Hospitals, field hospitals, community isolation centers, and finally home isolation

Unlike the first and second waves of COVID-19 pandemic in Thailand which were limited among certain populations in certain areas, the third wave starting in April 2021 spread nationwide. It was from less than 10 new cases a day in 2020, to be around 2,000 a day in June and then more than 20,000 new cases a day in August 2021. Among four doctors who were killed by COVID-19 during this third wave in Thailand, the Royal College of Radiologists of Thailand lost a very active and warm member, Associated Professor Wilaiwan Bhothisuwan. When hospitals and field hospitals were full, now COVID-19 infected patients were cared in community isolation centers. Home isolation, the last and probably the final form of health care, was set in this August. The Royal College of Radiologists of Thailand had launched a project “RadioVolunteer” to interpret and report chest radiographs of COVID-19 patients in prisons, field hospitals where there were shortage of radiologists, some community isolation centers, and radiographic units for patients with home isolation.

RadioVolunteer, a novel combination of social, management and technological innovations by the Royal College of Radiologists of Thiland in response to the COVID-19 pandemic

RadioVolunteer, a project launched by the Royal College of Radiologists of Thailand, combinedsocial, technological and management innovation, and integrated government, private and non-profit sectors, to overcome a complex task that only one sector could not seamlessly complete. Working on a digital platform which allowed radiologist volunteers from any part of Thailand to promptly read and report chest radiographs of patients with corona virus disease 2019 (COVID-19) who resided in prisons across the country. Its digitized reporting format helped triage patients with Covid-19 pneumonia, and also screen for tuberculosis.

Memorial-Associated Professor Wilaiporn Bhothisuwan

Dr. Bhothisuwan’s academic career in Faculty of Medicine, Siriraj hospital, Mahidol University was successful. She published articles and wrote books on ultrasonography and breast imaging. She was an active member of The Royal College of Radiologists of Thailand, the Radiological Society of Thailand, and the Medical Ultrasonic Society of Thailand. She served in Broad of Directors of The Royal College of Radiologists of Thailand during 1995- 2015 as president for the Medical Ultrasonic Society of Thailand during 2008-2011. We uniformly admired Dr.Bhothisuwan for her clinical expertise, commitment to education, and sweet and worm personality.

Rama Co-RADS: Cutting-edge tool for improved communication in management and treatment of COVID-19 patients in Thailand

In Thailand, the rapid and constant rise in the number of confirmed COVID-19 cases, together with the increasing number of patients requiring respiratory and other medical life support during the third wave of COVID-19, has drastically overwhelmed the existing country’s healthcare facilities, physicians, and other healthcare workers. Hence, early identification of vulnerable patients at risk and early COVID-19 pneumonia is crucial for timely management and treatment by antivirals or corticosteroids to prevent them from developing severe COVID-19 pneumonia. A prompt chest X-ray report with clear and concise information at baseline screening in alternative healthcare facilities, especially in resource-constrained conditions, is essential. The article presents the incorporation of Rama Co-RADS (a categorical assessment scheme for chest X-ray findings for diagnosing pneumonia in patients with confirmed COVID-19). Its use facilitates a rapid, clear, and concise X-ray report despite the various levels of radiologists’ experience. Comprehensibleand consistent chest X-ray information successfully reduces the time lapse and communication gap among medical staff and assists on-duty, frontline physicians to make prompt and more accurate decisions regarding the management and treatment of COVID-19 patients in accordance with the current national guideline.

Utility of screening chest radiographs in patients with asymptomatic and mildly symptomatic COVID-19 at a field hospital in Samut Sakhon, Thailand

Background: In a new episode of the COVID -19 pandemic in Thailand during the beginning of 2021, cases in Samut Sakhon Province mainly occurred in foreign workers and were mostly asymptomatic or had mild disease. To prevent overwhelming the local hospital, a field hospital was established which used chest radiography as one of screening tools for triaging patients. Objective: To determine the clinical utility of chest radiographs as a screening tool for COVID-19 patients who were asymptomatic or mildly symptomatic. Materials and Methods: Six hundred nineteen patients with COVID -19 (confirmed by reverse transcriptase-polymerase chain reaction) were registered at the field hospital at Samut Sakhon provincial sport stadium during 5-8 January 2021 and had chest radiographs taken. The image readings were based on the consensus of two radiologists and a final decision was made by a third radiologist if the first two did not agree. Findings on chest radiographs and clinical outcomes were evaluated. Results: The study included 619 radiographs; 328/619 (53%) men and 291/619 (47%) women had a mean age of 33.3+/- 9.7 (range, 5-64) years. There was mild disease in 13/619, and asymptomatic infections in 606/619. Chest radiographs were normal in 568 (91.7%) and abnormal in 51 (8.3%) patients; typical findings of COVID-19 were seen in 3 (0.5%) patients. Other abnormal findings were found in 23 (3.8%) patients such as active tuberculosis in 6 (1.0%). Four patients were transferred to the hospital, one of whom required supplemental oxygen. Conclusion: Combined chest radiographic and clinical information allows better decisions regarding hospital transfers of asymptomatic and mildly symptomatic COVID-19 patients at a field hospital.

Kinked coronary saphenous vein graft after aortic dissection surgery: An unusual differential diagnosis of cardiac tamponade

A 73-year-old female patient presented with cardiac tamponade following Stanford type A aortic dissection required immediate pericardiocentesis and followed by root replacement with coronary artery bypass grafting. The patient's postoperative course was eventful and coronary graft kinking contributed to myocardial ischemia, but the presentation was confused with cardiac tamponade.

Comparison of entrance surface air kerma measurement with MTS-N (LiF: Mg, Ti) chips with a kilovoltage X-ray source

Objective: Radiation detectors are key components that ensure the accuracy and performances of dosimetry equipment. The study is aimed to compare the mean entrance surface air kerma (ESAK) between a DCT-10mm ionization chamber (IC) and MTS-N (LiF: Mg, Ti) chips when both detectors are exposed to ≤ 5mGy with a 10 by 10 field size, with an X-ray source and to determine the accuracy of the Thermoluminescent (TL) chips. Also, the dose will be compared to similar studies. Materials and Methods: A functional, Digital Radiography (DR) X-ray System was used. A DCT-10mm ionization chamber (IC) and an XR Multidetector was positioned at a Source to Image Distance (SID) of 100cm on polystyrene, about 20cm thick. An X-ray spectrum generated at a Practical Peak Voltage (PPV) of 60-107kV with Half Value Layer (HVL) of 2.4-4.3mmAl and filtration > 3mmAl was used. The same setup was used for the MTS-N chips. Results: The mean doses for 1-5 mGy with the MTS-N chips were 1.07±0.07, 1.60±0.13, 2.23±0.11, 2.58±0.07 and 3.45±0.10 mGy respectively, with accuracies of 7, 20, 26, 36 and 31%. Dose accuracy at 1and 2mGy was within 25% respectively. Dose accuracies at 3, 4 and 5mGy was within >25%. The correction factor for 1-5mGy was 0.94, 1.25, 1.35, 1.55 and 1.45 respectively. Conclusion: Validation of the MTS-N chips with the reference ionization chamber to this study was within 36%. The Radiation and Nuclear Safety Authority (STUK) recommends that ESAK be within 25% for entrance surface dose. ESAK accuracy mostly increased with dose as observed in this study.

Abdominal CT radiation dose reduction at Siriraj Hospital (Phase III)

OBJECTIVE: To compare the image quality and the radiation dose between fixed tube current (FTC) low dose abdominal CT currently performed at our hospital and new automatic tube current modulation (ATCM) low dose abdominal CT. MATERIALS AND METHODS: We prospectively performed ATCM low dose abdominal CT in 88 participants who had prior FTC low dose CT for comparison. Four experienced abdominal radiologists independently and blindly assessed the quality of FTC and ATCM low dose CT images by using a 5-point-scale satisfaction score (1 = unacceptable, 2 = poor, 3 = average, 4 = good, and 5 = excellent image quality). Each reader selected the preferred image set between FTC and ATCM low dose techniques for each participant. The image noise of the liver and the aorta in both techniques was measured. The volume CT dose index (CTDIvol) of both techniques was compared. RESULTS: The mean satisfaction scores (SD) for FTC and ATCM low dose CT were 4.38 (0.66) and 4.38 (0.64), respectively with the ranges of 3 to 5 in both techniques, which were all acceptable for CT interpretation. The preferred image set between FTC and ATCM low dose techniques of each participant randomly selected by each reader were varied, depending on the readers’ opinions. The mean image noise of the aorta on FTC and ATCM low dose CT accounted for 34.75 and 36.46, respectively, while the mean image noise of the liver was 28.86 and 29.81, respectively. The mean CTDIvol (SD) of FTC and ATCM low dose CT were 8.42 (0.32) and 8.12 (0.43) mGy, respectively. CONCLUSION: FTC and ATCM low dose abdominal CT provided comparable acceptable image quality and showed no clinical significance in radiation dose optimization.

Pulmonary sclerosing pneumocytoma, an adenocarcinoma mimicker: a case report and review of the literature.

Pulmonary sclerosing pneumocytoma (PSP) is a rare condition, occupying only approximately 1% of all benign lung neoplasms and the description of this disease through a radiological perspective is limited. Only approximately a third of PSP has been correctly diagnosed pre-operatively through contrast-enhanced computed tomography (CECT) thorax. To date, only few radiological features have been described to ascertain this disease and there is still a significant portion of patients being misdiagnosed with a malignant neoplasm. We report a case of PSP that was initially misdiagnosed as lung adenocarcinoma stage IIA and the histopathological findings of surgical resection confirmed the diagnosis of PSP. We try to add some points from this case into the previous radiological description of this uncommon disease with a common presentation.