Characteristic imaging features of body packers: a pictorial essay

The drug-trafficking business has risen tremendously because of the current increased demand for illegal narcotics. The smugglers conceal the drugs in their bodies (body packers) in order to bypass the tight security at international borders. A suspected body packer will normally be sent to the hospital for imaging investigations to confirm the presence of drugs in the body. Radiologists, therefore, need to be familiar with and able to identify drug packets within the human body because they shoulder the legal responsibilities. This pictorial essay describes the characteristic imaging features of drug packets within the gastrointestinal tract.     

Initial experience of using intracardiac echocardiography (ICE) for guiding balloon mitral valvuloplasty (BMV)

Background and aimsBMV is an established treatment for rheumatic mitral valve stenosis. The procedure is historically guided by fluoroscopy, and the role of intracardiac echocardiogram (ICE) guidance is not well defined. We report our initial experience of using ICE to guide BMV procedures.MethodsDuring BMV procedure, ICE catheter was inserted into the right atrium from the right femoral vein, and the septal puncture was monitored by ICE, as well as positioning of the balloon in the mitral valve. Comparisons were made between ICE, transthoracic echocardiography (TTE), and catheterization derived hemodynamic measurements (cath).ResultsSeventeen patients with mitral stenosis underwent the procedure. The mean age was 44.4 ± 21 years. The mean MV area increased from 0.9 ± 0.1 cm² to 1.7 ± 0.2 cm², P < 0.0001 and the mean gradient decreased from 12.6 ± 5.8 mmHg to 4.9 ± 1.8 mmHg, P < 0.001. Atrial septum puncture and guidance of the balloon into the MV apparatus were obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily detected by ICE. ICE derived gradient measurements were comparable to those obtained by TTE, and cath.ConclusionICE guidance of BMV is feasible, and useful in monitoring safe septal puncture, optimizing balloon positioning, and in detecting complications. The hemodynamic measurements obtained were comparable to those obtained by TTE, and cath.     

The Effect of Sr-CoFe2O4 Nanoparticles with Different Particles Sized as Additives in CIP-Based Magnetorheological Fluid

This study investigated the effect of adding strontium (Sr)-doped cobalt ferrite (CoFe₂O₄) nanoparticles in carbonyl iron particle (CIP)-based magnetorheological fluids (MRFs). Sr-CoFe₂O₄ nanoparticles were fabricated at different particle sizes using co-precipitation at calcination temperatures of 300 and 400 °C. Field emission scanning electron microscopy (FESEM) was used to evaluate the morphology of the Sr-CoFe₂O₄ nanoparticles, which were found to be spherical. The average grain sizes were 71–91 nm and 118–157 nm for nanoparticles that had been calcinated at 300 and 400 °C, respectively. As such, higher calcination temperatures were found to produce larger-sized Sr-CoFe₂O₄ nanoparticles. To investigate the rheological effects that Sr-CoFe₂O₄ nanoparticles have on CIP-based MRF, three MRF samples were prepared: (1) CIP-based MRF without nanoparticle additives (CIP-based MRF), (2) CIP-based MRF with Sr-CoFe₂O₄ nanoparticles calcinated at 300 °C (MRF CIP+Sr-CoFe₂O₄-T300), and (3) CIP-based MRF with Sr-CoFe₂O₄ nanoparticles calcinated at 400 °C (MRF CIP+Sr-CoFe₂O₄-T400). The rheological properties of these MRF samples were then observed at room temperature using a rheometer with a parallel plate at a gap of 1 mm. Dispersion stability tests were also performed to determine the sedimentation ratio of the three CIP-based MRF samples.     

Third-party brachytherapy source calibrations and physicist responsibilities: report of the AAPM Low Energy Brachytherapy Source Calibration Working Group

The AAPM Low Energy Brachytherapy Source Calibration Working Group was formed to investigate and recommend quality control and quality assurance procedures for brachytherapy sources prior to clinical use. Compiling and clarifying recommendations established by previous AAPM Task Groups 40, 56, and 64 were among the working group's charges, which also included the role of third-party handlers to perform loading and assay of sources. This document presents the findings of the working group on the responsibilities of the institutional medical physicist and a clarification of the existing AAPM recommendations in the assay of brachytherapy sources. Responsibility for the performance and attestation of source assays rests with the institutional medical physicist, who must use calibration equipment appropriate for each source type used at the institution. Such equipment and calibration procedures shall ensure secondary traceability to a national standard. For each multi-source implant, 10% of the sources or ten sources, whichever is greater, are to be assayed. Procedures for presterilized source packaging are outlined. The mean source strength of the assayed sources must agree with the manufacturer's stated strength to within 3%, or action must be taken to resolve the difference. Third party assays do not absolve the institutional physicist from the responsibility to perform the institutional measurement and attest to the strength of the implanted sources. The AAPM leaves it to the discretion of the institutional medical physicist whether the manufacturer's or institutional physicist's measured value should be used in performing dosimetry calculations.     

Bail out lithotripsy to treat delayed valve-in-valve TAVR-related coronary obstruction

Coronary access difficulty and stent compression by the juxtaposed aortic valve leaflet hamper percutaneous management of delayed coronary artery obstruction (CAO) after valve-in-valve (Edwards Sapien 3 in St. Jude Trifecta) transcatheter aortic valve replacement (TAVR). Here, we present a case of delayed post-TAVR CAO treated with intravascular lithotripsy and multistenting to overcome stent compression by the adjacent calcified leaflet.