This document discusses the role of various imaging modalities in evaluating thyroid cancer. It covers:
1) Ultrasound is the primary imaging modality for evaluating thyroid nodules and detecting features suspicious for malignancy. CT and MRI are used for advanced staging.
2) Pre-operative imaging with CT or MRI helps determine the extent of primary tumor invasion and lymph node involvement.
3) Ultrasound and thyroglobulin levels are used for post-treatment surveillance, while radioactive iodine scans, MRI and PET are used if those are abnormal.
4) Recent advances discussed include elastography, optical coherence tomography, and MR spectroscopy for improved evaluation and differentiation of thyroid lesions.
Lecture dedicated to radiogenomics of renal cell carcinoma by Ph.d., MD, Mytsyk Yulian, Department of Urology/Radiology, Lviv National Medical University, presented at IV Ukrainian-Polish Conference on Radiology 2018, Rzeszów
Lecture dedicated to radiogenomics of renal cell carcinoma by Ph.d., MD, Mytsyk Yulian, Department of Urology/Radiology, Lviv National Medical University, presented at IV Ukrainian-Polish Conference on Radiology 2018, Rzeszów
Imaging in small bowel tumors Dr. Muhammad Bin Zulfiqar
Here we will discuss CT and MR enterography. We will further discuss the use of negative contrast.
Four important tumors will be discussed.
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Imaging in small bowel tumors Dr. Muhammad Bin Zulfiqar
Here we will discuss CT and MR enterography. We will further discuss the use of negative contrast.
Four important tumors will be discussed.
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Dr. Zahid Iqbal Mir, MBBS MS (General Surgery), DNB (General Surgery) has done his MBBS and masters in General Surgery from the prestigious Govt Medical College Jammu and DNB in General Surgery from NBEMS New Delhi. He is a passionate surgeon, earlier practising at Government Medical College, Jammu as Registrar in Department of General Surgery. Nowadays working as Senior Resident in Department of General Surgery, Government Medical College & Hospital, Sector 32, Chandigarh and a rising name in field of surgery.
This lecture proves an overview of assessing the thyrod nodule upon presentation. The use of imaging, including nuclear medicine, PET, CT/MR and Ultrasound is discussed.
There is more detail on ultrasound evaluation with particular emphasis on ACR TIRADS
PAPILLARY CARCINOMA IN THYROGLOSSAL CYST-By Dr.Juveria Majeed MS ENT.Dr.Juveria Majeed
Carcinoma of thyroglossal duct cyst is a very rare entity. Here we present a case report of papillary carcinoma in thyroglossal cyst in a 21 year old female patient and discussion regarding dilemmas in the management, whether total thyroidectomy should be done or not.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. IMAGING OF THYROID CANCER
-Dr.A.Joseph Stalin(M.Ch PG)
PROF RR UNIT
CENTRE FOR ONCOLOGY
GOVT ROYAPETTAH HOSPITAL
CHENNAI
2. An image is not simply a trademark, a design, a slogan or
an easily remembered picture. It is a studiously crafted
personality profile of an individual, institution,
corporation, product or service.
The paradox of reality is that no
image is as compelling as the one
which exists only in the mind's eye
3. CONTENT
Role of Imaging in
• A.Evaluation of Thyroid nodule
• B.Preop evaluation
• C.Followup/Surveillance
• D.Therapeutic purpose
Imaging features in common malignancy
Recent advances
7. Imaging
• USG ( High resolution)
• I -123 SCINTIGRAPHY (Low TSH)
8. Diagnostic thyroid USG
• Should be performed in all patients with
thyroid nodule.
• High resolution USG – most sensitive test to
detect thyroid lesion
• During USG- Look for coincidental nodules.
Select a nodule for FNA.
Look for nodes in neck.
9. Thyroid US answers following questions
• Whether Nodule corresponds palpable lesion?
• Cystic or solid ?
• How large?
• Benign or suspicious?
• Any other nodule in gland?
• Any suspicious cervical node?
15. Indication for USG guided FNA
1. Non-palpable nodule
2. Predominantly cystic nodule
3. Posteriorly located nodule
4. Repeating FNA for non-diagnostic nodule
16. Palpation-guided versus US-guided
FNA Cytology of thyroid nodules
• Diagnostic accuracy - P-FNA 60% and US-FNA - 80% .
• Inadequate specimen rate - 11.2% in the P-FNA group, 7.1%
in the US-FNA group .
• Sensitivity, positive predictive value, and negative predictive
value increased significantly with ultrasound guidance .
Izquiero R Endocr Pract. 2006 Nov-Dec;12(6):609-14
21. B.PRE OP EVALUATION
• To determine extend of primary tumour
• To evaluate regional nodal metastasis.
22. Extension of primary tumour
• Spread outside thyroid capsule- strap and
sternomastoid muscle involvement
• Spread to laryngx or trachea
• Esophageal invasion
• Vascular invasion
• Spread to prevertebral muscles or bone
• Mediastinal extension
23. TRACHEAL INVASION
• Atleast one of follwing CT criteria fulfilled :
• Tumor in contact with 180° or more of the tracheal
circumference (grades 3 and 4);
• Deformity of the tracheal lumen at the level of the
mass;
• Focal irregularity, thickening, or bulging in the mucosal
portion adjacent to the mass.
24. ESOPHAGEAL INVOLVEMENT
At least one of the following CT criteria were
fulfilled:
• Tumor in contact with 180° or more of the
esophageal circumference (grades 3 and 4) .
• Loss of the normal esophageal structures (wall
and lumen)
25. CAROTID VESSEL ENCASEMENT
• Invasion of the CCA or IJV was diagnosed if the
tumor was in contact with 180° or more of the
circumference of the vessel (grades 3 and 4).
26. Recurrent laryngeal nerve involvement
At least two of the following three criteria were fulfilled:
• completely effaced fatty tissue in tracheoesophageal
groove.
• More than 25% of the circumference of the tumor
abutted the capsule at the posterior portions of the
thyroid (posterior extracapsular invasion).
• Ipsilateral vocal cord palsy was present on the basis of
CT findings such as paramedian cord, anteromedial
deviation of the arytenoid cartilage, enlarged pyriform
sinus, or enlarged laryngeal ventricle
27. Recurrant laryngeal nerve involvement
• CT scan obtained at level
of vocal cords shows
• Anteromedial deviation
of arytenoid cartilage
(short arrow),
• Enlarged pyriform sinus
(long arrow),
• Enlarged laryngeal
ventricle (arrowhead) on
left side.
28. • Mass replacing entire right thyroid
lobe, isthmus, and medial portion
of left lobe (arrows).
• Tumor surrounds ≥ 180° of
circumference of trachea and
esophagus and completely
encircles right common carotid
artery (arrowhead).
• Right internal jugular vein has
been obliterated.
• Posterior tumor extension and
completely effaced fatty tissue in
right tracheoesophageal groove
indicate tumor invasion of
recurrent laryngeal nerve
29. • Contrast-enhanced CT scan shows
large heterogeneous mass (short
arrows) in left lobe and isthmus of
thyroid.
• Tumor is in contact with ≥ 180° of
circumference of trachea. Focal
bulging in mucosal portion of
trachea (long arrow) suggests direct
tumor invasion into tracheal lumen.
• Tumor encroaches esophagus
(arrowheads) but surrounds < 180°
of circumference of esophagus.
• Posterior tumor extension and
completely effaced fatty tissue are
evident in left tracheoesophageal
groove
34. INDICATION FOR CT/MRI
• Fixed immobile thyroid mass
• Palpable lymphadenopathy
• Hoarseness ,dysphagia , dyspnoea.
• Retrosternal extension
35. CT
• More sensitive /specific than USG&MRI in detecting nodal mets.
• Contrast interferes with iodine uptake
• The mean sensitivity, specificity, and accuracy of CT were as follows:
59.1%, 91.4%, and 83.2% for tracheal invasion; 28.6%, 96.2%, and 90.7%
for esophageal invasion; 75.0%, 99.4%, and 98.8% for invasion of the
common carotid artery; 33.3%, 98.8%, and 97.1% for invasion of the
internal jugular vein; and 78.2%, 89.8%, and 85.5% for invasion to the
recurrent laryngeal nerve. (AJR Am J Roentgenol.2010
Locally advanced thyroid cancer: can CT help in prediction of
extrathyroidal invasion to adjacent structures?
Seo YL, Yoon DY, Lim KJ, Cha JH, Yun EJ, Choi CS, Bae S )
36. Non thyroidal causes of decreased
radioiodine uptake
Contrast media :
Water soluable : 2- 4 wks
Fat soluble(lymphangiography) : months- year
Thyroid hormone
Iodinated drugs/foods
Heart failure /Renal failure
Prior irradiation
37. Interference for radioiodine uptake
• 1 mg of stable iodine can cause significant
reduction of the 24 hr radioiodine uptake
• 10 mg can effectively block the gland, with
98% reduction uptake.
• Iohexol contains 350mg of iodine
39. MRI
• Mainly for detecting extrathyroidal invasion
• Paratracheal , retrosternal extension and
nodes in deep spaces of neck are well defined.
• Advantage over CT :
- No interference with iodine uptake.
- Better tissue contrast
- Multiplane evaluation
48. ELASTOGRAPHY
• Elastography could be considered as an
“imaging palpation ”… technique to measure
the stiffness of tissues.
• USG elastography (SE) differentiates between
benign and malignant lesions on the basis of
their elasticity:
• Benign lesions have an elasticity similar to the
surrounding tissue, while malignant lesions
are harder than adjacent tissue.
49. 4% -1% Agar-
Gelatin Elastic
phantom
~ 100 µs
Step 1: Volumetric force
creation using
ultrasound beam focus
1D Cross-correlation
Step 3: Image
acquisition and
processing
Ultrasound beam
US
images
Uz(x,t)
Step 2: Ultra fast imaging
of the displacement
generated by ultrasounds
Texp=20 ms~ 0.3 ms
Acquisition time < 30 ms !!
Courtesy of Dr Anne Tardivon - Institut Curie - Paris
SuperSonic Elastography
50. Table1
Diagnostic performanceof conventional US and acombination of conventional US and elastography for diagnosing thyroid malignancy according to thetypeof elastography
US USE US USE US USE US USE US USE
Trimboli et al. [25] 2012 198 SE 85.0 97.0 54.0 34.0 62.0 50.0 38.0 33.0 91.0 97.0
Ragazzoni et al. [26] 2012 132 SE 70.0 85.0 92.4 83.7 85.6 84.1 80.0 69.4 87.6 92.8
Cappelli et al. [27] 2012 159 SE 80.0 ND 75.0 70.8 75.4 73.6 25.0 26.3 97.2 100
Moon et al. [19] 2012 703 SE 91.7 92.2 66.7 65.0 74.4 73.4 55.1 54.1 94.7 94.9
Unluturk et al. [28] 2012 237 SE 69.0 41.0 85.0 93.0 81.0 81.0 60.0 67.0 89.0 83.0
Veyrieres et al. [21] 2012 297 SWE 77.1 97.1 58.0 55.3 ND ND 19.7 22.5 95.0 99.3
Shweel et al. [23] 2013 66 SE 92.0 95.4 72.9 94.8 60.1 95.2 95.0 82.3 63.1 98.8
Russ et al. [24] 2013 4,550 SE 95.7 98.5 61.0 44.7 62.0 48.3 ND ND 99.7 99.8
Kim et al. [14] 2013 99 SWE 90.5 50.0 59.7 80.0 67.0 78.6 ND ND ND ND
Accuracy (%) PPV (%) NPV (%)
US, conventional ultrasonography;PPV, positivepredictivevalue;NPV, negativepredictivevalue;USE, combination of conventional ultrasonography and elastography;SE, strain
elastography;SWE,shear waveelastography;ND, not determined.
Reference Publication year Case number Type
Sensitivity (%) Specificity (%)
51. OPTICAL COHERENCE TOMOGRAPHY
• Optical coherence tomography (OCT) allows
tissue histologic-like evaluation, but without
tissue fixation or staining.
• Noncontact, non invasive microresolution
study of tissues based on principle of
Michelson interferometry
• OCM (Microscopy)is an extension of OCT and
provides high magnification resulting in
cellular imaging.
54. MR SPECTROSCOPY
• MR spectroscopy is a sensitive method in
differentiating thyroid carcinoma from benign
follicular lesion.
• Choline peak is identified in almost all
carcinomas, with raised choline/creatine ratio
ranging from 1.6 in well differentiated carcinoma
to 9.4 in anaplastic carcinoma.
• The normal thyroid tissue and benign follicular
lesions generally demonstrate no choline peak.
55. Take Home Message
• High resolution USG neck suffice for
evaluation of thyroid nodule /intrathyroidal
malignancy
• CECT better avoided if ablation therapy
planned
56. Thyroid…...
Ode To the Thyroid
•
The thyroid is such a funny thing wrapped inside
your neck
I’m strong I’m tough I’m young and bold so
thyroid…..what the heck
It won’t stop me from doing well and living life
in full
It’s such a tiny little thing who said it had to rule
I don’t see why I feel so cold my fingers hurt like
mad
I don’t see why I feel fatigue why is it so so bad
Why is that I fall asleep at every given chance
The muscle cramps the tired legs the sickly
looking stance
I would get help for all these things but my
memory lets me down
I m going mad it’s just not fair I forgot the way to
town
My minds a fuzz my hair is thin my nails a
breaking fast
The lack of hair around my eyes gives everyone
a laugh
• Please doctor can you help me now as I really feel so
sad
You call me in and look away you think I’m going mad
The test are taken all sent off, now its time to wait
At last there is a reason something I can hate
• And hate you very much I do for months of grief and
strife
For all the days you made me bad to both my kids and
wife
You will not win this battle now as I have all the facts
But hell it’s hard to fight this thing and get myself on
track
So all of you both young and old take heed and listen
good
You can’t ignore your body’s voice even if you could
Oh so fast things slow down you don’t see what it is
Your thyroids got you by your throat yes you! Not mine,
not his.
• -------Jack frost
• THANK YOU