nanoparticles

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Authors: Stefaan Carpentier, Aya Al Masri, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis, and ulceration to appear. In order to prevent these deterministic effects, a prediction of the peak skin-dose for the patient is important in order to improve the post-operative care to be given to the patient. The objective of this study is to estimate, before the intervention, the patient dose for ‘Chronic Total Occlusion (CTO)’ procedures by selecting relevant clinical indicators. Materials and methods: 103 procedures were performed in the ‘Interventional Cardiology (IC)’ department using a Siemens Artis Zee image intensifier that provides the Air Kerma of each IC exam. Peak Skin Dose (PSD) was measured for each procedure using radiochromic films. Patient parameters such as sex, age, weight, and height were recorded. The complexity index J-CTO score, specific to each intervention, was determined by the cardiologist. A correlation method applied to these indicators allowed to specify their influence on the dose. A predictive model of the dose was created using multiple linear regressions. Results: Out of 103 patients involved in the study, 5 were excluded for clinical reasons and 2 for placement of radiochromic films outside the exposure field. 96 2D-dose maps were finally used. The influencing factors having the highest correlation with the PSD are the patient's diameter and the J-CTO score. The predictive model is based on these parameters. The comparison between estimated and measured skin doses shows an average difference of 0.85 ± 0.55 Gy for doses of less than 6 Gy. The mean difference between air-Kerma and PSD is 1.66 Gy ± 1.16 Gy. Conclusion: Using our developed method, a first estimate of the dose to the skin of the patient is available before the start of the procedure, which helps the cardiologist in carrying out its intervention. This estimation is more accurate than that provided by the Air-Kerma.

Keywords: chronic total occlusion procedures, clinical experimentation, interventional radiology, patient's peak skin dose

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Authors: E. N. Masri, E. Takács

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Amplitude Versus Offset (AVO) and simultaneous model-based impedance inversion techniques have not been utilized for geothermal exploration commonly; however, some recent publications called the attention that they can be very useful in the geothermal investigations. In this study, we present rock physical attributes obtained from 3D pre-stack seismic data and well logs collected in a study area of the NW part of Pannonian Basin where the geothermal reservoir is located in the fractured zones of Triassic basement and it was hit by three productive-injection well pairs. The holes were planned very successfully based on the conventional 3D migrated stack volume prior to this study. Subsequently, the available geophysical-geological datasets provided a great opportunity to test modern inversion procedures in the same area. In this presentation, we provide a summary of the theory and application of the most promising seismic inversion techniques from the viewpoint of geothermal exploration. We demonstrate P- and S-wave impedance, as well as the velocity (Vp and Vs), the density, and the Vp/Vs ratio attribute volumes calculated from the seismic and well-logging data sets. After a detailed discussion, we conclude that P-wave impedance and Vp/Vp ratio are the most helpful parameters for lithology discrimination in the study area. They detect the hot water saturated fracture zone very well thus they can be very useful in mapping the investigated reservoir. Integrated interpretation of all the obtained rock-physical parameters is essential. We are extending the above discussed pre-stack seismic tools by studying the possibilities of Elastic Impedance Inversion (EII) for geothermal exploration. That procedure provides two other useful rock-physical properties, the compressibility and the rigidity (Lamé parameters). Results of those newly created elastic parameters will also be demonstrated in the presentation. Geothermal extraction is of great interest nowadays; and we can adopt several methods have been successfully applied in the hydrocarbon exploration for decades to discover new reservoirs and reduce drilling risk and cost.

Keywords: fractured zone, seismic, well-logging, inversion

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Authors: Rania Albsoul, Muhammad Ahmed Alshyyab, Baraa Ayed Al Odat, Nermeen Borhan Al Dwekat, Batool Emad Al-masri, Fatima Abdulsattar Alkubaisi, Salsabil Awni Flefil, Majd Hussein Al-Khawaldeh, Ragad Ayman Sa’ed, Maha Waleed Abu Ajamieh, Gerard Fitzgerald

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Purpose: The purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan. Design/methodology/approach: This was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons, and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data. Findings: Three main themes emerged from data analysis, namely compliance with the surgical safety checklist, the impact of the surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion, and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist and help enhance awareness about its importance. Originality/value: While steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges to consistent, complete, and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.

Keywords: patient safety, surgical safety checklist, compliance, utility, operating room, quality healthcare, communication, teamwork

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Authors: Eman Ismail, Adnan Masri

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Energy dissipation in ductile moment frames occurs mainly through plastic hinge rotations in its members (beams and columns). Generally, plastic hinge locations are pre-determined and limited to the beam ends, where columns are designed to remain elastic in order to avoid premature instability (aka story mechanisms) with the exception of column bases, where a base is 'fixed' in order to provide higher stiffness and stability and to form a plastic hinge. Plastic hinging at steel column bases in ductile moment frames using conventional base connection details is accompanied by several complications (thicker and heavily stiffened connections, larger embedment depths, thicker foundation to accommodate anchor rod embedment, etc.). An encased composite base connection is proposed where a segment of the column beginning at the base up to a certain point along its height is encased in reinforced concrete with headed shear studs welded to the column flanges used to connect the column to the concrete encasement. When the connection is flexurally loaded, stresses are transferred to a reinforced concrete encasement through the headed shear studs, and thereby transferred to the foundation by reinforced concrete mechanics, and axial column forces are transferred through the base-plate assembly. Horizontal base reactions are expected to be transferred by the direct bearing of the outer and inner faces of the flanges; however, investigation of this mechanism is not within the scope of this research. The inelastic and cyclic behavior of the connection will be investigated where it will be subjected to reversed cyclic loading, and rotational ductility will be observed in cases of yielding mechanisms where yielding occurs as flexural yielding in the beam-column, shear yielding in headed studs, and flexural yielding of the reinforced concrete encasement. The findings of this research show that the connection is capable of achieving satisfactory levels of ductility in certain conditions given proper detailing and proportioning of elements.

Keywords: seismic design, plastic mechanisms steel structure, moment frame, composite construction

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Authors: Aya Al Masri, Stefaan Carpentier, Fabrice Leroy, Thibault Julien, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: During an 'Interventional Radiology (IR)' procedure, the patient's skin-dose may become very high for a burn, necrosis and ulceration to appear. In order to prevent these deterministic effects, an accurate calculation of the patient skin-dose mapping is essential. For most machines, the 'Dose Area Product (DAP)' and fluoroscopy time are the only information available for the operator. These two parameters are a very poor indicator of the peak skin dose. We developed a mathematical model that reconstructs the magnitude (delivered dose), shape, and localization of each irradiation field on the patient skin. In case of critical dose exceeding, the system generates warning alerts. We present the results of its comparison with clinical studies. Materials and methods: Two series of comparison of the skin-dose mapping of our mathematical model with clinical studies were performed: 1. At a first time, clinical tests were performed on patient phantoms. Gafchromic films were placed on the table of the IR machine under of PMMA plates (thickness = 20 cm) that simulate the patient. After irradiation, the film darkening is proportional to the radiation dose received by the patient's back and reflects the shape of the X-ray field. After film scanning and analysis, the exact dose value can be obtained at each point of the mapping. Four experimentation were performed, constituting a total of 34 acquisition incidences including all possible exposure configurations. 2. At a second time, clinical trials were launched on real patients during real 'Chronic Total Occlusion (CTO)' procedures for a total of 80 cases. Gafchromic films were placed at the back of patients. We performed comparisons on the dose values, as well as the distribution, and the shape of irradiation fields between the skin dose mapping of our mathematical model and Gafchromic films. Results: The comparison between the dose values shows a difference less than 15%. Moreover, our model shows a very good geometric accuracy: all fields have the same shape, size and location (uncertainty < 5%). Conclusion: This study shows that our model is a reliable tool to warn physicians when a high radiation dose is reached. Thus, deterministic effects can be avoided.

Keywords: clinical experimentation, interventional radiology, mathematical model, patient's skin-dose mapping.

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Authors: Aya Al Masri, Naima Oubenali, Safoin Aktaou, Thibault Julien, Malorie Martin, Fouad Maaloul

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Introduction: The increased number of performed 'Computed Tomography (CT)' examinations raise public concerns regarding associated stochastic risk to patients. In its Publication 102, the ‘International Commission on Radiological Protection (ICRP)’ emphasized the importance of managing patient dose, particularly from repeated or multiple examinations. We developed a Dose Archiving and Communication System that gives multiple dose indexes (organ dose, effective dose, and skin-dose mapping) for patients undergoing radiological imaging exams. The aim of this study is to compare the organ dose values given by our software for patients undergoing CT exams with those of another software named "VirtualDose". Materials and methods: Our software uses Monte Carlo simulations to calculate organ doses for patients undergoing computed tomography examinations. The general calculation principle consists to simulate: (1) the scanner machine with all its technical specifications and associated irradiation cases (kVp, field collimation, mAs, pitch ...) (2) detailed geometric and compositional information of dozens of well identified organs of computational hybrid phantoms that contain the necessary anatomical data. The mass as well as the elemental composition of the tissues and organs that constitute our phantoms correspond to the recommendations of the international organizations (namely the ICRP and the ICRU). Their body dimensions correspond to reference data developed in the United States. Simulated data was verified by clinical measurement. To perform the comparison, 270 adult patients and 150 pediatric patients were used, whose data corresponds to exams carried out in France hospital centers. The comparison dataset of adult patients includes adult males and females for three different scanner machines and three different acquisition protocols (Head, Chest, and Chest-Abdomen-Pelvis). The comparison sample of pediatric patients includes the exams of thirty patients for each of the following age groups: new born, 1-2 years, 3-7 years, 8-12 years, and 13-16 years. The comparison for pediatric patients were performed on the “Head” protocol. The percentage of the dose difference were calculated for organs receiving a significant dose according to the acquisition protocol (80% of the maximal dose). Results: Adult patients: for organs that are completely covered by the scan range, the maximum percentage of dose difference between the two software is 27 %. However, there are three organs situated at the edges of the scan range that show a slightly higher dose difference. Pediatric patients: the percentage of dose difference between the two software does not exceed 30%. These dose differences may be due to the use of two different generations of hybrid phantoms by the two software. Conclusion: This study shows that our software provides a reliable dosimetric information for patients undergoing Computed Tomography exams.

Keywords: adult and pediatric patients, computed tomography, organ dose calculation, software comparison

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Authors: Aya Al Masri, Kamel Guerchouche, Youssef Laynaoui, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: Mobile C-arms move throughout operating rooms of the operating theater. Being designed to move between rooms, they are not equipped with relays to retrieve the exposition information and export it outside the room. Therefore, no light signaling is available outside the room to warn the X-ray emission for staff. Inadvertent exposition of staff outside the operating theater is a real problem for radiation protection. The French standard NFC 15-160 require that: (1) access to any room containing an X-ray emitting device must be controlled by a light signage so that it cannot be inadvertently crossed, and (2) setting up an emergency button to stop the X-ray emission. This study presents a system that we developed to meet these requirements and the results of its clinical test. Materials and methods: The system is composed of two communicating boxes: o The "DetectBox" is to be installed inside the operating theater. It identifies the various operation states of the C-arm by analyzing its power supply signal. The DetectBox communicates (in wireless mode) with the second box (AlertBox). o The "AlertBox" can operate in socket or battery mode and is to be installed outside the operating theater. It detects and reports the state of the C-arm by emitting a real time light signal. This latter can have three different colors: red when the C-arm is emitting X-rays, orange when it is powered on but does not emit X-rays, and green when it is powered off. The two boxes communicate on a radiofrequency link exclusively carried out in the ‘Industrial, Scientific and Medical (ISM)’ frequency bands and allows the coexistence of several on-site warning systems without communication conflicts (interference). Taking into account the complexity of performing electrical works in the operating theater (for reasons of hygiene and continuity of medical care), this system (having a size <10 cm²) works in complete safety without any intrusion in the mobile C-arm and does not require specific electrical installation work. The system is equipped with emergency button that stops X-ray emission. The system has been clinically tested. Results: The clinical test of the system shows that: it detects X-rays having both high and low energy (50 – 150 kVp), high and low photon flow (0.5 – 200 mA: even when emitted for a very short time (<1 ms)), Probability of false detection < 10-5, it operates under all acquisition modes (continuous, pulsed, fluoroscopy mode, image mode, subtraction and movie mode), it is compatible with all C-arm models and brands. We have also tested the communication between the two boxes (DetectBox and AlertBox) in several conditions: (1) Unleaded room, (2) leaded room, and (3) rooms with particular configuration (sas, great distances, concrete walls, 3 mm of lead). The result of these last tests was positive. Conclusion: This system is a reliable tool to alert the staff present outside the operating room for X-ray emission and insure their radiation protection.

Keywords: Clinical test, Inadvertent staff exposition, Light signage, Operating theater

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Authors: Marcelo Lopes Dias Kolling, Felipe Ferreira Laranjeira, Guilherme Augusto Hettwer, Pedro Salomão Piccinini, Marwan Masri, Carlos Oscar Uebel

Abstract:

Introduction: Injectable fillers are among the most common nonsurgical cosmetic procedures, with significant growth yearly. Knowledge of rheological and mechanical characteristics of fillers, facial anatomy, and injection technique is essential for safety. Concepts such as the use of cannula versus needle, aspiration before injection, and facial danger zones have been well discussed. In case of an accidental intravascular puncture, the pressure inside the vessel may not be sufficient to push blood into the syringe due to the characteristics of the filler product; this is especially true for calcium hydroxyapatite (CaHA) or hyaluronic acid (HA) fillers with high G’. Since viscoelastic properties of normal saline are much lower than those of fillers, aspiration with saline prior to filler injection may decrease the risk of a false negative aspiration and subsequent catastrophic effects. We discuss a technique to add an additional safety step to the procedure with saline aspiration prior to injection, a ‘’reverse Seldinger’’ technique for intravascular access, which we term SANIT: Saline Aspiration Negative Intravascular Test. Objectives: To demonstrate the author’s (PSP) technique which adds an additional safety step to the process of filler injection, with both CaHA and HA, in order to decrease the risk of intravascular injection. Materials and Methods: Normal skin cleansing and topical anesthesia with prilocaine/lidocaine cream are performed; the facial subunits to be treated are marked. A 3mL Luer lock syringe is filled with 2mL of 0.9% normal saline and a 27G needle, which is turned one half rotation. When a cannula is to be used, the Luer lock syringe is attached to a 27G 4cm single hole disposable cannula. After skin puncture, the 3mL syringe is advanced with the plunger pulled back (negative pressure). Progress is made to the desired depth, all the while aspirating. Once the desired location of filler injection is reached, the syringe is exchanged for the syringe containing a filler, securely grabbing the hub of the needle and taking care to not dislodge the needle tip. Prior to this, we remove 0.1mL of filler to allow for space inside the syringe for aspiration. We again aspirate and inject retrograde. SANIT is especially useful for CaHA, since the G’ is much higher than HA, and thus reflux of blood into the syringe is less likely to occur. Results: The technique has been used safely for the past two years with no adverse events; the increase in cost is negligible (only the cost of 2mL of normal saline). Over 100 patients (over 300 syringes) have been treated with this technique. The risk of accidental intravascular puncture has been calculated to be between 1:6410 to 1:40882 syringes among expert injectors; however, the consequences of intravascular injection can be catastrophic even with board-certified physicians. Conclusions: While the risk of intravascular filler injection is low, the consequences can be disastrous. We believe that adding the SANIT technique can help further mitigate risk with no significant untoward effects and could be considered by all performing injectable fillers. Further follow-up is ongoing.

Keywords: injectable fillers, safety, saline aspiration, injectable filler complications, hyaluronic acid, calcium hydroxyapatite

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