SOUVENIR - ewubd.edu · SOUVENIR INTERNATIONAL CONFERENCE ON PHYSICS IN MEDICINE AND CLINICAL NEUROELECTROPHYSIOLOGY ... BMPA, & Chairperson, Dept. of BMPT, University of …

SOUVENIR

INTERNATIONAL CONFERENCE ON PHYSICS IN MEDICINE AND

CLINICAL NEUROELECTROPHYSIOLOGY

PMCN2015

19-20 February, 2015 Dhaka, Bangladesh

<www.pmcn2015.info>

Venue

Nabab Nawab Ali Chowdhury Senate Bhaban

University of Dhaka

Organised by

Bangladesh Medical Physics Association (BMPA)

Bangladesh Clinical Neuro Electrophysiologist Society (BCNEPS)

Dept of Biomedical Physics & Technology (BMPT) University of Dhaka

Endorsed by

International Organisation of Medical Physics (IOMP)

American Association of Physicists in Medicine (AAPM)

Cover design: Prof K Siddique-e Rabbani Cover picture acknowledgement: web.mediamit.edu, its.uvm.edu, www.ob-ultrasound.net

http://www.pmcn2015.info/

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PROGRAMME &

ABSTRACTS

INTERNATIONAL CONFERENCE ON PHYSICS IN MEDICINE AND

CLINICAL NEUROELECTROPHYSIOLOGY (PMCN-2015)

19-20 February, 2015

Dhaka, Bangladesh

Venue: Nabab Nawab Ali Chowdhury Senate Bhaban, University of Dhaka

Registration : Lobby of Seminar room (1

st floor)

Inauguration : Main Auditorium (2nd

floor)

Scientific Sessions I – VII (Tack I) : Main Auditorium (2nd

floor)

Scientific Sessions I – VII (Tack II) : Conference room (1st floor)

Exhibition : Outside Lobby (1st floor)

Food and snacks : Dining Hall (1st floor)

Plenary Session : Main Auditorium (2nd

floor) AGM (BMPA) : Main Auditorium (2

nd floor)

AGM (BCNEPS) : Conference room (1st floor)

Schedule

19 February 2015 08:00 – 08:30 Registration

08:30 – 09:50 Scientific Session I (Track I, II)

10:00 – 11:20 Inauguration Ceremony

11:21 – 11:45 Refreshment

11:46 – 13:15 Scientific Session II (Track I, II)

13:16 – 14:30 Special Lunch & Prayer break

14:31 – 16:00 Scientific Session III (Track I, II)

16:01 – 17:00 Scientific Session IV (Track I, II)

17:01 – 17:15 Tea break & Prayer break

17:16 – 18:20 Scientific Session V (Track I, II)

20 February 2015

08:30 – 10:15 Scientific Session VI (Track I, II)

10:16 – 10:30 Tea Break

10:31 – 12:30 Scientific Session VII (Track I, II)

12:31 – 14:00 Lunch & Prayer break

14:01 – 16:00 Plenary Session

16:01 – 17:00 Open Floor Discussion

17:01 – 17:10 Certificate Distribution to Volunteers

17:11 – 17:30 Closing Tea

17:16 – 18:20 Annual General Meeting (AGM)

BMPA & BCNEP

Inauguration Ceremony & Opening of Exhibition

10:00: Welcome Address by Dr. Kamila Afroj Quadir, Secretary – I, Organizing Committee

10:05: Theme Lecture – 1 by Professor Sadiq R Malik, Chief Radiation Oncology Physicist, Delta

Medical College & Hospital, Dhaka.

10:15: Theme Lecture – 2 Address by Professor Naila Zaman Khan, Head, Dept of Pediatric

Neurosciences, Dhaka Shishu (Children‘s) Hospital and President, BCNEPS

10:25 Theme Lecture – 3 Address by Professor K Siddique-e Rabbani, President, BMPA, &

Chairperson, Dept. of BMPT, University of Dhaka

10:35: Award for Pioneering Research in Medical Physics in Bangladesh to Dr. Abdus Sattar Syed

10:40: Award for Lifetime contribution in Medical Physics to Dr Syed Reza Husain

10:45 Address by Mr. Mir Mahaboob Ali, Special Guest, Managing Director, Tradevision Ltd.

10:50: Address by Prof Syed Mukarram Ali, Special Guest, Chairman, Delta Medical College &

Hospital, Dhaka.

10:55: Address by Dr M R Khan, Chief Guest, National Professor, Bangladesh

11:05: Address by Professor K Siddique-e Rabbani, Co-Chair, Organizing Committee, President,

BMPA, & Chairperson, Dept. of BMPT, University of Dhaka

11:15: Vote of thanks by Dr. Nahid Nabi, Secretary-II, Organizing Committee

11:20: Refreshment

PMCN-2015: Programme

19 February, 2015, Thursday

From 8:00 am: Registration

8:30 - 9:50 am: Scientific Session – I (80 mins) TRACK-I (Main Hall)

TRACK –II (Conference Room)

Paper

ID Presenter Paper Title

Paper

ID Presenter Paper Title

RT-1 M.N. Sharmin Performance of the First ELEKTA Precise Linear Accelerator in Bangladesh

CN-1

Naheed Nabi

Recognizing normal Electrophysiological criteria and deviation to dysfunction in neonates

RT-2 Md. Anisuzzman Bhuiyan

Influence of Jaw tracking in Intensity Modulated and

Volumetric Modulated Arc Radiotherapy for Head and Neck

Cancers – A Dosimetric Study

CN-2 Mosiul Azam Co-relation of Neurodevelopmental status, seizures, EEG and neuroimaging findings of children having neurological problem

RT-3 Mahmud Hassan

Low Cost Proton Therapy for the Cancer Patients

CN-3

Shahjahan

Chowdhury Variation of Electroencephalographic Pattern in West syndrome

Invited

IPM-1 Saiful Huq, USA

Radiation therapy: state of the art and the future

(Through Skype Link + VIDEO, 50 min)

CN-4 Sahifa Nazia Role of EEG in children with febrile seizures.

CN-5 Kaniz Fatema Clinical Spectrum, Electrophysiologic Profile and Medical Treatment of Children with Nonconvulsive Status Epilepticus.

CN-6 Abu Saleh Musa Portable EEG service and epilepsy camps to reach the unreached

CN-7 Shanta Yesmin

Reporting the multiple EEG findings and clinical outcome in

children with and without overt seizure

CN-8

Khondakar Mamun

Dynamic Topographic Visualization and quantification of a

multichannel surface EMG grid array

Invited

ICN-1

Rahsan Gocmen,

Turkey

Technical aspect of neuroradiology and their clinical evaluation in

children presenting with seizures and neurodevelopmental comorbidities

(Proxy presentation-20 min)

10:00 - 11:20: INAUGURATION (80 mins) 10:00

10:05

10:15

10:25

10:35

10:40

10:45

10:50

10:55

11:05

11:15

Welcome Address Theme Lecture-1

Theme Lecture-2

Theme Lecture-3

Award

Award

Address, Special Guest

Address, Special Guest

Address, Chief Guest

Address, Co-Chair

Vote of Thanks

Dr. Kamila Afroj Quadir, Secretary-I, Organising Committee Role Of Medical Physicists In Nuclear Medicine, Radiology & Imaging And Radiotherapy Services, by Professor Sadiq R Malik, Chief Radiation Oncology Physicist, Delta

Medical College & Hospital, Dhaka.

Low Cost High Quality Technology Based Health Service For The Resource Poor Countries; Our Experience, by Professor Naila Zaman Khan, Head, Dept of Pediatric

Neurosciences, Dhaka Shishu (Children‘s) Hospital and President, BCNEPS

Empowering People - Developing Indigenous Design And Manufacture Capability For Medical Devices In Low Resource Countries For Affordable And Sustained Solution, by

Professor K Siddique-e Rabbani, Professor & Chairperson, Dept of BMPT, Dhaka University and President, BMPA Award for Pioneering Research in Medical Physics in Bangladesh to Dr. Abdus Sattar Syed

Award for Lifetime contribution in Medical Physics to Dr Syed Reza Husain

Mr. Mir Mahaboob Ali, Managing Director, Tradevision Ltd. Prof Syed Mukarram Ali, Chairman, Delta Medical College & Hospital, Dhaka.

Dr M R Khan, National Professor, Bangladesh

Professor K Siddique-e Rabbani, Professor & Chairperson, Dept of BMPT, Dhaka University and President, BMPA

Dr. Naheed Nabi, Secretary-II, Organising Committee

11:20 - 11:45: Refreshment (25 min)


11:45 - 1:15: Scientific Session-II (90 mins)

Invited

IPM-2 Lutfun Nisa, Bangladesh Problems and Pitfalls in PET/CT imaging (30 mins)

Invited

ICN-2

Naila Zaman

Khan, Bangladesh Transfer of medical technology in resource poor situation (20 min)

RI-1 Meherun Nahar Mammographic Breast Glandularity in Bangladeshi Women: Data Derived from Generic Radiography

Invited

ICN-3

Khondokar

Mamun,

Bangladesh

Advancement of human machine interface for rehabilitation

engineering (30 min) RI-2 Nasreen Sultana

3D/4D Ultrasound for Evaluation of Normal and Abnormal

Fetal Anatomy in 2nd & 3rd Trimester Pregnancy : Experience of

Level III ultrasound

NM-1 Mohammad Anwar-Ul Azim

Development of PET Vesicular Acetylcholine Transporter

(VAChT) Neuroimaging probe for the diagnosis of Neurodegenerative

diseases Invited

ICN-4

Sania Ahsan,

Bangladesh

MRI use in early childhood and post operative evaluation in Moya Moya disease (20 min)

NM-2 M.M.M. Siraz

Assessment of Effective Dose to Occupational workers in

Nuclear Medicine Practices

NM-3 Lutfun Nisa Introducing Targeted Alpha Therapy in Bangladesh

Invited

ICN-5

Osman Gony,

Bangladesh

Neurofeedback Brain training technology: Hemoencephalography

(20 min ) NM-4 Md. Nahid Hossain

Motion Correction of SPECT by employing frame-to-frame correlation functions with Linogram and Sinogram projection

technique

1:15 – 2:30: Special Lunch

2:30 – 4:00: Scientific Session-III (90 mins)

Invited

IPM-3

Md Adnan Kiber,

Bangladesh

Review of Electrical Impedance Tomography: Advantages and

Pitfalls (30 min)

CN-9 Sania Ahsan Fetal MRI (20 min)

El-1 Ariful Islam Development of Algorithm of Simplified Sensitivity Matrix for Electrical Impedance Imaging

CN-10 Mostafa Mahbub Electrmyographic finding (EMG) in the children of Spinal muscular atrophy.

El-2 Sayed Parvez Ahmed

Focused Impedance Method for Measurement of the Volume of

an Object Embedded in a Volume Conductor

CN-11 Shipra Rani

Transfer of Technology: Experience in Providing a Short Course

Of Training and Doing EEG Recording in, Tanzania, Ghana and Cox‘s Bazar

El-3 Md. Shariful Islam

Optimum Electrode Configuration to Study the Human Kidneys

Using Electrical Impedance Techniques: a Simulation study

CN-12 Humaira Rafiqa

Title: Evaluation of the prolonged EEG and clinical correlation in

35 children.

El-4 Sumana Shahidunnahar Use of Focused Impedance Method (FIM) in the Detection

of Cervical Cancer

CN-13 Naheed Nabi

Role of EEG in children with non-seizure clinical problems: An

electro-clinical correlation

El-5 Abdullah Al Amin

Electrical Impedance Method for Breast Tumour

Characterisation

CN-14 Shanta Yesmin

Posterior slow waves on eye closure: are they precursors of

epileptiform discharges in certain cases?

El-6 A.R. Abir Development of simple Pigeon hole imaging modality for medical applications

CN-15 Abdus Salam Video-EEG data analysis and electro-clinical correlation.

El-7 Tasnim Zerin Simulation Study on Electrical Impedance Imaging of Different Sizes for Human Breast Screening for Cancer

CN-16 Mostafa Mahbub Neuroradiology : A mandatory subspeciality for clinicians.


4:00- 5:00: Scientific Session-IV (60 mins)

Invited

IPM-4

John Damilakis, Greece

(IOMP)

IOMP perspective on education and training of Medical

Physicists (40 min)

Invited

ICN-6

Mr. Kazi Tanvir

Ahmmed,

Bangladesh

Learning Kit for children with special Needs: The RGACD

learning kit (20 min)

CN-17 Shayla Imam

Kanta

Can early detection of predictors of poor seizure outcomes

change the course of neurodevelopement ?

CN-18 Osman Gony

NeuroFeedback Brain Training (NFBT) Technology for

ADHD in Bangladesh: Single Case Study.

RDP-1 A. Begum Radiation Protection in Medical Practices in Bangladesh

CN-19 Eshtiak Ahmed

Identification of cognitive states based on Transcranial

Doppler Ultrasonography

RDP-2 A. Hoque

Effective Dose to Patient during Interventional Cardiac

Procedures

CN-20 Mehedi Masood

Fundamentals of PET-CT (Positron Emission

Tomography-Computed Tomography) and it’s application

in Oncology

5:00 - 5:15: Tea Break

5:15 - 6:20: Scientific Session-V (65 mins)

RDP-3 R.K. Khan Radiation dose of patient during CT scan

AIM-1 Mousumi Bala Study of the Broca Region of Brain to Analyze Autism

RDP-4 A. N. Monika Assessment of Radioactivity of Soil in Madaripur District of

Bangladesh AIM-2 Zubair Barkat

Need Assessment of Tele-Palpation

RDP-5 M.S. Rahman Assessment of Occupational Exposure in Interventional

Cardiology practices AIM-3 Rezwan Hussain

Findings from Two Urban Field Trials of the Dhaka University Solar Water Pasteurizer

RDP-6 Sariful

Study of Radioactivity Level in Soil, Sand and Sediment

Samples of Coastal Area in Cox‘s Bazar, Bangladesh and

Evaluation of Radiation Hazard

AIM-4 Ehsan A Chowdhury

A double blind trial to establish Distribution of F-Latency

(DFL) as an indicator of Cervical Radiculopathy or

Myelopathy

RDP-7 S. Yeasmin To Study the Natural and Artificial Radionuclides in Soil

Samples from Oil and Gas Field Area of Bangladesh AIM-5 Z B Mahbub

Distribution of F-Latency and MRI Study of the Brachial

Plexus

RDP-8 S. Yeasmin

Assessment of Natural Radioactivity Level in Different

Vegetable Samples of Brahmanbaria District in East-Central Bangladesh

AIM-6 Z B Mahbub Diffusion Features of the Brachial Plexus

RDP-9 S. Yeasmin

Assessment of Radionuclide Transfer from Soil to Vegetable in

Brahmanbaria District, (Bangladesh) using Gamma-Ray

Spectrometry System

AIM-7 Z B Mahbub Investigation of Different F-response Parameters at Different

Positions of the Head

Close of the day

http://en.wikipedia.org/wiki/Bangladesh

20 February, 2015

8:30 - 10:15 am: Scientific Session - VI (105 mins)

TRACK-I (Main Hall) TRACK –II (Conference Room)

Paper ID Presenter Paper Title Paper ID Presenter Paper Title

Invited

IPM-5

A Sattar Mollah,

Bangladesh

Lessons Learned From Major Radiotherapy Accidents: International and Bangladesh Perspectives (25 min)

LCD-1 Shekh Md Mahmudul Islam

Android Apps Based Intelligent Telemedicine System for Bangladesh Perspective

LCD-2 Md. Kamrul Hussain Indigenous Development of Ultrasound Doppler Based

Fetal Heart Monitor

RT-4 Md. Shakilur Rahman Dosimetry and Quality Assurance (QA) of photon and electron

beam of medical linear accelerator at Oncology Centers in

Bangladesh

LCD-3 Zisun Ahmed Introduction to PC Based ECG Acquisition Technique without

Switched Resistor Network at Input

RT-5 M A Sabur Beam Data Acquisition of an Accelerator and Commissioning of CMS XiO 4.8 Treatment Planning System

LCD-4 Zubair Barkat Alternative Solution of Manual Glob Top for Low Resource Countries

RT-6 Muhammad Masud Rana Verification of a Computer Treatment Plan by Manual Methods LCD-5 S. Ahmmed Decoding Movements from Human Subthalamic Local

Field Potentials Based on Neural Synchronization

RT-7 A.S. Mollah Verification of TPS dose calculation by means of measurements with virtual solid water phantom and ion

chamber: Preliminary results

LCD-6 M Obaidur Rahman Efficacy Study of DFL using large Number of F-Latency Recordings

RT-8 M.N. Sharmin, Evaluation Of Radiation Doses At Organ At Risk Due To Tangential Breast Cancer Radiotherapy At Kyamch Cancer Center During 2012-13

LCD-7 M Obaidur Rahman Determination of Distribution of Conduction Velocity (DCV) from measured Distribution of F-latency (DFL)

RT-9 Hirak Kumar Dey Comparison of Dosimetric studies of 3 Dimensional conformal

radiotherapy and Intensity Modulated Radiotherapy of Brain

Tumours from CMS XIO TPS in KYAMCH

LCD-8 Ismat Ara Roksana Development of an Electronic Stethoscope with Optimized

Frequency Response for Different Body Sounds

RT-10 Motiur Rahman Planning and Delivery of 3D Conformal, Classic and fitting

PTV (C3DCRT and f3DCRT) vs. Intensity Modulated

Radiation Therapy (IMRT): A Dosimetric Evaluation and Comparison of Case Studies

LCD-9 Maruf Ahmad Implementations of a system of transferring electronic

stethoscope sound over mobile phone call for live auscultation

in Telemedicine.

RT-11 Md. Harun Or Roshid Calibration of 192Ir high dose rate brachytherapy source using

different calibration procedures

LCD-10 Susmita Afruz Investigation of X-ray Image Quality for Telemedicine

RT-12 Md. Jamal Uddin Treatment Outcome Of Radiation Alone Versus Concurrent Chemoradiation On Unresectable Non- Small Cell Lung

Cancer

LCD-11 Mohammad Abu Yousuf Talukder

Phaco-Emulsifcation Using Rotating Needles: A New Technique

RT-13 Kazi Manzur Kader Stereotactic Body Radiation Therapy (SBRT)- Advancement of

Radiation Oncology – a review

10:15 - 10:30 : Tea

20 February, 2015

10:30-12:30: Scientific Session-VII (120 mins)

Invited

IPM-6 Sadiq R Malik,

Bangladesh Radiotherapy Physics: Practical perspective (30 mins)

LCD-12 MO Rahman Low cost Dynamic Pedograph and customized shoe for diabetic

patients

LCD-13 K M A Hussain A Study of Nuclear Detector Materials Using Thermal Evaporation Method

LCD-14 A Al Amin A PC based Data Acquisition System for Bio-medical

Instrumentation

Invited

IPM-7

Salahuddin Ahmad,

USA

Treatment Plan Evaluation and Optimization Based on

Radiobiologic Parameters (30 mins)

LCD-15 Ahamad Imtiaz Khan Development of user friendly software in Bangla for a PC based

rural health monitor with option for telemedicine

LCD-16 M Abu Yousuf Solar Water Pasteurizer and Rain Water Collector for provision of

safe drinking water in urban slums and rural areas

LCD-17 Sharmin Zaman Low Cost Technology for Inactivation of Diarrhoeal Pathogens in Drinking Water Using Metals

Invited

IPM-8

S Akram Hussain,

Bangladesh Accidents and their prevention in Radiotherapy (20 mins)

LCD-18 EA Chowdhury A low cost mechanical prosthetic hand

LCD-19 Md. Nazimul Kadir A Low Cost Prosthetic Bionic Hand

Invited

IPM-9

Taposundar

Majumdar, INDIA End to End Solution - from Training, Education and Clinical Helpdesk to handle the cutting edge technology in modern cancer care (40 mins)

12:30 – 2:00 Lunch and Prayer break

2:00 – 4:00 : Plenary Session (120 mins)

Invited

IPM-10 K S Rabbani,

Bangladesh New methods in peripheral Nerve conduction measurement from Dhaka University (35 mins)

Invited

IPM-11

John Damilakis, Greece

(IOMP) Accreditation, certification and Recognition issues (45 mins)

Invited

IPM-12

Kamila Afroj Quadir

Bangladesh Education, Accreditation of Medical Physics & Biomedical Engineering in Bangladesh (20 mins)

Invited

IPM-13 M A Hai, Bangladesh

Clinical demand on Medical Physicists in Radiation Oncology (20 mins)

4:00-5:00 : Open Floor Discussion:

How to promote Physics in Medicine and Clinical Neuroelectrophysiology in Bangladesh? Compilation of Recommendations

Moderators: K Siddique-e Rabbani, Kamila Afroj Quadir, Naheed Nabi

5:00 – 5:10 : Certificate Distribution to Volunteers

5:10 -5:30 : Closing Tea

5:30 – 6:30 Annual General Meeting : BMPA (Main Hall), BCNEPS (Conference Room)

Close of the Conference

PHYSICS IN MEDICINE PAPERS

Int Conf on Physics in Medicine & Clin Neuroelectrophysiology 19-20 February 2015

29

RT-1: Performance of the First ELEKTA Precise Linear Accelerator in

Bangladesh

M.N. Sharmin1, A.S. Mollah

2, Prof. M.A. Hai

1 and Dr. M.A. Bari

1

1KYAMCH Cancer Center, Enayetpur, Sirajgonj

2Khwaja Yunus Ali University, Enayetpur, Sirajgonj

Introduction: The first medical linear accelerator manufactured by Elekta Limited was installed in

the KYMCH Cancer Center, Enayetpur, Sirajgonj, and put into clinical operation in 2007. The aim of

this paper is to show the performance of the medical linear accelerator installed in the KYMCH

Cancer Center. This work describes the first Elekta Precise Treatment System installed in Bangladesh

as well as presents the results of some measurements. The main aim of this study was to show the

technical specifications of the accelerator and dosimetric performance of the LINAC by taking into

consideration of the stability of the performance for the last 8 years of clinical work. The results of

some acceptance tests and clinical performance checks are presented and discussed.

Materials and Methods: Measurements of percent depth doses and beam profiles were performed

using the PTW radiation field analyser (RFA). Beam quality parameters of photon and electron beams

were determined on the basis of the IAEA TRS 398 report. A Farmer type ionization chamber was

used with a PTW Unidose electrometer. The study presents the most important features of the system

as well as the results of dosimetric measurements for photon beams of nominal energies 6 and 15MV

and electron beams of energies 4, 6,8,10, 15 and 18 MeV.

Results and Discussion: Results gathered within a period of 6 years (2007-2013) have shown very

good stability of basic parameters of the machine. Most performance parameters were exceptionally

good having reproducibility of <0.1%, proportionality <0.5% with stability throughout the day for

photons (<0.2%) and electrons (<0.5%). Besides, angular dependence has been observed to vary a

maximum of 0.6% for photons and 0.8% for electrons with a very good uniformity of electron beams

(<105%).

Conclusions: Dosimetric measurements demonstrated the agreement of checked parameters with the

manufacturer‘s specification and IEC standards as well as national recommendations. Medical

accelerator Elekta Precise Treatment System demonstrated its full usefulness for clinical applications.

The machine parameters and functionality meet the requirements of the modern radiotherapy facility.

This machine is being used for treatment of cancer patient with negligible downtime at KYAMCH

Cancer Center since 2007.


30

RT-2: Influence of Jaw tracking in Intensity Modulated and Volumetric

Modulated Arc Radiotherapy for Head and Neck Cancers – A Dosimetric

Study

Md Anisuzzman Bhuiyan1, Karthick Raj Mani

1, Sagar Upadhayay

2 and Kh Anamuel Haque

1

1Department of Radiation Oncology, United Hospital, Dhaka, Bangladesh

2 Gono Bishwabidyalay, Savar, Bangladesh

Introduction: To Study the dosimetric advantage of the Jaw tracking technique in Intensity

Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for Head and

Neck Cancers.

Materials & Methods: We retrospectively selected ten previously treated Head and Neck cancer

patients stage (T1/T2, N1, M0) in this study. All the patients were planned for IMRT and VMAT with

Simultaneous Integrated Boost (SIB) technique to deliver a differential dose per fraction to the high,

intermediate and low risk volume using a single plan. We intend to deliver 70Gy to the high risk

volume, 64Gy to the intermediate risk volume and 56Gy to the low risk volumes in 35 fractions. All

the critical structures were delineated which includes both parotids, spinal cord and both sub

mandibular glands. Eclipse treatment planning system, version 11.0 (Varian Medical Systems, Palo

Alto, CA), was used in this study. All the plans were planned with 6MV photons using Millennium

120 MLC. Both IMRT and VMAT plans were planned with and without jaw tracking by keeping the

same constraints and priorities for the target volumes and critical structures for a particular patient.

Plans were normalized at the target mean of the high risk volumes. All the plans were accepted with

the criteria of parotid glands mean dose <25Gy and spinal cord maximum point dose <45Gy without

compromising the target volumes. Target conformity, dose to the critical structures and low dose

volumes were recorded and analyzed for IMRT and VMAT plans with and without jaw tracking for

all the patients.

Results & Discussion: Jaw tracking resulted in decreased dose to critical structures in IMRT and

VMAT plans. But significant dose reductions were observed for critical structure in the IMRT

Technique with jaw tracking compared to IMRT Technique without jaw tracking. In VMAT with jaw

tracking technique the dose reduction to the critical structure were not significant compared to the

without jaw tracking technique due to relatively lesser monitor units. Gamma analysis showed greater

than 97% of pixels were passed within 3mm distance and 3% dose criteria for all the plans.


31

RT-3: Low Cost Proton Therapy for the Cancer Patients

Mahmud Hassan

Dept of ECE, East West University, Aftabnagar, Dhaka, E-mail: [email protected]

Introduction: Although photon therapy saves lives of millions of cancer patient over the globe, the

quality of life of a patient may be compromised as the high energy photon beam (x-ray or gamma ray)

can damage adjacent tissues as it crosses the tumor. For particular types of cancer (eye, brain, liver,

lungs etc.) or for children or young adults photon therapy is not preferable. On the other hand proton

therapy can be a much better choice for these groups as protons slow down relatively fast when

entering biological tissues, and most of their energy is deposited, with little scatter, at the end of their

path in a peak called a Bragg peak (Fig. 1). Proton therapy is however very expensive and available in

only about 50 facilities around the world compared to several thousand photon therapy centres.

Fig. 1: Bragg peak for photon beam (pink line) and proton beam (red line). The blue line shows the

modified Bragg peak for proton beam of same energy. The modification is done to irradiate the

whole tumor and the thickness can be varied as per need.

Methods: Laser driven proton beams can reduce the cost of proton therapy by at least ten times in

future. When high intensity laser beam (I> 1019

W/cm2) is incident on a thin (few 10‘s of microns)

metal film, MeV proton beam comes out of the other side through a process known as TNSA.1We

used Halbach permanent quadruple magnets for focusing the proton beam. Initially GEANT4 and

Tosca Opera simulations were carried out to determine the positioning of the quadruple magnets. The

quadruple arrangements were used in the Forschungzentrum Rossendorf Tandem Accelerator in

Dresden, Germany and could successfully focus the beam.

Results: The quality of the beam was checked using the VULCAN petawatt laser beam in the

Rutherford Appleton Lab, Didcot, Oxfordshire, UK and we could produce up to 1011

protons per shot.

Although the proton beam was not mono-energetic, simulations show that at higher intensities, RPA

(radiation pressure acceleration) can produce quasi mono-energetic protons beams.2 With ELI

(extreme light infrastructure) to start in 2018, we expect to see GeV proton beam as a result of direct

acceleration from the intense (1022

W/cm2) laser beam.

Conclusion: Together with the Halbach quadruple magnet arrays we expect to see tabletop low cost

proton accelerators for proton therapy in not so distant future.

References: 1. S. C. Wilks et al., Physics of Plasmas, AIP, 2001, 8, 542-549

2. Keith Markey, CLF, STFC, STFC report (http://www.stfc.ac.uk/CLF/science/40078.aspx).

mailto:[email protected]

http://www.stfc.ac.uk/CLF/science/40078.aspx


32

Invited Talk

IPM-1: Radiation therapy: State of the art and the future

M. Saiful Huq, PhD, FAAPM, FInstP Professor and Director of Medical Physics

Department of Radiation Oncology

University of Pittsburgh Cancer Institute and UPMC CancerCenter

Pittsburgh, Pennsylvania, USA E-mail: [email protected]

During the last two decades there has been significant advances in technical innovations in radiation

therapy such as stereotactic radiosurgery (SRS), stereotactic body radiotherapy (SBRT), intensity

modulated radiotherapy (IMRT), and image guided brachytherapy (IGBT). Biologic information from

various physiologic imaging modalities are now routinely used to delineate target volumes accurately

and has become an integral part of the treatment design process. These advances have made it

possible to develop radiotherapy treatment plans based on 3D and 4D images that describe cancerous

targets and normal tissues and their movements. Linear accelerators are now integrated with

kilovoltage imaging devices to provide a means of seamless target identification and image guided

radiotherapy (IGRT), real time or near real time target monitoring, flattening-filter free beams and

volumetric modulated arc therapy. These technological innovations have enabled the delivery of

ideally distributed radiation dose to the target with great precision and accuracy while sparing the

adjacent organs at risk. The next generation linear accelerators will be integrated with MRI to provide

better contrast of various tissues in MRI for accurate targeting and normal tissue delineation and the

potential for real-time MRI-based tumor tracking and doing adaptive radiotherapy. In parallel

significant development is taking place in the world of nanotechnology, molecular imaging, genomic

analysis in the understanding of biology of cancer, targeted therapies, biologic therapies and systemic

therapies using novel chemotherapeutic agents. Trends in cancer therapy are moving from

population-based approaches to personalized approaches. It is likely that all these various modalities

will work together to provide evidence based highly personalized form of cancer medicine. This

presentation will provide an overview of these exciting advances in radiotherapy technology and

suggest how these innovations might work synergistically with advances in other field of oncology in

the years ahead of us.



33

RI-1: Mammographic Breast Glandularity in Bangladeshi Women: Data

Derived from Generic Radiography

M. Nahar1, M. Sazzad

2, M.M.A. Zaman

2, A.S. Mollah

3

1Bangladesh Atomic Energy Regulatory Authority, Dhaka

2 Department of Physics, Jahangirnagar University

3Department of Medical Physics, Khwaja Yunus Ali University, Enayetpur, Sirajgonj.

Introduction: Breasts are made up of adipose, glandular and areolar tissues together with the

overlying skin. Of these, the glandular tissue is the most vulnerable and a common site for cancers. In

breast imaging with mammography, the percentage of glandular tissue is known as mammographic

breast glandularity. For calculation of the mean glandular radiation dose from a mammography

procedure, knowledge of the breast glandularity and compressed breast thickness for each breast is

required in order to choose mean glandular dose conversion factors. The amount of glandular tissue is

also linked to breast cancer risk. Thus, an objective quantitative analysis of glandular tissue can aid in

risk estimation.

The primary objective of this study was to determine the percentage of breast granularity of

Bangladeshi women which will affect mean glandular dose (MGD) during diagnostic mammography.

The secondary objective was to evaluate some of the factors affecting women‘s glandular tissue.

Materials and Method: Estimation of mammographic breast glandularity in Bangladeshi women

was done from generic radiographic data. A fitted equation was applied for 78 women who underwent

diagnostic mammography. A mammography X-ray unit was used to expose different thicknesses of

phantom material of varying glandular and adipose composition to develop this equation. Values of

compressed breast thickness (CBT), tube voltage kV, mAs and target/filter combination, were

collected for 78 women ranging in age from 16 to 70. The expected dependence of breast density on

age and CBT were analyzed.

Results: The average breast glandularity in women included in this study sample was 50.92% ±

17.45%. Breast glandularity was found to decrease with compressed breast thickness and age. A 15%

reduction of breast glandularity from 36 to 70 years was observed. Women above the age of 40 years

showed the greatest rate of change in glandularity. The average breast glandularity obtained in our

study was higher than that reported in studies from the United States, but comparable to values

reported for women in Australia, Germany and Malaysia. No significant variation of mean

glandularity has been found with Body Mass Index (BMI).

Conclusion: A method has been tested for estimation of mammographic breast glandularity in

Bangladeshi women from generic radiographic data. It provides a preliminary approach for

estimation of glandular tissue. This information will permit mean glandular dose calculations to be

extended from breasts of average composition (50% glandular and 50% adipose) to breasts of

individually determined composition. Image processing technique or quantitative interpretation of

fibro glandular and adipose tissue on mammogram remains to be developed in future studies.


34

RI-2: 3D/4D Ultrasound for Evaluation of Normal and Abnormal Fetal

Anatomy in 2nd

& 3rd

Trimester Pregnancy: Experience of Level III

ultrasound

N Sultana1, A Ihsan

2

1National Institute of Nuclear Medicine & Allied Sciences (NINMAS)

Bangladesh Atomic energy Commission 2Amimul Ihsan. IUT (Islamic university of technology)

E-mail: [email protected]

Introduction: Invent of 3D/4D ultrasound (US) has made a dramatic improvement in fetal imaging.

On 3D ultrasound, multiple 2D ultrasound sections are taken. Software like magic cut and

tomographic ultrasound imaging (TUI) helps to understand the anatomy better. Volume ultrasound is

an excellent tool for diagnosis of facial defects, spinal abnormalities and limb abnormalities etc. 4D

US shows fetal movements and expression that are basis for the neurodevelopment of the fetus. The

purpose of this study is to present the refined anatomical details obtained with 3D/ 4D ultrasound

over the classic 2D ultrasound in obstetrics and to emphasize the usefulness of this new technique

for the study of fetal anomaly.

Material & Method: Between May 2014 and October 2014 a total number of 350 fetuses were

evaluated by 2D & 3D/4D ultrasonography. Only consenting patients with singleton pregnancies

referred for anomaly scans were subjected to the 3D/4D imaging technique.

All examination was carried out as part of a detailed level III US procedure for fetal anomaly study.

The gestational age was between 18-30 weeks. We used a Voluson S6 advanced ultrasound machine

from GE with A RAB 4D abdominal probe (4-8MHz). Various viewing directions, rendering modes,

multiplanar modes and volume ultrasound modes were employed for visualization of fetal anatomy

and detection of malformations.

Results: In the total number of 350 high risk pregnancies studied, 48 women had fetuses with one to

three fetal defects. The total number of defects detected was 73. These are shown below in tabulated

form in Table I.

Conclusion : In comparison to conventional 2D ultrasonogram, the new 3D/4D ultrasound is not

only a useful tool in appreciating the severity of fetal defect but also provides more convincing

evidence of a normal fetus. This is especially the case in pregnancies that carry an increased risk of

surface malformation. Table I: No. of defects detected

System Number of defects ( total 73)

Central nervous systems 25

Spinal abnormality 05

Gastrointestinal abnormality 15

KUB 17

Skeletal systems 08

Facial abnormality 03

Image 1, 2, 3D US images of skeletal abnormality & image 3 shown 2D image of skeletal

abnormality. Image 4, 3D US of Fetal Face (normal)



35

NM-1: Development of PET Vesicular Acetylcholine Transporter (VAChT)

Neuroimaging probe for the diagnosis of Neurodegenerative diseases

Mohammad Anwar-Ul Azim1,2

, Takashi Kozaka2, Izumi Uno

2, Daisuke Miwa

2, Yoji Kitamura

2,

Kazuma Ogawa3, Yasushi Kiyono

4, Kahuhiro Shiba

2

1National Institute of Nuclear Medicine and Allied Sciences, BAEC, BSMMU, Shahbagh, Dhaka. 2Division of Tracer Kinetics, Advanced Science Research Center, Kanazawa University, Japan.

3Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan.

4Biomedical Imaging Research Center, University of Fukui, Fukui, Japan.

Introduction: Neurodegenerative diseases are generally characterized by progressive diminution in

cognitive function. The decreased cognitive function and level of dementia are associated with the

loss of cholinergic neurons and synapses accompanied by deficiencies in cholinergic

neurotransmission. In cholinergic neurotransmission, a marked diminution of VAChT is sufficient to

interfere with the release of Acetylcholine (Ach) in the brain and affects cognitive behavior. Hence,

positron labeled VAChT imaging probe might be a tool for the diagnosis of neurodegenerative

diseases using Positron Emission Tomography (PET).

The outcome of PET neuroimaging depends on: the number of receptors available for binding with

the PET radioligand; the affinity of available receptors toward the PET radioligand and the

concentration of molecules other than the PET radioligand that bind to those receptors. Challenges

involved in the development of VAChT PET neuroimaging probe includes short half-life of

conventional positron emitters; synthesis of highly purified radioligands of high specific activity;

reasonable lipophilicity of the radioligand to access blood brain barrier (BBB) and high specific

regional accumulation in VAChT rich regions in the brain.

Objectives: The objective of the present study is to report the prospect of a newly synthesized

decalinvesamicol (DV) analogue radiolabeled with the unconventional long-lived positron emitter

(77

Br) as a potential VAChT PET imaging probe.

Method: [77

Br]OBDV was synthesized by a standard halogenation reaction from o-trimethylstannyl-

trans-decalinvesamicol (OTDV) and this [77

Br]OBDV was injected intravenously into 12 rats. These

rats were sacrificed in groups of four at intervals of 2 min, 30 min and at 60 min post-injection. The

blood, brain regions, and the organs of interest were harvested, weighed and radioactivity was counted

to investigate the in vivo biodistribution. In vivo blocking study was performed to check the binding

selectivity of [77

Br]OBDV for VAChT. Ex-vivo autoradiography was performed to reveal the regional

brain distribution of [77

Br]OBDV at 30 min post-injection.

Results: In- vivo biodistribution study showed rapid penetration of [77

Br]OBDV through the blood-

brain barrier. At 2 min and 60 min post- injection the accumulation of radioactivity in the brain was

found to be > 0.6 % ID/g and 0.45 ~ 0.53 % ID/g respectively. The uptake of [77

Br]OBDV in brain

was blocked by about 41% after co-administration of 0.250 μmol vesamicol (VAChT ligand) in the

in- vivo blocking study. In ex-vivo autoradiography, accumulation of [77

Br]OBDV in striatum and

cortex was observed visually.

Conclusion: Selective binding and high affinity of [77

Br]OBDV to VAChT in rat brain in- vivo

suggests that OBDV radiolabeled with 77

Br can be a potent VAChT imaging probe for PET.


36

NM-2: Assessment of Effective Dose to Occupational workers in Nuclear

Medicine Practices

M.M.M. Siraz, R.K. Khan, A. Hoque and A. Begum

Health Physics Division, Atomic Energy Centre, Dhaka-1000, Bangladesh E-mail: [email protected]

Introduction: Nuclear medicine is a medical specialty involving application of radioactive substances

in diagnosis and treatment of disease. The most commonly used radioisotopes in nuclear medicine

facilities in Bangladesh are Tc-99m and I-131. The medical use of ionizing radiation, while offering

great benefits to patients also contributes significantly to radiation exposure to individuals and

populations. This report describes occupational radiation doses of nuclear medicine personnel in 17

nuclear medicine facilities in Bangladesh.

Materials and Methods: Calibrated thermoluminescent dosimeters (TLD-100, LiF: Mg,Ti) were

used to determine radiation dose and were worn by nuclear medicine personnel on their torso for 3

months. Harshaw TLD reader (Model 4500) had been used for reading out the TLD cards.

Result and Discussion: In this study it was observed that the dose received by all the occupational

workers was within the occupational dose limit of 20 mSv per year. Average dose received by the

occupational workers is shown in Figure-1 and their dose range distribution is tabulated in Table-1.

Figure-1. Average dose received by Nuclear Medicine personnel from 2010 to 2013

Table-1. Distribution of workers on different dose range (mSv) from 2010 to 2013

Year Total

Worker

<MDL MDL-

0.99

1-

2.99

3-

4.99

5-

9.99

10-

14.99

2010 264 132 121 9 2

2011 304 162 125 14 2 1

2012 320 168 130 20 2

2013 294 202 75 12 3 2

Conclusion: The dose received was within the maximum annual dose limit for occupational workers.

Nevertheless, for continued radiation protection, the occupational workers must remain vigilant about

procedures and practices to keep radiation exposure dose as low as possible.

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Avera

ge D

ose (

mS

v)

2010 2011 2012 2013

Physician

Scientist

Staff



37

NM-3: Introducing Targeted Alpha Therapy in Bangladesh

Lutfun Nisa1, Kamila Afroj Quadir

1 and K Siddique-e Rabbani

2

1National Institute of Nuclear Medicine & Allied Science, BAEC

BSM Medical University, Dhaka, Bangladesh. 2Department of Biomedical Physics & Technology, University of Dhaka, Bangladesh


Introduction/Background: Targeted alpha therapy (TAT) is a new experimental, systemic therapy

that targets cancer cells and tumor capillary endothelial cells by intravenous injection of an alpha

immunoconjugate (AIC). The AIC is formed by labeling the cancer targeting monoclonal antibody

with the alpha emitting radioisotope Bi-213 using a bifunctional chelator. The monoclonal antibody is

raised against antigens that are over expressed by cancer cells. There are several centers for TAT,

notably in Europe, the US and Australia. Bangladesh recently obtained ethical clearance for a Clinical

Phase 1 trial of TAT in patients with MUC1 antigen positive cancers. The TAT technique will be

discussed and highlighted in this presentation.

Objective: The aim of the study is to introduce and establish TAT technology in Bangladesh as a safe

therapeutic option for management of patients with advanced MUC1 positive cancers.

Method: The study will be done in collaboration with Australia. The monoclonal antibody C595

against MUC1 and the Actinium:Bismuth generator required for the study will be obtained through

the collaborating partner. Patients with stage four MUC1 positive cancers having progressive disease

and those who have either completed or have declined other systemic therapies will be included in the

trial. Cohorts of 3 subjects with end-stage cancer will be treated with escalating doses of 5 mCi, then

10, 15, 20, 25, 30 mCi every 2 months. If adverse events are seen in one patient then the maximum

tolerance dose will be the preceding dose. Patients will be followed up for 12 months with emphasis

on the detection of delayed radiation nephrosis.

Result: The proposed study will bring together the highly selective features of a unique targeting

system with the high cytotoxicity of alpha particles for treatment of mucin (MUCI) expressing tumors

of the breast, ovary, pancreas and prostate. It will optimize the key parameters of targeted alpha

therapy, ie stability and specific activity of the alpha – conjugate and maximum tolerance dose that

may lead to a much higher rate of tumor control.

Conclusion: Currently there is no systemic treatment that can inhibit the progression of cancer that

leads invariably to the death of the patient. If successful, TAT would be indicated for durable

therapeutic responses in stage four cancer patients.



38

NM-4: Motion Correction of SPECT by employing frame-to-frame

correlation functions with Linogram and Sinogram projection technique

Md. Nahid Hossain1, Kamila Afroj Quadir

1, Ferdoushi Begum

1, Tanvir Ahmed Biman

1,

Md. Nurul Islam1 and Adnan Kiber

2

1National Institute of Nuclear Medicine & Allied Sciences, BAEC. BSM Medical University campus.

Shahbagh, Dhaka, Bangladesh 2Department of Electrical and Electronic Engineering, University of Dhaka, Bangladesh.


Introduction: Single Photon Emission Computed Tomography (SPECT) study involves data

acquisition over a relatively long time, typically in the range of 5-30 minutes. For good image

quality, the patient must ideally lie still during this period but quite frequently patient movement

occurs during aclinical procedure. This movement causes misalignment of the projection frames,

which degrades the image quality and may introduce artifacts in reconstructed images. The ability to

detect and correct for the motion using a computational method is valuable for quality assurance of

SPECT imaging. In this work, a frame-to-frame correlation function based on linogram and sinogram

of the projection technique was evaluated to estimate the occurrence of motion and to make correction

for best alignment.

Methods: A Technetium-99m point source was placed at 15cm radius of rotation and images were

obtained with a rotating dual head gamma camera. Data was acquired with 32 views over 360 into a

128 x 128 acquisition matrix. To evaluate the process, some axial displacements and frame-to-frame

correlation functions were applied on several frames of the point source object.

Results: Misalignment of the source was detected in 16 frames in projection data. The results showed

that misalignment due to motion between the projections can be corrected with the application of

frame-to-frame correlation method. The linogram and sinogram were used to show better alignment.

The motion artifacts of images were reduced considerably after motion correction.

Conclusion: The frame-to-frame correlation technique represents a sensitive method for the

correction of patient motion during a tomographic scan. Patient motion as small as 1 pixel could

easily be distinguished by this method and thus, the motion artifacts of images were reduced

significantly which eventual improvement of the image quality.



39

EI-1: Development of Algorithm of Simplified Sensitivity Matrix for

Electrical Impedance Imaging

Ariful Islam, Sabbir Akhanda & Dr. Md. Adnan Kiber

Dept of Electrical and Electronic Engineering, University of Dhaka, Dhaka, Bangladesh E-mail: [email protected], [email protected], [email protected]

Introduction: Electrical impedance tomography (EIT) is a kind of medical imaging technique in

which conductivity distribution within the object is estimated from the boundary voltage and current

measurements. Electrodes are placed on the surface of the body and by applying low currents

resultant voltages are calculated from these surface electrodes. We can only measure boundary

voltages in real life. Many developed algorithms are very complex and failed to real life data. We

offered a very simple and innovative way to calculate the discretized sensitivity matrix to estimate the

conductivity distribution.

Methods: The boundary voltage (V) data and the conductivity (C) distribution are related by the

equation V=SC, where S is the sensitivity matrix of the considered section. For simplicity, we have

assumed a square section and placed one electrode at each corner of the section (Figure 1). We also

have assumed that the conductivity distribution is equal to 1 S\m. So we can write V=S. Here V is a

vector (size 16×1) and S is a matrix (size 16×16). To find the elements of the matrix at first we drive

two successive electrodes and consider middle point as the output point of any two successive

electrodes. The voltage induced at this point is equal to the total contribution of each small square

voltage and the value will depend on the relative distances between the squares and the middle point.

For infinite medium it will change inversely according to

, where r and d are the corresponding

distances from driving and receiving point to the center of each small square. These distance values

are the coefficients of the sensitivity matrix. Firstly we have calculated the distance values according

to the analytical formula

then modified it by

since our considered medium is finite. We

have formed the sensitivity matrix by the distance values as its coefficients. Then we have multiplied

the sensitivity matrix with unity conductivity to measure the analytical voltage and compared with the

voltage data simulated by COMSOL Multiphysics 4.3 to compute the percentage of error (Figure 2).

Figure 1: Considered section. Figure 2: Data comparison. Figure 3: Error estimation.

Results and Observations: It is found that the voltage data obtained by simulation from COMSOL

and voltage data (analytical) calculated from our sensitivity matrix results an error, =6.59% .The

analytical formula is based on infinite medium. However medium considered here is finite. So we

argued that the distance function

should be changed by

. We have changed the parameter

from m=1.8 to m=2.7 and calculated respectively. Minimum error occurs when m=2.2 which is

equal to =.762% (Figure- 3).

Conclusion: So our suggested model of developing the simplified sensitivity matrix from V=SC by

assuming uniform conductivity can be considered to be a good estimation of the true theoretical

sensitivity matrix.





40

EI-2: Focused Impedance Method for Measurement of the Volume of an

Object Embedded in a Volume Conductor: Finite Element Simulation

Sayed Parvez Ahmed1, 2

, M Abdul Kadir1, Golam Dastegir Al Quaderi

3, Rubina Rahman

2 and K

Siddique-e Rabbani1

1Department of Biomedical Physics & Technology, University of Dhaka, Dhaka-1000, Bangladesh

2Department of Physics, Jahangirnagar University, Savar, Dhaka, Bangladesh

3Department of Physics, University of Dhaka, Dhaka-1000, Bangladesh

E-mail: [email protected], [email protected]

Introduction: In many applications the volume of a target organ inside the body needs to be

measured from outside non-invasively. The present work aims at developing such a method using a

localized impedance measuring technique called the Focused Impedance Method (FIM) which was

innovated by the Biomedical Physics group of the University of Dhaka.

Methods: The present method is based on the 4-electrode FIM version where the electrodes are

placed at the corners of a square region. In this method multiple concentric FIM electrode sets having

different separations are placed centrally over the region with the target object underneath. Using

Finite Element simulation using a software package named

Comsol Multiphysics (version 4.3) FIM values were obtained

with and without objects of different conductivity, size and depth

embedded in a volume of uniform and known conductivity and

the change in impedance were obtained. Simulations indicated

that these impedance-change decreased with electrode separation

almost linearly up to a certain value. The top figure shows such

changes for object conductivities less and more than the

background conductivity, and for varying object diameters (d),

using spherical objects. The slopes in the early part of this figure

were then plotted with 1/d which appears to be a straight line as

the lower figure shows. From this finding an equation was

developed as:

|

|

where K and C are constants which

depend on the conductivity and permittivity of the object and the

volume conductor under investigation, dimension of the volume

conductor and the electrodes used and the electrode separations

chosen.

Results: Using the above method simulation and

phantom experiments were carried out respectively. In

the first case the obtained volume was compared with

the modeled object volume while in the latter the

obtained volume was compared with the actual object

used in a phantom of uniform conductivity. The two

tables give the values obtained (top: simulation, bottom:

actual phantom experiment).

Discussion: It may be seen that the error values are very

small. Of course, this method needs a knowledge of the

conductivities and permittivities of the object and the

background, which may be obtained using other means.

The present work gives a method which may be useful

not only in medical field but also in other areas like

geology, oceanography, etc.

Acknowledgement: International Science Program of Uppsala University, Sweden for part support.

Electrode separation

Ch

ang

e in

Fo

cuse

d i

mp

Inverse of depth

Slo

pe

val

ue




41

EI-3: Optimum Electrode Configuration to Study the Human Kidneys

Using Electrical Impedance Techniques: a Simulation study

Md. Shariful Islam, M Abdul Kadir and K Siddique-e Rabbani Department of Biomedical Physics and Technology, University of Dhaka, Dhaka, Bangladesh


Introduction: There is a growing interest on non-invasive examination of living tissue using

electrical impedance techniques. Impedance measurements using skin surface electrode can sense the

change in transfer impedance of an organ within the body. Electrical impedance properties of human

kidney may give useful information about its functionality. The present work was taken up to find an

optimum electrode configuration to study electrical properties of human kidneys using electrical

impedance techniques.

Methods: A Finite Element simulation software package (COMSOL Multiphysics) was used for all

the simulated measurements in the present work. A cylindrical (diameter: 28cm, height: 30cm)

thorax-abdomen model with a uniform background conductivity (equal to that of typical values for

muscles) was assumed with the kidney (assumed rectangular, of size 11cm x 6cm x 3 cm) having a

different conductivity and placed at a depth of 5cm from the surface. Total impedance of this thorax-

abdomen model with and without a kidney were measured using conventional Tetrapolar Impedance

Method (TPIM) and three versions of Focused Impedance Method (FIM with 8, 6 and 4 electrode

versions)> These FIM techniques were conceived and developed by the Biomedical Physics group of

the University of Dhaka. For the desired measurements in the simulation, electrodes were placed on

the body surface at various positions to determine the contribution of the kidney. To obtain the

optimum electrode configuration, the measurements were simulated with different electrode positions

for all the measurement techniques.

Results: It was observed that for all measurement techniques, contribution of a kidney to the total

measured impedance is maximum when the kidney is just below the center of the electrode

configuration. For a particular measurement system, the contribution of kidney initially increases with

increased electrode separation, reaches a maximum and then decreases again. Focused Impedance

Method with 4 electrodes having an electrode separation of 12cm appeared to give the best result.

Discussions: The behavior shown in the figure may depend on the depth of the target object. A

smaller electrodes separation may

be needed if the depth is reduced.

This optimum configuration needs

to be verified first by phantom

experiments and then through

measurements on the human

body. In this model the thorax was

assumed to have a uniform

conductivity except the kidneys. If

we could consider other organs as

the part of the model, the result

might be more accurate which can

be investigated in future.

Acknowledgement: International

Science Program of Uppsala

University, Sweden for part support.




42

EI-4: Use of Focused Impedance Method (FIM) in the Detection of Cervical

Cancer

Sumana Shahidunnahar, M A Kadir, Shahnaj Parvin and K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka, Dhaka 1000,

Bangladesh E-mail: [email protected], [email protected]

Introduction: In Bangladesh approximately 200,000 new female cancer cases are added each year in

which the prevalence of cervical cancer (21.5%) comes only second to that of breast cancer (25.6%).

In cancer changes occur at cellular level as shown in Fig.1 for which the electrical impedance at

different frequencies differ significantly from that of the healthy cells.

Methods: The thickness of epithelium layer of cervix is about 0.5 mm which

is affected by cancer. Based on the above information a group in Sheffield,

UK developed a pencil like impedance probe with four tiny gold electrodes

placed at the corners of a square region with 2mm sides. They showed that

the peak sensitivity of such a probe is at one third the electrode separation,

which guided the choice of the electrode geometry. Using multi-frequency

Tetra Polar Impedance Measurement (TPIM) this group succeeded in

detecting cervical cancer at early stage, known as CIN-1, as shown in fig.2.

Results: The present work was taken up in laboratory of Department of

Biomedical Physics & Technology, University of Dhaka, to apply Focused

Impedance Method (FIM), a recent innovation of our extended group, in the detection of Cervical

Cancer. The geometrical sensitivity distribution of FIM is more localised than that of TPIM, and this

localisation may bring advantages to this technique. Besides, to make the measurement simpler the

measurement would be made at only two frequencies, one around 5kHz and the other around 500kHz.

A pencil impedance probe similar to that of the Sheffield group but with 1.5mm sides has been made.

Discussions: Since the current density may be high with small electrodes, an FIM instrument is being

developed with small currents, of the order of 10µA. Measurements will be made first on phantoms

and other biological samples before applying on human subjects. If successful, this work may produce

a cost effective device for use in the Third World.


Normal CIN 1 CIN 3 InvasiveCIN 2

Fig.1: Normal cervix and a

cervix with an early form of

cancer (cervical dysplasia)

Fig.2: Cellular structure of cervical epithelial cells for normal, cancerous, and

intermediate stages (surface at the top).




43

EI-5: Electrical Impedance Method for Breast Tumour Characterisation

Abdullah Al-Amin1, Shahnaj Parvin

1, M A Kadir

1, Tasmia Tahmid

2, S Kaisar Alam

3,

K Siddique-e Rabbani1

1Department of Biomedical Physics & Technology, University of Dhaka, Dhaka 1000,

Bangladesh. 2Tasmia Tahmid Breast Care, Dhaka.

3Center for Computational Biomedicine Imaging and Modeling

(CBIM), Rutgers University, Piscataway, NJ 08854, USA


Introduction: Cell morphology and blood flow are significantly different in malignant and benign

conditions in breast tumours contributing to significant differences in electrical impedance at a

particular frequency of measurement, as well as in the frequency spectrum of impedance. The aim of

the present work was to explore the feasibility of using Focused Impedance Method (FIM), a

localized measurement technique conceived and developed by the Biomedical Physics group of the

University of Dhaka, to characterize a breast tumour non-invasively, i.e., to determine whether a

tumour is malignant or benign. The only existing alternative is needle or core biopsy, which are not

hazard free; in a few percent of cases where the tumour is cancerous, tissue adhering to the tip of the

needle sometimes introduces cancer at the upper layers

Methods: A 4-electrode probe as shown in the figure (left)

with an adjacent electrode separation of 5cm was used to

obtain transfer impedance values using the traditional

Tetrapolar Impedance Method (TPIM) in both horizontal

and vertical directions. These were combined to get FIM

values too. Measurements were carried out at two

frequencies, 5kHz and 200kHz, keeping the tumour at the

centre of the electrode geometry as far as possible. Data

were obtained from 23 consenting subjects in the age range 17 - 55 years who had palpated lumps.

Location and size of the tumours were determined earlier through ultrasound scan and some patients

had core biopsy afterwards. The data were analysed using statistical and Feature classification

methods, which used 12 features in this case. Classification using K-Nearest Neighbour (K-NN)

method was performed.

Results and observations: 4 patients out of the

23 had malignancy, based on core biopsy

results. The statistical analysis showed

significant variation between the affected and

unaffected sides of a particular patient but there

was a large person to person variation. The plot

obtained with the Feature classification method,

as shown in the bottom figure, provided a

reasonable distinction between benign (dotted

lines) and malignant cases (solid lines) when

the impedance data were divided by the age of

the patients. A positive predictive value of 60%

and a negative predictive value of 93% was

obtained in this preliminary study.

Conclusion: This method has scope to improve and may provide a new technique for non-invasive

biopsy of breast tumours.


H

Vt




44

EI-6: Development of simple Pigeon hole imaging modality for medical

applications

A.R. Abir, K.S. Rabbani, A.I. Khan, K. Hossain

Department of Biomedical Physics and Technology, University of Dhaka, Bangladesh. E-mail: [email protected]

Introduction: Pigeon Hole Imaging (PHI) is a new and simple imaging modality to give a low

resolution electrical impedance image conceived and developed in our laboratory earlier. This may be

used to perform measurements on large organs inside the body whose positions are not accurately

known, or which moves during measurement. This earlier version of PHI was conceived as an

extension of the 6-electrode Focused Impedance Method (6-FIM). Two pairs of orthogonal current

electrodes, and a number of diagonal electrodes at the central zone were required for the PHI.

However, the images away from the diagonal had to be corrected based on several empirical rules. A

newer version of PHI has recently been conceived based on 4 electrode Focused Impedance Method

(4-FIM). Both 6-FIM and 4-FIM were developed by extended groups of our department earlier.

Methods: In the current version of the PHI, many electrodes are arranged in a square matrix as shown

in figure 1 (dots represent electrodes). Using the 4 electrodes at the corners of each square matrix

element, a 4-FIM measurement is made which gives the respective impedance within the individual

matrix position with negligible contribution from the neighboring zones. Thus all the results

combined, arranged and assigned to respective matrix positions, gives the desired PHI image directly.

Because of the inherent 3D sensitivity, large internal body organs may be imaged by placing the

electrodes on the chest or on the back of a human thorax.

Results and Discussion: For PHI, when objects are far apart, the straightforward image is reasonably

good. However, when a single object extends beyond a single pixel, or when several objects lie in

close proximity, some uncertainties occur in the image generation. Some rules have been developed to

generate images in such cases to include these effects and necessary software has been developed.

Figure 2 shows such an image with four simulated objects in different positions in a 5x5 matrix. PHI

is suited to surface electrodes looking at organs within certain depths. It should be useful in locating a

reasonable large organ inside the body, and for following it if it changes positions or size with time.

This may have use in the application of electrical impedance for diagnosis or for applying precise

radiotherapy dose to a particular organ that is moving with breathing. It is conceptually simple, and

the instrumentation necessary is simple too. Therefore, the instrumentation can be developed and

made in a low resource country, at a considerably low cost.

Z11

Z12

Z13

Z21

Z22

Z23

Z31

Z32

Z33

Z14

Z24

Z34

Z41

Z42

Z43

Z44

Figure 2: PHI for four objects

positioned at different places in a

5x5 matrix.

Figure 1: Concept of PHI based on

4 electrode FIM. This shows a 4x4

imaging method.



45

El-7: Simulation Study on Electrical Impedance Imaging of Different Sizes

for Human Breast Screening for Cancer

Tasnim Zerin, Selina Akter and Md. Adnan Kiber Department of Electrical & Electronic Engineering, University of Dhaka.

Email: [email protected], [email protected], [email protected]

Introduction: Breast cancer is the most common invasive cancer in females worldwide. However,

early diagnosis and detection by screening method can save life.

Methods: At present, commonly mammography is used as screening method for detecting breast

tumor which uses low-energy X-ray radiation. Although the radiation exposure is low, the repeated x-

rays have the potential to cause cancer along with the high probability of false diagnosis.Ideally, a

non-invasive, no health hazard, simple and inexpensive method for breast cancer screening is needed

and Electrical Impedance Tomography (EIT) meets these requirements, however its resolution is low.

Most image reconstruction method in EIT uses sensitivity matrix and this matrix has a dependency on

size and shape of the object. It is known from the works of other researchers that size of breast do

vary from one woman to other woman. Here, we used ‗Comsol multiphysics‘, a simulation software

to observe the corresponding voltage distribution EIT data by varying the size of the object in both 2D

& 3D. The half-sphere shaped object model rather than cylindrical shaped object is used, which

mimics closely the shape of the human breast.

Results and Observations: In this work, 16 equidistant electrodes have been placed at the mid-level

on the surface of the objects having radius of 5cm , 6cm, 7cm, 8cm, 9cm and 10cm for 2D circular

object and 3D half-sphere models. For every object for 16 electrodes, there is a corresponding 13 EIT

voltage data. For uniform conductivity, we summed all the 13 EIT data and got Vtot for each size

object for both 2D and 3D object. Then we have introduced a small object having volume 26 cm^3 for

all cases at the center having conductivity 100 times of uniform conductivity. After that we have used

equation

∑

) ) , where Vc and Vu implies 13 EIT data for non-uniform and

uniform conductivity. For uniform conductivity, it is seen from the graph in fig-1 & fig-2, Vtot is

practically constant for 2D object and fall almost linearly as the size increases in case of 3D. While

for non-uniform conductivity, Vd changes in 3D shown in fig-3 and the rate of decrease is faster.

Fig-1: Vtot for different sizes of object for Fig-2 : Vtot for different sizes of object for Fig-3 : Vd for different sizes of object for

2D uniform conductivity. 3D uniform conductivity. 3D uniform & non-uniform

conductivity

Discussions: From this work, it is clear that for 3D object (breast), size information need to be

incorporated in calculating sensitivity matrix to get a better EIT image.

References: 1. http://www.cancer.gov/cancertopics/factsheet/detection/mammograms

2. http://www.mobecomm.com/docs/pubs/A_3D_electrical_impedance_tomography-(EIT)-

system_for_breast_cancer_detection.pdf)




http://www.cancer.gov/cancertopics/factsheet/detection/mammograms

http://www.mobecomm.com/docs/pubs/A_3D_electrical_impedance_tomography-(EIT)-system_for_breast_cancer_detection.pdf)

http://www.mobecomm.com/docs/pubs/A_3D_electrical_impedance_tomography-(EIT)-system_for_breast_cancer_detection.pdf)


46

Invited Talk

IPM-4: IOMP perspective on education and training of Medical Physicists

John Damilakis

Professor of Medical Physics

Faculty of Medicine, University of Crete, Greece E-mail: [email protected]

Abstract: The International Organization for Medical Physics (IOMP) has recently published policy

statements on the principal functions and responsibilities of medical physicists (1) and on basic

requirements for education and training of Medical Physicists (2). IOMP states that ‗Medical

physicists (MPs) working as health professionals shall demonstrate competency in their discipline by

obtaining the appropriate educational qualification and clinical competency training in one or more

sub-fields of medical physics. Basic knowledge of the other sub-fields is also required. MPs

practicing in hospitals/clinical environments shall also participate in a continual professional

development program. Recommendations on the minimum levels of education and professional

training for MPs are given in the following sections‘ (2). In another paragraph of the same policy

statement, IOMP states that ‗Educational qualification could be accomplished in two phases. The first

phase of the education program is completion of a bachelor‘s degree in physics or an equivalent

degree in a relevant physical or engineering science subject. The second phase of the program is

completion of a postgraduate program2 at a master‘s degree level in medical physics or an equivalent

degree in an appropriate physical science subject‘.

The European Federation of Organizations for Medical Physics (EFOMP) has published policy

statement no. 12 on ‗The present status of Medical Physics education and training in Europe. New

perspectives and EFOMP recommendations‘ (3). Moreover, the International Atomic Energy Agency

(IAEA) has published a document entitled ‗Roles and Responsibilities and education and Training

Requirements for Clinically Qualified Medical Physicists‘ (4).

Large variations in the education and professional development of Medical Physicists exist in Europe.

In 2010, the European Commission (EC) launched a 2-year project on the Medical Physics Expert

(MPE) to provide for improved implementation of the Medical Exposures Directive (MED)

provisions related to the MPE and to facilitate the harmonization of the MPE among the member

states aiming at their cross-border mobility. The MPE project has distinguished between 3 levels of

medical physics education and training:

(1) the level of the graduate with a Master‘s degree in Medical Physics or equivalent,

(2) the Medical Physicist level in one specialty area of medical physics after having followed two

years of training in the particular specialty of medical physics,

(3) the MPE level in a given specialty after two additional years of advanced training and practice.

Eutempe RX is a new EC project launched on August 2013. The aim of EUTEMPE is to provide the

best possible training opportunities to European Medical Physics professionals to become MPEs

working in Diagnostic and Interventional Radiology.

References 1. IOMP Policy Statement No.1. The medical physicist: roles and responsibilities.

http://www.iomp.org/?q=node/5.

2. IOMP Policy Statement No.2. Basic requirements for Education and Training of Medical Physicists.

http://www.iomp.org/?q=node/5.

3. EFOMP Policy statement No 12. The present status of Medical Physics education and training in

Europe. New perspectives and EFOMP recommendations‘. www.efomp.org.

4. Roles and responsibilities and education and training requirements for clinically qualified

medical physicists. IAEA Human Health Series, No. 25


http://www.iomp.org/?q=node/5

http://www.iomp.org/?q=node/5

http://www.efomp.org/


47

RDP-1: Radiation Protection in Medical Practices in Bangladesh

A. Begum, M.S. Rahman, A. Hoque, J. Ferdous and R.K. Khan

Health Physics Division, Atomic Energy Centre, GPO Box 164, Shahbag, Dhaka-1000. E-mail: [email protected]

Introduction: Ionizing radiations have many beneficial applications in medicine but undue usage of it

may cause adverse health effect. Radioactive sources and radiation generating equipments are being

widely used in different medical practices such as radiology, interventional cardiology, nuclear

medicine, radiotherapy, etc. in Bangladesh for diagnosis and treatment purposes. The implementation

of as low as Reasonably Achievable (ALARA) concept in medical practices following the three basic

radiation protection principles, namely justification, optimization and dose limitation is required as

per requirements of the IAEA GSR Part-3 [1]. These principles must be followed, first to reduce the

dose to patients without compromising the image quality and second to reduce the dose to

occupational workers. The dose assessment of occupational workers in medical practices is mandatory

as per requirements of the Nuclear Safety and Radiation Control (NSRC) Rules-1997 of Bangladesh.

Methods: Radiation protection in medical practice is performed by the following monitoring

methods:

(I) External monitoring by using Harshaw two element TLD-100 (LiF:Mg,Ti) cards for quarterly

basis throughout the country and TL chips for extremity and patient-dose monitoring;

(II) Workplace monitoring by using beta/gamma & neutron survey meters. Prime responsibility of

this method belongs to the licensee but is initiated by Health Physics division;

(III). Internal monitoring by indirect bio-assay method (urine samples of workers who are using

unsealed radioactive sources) and collection of air particulates at workplace by suction of indoor air

through filter paper using Staplex air sampler. The samples were measured by High Purity

Germanium (HPGe) Detector;

(IV) Arrangement of National Training Courses for occupational workers on radiation protection for

dissemination of knowledge through comprehensive theoretical and practical classes.

Results: The annual average dose for most (about 99 %) occupational workers was below the average

annual permissible dose limit. For a few (about 1 %) workers, the annual dose exceeded the average

annual dose limit of 20 mSv. The average annual dose of workers in four medical practices, namely

nuclear medicine, interventional cardiology, radiotherapy and radiology were found to be 0.34, 1.54,

0.24, and 0.18 mSv respectively. From this study, it is observed that the highest annual individual

dose incurred by the worker in interventional cardiology department is 49.37 mSv. The activity

concentration of artificial radionuclides in air filter ranged from 0.19 to 60.67 mBq/m3 with average

of 6.4 ± 0.0 mBq/m3 for

131I; from 0.25 to 40.27 mBq/m

3 with average 4.17 mBq/m

3 for

99mTc. The

activity concentration of 99m

Tc and 131

I in urine samples of workers ranged from 8.58 to 314.92 Bq/l

and 6.47 to 283.27 Bq/l respectively. The effective dose of 99m

Tc ranged from 0.402 to 14.7 µSv and

those of 131

I ranged from 0.12 to 5.58 µSv

Discussion: Although effective dose of an individual worker complies with the requirements of

NSRC Rules-1997 of Bangladesh, workers should follow the radiation protection procedures at

workplace in order to implement the ALARA concept.

Acknowledgement: Authors would like to thanks the GOB and IAEA for providing financial &

technical supports through the national projects to strengthen radiation protection infrastructure.

Reference: [1] Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, IAEA, GSR

Part-3 (July 2014).



48

RDP-2: Effective Dose to Patient during Interventional Cardiac Procedures

A. Hoque1, M.A. Ahad

2, A. Begum

1*, R.K. Khan

1, M.M.M. Siraz

1 and M.A. Rahman

2

1Health Physics Division, Atomic Energy Centre, Dhaka-1000, Bangladesh

2Department of Physics, University of Dhaka


Introduction: The medical use of ionizing radiation, while offering great benefit to patients, also

contributes significantly to radiation exposure of occupational workers and patients. Interventional

cardiac procedures result in substantial patient radiation dose due to prolonged fluoroscopy time and

radiographic exposure. The aim of present study is to monitor the effective dose of patients during

interventional cardiac procedures mainly CAG (Coronary Angiography), PTCA (Percutaneous

Transluminal Coronary Angioplasty) and (CAG+PTCA) at a renowned cardiac hospital in Dhaka.

Materials and Methods: Thermoluminescent dosimeters (TLD-100, LiF:Mg,Ti) [1,2] suitably

calibrated 50 chips were used in a packed polythene sheet in 10 rows and 5 columns covering the

whole back of a patient from shoulder to waist line to determine effective dose. Harshaw TLD reader

(Model 3500) had been used for reading out the TLD cards.

Result and Discussion: Patients who underwent CAG, PTCA and (CAG+PTCA) have average

effective dose 29.969 mSv, 44.07 mSv & 65.95 mSv respectively and the corresponding mean

fluoroscopy time are 7.37 min, 5.5 min and 13.75 min respectively. Patient information with

corresponding effective doses are shown in Table 1. Average effective dose corresponding to

fluoroscopy time in the patients are shown in Figure-1. Table 1: Distribution of patient‘s information and average effective dose for different cardiac

procedures

Figure-1: Average effective dose and corresponding fluoroscopy time of the monitored patient

Conclusion: Although there is a maximum dose limit for the occupational workers defined by IAEA

Basic Safety Standards (BSS) GSR Part-3, there are no dose limit for patients. So the occupational

workers should pay more attention to radiation protection procedures and practices to keep patient

radiation doses as low as reasonably achievable (ALARA).

References: [1] A. F. McKinlay, Thermoluminescent Dosimetry (Bristol: Hilger) (1981).

[2] IEC Publication 1066, Thermo luminescence dosimetry systems for personal and environmental monitoring

(1991).

Patient‘s information CAG PTCA (CAG+PTCA)

Age (yrs) 53.71 48 51

Height (cm) 158.43 168 172.50

Weight (kg) 57.29 85.25 67.50

Average effective dose (mSv) 29.97 44.07 65.95

0

10

20

30

40

50

60

70

1.4 2.4 2.7 2.9 6.4 8.2 11.3 13.1 13.5 13.7 14.4

Fluoro time (min)

Ave

rage

Eff

ectiv

e D

ose

(mSv

)



49

RDP-3: Radiation dose of patient during CT scan

R.K. Khan1, Robiul Islam

2, A.Begum

1, A.Hoque

1 and N.Ferdous

2

1Health Physics Division, Bangladesh Atomic Energy Commission;

2Department of Physics, University of Dhaka.


Introduction: CT (Computed tomography), also known as "computerized tomography" or "computed

axial tomography" (CAT) is a noninvasive medical procedure that uses specialized X-ray equipment

to produce cross-sectional images of the body. Figure 1 shows a typical CT scan [1]. Concern about

CT scans includes the risks from exposure to ionizing radiation. Organ doses from CT scanning are

considerably larger than those from corresponding conventional radiography [2]. The purpose of this

study was to measure the ionizing radiation dose to different organs of human body during CT scan.

Figure 1: Typical diagram of CT scan.

Methodology: Radiation dose obtained by the patients during CT procedures were measured at a

famous hospital in Bangladesh. For this purpose 50 calibrated chips arranged on a polythene sheet in

10 rows and 5 columns were used. The radiation exposures were read by using TLD reader

(HARSHAW 3500 Manual TLD reader) with hot nitrogen gas flow.

Results: Total 19 male and female patients were monitored. The dose range was from 0 to 233.1 mSv

and the average dose was found 42.80 mSv. The highest maximum dose, 233.1 mSv, was received by

a female patient during chest CT scan with 100ml contrast agent. Information regarding patient dose

for different regions of body is shown in Table 1. The maximum average dose to the patient incurred

during an abdomen scan. Table 1: CT scan of different regions of body and corresponding radiation dose.

Region of body Head Neck Chest Abdomen Ureter

Maximum dose (mSv) 89.23 152.00 233.10 233.00 26.15

Minimum dose (mSv) 0.23 0.00 0.36 0.71 0.00

Average dose (mSv) 22.81 41.37 30.50 72.94 10.98

Conclusion: The widespread use of CT probably represents the single most important advance in

diagnostic radiology. However, as compared with plain-film radiography, CT involves higher doses

of radiation. Since there is no dose limit which can be considered safe, strict measures should be

taken to avoid any unnecessary radiation exposure not only to patients but also to occupational

workers.

References:

[1] U.S. Food and Drug Administration, web link: Description, Computed Tomography.

[2] Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med.

2007 Nov 29;357(22):2277–2284.


http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115317.htm#1


50

RDP-4: Assessment of Radioactivity of Soil in Madaripur District of

Bangladesh

A. N. Monika1, M.M. Rhaman

2, J. Ferdous

2*, A. Begum

2, N. Ferdous

3

1Medical Physics Unit, Bangladesh Atomic Energy Commission, Agargon, Dhaka, Bangladesh.

2Health Physics Division, Atomic Energy Centre, Shabagh, Dhaka-1000, Bangladesh.

3Department of Physics, University of Dhaka, Shabagh, Dhaka-1000, Bangladesh.


Introduction: Human population are exposed to radiation that originates from a variety of sources,

such as exposure from natural sources and from manmade sources. Radiation from natural sources in

the environment is the major cause of radiation exposure to men. Uranium and thorium are two

dominant elements in the radioactive series that decays to many interesting isotopes such as radium

and radon along with radioactive lead. The specific activities of natural radionuclides in 12 soil

samples collected from Madaripur district of Bangladesh, have been studied and evaluated.

MATERIALS AND METHODS: Soil samples are collected at the depth of 0-5 inch from each

location with the use of a crowbar with great care. About 1 Kg of sample from each location is

collected in separate dry polythene bag labeled with proper identification code. At the lab, the

collected samples are transferred from the polyethylene bags to the acetone-cleaned stainless steel

bucket and dried in an oven at 100-105 0C until a constant weight is achieved. Each of the dried

samples were grounded to fine powder in an agate motor separately and sieved using a fine aperture

mesh screen in order to remove extraneous items like plant materials, roots, pebbles etc. and to obtain

a fine-grained sample that would present a uniform matrix to the detector. Each of the samples is

transferred to cylindrical plastic-container. The net weight of each sample is calculated using a

microbalance. The sealed containers of sample were stored for at least four weeks to reach secular

equilibrium between the 238

U and 232

Th series and their respective progenies to get ready for

measurements.The activity concentration of gamma ray emitting radioisotopes in the samples were

measured by using a gamma ray spectrometer with a high-resolution HPGe coaxial detector coupled

with a Silena Emcaplus multichannel analyzer (MCA).

RESULTS AND DISCUSSION: The activity concentration of 238

U ranged from 51.08 to 97. 35

Bq.kg-1

with mean 59.62 ± 12.62Bq.kg-1

. Activity concentration of 232

Th ranged from 16.60 to 59.44

Bq.kg-1

with mean 40.26 ±11.12 Bq.kg-1

. Activity concentration of 40

K ranged from 301 to 437 Bq.kg-

1 with mean 385 ± 37.15 Bq.kg

-1.

CONCLUSIONS: Soil is one of the major source and pathways of radio nuclides to living beings.

The average activities of 238

U and 232

Th in soil samples of the present study are higher than the world

average. On the other hand, the average activity of 40

K was found to be lower than the world average.

In addition, no evidence of 137

Cs was found in the collected samples. These findings are in

conformity with absent nuclear fallout in the places of study. Therefore it may be concluded that

natural radioactivity in soil samples of Madaripur district poses no health-hazards to the population

living there.



51

RDP-5: Assessment of Occupational Exposure in Interventional Cardiology

practices

M.S. Rahman*, A. Begum. A. Hoque, R.K. Khan and M.M.M. Siraz

Health Physics Division, Atomic Energy Centre, GPO Box 164, Shahbag, Dhaka, Bangladesh E-mail: [email protected]

Introduction: Interventional cardiologists work in the catheterization laboratory for many hours,

some on a daily basis, usually for many years. Several reports found that the effective dose of ionizing

radiation in interventional cardiology practices were the highest ones registered among medical staff

using x-rays [1]. There is particular concern regarding occupational dose to the lens of the eye in

interventional cardiology practices. ICRP in April 2011 [2] recommended a new occupational dose

limit of 20 mSv/yr for the lens of the eye (100 mSv for 5 years and maximum 50 mSv in a year). This

recommendation has been incorporated into the International Basic Safety Standards, IAEA GSR

Part-3 [3]. Methods for reducing or minimizing occupational radiation dose includes: minimizing

fluoroscopy time and the number of acquired images; using available patient dose reduction

technologies; using good imaging-chain geometry; collimating; avoiding high-scatter areas; using

protective shielding; using imaging instruments that has equipment performance controlled through a

quality assurance programme; and wearing personal dosimeters. Effective use of these methods

requires both appropriate education and training on radiation protection for all interventional

cardiology personnel, and the availability of appropriate protective tools and equipment.

Methods: Occupational workers were monitored by using calibrated Harshaw two element TLD-100

(LiF:Mg,Ti) cards for quarterly basis. The workers wear the TLD badges (TLD-100 card with holder)

on torso during exposure to ionizing radiation. The quarterly effective doses of occupational workers

were assessed by measuring the TLD-100 cards with Harshaw TLD Reader Model 4500.

Results: The average annual effective dose of the occupational workers in interventional cardiology

practices is 1.54 mSv. The maximum annual dose of individual worker is 49.37 mSv. Table 1: Number of monitored workers in interventional cardiology by year

and received total dose.

Year Total Worker Total dose (mSv)

2010 104 108.29

2011 95 127.50

2012 95 208.03

2013 91 150.15

Discussion: Radiation dose of the workers are below the maximum permissible limit in a year.

However, workers must be aware about radiological protection in every procedure to keep the doses

below the average annual dose limit.

References: [1] Vano E, Gonzalez L, Guibelalde E, Fernandez JM, Ten JI. Radiation exposure to medical staff in

interventional and cardiac radiology, Br. J. Radiol, Vol. 71, pp. 954-60 (1998).

[2] International Commission on Radiological Protection (ICRP), the 2011 Recommendations of the

International Commission on Radiological Protection.

[3] Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards, IAEA, GSR

Part-3 (July 2014).



52

RDP-6: Study of Radioactivity Level in Soil, Sand and Sediment Samples of

Coastal Area in Cox’s Bazar, Bangladesh and Evaluation of Radiation

Hazard

Sariful1, M.M.M. Siraz

2, S. Pervin

2, S. K. Das

1 and S. Yeasmin

2*

1Department of Environmental Sciences, Jahangirnagar University, Savar, Dhaka, Bangladesh



Introduction: Radiation is present in all environment of the earth‘s surface, beneath the earth and in

the atmosphere. According to UNSCEAR [1], about 87% of the radiation dose received by mankind is

due to natural radiation sources and the remaining is due to anthropogenic radiation.

Materials and Methods: Activity concentrations of natural and artificial radionuclide‘s (238

U, 226

Ra, 232

Th, 40

K and 137

Cs), outdoor and indoor annual effective dose rates and radiation hazard indices were

investigated using a high-purity germanium (HPGe) detector [2] in twenty four soil, sand and

sediment samples (each category consists of eight samples) collected from different coastal area of

Cox‘Bazar ranging about thirty kilometer.

Result and Discussion: Mean activity concentrations of the measured radionuclide is shown in

Figure-1 and annual effective dose rate & radiation hazard indices [3] are enumerated in Table-1.

Figure-1. Mean activity concentrations (Bqkg

-1) of the measured radionuclide‘s

Table-1. Annual effective dose rate and radiation hazard indices of the measured radionuclide‘s

Category Radium

equivalen

t activity

(Bqkg-1

)

Externa

l hazard

index

(Hex)

Interna

l

hazard

index

(Hin)

Outdoor

absorbe

d dose

rate

(nGy/h)

Indoor

absorbe

d dose

rate

(nGy/h)

Outdoor

annual

effectiv

e dose

rate

(mSv/y)

Indoor

annual

effectiv

e dose

rate

(mSv/y)

Total

annual

effectiv

e dose

rate

(mSv/y)

Maximu

m

174.54 0.47 0.56 85.31 102.37 0.13 0.50 0.63

Minimum 60.51 0.16 0.19 30.39 36.46 0.04 0.18 0.22

Average 122.75 0.33 0.40 59.73 71.67 0.09 0.35 0.44

Conclusion: In this study, no fallout of 137Cs was noted. Mean activity concentrations, annual

effective dose rates and radiation hazard indices of the measured radionuclides were below the

recommended value set by IAEA. Results obtained indicates that the study area is safe from

radiation hazard.

Reference: [1] United Nations Scientific Committee on the Effects of Atomic Radiation. Sources, effects and risk of

ionization radiation. Report to General Assembly. UNSCEAR (2000).

[2] Knoll, G. F. Radiation Detection and Measurement (3rd edition), USA: John Wiley & Sons Inc.

[3] International Atomic Energy Agency. Measurement of radio-nuclides in food and the environment.

Technical Report Series No. 295. IAEA (1989).



53

RDP-7: To Study the Natural and Artificial Radionuclides in Soil Samples

from Oil and Gas Field Area of Bangladesh

S. Yeasmin1*, S. Pervin

1, M. M. M. Siraz

1, M. N. Ali

2 and M. S. Sultana

2




Introduction: Natural radioactivity arises mainly from the primordial radionuclides, such as 40

K, and

the radionuclides from 238

U and 232

Th series and their decay products, which are present at trace levels

in all ground formations.The knowledge of specific activities or concentrations and distributions of

the radionuclides in these materials are of interest since it provides useful information in the

monitoring of environment radioactivity.

Materials and Methods: 20 soil samples were collected randomly from different locations in oil and

gas field area of the Brahmanbaria district in Bangladesh. All the samples were processed following

the standard procedures of International Atomic Energy Agency (IAEA) guidelines. Then the activity

concentrations of radionuclides in food samples were measured by gamma-ray spectrometry system

using HPGe detector.

Results and Discussion: The mean activity concentrations of 226

Ra, 238

U, 232

Th and 40

K in soil were

28.47±3.43 BqKg-1

, 29.11±3.36 BqKg-1

, 44.59±3.78 BqKg-1

and 258.43±25.89 BqKg-1

respectively.

The mean value of radium equivalent activity, estimation of external and internal radiation hazard,

absorbed dose rate of soil samples and total annual effective dose rate were 112.13 BqKg-1

, 0.30, 0.38,

55nGyh-1

and 0.38 mSvy-1

, respectively. 137

Cs (artificial radionuclides) was not found in these

samples. The results found in this study were not higher than the average worldwide limit provided by

UNSCEAR.

Figure 1: Comparison of activity concentrations in soil with world average value.

Conclusion: The obtained results indicate that the study area seemed to be radiologically safe to the

inhabitants due to the harmful effects of ionizing radiation from natural radionuclides.

Acknowledgement: The authors would like thanks to Health Physics Laboratory, Atomic Energy

Centre (AEC), Dhaka.

Activity Concentrations in Bq/Kg of soil with world average

value

28.47 44.59 29.11

258.43

28 33 35

400

0

100

200

300

400

500

226Ra 232Th 238U 40K

Radionuclides

Acti

vit

y C

on

cen

trati

on

s

in B

q/K

g

Present study

World Average



54

RDP-8: Assessment of Natural Radioactivity Level in Different Vegetable

Samples of Brahmanbaria District in East-Central Bangladesh


1, M. M. M. Siraz

1, M. N. Ali

2 and M. S. Sultana

2




Introduction: Naturally occurring radioactive materials exists in soil, water, air, food, and even in

our own bodies. The activity concentrations of natural radionuclides such as 226

Ra, 238

U, 232

Th and 40

K were measured for 20 vegetable samples from Brahmanbaria district of Bangladesh.

Materials and Methods: A total of 20 vegetable samples were collected from 20 different points of

the of Brahmanbaria district which is in east-central Bangladesh. The vegetable samples were first

washed with water to remove all attached dust particles. Next, the samples were kept in a tray to be

sun dried for 48 hours. After that, further drying was done in the oven at 105°-110° C temperature for

48 hours. Then all the samples were kept at room temperature for about 30 days to ensure that 238

U

and its daughter products were in secular equilibrium. Then the activity concentrations of

radionuclides in food samples were measured by gamma-ray spectrometry system using HPGe

detector.

Results and Discussion: The mean activity concentrations of 226

Ra, 238

U, 232

Th and 40

K in vegetables

samples were found to be 62.50±16.39 BqKg-1

, 52.91±16.19 BqKg-1

, 67.13±13.60 BqKg-1

and

1412.10±153.81 BqKg-1

respectively. The radioactive 137

Cs was not found in these samples. In this

study the result for 232

Th was slightly higher than the average worldwide limit provided by

UNSCEAR whereas the results for other radionuclides were below the international level. The

slightly increased 232

Th level is however not significant.

Figure 1: Graphical representation of activity concentrations in vegetable with world average value.

Conclusion: The results of the radioactivity levels measured in east-central Bangladesh can be

considered as baseline data for reference in any future studies.

Reference: [1] UNSCEAR Ionizing Radiation, Sources and Biological effects, United Nations Scientific Committee on the

Effect of Atomic Radiation, United Nations, New York (1982).

[2] G. F. Knoll, Radiation Detection and Measurement, 2nd Edition (USA: John Wiley and Sons) (1989).

[3] International Atomic Energy Agency, Measurement of radionuclides in food and the environment.

Technical Report Series No. 295 (Vienna: IAEA) (1989).

62.5

318

67.13 53 52.91

318

0

50

100

150

200

250

300

350

Acti

vit

y

Co

ncen

trati

on

s in

Bq

/Kg

226Ra 232Th 238U

Radionuclides

Present study

World Average

http://en.wikipedia.org/wiki/Bangladesh



55

RDP-9: Assessment of Radionuclide Transfer from Soil to Vegetable in

Brahmanbaria District, (Bangladesh) using Gamma-Ray Spectrometry

System


1, M. M. M. Siraz

1, M. N. Ali

2 and M. S. Sultana

2



*E-mail: [email protected]

Introduction: Soil-vegetables are recognized as one of the major pathways for the transfer of

radionuclides to human beings. Transmission of uranium and thorium along with nutrients through the

absorption of minerals, and accumulate in various parts or even up to the edible parts. Transfer factor

(TF) is a useful parameter for the radiological assessment. Radionuclide is necessary to determine and

estimate the activity of various radionuclides present in soil and their transfer factors are different in

different food samples. This difference helps assess the radiation doses in human beings, the ultimate

consumers of food. Three adjoining upazila Saril, Ashugonj and Brhmanbaria Sadar upazila of

Brhmanbaria district, situated at the central East part of Bangladesh and about 90 Km East to the

Capital were selected as the study area.

Materials and Method: Total 40 samples (20 soil samples and 20 associated vegetable samples)

were collected from locations of Brhmanbaria district. Brinjal (Solanum melongena), Winter melon

(Benincasa hispida), Ladysfinger (Abelmoschus esculentus), Bitter gourd (Momordica charantia),

starfruit (Averrhoa carambola), Data Shakh (Amaranthus gangeticus), Banana (Musa sapientum),

Pomelo (Citrus grandis), Papaya (Carica papaya), Pumpkin (Cucurbita maxima), Mango (Mangifera

indica), Kidney bean (Vigna sinensis) were the selected vegetable samples. All prepared samples were

measured by means of gamma-ray spectrometry system using high purity Ge-detector (HPGe).

Transfer factor (TF) is defined as the ratio of radionuclide concentration in a soil (in Bq kg-1

dry

weight) and concentration of the radionuclide in the vegetable (in Bq kg-1

dry weight).

Results and Discussion: The transfer factor soil-to-vegetable was observed 2.43, 1.92, 1.56 and 5.66

respectively for 226

Ra, 238

U, 232

Th and 40

K. The highest transfer factor of 226

Ra and 238

U were found in

the Papaya and Brinjal respectively and 232

Th and 40

K were found in Data Shakh. The sequence of the

transfer factors is in order of 40

K 226

Ra 238

U 232

Th. While the lowest transfer factor of was found

in Pumpkin and 238

U, 232

Th and 40

K were found in Mango. The results are low and within the range of

internationally recommended limits and no significant radiological hazard was found.

Conclusion: The results of this study may be considered as the baseline levels of radio activities in

the foodstuffs in these studied areas of Bangladesh to check future activities in the area.

Acknowledgement: The authors thankful to all stuff of Health Physics Division, Atomic Energy

Centre (AEC), Dhaka, for helping to perform this experiment successfully.

Reference: [1] UNSCEAR Sources and effects of ionizing radiation, A Report to the general assembly with scientific

annexes (New York: United Nations) (2000).

[2] International Atomic Energy Agency, Measurement of radionuclides in food and the environment. Technical

Report Series No. 295 (Vienna: IAEA) (1989).

[3] G. F. Knoll, Radiation Detection and Measurement, 2nd Edition (USA: John Wiley and Sons) (1989).

[4] International Atomic Energy Egency, generic models and parameters for assessing the environmental

transfer of radionuclides from routine releases. Exposure of Critical Groups Safety Series, Vienna (1982).



56

Invited Talk

IPM-5: Lessons Learned From Major Radiotherapy Accidents:

International and Bangladesh Perspectives

A. S. Mollah

Department of Medical Physics,

Khwaja Yunus Ali University, Enayetpur, Sirajgonj, Bangladesh E-mail: [email protected]

Background: In order to avoid accidents in radiotherapy, it is very important to remember the lessons

that can be learned from previous radiotherapy accidents and to ensure that preventive actions are

applied in a clinical setting.

Case Histories of Radiation Accidents in Radiotherapy Practices: A number of accidents have

been thoroughly investigated and the lessons learned have been disseminated by the International

Atomic Energy Agency (IAEA). The complexity of medical radiation technology has created new

avenues for error-through software flaws, faulty programming, poor safety procedures or inadequate

staffing and training. When those errors occur, they can be deadly. Regulators and researchers can

only guess how often radiotherapy accidents occur. Accidents are chronically underreported, and

some countries do not require that they be reported at all. In USA (2013), a Philadelphia hospital gave

the wrong radiation dose to more than 90 patients with prostate cancer—and then kept quiet about it.

In 2005, a Florida hospital disclosed that 77 brain cancer patients had received 50 percent more

radiation than prescribed because a powerful linear accelerator had been programmed incorrectly for

nearly a year. Preventing errors in the delivery of radiation therapy involves not only understanding

and appropriately utilizing new advances in technology, but also utilizing established patient safety

procedures that optimize safe healthcare delivery. Major accidental exposures occurred in the absence

of quality assurance programme and written procedures and checks.

Specific lessons learned from some of the major radiotherapy accidents are reviewed and discussed in

this paper to create awareness in the radiotherapy practices in order to prevent radiation accidents in

Bangladesh.

Procedures for Radiation Accident Prevention: Accidental exposures have occurred when there is a

lack of procedures and checks, or when they are not comprehensive, documented or fully

implemented, e.g. independent checks. Accidental exposures have occurred when there is a lack of

qualified and well-trained staff or lack of staff overall), with necessary educational background and

specialized training. Accidental exposures have occurred owing to inattention to details, and lack of

alertness and awareness. The major recommendations to be implemented for overall preventive

measure are: i) Quality Assurance Program, ii) Education and training, iii) Acceptance testing and

commissioning, iv) Follow-up of equipment faults, v) Written communication policy, and vi) External

independent audits.

Conclusion: Lessons have been learned from investigations into a relatively large number of

accidents that have occurred in radiotherapy practices. Radiation accident in radiotherapy practices is

normally caused by poor education and training of radiotherapy medical physicists and by a lack of

quality assurance which allowed the error to remain undetected. The absence of written procedures

and protocols for acceptance tests and the commissioning of new equipment have led to the use of

incorrect values of basic parameters subsequently used for the treatment of patients. Given the

complexity of radiotherapy and its sensitivity to errors and mistakes, nothing should be left to chance,

but rather, a structured and systematic approach is needed. Licensing of a radiotherapy department

should be conditional on a comprehensive quality assurance program being in place. At the licensing

stage, regulatory authorities should verify that managers are fully aware of the potential for accidents

and their consequences and that this awareness is reflected in an unambiguous policy and appropriate

supervision. Regulatory authorities can actively contribute to this awareness by disseminating

information on real accidents, case histories and pictures of the effects of radiation from accidents.



57

RT-4: Dosimetry and Quality Assurance (QA) of photon and electron beam

of medical linear accelerator at Oncology Centers in Bangladesh

Md. Shakilur Rahman1*

, Md. Abdus. Sattar2, S. M. Enamul Kabir

3, Debasish Paul

1,

M. Shamsuzzaman1, M. Mosharraf Hossain Bhuyian

1, M. Abdullah-Al Maruf

4,

Md. Mushtaq. Ahmed4, AKM Moinul Haque Meaze

2

1Secondary Standard Dosimetry Laboratory, Institute of Nuclear Science & Technology,

Bangladesh Atomic Energy Commission, Savar, Dhaka, Bangladesh 2Department of Physics, University of Chittagong, Chittagong, Bangladesh

3Department of Radiation Oncology, National Institute of Cancer Research and Hospital, Dhaka,

Bangladesh 4Department of Radiotherapy, Dhaka Medical College Hospital, Dhaka, Bangladesh

*E-mail : [email protected]

Introduction: Medical linear accelerator (LINAC), a potential source of photon and electron beam

are being used in curative and palliative treatment modality for a variety of cancers. It provides the

facility of treatment with high energy x-rays for tumor at depth and electron beam for superficial

structure near the skin and soft tissue. The aim of radiation therapy by LINAC is to maximize killing

of cancer cells in a tissue by radiation beam keeping the sparing of healthy cells at acceptable level.

The effectiveness of the output of treatment is highly dependent on the radiation dose being delivered

to the treatment site. Tumor eradication and normal tissue complications correlate to dose absorbed in

tissue. The clinical practice leads to generally agreed recommendations on the required accuracy in

clinical dosimetry for radical curative being given in ICRU report-24 (1976) for at least accuracy of

±5%.

Materials and Methods: The output dose measurement of Clinac 2100 of photon beam of energy

6, and 15 MV and electron beam of energy 6, 9, 12, 15, and 18-MeV of Dhaka Medical College and

Hospital, and National Institute of Cancer Research and Hospital have been measured with semiflex

ionization thimble chamber TW31010 and parallel plate ionization chamber TW23343, & A10 using

PTW water phantom at reference condition. Two different dosimetry protocols TRS-398 and AAPM

TG-51 were used in the present measurement.

Results: The measured dose of 6 MV and 15 MV photon beams have also been verified with the

international system by the participation of the IAEA/WHO TLD postal dose intercomparison

program for radiotherapy level dosimetry. The ratios found in that intercomparison program of IAEA

mean dose to user stated dose were 1.00 and 1.01 which lies with an excellent agreement within IAEA

limit 0.95-1.05. The dosimetry of electron beam has been measured by thimble and parallel plate

ionization chamber and a deviation between the chambers have been observed with a maximum

3.22% at lower electron energy 6 MeV. The perturbation effect in respect to electron beam energies

are also described.

Conclusions: The dose ratios of TRS 398 in comparison with AAPM codes of practice TG-51 were

in good agreement with IAEA-TECDOC-1455. The accuracy of dose determination using absorbed

dose to water based protocol will reduce the uncertainty of dose measurement. The dosimetry of

electron beam by two different chambers; parallel plate and cylindrical type shows a large variation of

doses at lower electron energy due to Pwall correction factor in determination of kQ,Qo. This large

variation could be reduced while using parallel plate chamber below 15 MeV.



58

RT-5: Beam Data Acquisition of an Accelerator and Commissioning of

CMS XiO 4.8 Treatment Planning System

MA Sabur1, Hirak Kumar Dey

1, M A Hai

2, M A Bari

3, Basu Saumen

2, S Deepak Ray

2

1Department of Medical Physics, Kyamch Cancer Center, Sirajgonj, Bangladesh.

2Department of Radiation Oncology, Kyamch Cancer Center, Sirajgonj, Bangladesh.

3Department of Oncology, BSMMU, Dhaka, Bangladesh.

Introduction: Cancer is one of the most significant health problems with respect to its incidence and

mortality alike. Globally more than 50% cancer managements are carried out using ionizing radiation

or its combination with surgery and or chemotherapy. The main goal of the radiation therapy is to kill

the cancerous cell and save the surrounding normal structures. Accurate beam data acquisition

during commissioning is essential for modeling the treatment planning system (TPS) and dose

calculation in radiotherapy.

Methods: All the basic data of linear accelerator and Comercial Medical System (CMS) XiO 4.8 have

been used as input data for the TPS. The Machine data, Percentage Depth Dose (PDD), Beam

Profiles, Total Scatter Correction Factor (TSCF), Collimator Factor (Sc), Peak Scatter Correction

Factor (PSCF), and Wedge Factor (WF) have been collected according to CMS XiO instructions and

the above data have been transferred to the TPS.

Results: The information in the data files of the accelerator was found to agree in all aspects with the

output data obtained from the TPS. The absolute doses calculated at the reference point for photon

beam were in agreement with those of measurements for both open and wedged fields. The errors

were within the limit of truncation errors. It should be noted that this error includes uncertainties due

to the phantom setup and the difference of the protocol such as step size, measurement time and

scanning methods.

Conclusions: It is concluded that implementation of a CMS XiO 4.8 Treatment Planning System is

very suitable for accurate radiation therapy treatment planning and its practical use would decrease

the uncertainty in radiotherapy.


59

RT-6: Verification of a Computer Treatment Plan by Manual Methods

Muhammad Masud Rana1, G. A. Zakaria

2, Gϋnther Hartmann

3, Sarwar Alam

1,

Zillur Rahman Bhuiyan1, Jamal Uddin

1

1Oncology Department, Bangabandhu Shekh Mujib Medical University, Shahbagh, Dhaka,

Bangladesh 2Gummersbach Hospital, Academic Teaching Hospital of the University of Cologne, Germany,

3German Cancer Research Center, Heidelberg, Germany.

E-mail: [email protected], [email protected], [email protected]

Introduction: Treatment planning prior to the 1970s was generally carried out through the manual

calculation from the charts onto patient body contours that were generated by direct tracing or lead

wire. The simultaneous development of computerized tomography lead to the development of CT-

based computerized treatment planning providing the ability to view dose distributions directly

superimposed upon patients axial anatomy.

Methods and Materials: Different dosimetric quantities such as dose rate in phantom, percentage

depth dose and output factor were measured in PTW water phantom for a Linear Accelerator

PRIMUS II (Siemens) using a Farmer ionization chamber of Type PTW 3006. The applied photon

beam energy was 6 MV. In addition, a patient equivalent phantom was used to calculate dose

distribution using computerized treatment planning system (TPS). The computer treatment planning

dose distributions have been verified with manual dose calculation. A three-field techniques such as

Field 1 at 0°, field 2 at 120° and field 3 at 240° with three different field sizes of 8.6x12 cm2, 11.2x12

cm2 and 10.7x12 cm

2 of isometric technique have been used for treatment planning purpose at the

Alderson phantom in the thorax level. Computerized TPS used in this study was KONRAD of the

German Cancer Research Centre (DKFZ). Simple treatment planning based on a hardcopy of the CT

slice through the lung region of the Alderson phantom showing the position of the target volume, the

point and the central ray of the three fields.

Figure 1 Results: About 75 MU (Monitor unit) was required to apply 2 Gy by TPS calculation for field 1, 2 &

3 respectively. On the other hand, monitor units required to apply 2 Gy by manual calculation for field

1, 2 & 3 were found to be 67 MU, 76 MU and 86 MU, respectively.

Discussion: The results of manual calculations deviate from TPS calculations by 10%, 1 % and 12%

for field 1, field 2 and field 3 respectively. In case of field 2 both results coincide well but of the other

two they do not because the pathways of beams are more inhomogeneous densities.

Conclusion: Central axis calculations can be performed very easily and straight forward. They agree

very well with results of computer-based TPS. Therefore, manual calculations should be used to

check the computer results, especially if a new TPS is being to be commissioned.





60

RT-7: Verification of TPS dose calculation by means of measurements with

virtual solid water phantom and ion chamber: Preliminary results

A.S. Mollah* and M.N. Sharmeen

KYAMCH Cancer Center, Enayetpur, Sirajgonj *Department of Medical Physics, Khwaja Yunus Ali University, Enayetpur, Sirajgonj.

Introduction: The administration of radiation therapy (RT) in the management of any cancer calls for

a quality assurance (QA) program to ensure the best possible treatment for the individual patient.

Quantitative verification of the prescribed daily dose is of paramount importance during RT to ensure

precision in patient setup and accuracy in dose delivery. The verification of dosimetric accuracy

requires the comparison of the prescription dose to the patient as determined by a customized

treatment plan to the dose that is actually delivered. The verification of accuracy in dose delivery

involves the comparison of prescribed dose as determined from a customized treatment plan [monitor

units (MU), minutes etc.] to the dose that is actually received by the patient. In an effort to implement

a comprehensive QA program via dose verification at our cancer center, as a first step, we tested the

feasibility of using a commercial virtual solid water phantom with ion chamber for patient dose

verification against TPS dose values. It is widely accepted that an accuracy of dose delivery of about

3.5% (1σ) is required in modern radiotherapy. This paper describes our preliminary experience with

the control of dose delivery and TPS dose calculations at the reference point in the phantom.

Materials and methods: The calculations of dose at the reference point performed with the treatment

planning systems (such as PrecisePlan, CMS XiO and Ergo++) were checked by measurements carried

out in the virtual solid water phantom. All measurements were performed with the ion chamber

positioned in the phantom, at the central axis of the beam, at standard depth and with the UNIDOS

electrometer. The dose was measured according to IAEA TRS 398 report for measurements in solid

phantoms. The measurement results were corrected with the actual accelerator‘s output factor and for

the non-full scatter conditions. Measurements were made for 10 fields on the Elekta Synergy linear

accelerators for each photon treatment field.

Preliminary results: The average differences between measurements and calculations were 3.2%

(SD = 1.1%) for total dose measurements. The greatest advantage of the dose verification with the

solid water phantom is that it allows verification of dose calculation and delivery directly to the point

of interest. Further works on total dose measurements are in progress for patient specific fields.

Conclusion: A method has been developed for verification of TPS dose calculation by means of

measurements with virtual solid water phantom and ion chamber. The verification method provides an

instantaneous verification of dose calculations before the beginning of a patient‘s treatment. It allows

detecting differences smaller than 3.5%.


61

RT-8: Evaluation of Radiation Doses at Organ-at-Risk Due to Tangential

Breast Cancer Radiotherapy at Kyamch Cancer Center During 2012-13

Sharmin, MN, Mollah, AS*, Hai, MA and Bari, MA

Khwaja Yunus Ali Medical College Hospital Cancer Center, Enayetpur, Sirajgonj. *Department of Medical Physics, Khwaja Ynus Ali University, Enayetpur, Sirajgonj.


Introduction: Radiation dose distribution plays an important role in the outcome of radiation

treatment. The objective of this study is to quantify the radiation doses received by the organ at risk

(OAR) from such a tangential breast or chest wall radiotherapy.

Methods: Ten patients were selected for this study having left/right-sided breast cancer treated at

KYAMCH Cancer Center during 2012-2013. All patients were positioned on a breast board with the

sternum horizontal to the treatment couch and both arms above the head. Patients were scanned with a

wide-bore simulator, with 5-mm slices, from the clavicle to the diaphragm. Computerized tomography

data and treatment parameters were exported to a computerized treatment-planning system. All

patients were irradiated with 6 MV tangential beams to the breast or chest wall. All patients had

isocentric treatment with a tumor dose of 50 Gy per 25 fractions in 5 days per week. For each

treatment plan, dose–volume histograms (DVHs) for the heart and for the lung were generated using

treatment planning system.

Results: For left-sided 5 patients, the heart was close to the tangential fields and the average mean

heart dose was 7.52 Gy. In contrast, for the 5 patients who received right-sided irradiation, the heart

was distant from the fields. It received scattered dose alone (i.e., dose from radiation outside the

radiotherapy beams), and the average mean heart dose was observed to be 1.5 Gy. Mean heart dose

ranged from 1.5 to 7.52 Gy for all left- and right-sided irradiation. Thus the mean heart dose from left-

sided irradiation was approximately five times higher than the dose from right-sided irradiation. For

the 5 patients who were given left-sided irradiation, the average mean dose was 19.3 Gy to the Lt.

Lung and for the 5 patients given right-sided irradiation, the average mean dose was 18.8 Gy to the

Lung. Patient-to-patient dose variability was observed and was largely determined by differences in

patient anatomy.

Conclusion: The breast cancer patients have been treated with a 2-field radiotherapy technique,

which includes the axillary, supraclavicular and internal mammary nodes as well as the chest wall.

The study has provided satisfactory dose homogeneity within the volume of interest, and an

acceptable dose to critical structures such as the heart and lung.



62

RT-9: Comparison of Dosimetric studies of 3 Dimensional conformal

radiotherapy and Intensity Modulated Radiotherapy of Brain Tumours

from CMS XIO TPS in KYAMCH

Hirak Kumar Dey, Md. Abdus Sabur, Saumen Basu, Deepak S. Ray, M.A. Hai, M.A. Bari

Khwaja Yunus Ali Medical College Hospital Cancer Centre, Enayetpur, Sirajgonj

Introduction: Radiotherapy aims to give the prescribed dose to the tumour and to protect as much as

possible the organs at risk and surrounding healthy tissue. The radiotherapy nowadays, together with

chemotherapy and surgery, is a way to treat the patients which have different kind of tumours.

Intensity-modulated radiation therapy (IMRT) is an advanced technique of high-precision

radiotherapy that uses computer-controlled linear accelerator to deliver precise radiation doses to a

malignant tumour or specific areas within the tumour. IMRT allows for the radiation dose to conform

more precisely to the three-dimensional (3-D) shape of the tumour by modulating or controlling the

intensity of the radiation beam in multiple small volumes. Also it allows higher radiation doses to be

focused to regions within the tumour while minimizing the dose to surrounding normal critical

structures. The main advantage of IMRT is 70% of the tumours do have a concave shape where 3D

CRT gives more doses to the OAR (Organ at risk) and cannot follow the shape of the tumour where

IMRT can cover the shape of the tumour providing better tumour control and minimal doses to the

OAR‘s.

Methods and Materials: In this study are taken into account five patients with Brain tumours. The

patients are scanned in the Phillips CT simulator. The slices‘ thickness is 3 mm and then the images

are transferred to the Monaco Sim. Also from the Hospital MRI machine we take the MRI images for

the same patients and send them to Monaco Sim. The Monaco Sim is the system where the

oncologists delineate the target volumes and the organs at risk by Fusing the Images of CT and MRI.

Then the images go from Monaco Sim to the CMS XIO treatment planning system. It is composed of

several modules; the most important are module of patients‘ data, including patient demographic and

anatomic data and the teletherapy planning module.

Results and Discussion: Three dimensional conformal radiotherapy and intensity modulated

radiotherapy plans were performed for five patients with Brain tumours. Dosimetric comparison is

done first according to dose-volume histograms and then according to time consuming QC checks.

For all organs at risk such as Retina, Eye Lens, Pituitary, Optic Chiasma, Brain Stem, Optic Nerve,

Temporal Lobes the Maximum Dose, Mean Dose and the desired dose for the specific OAR volume

were all taken into account. It is observed that the average doses, for all patients, are much lower in

IMRT technique then in 3D CRT giving better tumour coverage.


63

RT-10: Planning and Delivery of 3D Conformal, Classic and fitting PTV

(C3DCRT and f3DCRT) vs. Intensity Modulated Radiation Therapy

(IMRT): A Dosimetric Evaluation and Comparison of Case Studies

Sadiq R. Malik, Motiur Rahman, Shohel Reza, A. Jobber, Mohsin Mia,

M. S. Sarwar Alam and Parvin A. Banu

Radiation Oncology Division, Delta Hospital Ltd., Bangladesh; E-mail: [email protected]

Introduction: Treatment plans for Cancer Patients are executed by examining combinations of

Software, Hardware and Human ware. This paper enunciates the fundamental protocols and

guidelines to review a treatment plan before accepting it by Radiation Oncologists. This requires

flawless imaging (CT, MRI and PET), target volume delineation, organ at risk identification, dose

overlap and dose inhomogeneity correction, DVH of all adjacent organs and tolerance doses of

relevant organs and, finally, avoidance of hot or cold spots. Differential DVH curve is examined

before accepting the treatment plan.

In our study at DHL we observe that in some cases (i.e. prostate Larynx with N.N Mets and Neck

Node Mets) it needs very complex plan to save the organ at risk. In that case it is better to use IMRT

instead of 3DCRT. In DVH study we can see the dose differences in all of our studies. Since 1991

oncologists started to consider partial organ doses to limit uncertainties and limitations to fulfill a

clinical need. QUANTEC summary presents the Dose/Volume/Outcome of several organs following

conventional fractionation.

Methods: Image quality is of paramount importance in securing the quality of the plan with an

accurate contouring. A number of patients are chosen where 3DCRT and IMRT plans were executed.

The comparable data on DVH, OAR, Dose-Volume data and the prognosis of the choice of modality

of treatment were evaluated and explained. Target coverage and target dose distribution were

evaluated in the GTV, CTV, and PTV to determine the target dose. The minimal dose to 95% of the

volume (GTV95, CTV95, and PTV95) is assured. OAR and normal tissue avoidance ware evaluated

using the parameters of organ volume and the minimal dose received by 5% or less of the volume e.g.

bladder D5. Optimization of a treatment plan is completed before the acceptance of the treatment

plan.

Results: Target Coverage and Target Dose Distribution using 3DCRT and IMRT plans on similar

anatomical sites are compared and tabulated for prescription Dose (Rx), Dose Coverage 95% volume

of PTV and the doses at the organs at risk for the above two modalities of treatment. DVH and the

differential DVH are also examined by the treatment planner and the physician where the target

coverage, hot and cold spots are viewed when the treatment plan is modified to be acceptable for

delivery of the plan to treat the patient.

Conclusion: Optimization of a treatment plan is critically examined to meet those constraints before

acceptance of the plan. IMRT plan algorithm uses small beams of non-uniform fluence and gantry

angles where the volume of target is judged. The beam angles are optimized to avoid overlap of

beams. 3DCRT has capabilities of using wedges and transmission blocks to shape the isodose

coverage of the target even at an irregular site of a body shape.

Plan Quality Variation (PQV) is significant which can involve cancer patients. Treatment Plan Dose

and Dose Volume Histogram predictions (pDVH) use patient-specific anatomical (OAR) DVH for a

Quality Plan (QP). The study is designed to compare the degree of target coverage and target dose

distribution, Rx, conformality, normal tissue avoidance and amount of irradiated body volume in

IMRT, c3DCRT and f3DCRT.The Quality Plan is then approved for the delivery of treatment at the

prescription dose (Rx).



64

RT-11: Calibration Of 192

ir High Dose Rate Brachytherapy Source Using

Different Calibration Procedures 1Md.

Harun Or Roshid,

1 Muhammad Masud Rana,

1Taskin Dilshad,

2Mohammad Abdullah Al

Maruf, 1Jamal Uddin,

1Sarwar Alam,

1Shamsun Nahar,

4Md. Shakilur Rahman

1 Dept of Oncology, Bangabandhu Sheikh Muzib Medical University, Shabagh, Dhaka, Bangladesh

2Dhaka Medical College Hospital,Dhaka

4Secondary Standard Dosimetry Laboratory (SSDL), Bangladesh Atomic Energy Commission, Savar,

Dhaka E-mail: [email protected]

Introduction: Calibration of Ir-192 high dose rate (HDR) brachytherapy source using different

calibration methods and to determine the accuracy and the suitability of each method for routine

calibrations are described here. The source calibration is an essential part of the quality assurance

programme for dosimetry of brachytherapy sources. The clinical use of brachytherapy source requires

an independent measurement of the air kerma strength according to the recommendations.

Materials and methods: Sources are calibrated in three techniques- Free in air Measurement, Well

type ionization chamber, Solid phantom (Krieger Phantom). Well type and and Free in air

measurement techniques are recommended by IAEA(International Atomic Energy Agency) and Solid

phantom technique is recommended by German Society of Medical Physics (DGMP). In this paper

we have calibrated the HDR Ir- 192 source by using three techniques. For Free in air measurement &

Solid phantom techniques. We have used Microselectron HDR machine, Microselectron V2

Iridium192 HDR source, Serial Number (S/N) –D36B1582, Farmer type Ionization chamber 0.6cm3

type PTW M30002, S/N- 0209 and PTW 0.3cm3 rigid chamber which type PTW M23332, serial

number 067 and a Unidos Electrometer. For Well type ionization chamber technique We have used

Gamma Med Plus HDR machine, 192-Ir source which type IR-192 GAMMAMED PLUS 0.9MM,

S/N-NLF-01D24B-088, a Well Type Ionization Chamber –HDR 1000PlLUS, S/N- A03447 (Standard

Imaging) and an Electrometer Type CD2x2000B, S/N- JO33354 (standard Imaging).

Results: The RAKR determined using different calibration methods were in good agreement with the

manufacturer stated value. The deviation between measured and quoted source strength by

manufacturers was found to be 0.46% for solid phantom technique, 0.469% for Well type ionization

chamber technique and 2.78% in free in air measurement technique, which was within tolerance the

limit (±3%).

Conclusion: Measurements with a well-type chamber are relatively simple to perform. For in-air

measurements, the indigenously designed calibration jig provides an accurate positioning of the

source and chamber with minimum scatter contribution. The room scatter correction factor was

determined by a method based on the inverse square law. Various other correction factors were

applied on measured air kerma values at multiple distances and mean value was taken to determine

the reference air kerma rate of the source. The solid phantom system has an advantage that no

additional phantom and chamber are required other than those used for Rectum and Bladder point

dosimetry. All the methods of calibration discussed in this study are effective to be used for routine

calibration purposes.



65

RT-12: Treatment Outcome Of Radiation Alone Versus Concurrent

Chemoradiation On Unresectable Non- Small Cell Lung Cancer 1 Md. Jamal Uddin,

1Sarwar Alam,

1Md Shahidul Islam,

1M. A. Bari,

2Toufiq Hassan Firoz,

3Mustafa Aziz Sumon,

1Muhammad Masud Rana,

1Md. Harun Or Roshid and

1Taskin Dilshad

1Dept. of Oncology, Bangabandhu Sheikh Muzib Medical University, Shabagh, Dhaka

2National Institute for Cancer Research & Hospital, Dhaka,

3Kurmitola General Hospital, Dhaka

Introduction: Lung cancer develops from pulmonary parenchymal or bronchial supportive tissues. It

is the most common and deadly tumor worldwide and approximately 1.3 million patients a year die of

it (Cancer statistics 2011).According to ―GLOBOCAN – 2008‖ lung cancer is the leading cause of

cancer and 19529 patients were diagnosed as lung cancer (13%) in the year 2008 in Bangladesh. The

Hospital-based ―Cancer Registry Report 2005-07of National Institute of Cancer Research and

Hospital‖ published in December 2009 indicates that lung cancer is the leading cancer and a total

number of 3209 (Cancer Registry Report 2007) lung cancer patients attended NICRH during the last

three years(2005-2007), Most of the lung cancers are Non-Small Cell Lung Cancer(NSCLC) that

accounts for approximately 85% of all lung cancers.

Materials &Method: The prospective observational study was carried out among 60 unresectable

NSCLC patients attending at NICRH and DMCH from July 2012 to June 2013.The study was

designed to observe: i) the radiological response of 50Gy RT and 50 Gy CCRT(Cisplatin 30 mg/m2

weekly) to assess the local control as a strong predictor of overall survival , ii) To compare the

effectiveness of RT alone (50Gy) versus CCRT in NSCLC, iii) To compare the morbidity of RT

alone and CCRT in NSCLC. The patients were from 35 to 72 years age range where 95.2% patients

were male, 91.9 % were smoker and 88.7% oral tobacco user. About 78.3 % patients were suffering

from squamous cell carcinoma and 21.7% adenocarcinoma. Regarding grading, 8.3% well

differentiated, 71.7% moderately differentiated, 20% poorly differentiated based on

histopathologicaly data. Complete response was 16.7%% in CCRT arm while in the 50Gy RT alone

arm it was only 9%. Partial response was 56.6% and 43.3% respectively. No response was seen in 13

patients, 5 in CCRT arm and 8 in RT alone arm. Only 10%patients in the CCRT arm and 20%patients

in RT alone arm was reported with progressive disease. No statistical significance was found

regarding the radiological response between these two arms (P 0.512). No significant difference was

found in mean size at day 0 (P 0.75), day 45 (P 0.41 and day 180 (P 0.43) between these two arms.

Treatment related morbidity was observed in the CCRT arm with 53.3% Grade ≥3 Pneumonitis

(p<0.001), 56.7% Grade ≥3 Leucocytopenia (p<0.001), 53.3% Grade ≥3 Neutropenia (p<0.001) and

6.7% Grade ≥3 anemia (p<0.001). Regarding metastasis, 10 patients in CCRT arm and 12 patients in

RT alone arm had presented with metastasis at different sites within this period. No statistically

significance was found between these two groups (P 0 .792). Death during follow up was observed in

34.7% patients in CCRT arm and 36.4 % patients in RT arm; this difference was not statistically

significant (P 0 .851).

Results & Conclusion: 50Gy Radiotherapy concurrently with weekly Cisplatin results in improved

the treatment response but does increased toxicities compared with the 50Gy Radiotherapy alone in

unresectable Non-Small Cell Lung Cancer. In this study CCRT gives better result than RT alone in

unresectable NSCLC with more toxicities in acceptable range. If we can use this protocol for

palliation and better quality of life of the patient it will be easier to give treatment in unresectable

NSCLC within a short time in the context of developing countries like Bangladesh.


66

RT-13: Stereotactic Body Radiation Therapy (SBRT)- Advancement of

Radiation Oncology – a review

Kazi Manzur Kader

Department of Radiation Oncology, National Institute of cancer research and Hospital, Mohakhali,

Dhaka

Abstract: Approximately 60% of all cancer patients received Radiation therapy each year as definite,

palliative, or adjuvant to surgery or Chemotherapy. Management of the patient with cancer is complex

& requires close integration of basic concept & sophisticated technology to evaluate the stage of the

tumor & by using various modalities to obtain the therapeutic results.

Official figure indicates that in Bangladesh about 12 lacs people suffers from various types of cancer

is any point of time. Newly diagnosed cancer patients in each year is about 0.2 million & long then

0.15 million are dying.

Stereotactic body radiation therapy (SBRT) refers to an emerging radiotherapy procedure that is

highly effective in controlling early stage primary & oligometastatic cancer at locations throught the

abdomino pelvic and thoracic cavities, and at spinal and para spinal sites. The major feature that

separates SBRT from conventional Radiation treatment is the delivery of larger doses in a few

fractions, which results in a high Biological Effective Dose(BED). In order to minimize the normal

tissue toxicity, conformation of high doses to the target and rapid fall – off doses away from the target

is critical. The Practice of SBRT therefore requires a high level of confidence in the accuracy of the

entire treatment delivery process. In SBRT, confidence in this accuracy is accomplished by the

integration of modern imaging, simulation, treatment planning, and delivery technologies into all

phases of the treatment process; from treatment simulation and planning, and continuing throughout

beam delivery.

In addition to this major features, there are other characteristics that distinguish SBRT from

conventional radiation therapy. These include a general increase in the number of beams used for

treatment, the frequency use of non-coplanar beam arrangements, small or no beam margins for

penumbra, and the use of in homogeneous dose distribution and dose painting techniques(including

IMRT). All of these technology improvements result in the highly conformal dose distribution that

characterizes the SBRT technique.

Over 4000 publications spanning several decades have affirmed the clinical usefulness of stereotactic

radiosurgery (SRS) in the treatment of benign and malignant lesions, as well as functional disorders .

The radiobiological rationale for SBRT in similar to that for SRS; delivering a few fractions of large

dose in relatively short overall treatment time results in a more potent biological effect. The clinical

outcomes of SBRT for both primary and metastatic disease compare favourably to surgery with

minimal adverse effect. In addition , the limited number of treatment fractions makes SBRT more

convenient or the patient, and a potentially more cost- effective treatment modality than traditional

radiation therapy.

The majority of the patients treated with SBRT are those with lung, liver, and spinal tumors. Most

investigations limit eligibility to well-circumscribed tumors with maximum cross-sectional diameter

of up to 5cm, although some centers have reported results for tumors as large as 7cm. The use of

SBRT as a boost in addition to regional nodal irradiation has been proposed. Even with the

expectation that small volumes of adjacent organs at risk(OARs) will be irradiated during SBRT , an

assessment of patient eligibility should include a careful evaluation of normal tissue function and dose

distribution. Typically , pulmonary function and the volume of normal liver that is irradiated are the

most immediate considerations. Tumors proximal to mainstem bronchi, trachea, esophagus, gastric

wall, bowel, blood vessels, or spinal cord should be approached with great caution, or not at all, if the

lack of spatial separation places them within the high-dose gradient region of treatment, which can

lead to potentially devastating clinical outcomes.


67

RT-14: Planning experience of radiosurgery using a LINAC in Guatemala

city

Hernández, E1. Contreras, R.

1 Ortega, M.

2 Ureta, L.

2

1Physics Department, Faculty of Engineering, San Carlos University from Guatemala

2Clinica de Radioterapia La Asunción, Guatemala

Introduction: The Clinica de radioterapia La Asuncion (Radiotherapy clinic La Asuncion) was the

first clinic in Guatemala, to provide radiosurgery services since 2007, and among the diseases that

were treated, arteriovenous malformations is the most frequent. The radiosurgery treatment planning

is carried out with the MNPS system of Mevis, treatment is administered with a linear accelerator

Clinac 1800 and Clinac 6EX using beams of 6 MV X-ray and cone system. The criteria used in

deciding the treatment plan are: Jackie Wessels conformity index, Ian Paddick conformity index,

integral dose, dose volume histogram and volume coverage. This paper shows the results of

experience gained since the treatments were initiated in 2007, until 2014 (94 cases), focusing on study

arteriovenous malformations, as the lesion most frequent.

Materials and methods: In this paper, we present the experience with 94 cases of radiosurgery with a

linear accelerator of Varian Clinac 1800 and recently (last 15 cases) with a Varian 6EX. System of

cones to collimate was adapted to the accelerator; the diameters of the cones used is 30 mm, 27 mm,

24 mm, 21 mm, 18 mm. 15 mm, 12 mm and 9 mm at isocenter. Photons of 6 MV was used in every

case. The TPS used is MNPS developed by Mevis and a stereotaxic system used to fix the patient

made by FiMe. In every patient treated initially was studied his case by the radiation oncologist and

neurosurgeon, who decided the treatment to administer, dose, and risk organs. The stereotaxic frame

is placed to the patient by radiation oncologist used local anesthesia. After placed the frame, a CT

image is acquired, with the frame how reference system. The CT image is processed with the MNPS

treatment planning system; this is a special TPS used to planning the radiosurgery cases. The MNPS

brings the information of Jackie Wessels conformity index, Ian Paddick conformity index, integral

dose, dose volume histogram and volume coverage, used to choose the acceptance of the plan. The

patient is fixed to the couch with a special system; the MNPS brings the coordinates of every

isocenter to place the target in position of treatment. A support of cones is attached to the collimator

exit used to the isocenter corresponding. The treatment is administered using the control console of

the Linac. When the treatment is finished, the frame is retired of the patient.

Results: Graphics of Integral dose versus target volume for arteriovenous malformations (AVM) is

presented, Jackie Wessels Index versus target volume, frequency of isocenters used, Ian Paddick

index versus target volume, age frequency of the patients treated, and frequency of target volume is

presented.

Conclusion: Arteriovenous malformations, was the lesion most frequent treated (53%). The volume

more frequently treated is menor to 5 cc. A relation of integral dose and target volume for the AMVs

treated was obtained with 0.9837 of correlation


68

Invited Talk

IPM-7: Treatment Plan Evaluation and Optimization Based on

Radiobiologic Parameters

Salahuddin Ahmad, Ph.D., DABR, FACMP, FAAPM

Professor and Director of Medical Physics

Department of Radiation Oncology

University of Oklahoma Health Sciences Center

Oklahoma City, USA

Abstract: Treatment plan optimization using radiobiological parameters is an improvement to

optimization based on physical dose constraints evaluated on the basis of dose volume histograms.

Such optimization enables the comparison of treatment plans based on the estimation of the

equivalent uniform dose (EUD), Tumor Control Probability (TCP) which provides a quantitative

biophysical measure of tumor dose, Normal Tissue Complication Probability (NTCP) which provides

the percentage of the patient population with unfavorable reactions in the contiguous tissue at a

particular dose, Therapeutic Index or Ratio (TI or TR) referring to the ratio of the TCP and NTCP at a

specific level of response for normal tissues, Uncomplicated Tumor Control Probability (UTCP)

referring to the probability of tumor control without complications, and the Therapeutic Gain (TG)

referring to the ratio of relative biological effectiveness in tumor to normal tissue. However, lack of

accurate knowledge of spatial distributions of clonogenic cells within the tumor, the tumor

radiosensitivity and the variability in cell surviving fractions are factors that impede accurate

radiobiologic estimations. The biological estimation along with the spatial information of tumor and

normal tissue cells are expected to generate the novel technique of biologically optimized image

guided radiation therapy.

Invited Talk

IPM-8: Challenges of Patient Safety in Radiation Oncology Practices In

Bangladesh

Prof Syed Md Akram Hussain,

Senior Consultant,Ahsania Mission Cancer Hospital

Introduction: Radiotherapy plays a major role for cancer management, particularly in the Indian

sub- continent. In Bangladesh, around eighty percent patients require radiation therapy. Radiation

treatment is teamwork. Quality care could only ensure patients' safety. It is highly important for

high dose rate treatment such as CFRT, IMRT, IGRT, SRT, and SBRT. Patient safety in

radiotherapy is a critical and challenging issue worldwide. National agencies and international

organizations such as IAEA, IOMP, and WHO are involved with this matter.

Methodology: Review of national and international relevant documents.

Result and Discussion: Quality control has utmost importance for ensuring patient's safety. Error may

occur in different steps and stages of human and technical interactions. Quality assurance requires

appropriate skill, education, qualification, and training of radiation medical physicists following

international guidelines and framework. Over the last three decades, at least 3,000 patients have been

affected by radiotherapy incidents and accidents, which have been accounted for more acute radiation

deaths than any other source, including Chernobyl.

Quality assurance activities could ensure patient's safety. Radiation Oncologists, Clinical Radiation

Medical Physicists, and Dosimetrists are responsible for technical quality assurance of radiation

treatment. International Labour Organization (ILO) has recognized medical physicist as an

occupation; and OMP, IAEA, and AAPM have defined who will be a medical physicist and what will

be their role and responsibilities. The Fundamental Safety Principles issued by IAEA is, "The

fundamental safety objective is to protect people and the environment from harmful effects of

ionizing radiation" which is stated in IAEA Basic Safety Standards ( BSS).


69

In Bangladesh, advanced radiotherapy technologies have both in government and privet sectors.

So, patient safety issue becomes more crucial. Bangladesh Atomic Energy Regulatory Authority

(BAERA) is responsible for enforcing rules and regulations for radiation safety in Bangladesh. Safety

is everyone's responsibility.

Conclusion: To achieve adequate patient safety, internationally standard certification and a legal

framework such as licensing would be pertinent by the competent authority in Bangladesh.

Invited Talk

IPM-10: New methods in peripheral Nerve conduction measurement from

Dhaka University

K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka, Bangladesh Email: [email protected]

Abstract: Distribution of F-Latency (DFL) is a new nerve conduction parameter conceived by the author

and developed by his team at Dhaka University. Work has been going on since 2002 on DFL and it appears

to be a very useful technique in the screening or diagnosis of peripheral neuropathy. Already research

groups in Singapore and UK have started working on DFL. It is expected that this measurement parameter

will become a first line testing method in peripheral neuropathy in the near future.

Invited Talk

IPM-11: Accreditation, Certification and Recognition Issues

John Damilakis

Professor of Medical Physics

Faculty of Medicine, University of Crete, Greece E-mail: [email protected].

Abstract: An increasing number of higher education institutions have in recent years started to offer

courses on Medical Physics. Moreover, Continuing Professional Development (CPD) for medical

physicists is of great professional interest. CPD courses is an excellent way to ensure that Medical

Physicists become knowledgeable about all current issues in their field and to provide the necessary

knowledge, skills and competences for certified Medical Physicists to become Medical Physics

Experts. However, external assessment of the quality of education or training provision is needed.

Accreditation is the formal recognition that education and training on medical physics provided by an

institution meets acceptable levels of quality. Accreditation should be based upon standards and

guidelines. Requirements for accreditation of a training programme should take into account several

aspects including facilities, staff, educational material and teaching methods. In Europe, ENQA

(European Network for Quality Assurance) promotes European co-operation in the field of Quality

Assurance in higher education. ENQA members are national agencies and organizations, which play a

major role in the accreditation process. A European organization is needed to offer accreditation of

medical physics CPD and training programs. Certification is the recognition of knowledge of a

professional who has completed his/her education or training. The EC has developed tools and

frameworks to promote training and facilitate mobility. ECVET is a European system of accumulation

and transfer of credits designed for vocational education and training in Europe.




70

Invited Talk

IPM-12: Clinical Training of Medical Physicists and Accreditation: Efforts

in Bangladesh

Kamila Afroj Quadir

National Institute of Nuclear Medicine & Allied Science, BAEC, Block D, BSM Medical University,

Dhaka, Bangladesh E-mail: [email protected].

Introduction: Medical physicists are fundamental to any radiation medicine discipline. With the

development and sophistication of radiation medicines in both diagnosis and therapy, the role of

medical physicist is increasingly becoming ever more important. In hospitals with radiation medicine

services either for diagnosis or therapy, physicists play an important role for the optimization of

image and dose, radiation safety, instrumentation, quality control and quality assurance. As actions of

medical physicists working in the hospitals directly impact human life, therefore, it is very important

that they are clinically competent.

Clinical training efforts in Bangladesh: Clinical guide books TCS series 371, 47

2 and 50

3 published

by IAEA, are of international standard for structured clinical training in radiation oncology, diagnostic

radiology and nuclear medicine training respectively. Bangladesh, for the first time, completed a 2

years structured in-service clinical training program for nuclear medicine physicists with the support

of IAEA following guide book TCS-503 in 2012. This was carried out by the National Institute of

Nuclear Medicine and Allied Sciences (NINMAS) of the Bangladesh Atomic Energy Commission.

Physicists who qualified in the clinical training program were evaluated by IAEA expert by written,

practical and oral examination. Later these Physicists were given certification by the Bangladesh

Medical Physics Association (BMPA) after they successfully passed an examination taken by

BMPA.

Initiative for Accreditation: The Department of Biomedical Physics and Technology of Dhaka

University and Bangladesh Medical Physics Association took an initiative for a round table meeting

in the beginning of this year on Accreditation and Certification issues in the field of Medical Physics

and Biomedical Engineering, both for relevant courses and for clinical residency programmes. The

meeting resolved that an independent Board should be created under the leadership of University of

Dhaka with membership from individual specialists, relevant associations, Government and non-

Government organisations. Later, arguments came that since the University gives a course, there may

be a conflict of interest and an independent body or institute be formed to provide such Accreditation.

For this purpose a suggestion for an ‗Institute of Medical Physics and Biomedical Engineering‘, to be

registered as a social organization came through a couple of meetings held later. Efforts should then

be taken to have the Government endorse the accreditation given by this Institute. Further steps in this

direction are being awaited.

Conclusion: If the suggested Institute is formed it will fill up a great void that exists today in

Bangladesh in the quality assurance of clinically qualified Medical Physicists and Biomedical

Engineering.

References 1. Clinical Training of Medical Physicists Specializing in Radiation Oncology; Training Course Series

(TCS) 37, IAEA, Vienna, 2009.

2. Clinical Training of Medical Physicists Specializing in Diagnostic Radiology; Training Course

Series (TCS) 47, IAEA, Vienna, 2010.

3. Clinical Training of Medical Physicists Specializing in Nuclear Medicine; Training Course Series

(TCS) 50, IAEA, Vienna, 2011.



71

AIM-1: Study of the Broca Region of Brain to Analyze Autism

Mousumi Bala, Mohammad Hanif Ali

Department of Computer Science and Engineering, Jahangirnagar University, Savar, Dhaka,

Bangladesh. E-mail: [email protected], [email protected].

Introduction: Autism is of great concern in the present world. It is a neuro-developmental disorder

that occurs in the early age of a child. Autism is characterized by impairment of verbal and nonverbal

communication, social interaction, and imagination, whose origin is largely unknown. Recent studies

show abnormalities in the various regions of brain in autistic persons. To investigate the causes of

autism, the study of Broca region of brain is carried out among the control and autistic individuals. In

carrying out the work, advanced diffusion-weighted magnetic resonance imaging (MRI) is performed

on control and autistic individuals. Using a validated automatic method, white matter in Broca region

are identified and micro-structural characteristics including fractional anisotropy (FA) and mean

diffusivity (MD) are examined. Broca‘s area is a region of the hominid brain with functions linked to

speech production. Functional MRI (fMRI) studies have identified activation patterns in Broca‘s area

associated with various language tasks. Functions of Broca‘s area i) Language comprehension ii)

Action recognition and production ii) Speech-associated gestures. Furthermore, the degree of

synchronization between the various participating areas was consistently lower for the autistic than

the control participants. So, Autistic patients do not integrate and synchronize information as

effectively as healthy controls during language processing.

Materials and Methods: In carrying out the work, the broca region is divided into anterior, long and

posterior segment. Using validated automatic selection method, fractional anisotropy (FA) and mean

diffusivity (MD) are calculated for the control and autistic individuals. The MRI scan image is taken

as input and the experiment is implemented in MATLAB 7.12.0.635.

Figure: shows the FA for control and autistic

Results: Fractional Anisotropy (FA) and Mean Diffusivity (MD) in the anterior segment, long

segment and posterior segment in the broca region for control and autistic individuals have been

calculated using validated automatic method. From the study it is clearly observed that autistic

individuals have a lower FA and greater MD than controls in the Broca region.

Conclusion: From the experiment it is very much clear that FA in control and autistic are different.

The cause of these differences needs to be investigated in details which demands further study.




72

AIM-2: Need Assessment of Tele-Palpation

Zubair Barkat and K Siddique-e Rabbani,

Department of Biomedical Physics & Technology, University of Dhaka, Dhaka, Bangladesh. E-mail: [email protected], [email protected].

Introduction: Because of the geographical maldistribution of healthcare resources due to a great

disparity in economy, about two thirds of the world‘s population, mostly living in the least developed

countries (LDCs), lacks adequate access to quality health care. Telemedicine appears to be a solution

where the doctor is situated at a distance from the patient and two way audio-visual communication

together with real time diagnostic support using appropriate digital equipment is provided. A

significant part of a primary medical examination is ‗Palpation‘ in which a doctor touches and presses

onto different anatomical sites for diagnosis, for which no equivalent solution has come up so far for

telemedicine. The challenge of the present work is to give the remote doctor an experience of virtual

palpation in real time through development of appropriate hardware and software technologies. In this

article, we present study results of need assessment of tele-palpation for remote healthcare. The study

has been conducted on ten practicing doctors including professors from various medical units like

Cardiology, surgery, pediatrics.

Methods: The participants were first introduced with the project information. Then, they were asked

to fill up the questionnaire containing ten different questions covering different tele-palpation issues.

Results and Observations: Given in the figure a series of comparative graphs were drawn, combined

and opinions of specific medical units are presented. All of them agreed on usefulness of palpation in

clinical diagnosis and examinations. Different kind of tumor appears to show highest importance in

terms of diseases relevant for Bangladesh and LDCs that can be identified using palpation.

Pneumonia, malaria diarrheas, appendicitis, pancreatitis, breast lump tuberculosis, thalassemia are

among the diseases that are among the priorities identified by the doctors. In terms of skill in

palapation measurement Training of remote technicians got highest priority among all medical units.

Conclusions: Despite the challenges this project gives hope of better future and worth developing.





73

AIM-3: Findings from Two Urban Field Trials of the Dhaka University

Solar Water Pasteurizer

Rezwan Hussain1, M Abu Yousuf


2

1 University of Liberal Arts, Dhaka, Bangladesh

2 Dept of Biomedical Physics & Technology, University of Dhaka, Dhaka, Bangladesh


Introduction: The academic literature indicates that uptake or adoption of point-of-use health

interventions, even when they offer measurable health benefits, tends to be poor. Chlorination and SODIS

bottles [1] are two such interventions that have fared poorly, whether due to burden of use or other reasons.

Accordingly, two recent field trials of an affordable, portable solar water pasteurizer, developed by the

Department of Biomedical Physics and Technology at Dhaka University [2], sought to answer two

questions: (i) will impoverished, resource-poor urban households use the device with any regularity, and

(ii) will it offer health benefits to those most at risk from unsafe drinking water i.e. young children?

Methods: To answer these two questions, two field trials were conducted, in September, 2014, and

December 2014, in two Dhaka slums, located in Rayer Bazar. Each trial lasted three weeks, and ten

households, located within the same community, were selected to participate in each trial. There were three

selection criteria: the monthly rent not to exceed Tk.1500, no gas supply to the household, and the

household water supply to be contaminated with E-coli bacteria, as confirmed by lab tests.

Each household was supplied with one device, and training in its use. A baseline survey was conducted,

followed by weekly surveys for the three-week duration of each trial. One survey measured frequency of

use of pasteurizer, and gathered feedback from trial participants; the other survey gathered data on child

health outcomes. The picture shows the devices in actual use.

Results and Discussion: Both trials indicate significant uptake

and adoption by the pilot households, with approximately 90%

of households in both trials reporting regular usage during the

trial period. This may be partly due to due to site selection,

given the significant E-coli contamination of the drinking water

at both locations. Nevertheless, the rates of adoption indicate

that the device is effective and usable in the field.

Most importantly, both trials suggest that child health outcomes

were affected in a positive manner. In the first trial, the rate of

incidence (RI) of diarrhea or watery stool among children five

or under fell from 19 cases at baseline to 10 cases at trial end. In the second trial, the RI of diarrhea or

watery stool fell from 3 cases at baseline, to 0 cases at trial end. While findings for the second trial are less

conclusive, the first trial, conducted during the warmer month of September, when water quality is

typically worse, suggests that the pasteurizer may significantly reduce rates of diarrhea and water stool

among young children living in urban poverty.

Conclusion: The two field trials of the Dhaka University solar water pasteurizer offered proof of concept,

and demonstrated significant potential for uptake and adoption by poor, urban slum households with access

to only poor quality drinking water. The trials also suggest that pasteurizer use can significantly benefit

health outcomes in children five and under, who tend to be most at risk from poor quality drinking water.

These findings suggest that a larger study studying the impact and efficacy of the solar water pasteurizer is

warranted.

References: 1. http://www.sodis.ch/index as on 31 Jan 2015

2. MA Yousuf, RB Hussain and KS Rabbani, Solar Water Pasteurizer and Rain Water Collector for provision

of safe drinking water in urban slums and rural areas, Abstracts, International Conference on Physics in

Medicine and Clinical Neuroelectrophysiology (PMCN2015), Dhaka, Feb 19-20, 2015.

mailto:[email protected],



http://www.sodis.ch/index


74

AIM-4: A double blind trial to establish Distribution of F-Latency (DFL) as

an indicator of Cervical Radiculopathy or Myelopathy

Ehsan Alam Chowdhury and K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka, Dhaka, Bangladesh E-mail: [email protected], [email protected].

Introduction: The research group now at the Department of Biomedical Physics & Technology of the

University of Dhaka developed a new nerve conduction technique more than a decade back given the

name of ‗Distribution of F-Latency (DFL)‘ and had found that it could be useful for identification of

peripheral Neuropathy due to compression of nerve roots (Radiculopathy) or compression of the

spinal cord (Myelopathy) at the cervical and lumbo-sacral regions [1,2]. The aim of the present work

was to study the effectiveness of DFL for diagnosis or screening of cervical Radiculopathy or

Myelopathy (CRM). In the diagnosis of CRM, MRI is the standard investigation carried out. So we

decided to do carry out a double blind trial of DFL where MRI would be taken as the gold standard.

Methods: The investigation was performed on median nerves of both hands of 31 informed

volunteers chosen randomly between the ages 20 and 64. So that made it 62 cases to study. It was

noted whether the patient had any history of cervical pain or prior diagnosis of cervical radiculopathy

or myelopathy. The Radiologist conducting MRI was not informed of the DFL findings. Also the

investigator assessing the DFLs was unaware of the MRI results. This was done to keep the trial

double blind and minimize bias. The identification of patterns of DFL went through some refinements

through a work done in Singapore earlier [3] and the present work used these refinements.

Results: Row 2 of the Table below shows the results of the study on all 62 nerves (cases here) of the

31 subjects, while Row 3 is for age group < 50yrs (no. of cases: 44) and Row 3 for >50 yrs (no. of

cases: 18). Age

group

No. of

nerves

(cases)

TP TN FP FN Correctly

Predicted % Wrongly

Predicted % Sensitivity

% Specificity

%

20-64 62 45 2 2 13 76 24 78 50

20-50 44 29 2 2 11 70 30 73 50

50-64 18 16 0 0 2 89 11 89 *

TP: True positive, TN: True negative, FP: False positive, FN: False negative

Sensitivity = True positives/All positives; Specificity = True negatives/ All negatives

* Number of TN cases was zero, so specificity could not be calculated

Discussion: The results show that DFL gives a reasonably good indication of CRM. In fact it was

found that even in cases where the effect was almost subclinical and MRI only reported mild

compressions that normally would be ignored by doctors, DFL showed the abnormality clearly.

Therefore, DFL can be used as a first line screening test for identification of CRM, giving a cost

effective solution. MRI, a very expensive and bulky machine, is not widely available and has a very

high consumable cost, making DFL attractive for screening patients for CRM since DFL requires

standard nerve conduction equipment that can be made into a portable unit at low cost and has almost

zero consumable cost.

Acknowledgement: International Science Program of Uppsala University, Sweden for part support. References: [1] Rabbani KS et al: Frequency Distribution of F-Latencies (DFL) has Physiological Significance and Gives

Distribution of Conduction Velocity (DCV) of Motor Nerve Fibres With Implications for DIagnosis. J Biol

Phys 2007, 33:291-303.

[2] Alam MJ and Rabbani KS: Possible detection of cervical spondylotic neuropathy using Distribution of F-

latency (DFL), a new neurophysilogical parameter. BMC Research Notes 2010, 3(112).

[3] KS Rabbani, N Yassin and Y L Lo, Identification of Cervical Spondylotic Radiculo-Myelopathy using

Distribution of F-Latency (DFL), a new nerve conduction parameter, Submitted, BMC Research Notes.




75

AIM-5: Distribution of F-Latency and MRI Study of the Brachial Plexus

Z B Mahbub1, P A Gowland

2

1Department of Arts & Sciences, Ahsanullah University of Science & Technology, Bangladesh

2School of Physics & Astronomy, University of Nottingham, United Kingdom

Introduction: Brachial plexus imaging by MRI can efficiently detect disorders and study the

microstructures qualitatively and quantitatively. EMG can detect the peripheral neuropathies using

time dependent behaviour of nerve conduction. Thus the combination of EMG and MRI could provide

important insight and information about the brachial plexus1. The objective of this work is to measure

the distribution of F-response latencies (DFL) as a new parameter2 in EMG and combine it with MRI

at different head positions of the normal subjects.

Figure 1: MRI of brachial plexus using STIR TSE sequence

Methods: This study was approved by the local ethics committee. MR images of the brachial plexus

were acquired from six healthy subjects on a 3T Philips Achieva scanner using the torso XL 16

channel array coil. Short tau inversion recovery turbo spin echo (STIR TSE) sequence was

implemented for acquiring MR images. Sizes of the DRG, Rami and trunks were calculated from the

intensity profiles fitted with Gaussian curves. DFLs were measured from the same subjects based on

the F-responses by stimulating the median nerve at the wrist using surface electrodes stimulator with

12mA, 220V and 500µs pulses. Elicited F-responses were recorded with sampling rate 5kHz,

resolution 0.5μV, and low/high cut-off=10/1000Hz from the abductor pollicis brevis (APB) muscle

using the BrainAmp amplifier and Brain Vision Recorder software, Brain products, Germany. Nerves

were supramaximally stimulated for 30 times, the DFLs were calculated between 20ms to 40ms F-

latencies with 2ms bin size, and then fitted to Gaussian function to find corresponding peak (DFLpeak).

To observe the effects the different head positions, all the MRI and F-responses were measured at

normal position of the head and tipped to left and right for compressed and extended positions. Page‘s

L trend tests3 were used to assess the effects of head positioning on the DFLpeak and MRI parameters

for individual measurements, and then correlation between averaged DFL and MRI measurements

calculated.

Results: Table1 shows the Page‘s L trend test values for DFL and MRI measurements. Figure 2

shows the correlation between DFLpeak and MRI parameters. Table 2 shows the coefficients.

Figure 2: Correlation between DFL peak and MRI measurements from brachial plexus

Discussion: Combined DFL and MRI measurements was carried out successfully for the first time.

Clear decreasing trend for DFLpeak, DRG_C7 and trunks were observed for compressed-normal-

extended positions of the head. Strong correlation between DFLpeak, Rami and DFLpeak, lower trunk

were detected, that could relate the eliciting nerve roots and conduction path of the F-responses. Thus

the combination of two complimentary techniques MRI and DFL can provide a great clinical

applications in quantitative and qualitative peripheral neurophysiology.

Table 1 Table 2


76

AIM-6: Diffusion Features of the Brachial Plexus

Z B Mahbub1, P A Gowland

2

1Department of Arts & Sciences, Ahsanullah University of Science & Technology, Bangladesh

2School of Physics & Astronomy, University of Nottingham, United Kingdom

Introduction: Brachial plexus is the upper portion of the peripheral nervous system. Imaging of this

area are difficult because of the problems of distinguishing vascular structures from nerves, but

diffusion weighted imaging with background suppression (DWIBS)1 has been used to improve the

visibility of the nerves and combined with Maximum Intensity Projection (MIPS) mapping allow

localisation and visualisation of the anatomy. The aim of this work is to develop robust methods of

measuring the Apparent Diffusion Coefficient (ADC) in the brachial plexus. Moreover, study the

presence of intravoxel incoherent motion (IVIM) and variation of the ADC with diffusion evolution

time (Δ) which may provide further information about tissue microstructures2, 3

.

Methods: This study was approved by the local ethics committee. Diffusion weighted images were

acquired from five healthy volunteers on a 3T Philips Achieva scanner using the torso XL 16 channel

array coil. Axial EPI scans (3mm isotropic resolution, 192×75×300 mm FOV, whole volume

shimming, NSA=20) were acquired from C1 to T1 nerves. Tow PGSE data sets were acquired: (1)

IVIM study: Diffusion factor b=0, 25, 50, 75, 100, 300, 500, 700, 900s/mm2, with TE=60ms,

diffusion time, Δ=28.3ms, diffusion gradient duration δ=10ms; (2) Diffusion time dependent ADC:

with Δ=18.3 to 81.3ms, δ=10ms, TE= 100ms, for b=300,600 s/mm2. Coronal MIPs were

reconstructed to confirm image features; sagittal images were reconstructed through the nerve roots.

ROIs were selected over the nerve roots at C5/C6/C7/C8 and over the spinal cord, based on their high

image contrast by fitting with 2D Gaussian surface and selecting only those ROIs which are at least 2

times the standard deviation of the background. The IVIM data were nonlinearly fitted to

, where f= IVIM fraction, D=diffusion coefficient, and D*= apparent

diffusion coefficient. ADC were measured by using the diffusion equation, .

Results: Figure 1 shows the IVIM signal attenuation curve for the nerves and cord. Table1 shows the

fitted IVIM results. Figure 2 shows

the corresponding ADC vs diffusion

time plots.

Figure1: IVIM curves for Nerves and Cord

compared agar phantom

Table1: IVIM and T2 for Nerve and Cord

Nerve Cord

Subject D×10-3

mm²/s

D*×10-

3 mm²/s

f D×10-3

mm²/s

D*×10-

3 mm²/s

f

Sub1 1.4±0.04 7.0±0.4 0.20±0.04 1.0±0.04 70±4 0.50±0.04

Sub2 0.9±0.02 5.0±0.6 0.20±0.02 0.9±0.02 60±3 0.46±0.01

Sub3 1.0±0.03 6.0±0.8 0.30±0.01 1.0±0.04 90±6 0.48±0.00

Sub4 1.3±0.05 7.0±1.0 0.15±0.01 0.8±0.01 70±7 0.46±0.02

Sub5 1.1±0.05 8.0±1.4 0.33±0.02 0.9±0.00 60±5 0.50±0.03

Mean±Std 1.1±0.02 7.0±1.0 0.24±0.01 0.9±0.011 70±7 0.48±0.02

Figure2: ADC vs Δ plot

Discussion: IVIM (due to blood flow or CSF movement) was

detected by DWIBS technique in the brachial plexus up to a

reference b-value of ~300s/mm2. Decreasing ADC with diffusion

time reflects diffusion in the extracellular fluid surrounding the

axons. Interestingly ADC decreased slightly faster for the nerves

this result may reflect the fact that axons in the peripheral nerves

have a larger diameter (12 -22 µm) than axons in cord white

matter (2-10 µm), and the interaxonal spacing may vary as the

fibres form into bundles near their point of egress from the spinal

cord. ADC measurements and Δ dependent ADC measurements

will be correlated with EMG results in future.


77

AIM-7: Investigation of Different F-response Parameters at Different

Positions of the Head

Z B Mahbub, M H R Khan, M S A Khan, M K Sarkar, M M Billah

Department of Arts & Sciences, Ahsanullah University of Science & Technology

Introduction: The F-responses results from the backfiring of antidromically activated anterior horn cells.

Thus its measurement helps in assessing motor conduction characteristics along the entire length of the

peripheral axons. The inherent variability of the latency and configuration of the F responses makes its use

as a technically demanding neurophysiological parameter1. Physically it is expected to observe distinctive

changes in latencies of motor responses with different positions of the head that can cause temporary

compression or extension over the brachial plexus nerve roots, such conditions could reflect similar

neurological disorders. Objective of this study is to estimate the variations of different F-response

parameters such as maximum and minimum latencies, chronodispersion and recently introduced

distribution of F-latency (DFL) 2, 3

at different head positions of the normal subject.

Methods: This study had local ethics committee approval. F-responses were recorded at room temperature

(~200C) from four healthy subjects (age limit 25-45 years) by stimulating the median nerve at the wrist

using surface electrodes (cathode proximal) attached to a constant current (~20mA), high voltage (220V)

stimulator. Elicited F-responses were recorded (sampling rate 5kHz, resolution 0.5μV, and low/high cut-

off=10/1000Hz) by placing the active/reference/ground electrodes over the abductor pollicis brevis (APB)

muscle, at the thumb, and at the back of the palm respectively using the Brain Amp amplifier and Brain Vision Recorder software, Brain products, Germany. Nerves were supramaximally stimulated for 30 times

at each of the normal, extended and compressed positions of the head and resulting F-responses were

recorded from which following parameters were calculated: minimum, maximum and mean F-latencies

(Fmin, Fmax, Fmean), chronodispersion, Fchrono = Fmax - Fmin, amplitude (FAmp) and DFL with 2ms bin size

from 20ms to 40ms. DFL were fitted to Gaussian function to find corresponding peak and width (DFLpeak ,

DFLwidth). To observe any trend with head positions in the above parameters Page‘s L trend test4 were

implemented.

Results: Figure 1 shows the measuring parameters from

different F-responses. The probability values from Page‘s

L trend test shown in Table 1.

Discussions: Different F-response parameters were measured at different head positions successfully.

For compressed-normal-extended positions of the head clear decreasing trends in DFLpeak, DFLwidth and

Fmin, adequate decreasing trends in FAmp and Fmean were observed. These observations reflect the temporary

compressions and extensions of the nerve roots at brachial plexus which in turn controls the F-latencies of

the fastest nerve fibres. However, the Fchrono, Fmax were not showing similar trend, may be due to

variability of number of participating backfiring neurons at spinal cord that reach the APB muscle later. F-

response measurements and different angular position dependent parameters will be correlated with EMG

results, cervical spondylotic patients in future.

Acknowledgement: Professor Penny Gowland, University of Nottingham, Professor K S Rabbani,

University of Dhaka for excellent ideas and supervision.

References: 1. D C. Preston, Electro. & Neuro. disorders, 2nd Ed. 2005;

2. M Fisher, F-waves phys. uses, The Sci. world 2007(7);

3. Rabbani et al, DFL physiol. parameter, J Biol. Physics 2007(33); 4.

Cuzick, J. Statistics in medicine 1985(4).

Figure 2: Different F-response

parameters shown in three responses

Table1: Page‘s L trend P-values for different parameters


78

LCD-1: Android Apps Based Intelligent Telemedicine System: Bangladesh

Perspective

Shekh Md Mahmudul Islam and Md Adnan Kiber Department of Electrical & Electronic Engineering, University of Dhaka, Dhaka.Bangladesh

E-mail: [email protected].

Introduction: Health is a fundamental human right although more than one billion people are

unreached in terms of quality healthcare services. Insufficient healthcare facilities and unavailability

of medical experts in rural areas are the two major reasons that kept the rural people unreached to

healthcare services in developing countries like Bangladesh. According to the World Health

Organization (WHO) statistics, the doctor to population ratio is 1: 1500 in urban areas and 1:15000 in

rural areas of Bangladesh. This scenario can be dramatically changed if we can simply convey

medical tips using ICT infrastructure to the targeted unreached community. Due to the recent

development of Information and Communication Technologies (ICT) the digital divide has been

reduced and these technologies have the great potential to address contemporary global health

problems. Telemedicine refers to the use of information and communication technologies to distribute

information and or expertise necessary for healthcare services provision, collaboration and or delivery

among geographically separated participants including physicians and patients.

Methods: DICOT (Digital Imaging and Communication for Telemedicine) is the name of the

machine which has been built by the Telemedicine Working Group (TWG) of Bangladesh, and is in

use at some telemedicine centers. One of the major problems of the DICOT users is long cumbersome

registration process. In this thesis work we have developed android apps which will provide

opportunity of health care at home. After logging in apps, user can update their basic medical records

and can choose and get a confirmation of appointment of specialist doctors. Different medical records

can be updated like body temperature, glucometer, ECG, personal information and others. After

updating with database then a confirmation message of assigned appointed day and time will be sent

to the patient through android app. So, patients need not experience a long cumbersome process of

registration.

Results and Observations: Some snapshots of our designed Android App for registration purposes

are given below:

Conclusion and Future Work: In our developed android app medical records like Blood Pressure,

Glucometer, and Temperature can be updated manually through smart phone as embedded sensor

devices are not available in our country, so automated android app with diagnosis device could be

implemented in our future work.



79

LCD-2: Indigenous Development of Ultrasound Doppler Based Fetal Heart

Monitor

Md. Kamrul Hussain and K Siddique-e Rabbani

Department of Biomedical Physics and Technology, University of Dhaka, Dhaka, Bangladesh Email: [email protected], [email protected]

Introduction: A foetal heart monitor gives general information on foetal development through

determination of its heart rate which can improve the scenario of neonatal and perinatal death besides

maternal mortality. Antenatal care in the rural areas of Bangladesh still needs a lot of improvement

through technology but foreign equipment are expensive and do not provide sustained service because

these are not designed to suit our weather conditions and extreme power line abnormalities. The goal

of this research work is to design and develop a Fetal Heart Monitor based on Ultrasound Doppler

technique indigenously as a solution to the above problem.

Methods: Two ultrasound Doppler sensors - a transmitter and a receiver - were fabricated using

piezoelectric transducers, available commercially. Backing layers for the mounting of the transducers

were designed to get high efficiency, and fabricated using locally available materials. Electronic

circuitry were developed to retrieve the movement of an object in the path of the ultrasound beam

which involved the following: i) excitation signal for the transmitter, ii) amplification of the weak

received signals, iii) appropriate filtering, iv) conditioning of the output, v) demodulation using a

PLL. To test the developed prototype a water phantom was designed with an object inside that moved

with time (Fig a). Pulsed wave unipolar drive technique was used with two separate transducers as

transmitter and receiver. The movement of the object inside the phantom simulated the contraction

and expansion of the baby‘s heart inside a fetus.

Results: The tests revealed that the outputs of the transducers and different stages of the circuitry

behaved as expected. The transducer has sharp excitation and the ringing is reduced significantly (Fig

b) showing success of the mounting method. The output was fairly stable and the demodulator was

capable of recovering the movement of the object inside the phantom (Fig c).

Discussions: It was a success to construct the transducers and the electronic circuitry for the

ultrasound Foetal Heart Monitor with limited resources locally. The overall system performance can

only be verified by experimenting on the human body. In that stage, the demodulator has to be tuned

precisely to capture the slightest change of Doppler frequency due to heart movement. Further

development work is required for experiments on human body. Once it is successful, further work will

be carried out to make the device portable and linking this device to telemedicine.


(a) Transducer

(b) Received pulse signal: receiver o/p

(lower trace) and conditioned o/p (top

trace)

(c) Output due to a moving object (top

trace)and demodulated o/p (lower trace)

representing the movement of the object




80

LCD-3: Introduction to PC Based ECG Acquisition Technique without

Switched Resistor Network at Input

Zisun Ahmed, K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka, Dhaka, Bangladesh. E-mail: [email protected]

Introduction: In the standardized ECG system ten electrodes are needed to produce 12 electrical

views of the heart. To obtain all 12 Lead signals it is required to have different combination of analog

signal switching for positive and negative input of the instrumentation amplifier. This switched

resistor network at the input is responsible for a number of inevitable problems such as- non-uniform

amplification of different leads due to resistance mismatch, degradation of CMRR due to unequal

impedance seen by the two inputs amplifier, lead reversal during switching, increased hardware bulk,

decreased reliability over time due to changes in resistance. Though it has been more than a century,

the basic principle of acquiring ECG signals from the body has remained almost the same.

Methods: As ECG is a very slow moving signal, it is fairly easy to sample the signal and transfer it to

a computer without losing any important information. If, somehow, we can associate a PC with the

ECG acquisition system in such a way that the computer will take signals from different portion of the

body with respect to a reference point and after some amplification, necessary filtering and

digitization, the PC can have enough samples to calculate different lead signals within its processing

unit. A multiplexer can be incorporated to switch between the signals coming from different position

of the body before comparing it to the reference point. That way the total resistive network switching

process can be avoided.

To investigate the feasibility of this alternate method of acquiring different ECG leads which will be

based on PC without needing any switched resistor network at input an experiment was set up and

was tested on a couple of subjects. Two different ECG amplifiers were constructed and signals from

different limbs associated with certain leads were sampled using multiplexers and filtered to

differentially amplify with respect to a reference using instrumentation amplifiers. The amplified

signal was filtered and then using opto-isolators transmitted to an oscilloscope. The outputs of both

the ECG amplifiers were then subtracted using the math function of the oscilloscope.

Results: After the successful conduction of the experiment, the results were acquired and analyzed.

The results showed very strong resemblance to the result from a conventional ECG, proving the

possibility of existence of an alternate method of acquiring ECG.

Figure 3(a): Lead I Figure 4(b): Lead II Figure 5(c): Lead III

Conclusions: If this method can be implied the hardware bulk of resistor switched network and the

limitations associated with it can be eliminated completely. As there is no resistor network needed the

system will be more reliable to use over time and it will require less maintenance. This method will

also make it easier for ECG to be calculated in personal devices, which can be helpful for providing

health care to the people of the under privileged countries.



81

LCD-4: Alternative Solution of Manual Glob Top for Low Resource

Countries

Zubair Barkat

Institute for micro and sensor system (IMOS), Otto-von-Guericke university of Magdeburg, Germany.

*Currently working at Department of Biomedical Physics & Technology, University of Dhaka. E-mail: [email protected]

Introduction: Glob-top is a variant of conformal coating used in chip-on-board assembly

(COB).Manual glob top is always challenging especially for small diameter sensors. In This article we

have proposed a solution for manual glob top for differential pressure sensor. These sensors can be

used in different medical applications. This invention has the potential to solve manual glob top

challenges for low resource countries. Glob top is made of a drop of specially formulated epoxy or

resin deposited over a semiconductor chip and its wire bonds, to maintain mechanical support and

exclude contaminants such as fingerprint residues which could disrupt circuit operation. Looking into

the details of the failure of the experimental setup due to manual glob top application, excess adhesive

was observed in the top surface of the sensor. This adhesive comes from manual glob top using a

needle.

Methods: Given in the figure, the first step was to protect the pressure sensor from outside

contaminants and provide mechanical support, as we do not want to do the glob top on the sensor top

surface due to the risk of excess adhesive might come to the surface because of manual glob top. So,

we made a roof like structure using copper plate to protect the sensor. To maintain the balance of the

packaged sample a similar kind of supporting structure was made on the rightmost corner of the

packaged sample.

Results: The experimental setup for differential pressure sensor was tested later on and provides

accurate output voltage as suggested in the data sheet of First sensor (IL20M-40MP-G08).

Conclusions: This solution has the potential to solve the manual glob top challenges faced by low

resource countries and can be used for various medical applications.



82

LCD-5: Decoding Movements from Human Subthalamic Local Field

Potentials Based on Neural Synchronization

S. Ahmmed1, F. Ahamed

1, M. Mace

2, R. Vaidyanathan

2, J. Stein

3, T. Aziz

3, S. Wang

4, K.A.

Mamun1

1Department of Computer Science & Engineering, United International University, Dhaka, Bangladesh,

2Department of Mechanical Engineering, Imperial College London, UK,

3Functional Neurosurgery and Experimental Neurology Group, University of Oxford, UK,

4Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou,

China.

Introduction: Neuro-motor prosthesis is a device to provide movement commands from brain

signals so that neurologically impaired patients are able to perform daily tasks to interact with

environment. Studies in monkey [1] and human [2] have shown that the primary motor cortex (M1)

could potentially provide movement-related signals to control assistive devices for paralyzed patients.

However, other areas of the brain may provide alternative or additional information. Deep brain

stimulation (DBS) offers a unique interface to sense and intervene the human brain circuits. Oscillatory

local field potentials (LFPs) activity in the sub thalamic nucleus (STN) is directly or indirectly

involved in motor preparation and control [3], which suggests that useful movement signals may be

available in this area as well. This study aims to decode the neural activity related to human voluntary

movements by identifying neural synchronization features and patterns related to movement execution and

laterality.

Methods: LFPs were recorded from bilateral STN via implanted DBS electrodes in patients with

Parkinson‘s disease while they performed left or right finger clicking task guided by visual cues. The STN

LFPs were low-pass filtered at 90Hz and then the frequency dependent components were extracted

as = 0-4Hz, θ = 4-8Hz, α = 8-12Hz, low β = 12-20Hz, high β = 20-32Hz, low γ = 32-60Hz and high γ =

60-90Hz frequency bands using wavelet packet transform. In each frequency band signal features were

extracted based on instantaneous power and neural synchronization. The instantaneous power of each

component was computed using the Hilbert transform. The power features were defined as the

average amplitude within each of five consecutive 100ms windows located around the motor response [4].

The long range neural synchronization based features for motor response were computed by analyzing

Granger causality between the left and right STN [5]. A Bayesian classifier incorporating these features

was designed for optimal feature selection and classification. The features were ranked (highest to

lowest) according to their individual classification accuracies and then a subset of features was

accumulatively selected either when the classification rate reached maximum or plateaued. The classifier

was validated using ten-fold cross-validation.

Results: Consistent significant power decreases in the β bands and increases in and γ bands, as well as

significant contralateral causal synchronization in β and γ bands were observed during the motor

response. Both movement, i.e. resting or action, and laterality, i.e., left or right clicking were evaluated from

four subjects. The average accuracy obtained was 90% for identifying movement, with significant

contribution from , β and high γ bands features. The following laterality classification achieved 81%

average accuracy with significant contribution from β and γ bands features.

Conclusions: The results suggest that the neural activity in human STN contain movement information. The

bilateral synchronization features significantly facilitated to identify movement laterality. These findings

may enhance our understanding on the underlying processes in STN for voluntary movement control and

its important implications for the development of neuro-motor prostheses in humans. Movement

related information in STN might be useful for developing more advanced neuro-prostheses in combination

with motor cortex activity.

References: [1] Musallam S, Corneil BD, Greger B, Scherberger H, Andersen RA: Cognitive control signals for neural

prosthetics. Science 2004, 305(5681):258-262.

[2] Patil PG, Turner DA: The development of brain-machine interface neuroprosthetic devices. Neurotherapeutics

2008, 5:137–146.

[3] Loukas C, Brown P: Online prediction of self-paced hand-movements from subthalamic activity using neural

networks in Parkinson's disease. J Neurosci Methods 2004, 137(2):193-205.


83

LCD-6: Efficacy Study of DFL using large Number of F-Latency

Recordings

M Obaidur Rahman, Ehsan Alam Chowdhury and K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka, Dhaka, Bangladesh.


Introduction: Distribution of F-Latencies (DFL) is a method conceived and developed by the

Department of Biomedical Physics and technology, Dhaka University group to diagnose Cervical

Spondylosis Neuropathy (CSN) in early stage. Since there is a inverse relation between F-latency and

conduction velocity, so DFL could provide the information about the conduction velocity distribution

of peripheral nerves. Forty successive supramaximal stimulations with a time interval of one second

were applied to the median nerve at wrist. A smaller response which follows the M-response is called

the F-response. This response is randomly generated and has varying latencies. A distribution plotted

using these latency values give the Distribution of F-Latency (DFL). This study attempts to test the

reproducibility of DFL using various combinations of recorded data.

Methods: Three median nerves of two male volunteers aged 41 and 42 were selected and stimulated

for more than 200 times. The room temperature was recorded as 30°C. From this set of data values

about 200 non-zero data points were chosen. This gives us an option to generate multiple sets of DFL

with a combination of 40 data points at a time. Five individual DFL patterns with 40 data values each

were then checked with each other and the pattern generated from 200 data values. For all of the

patterns the corresponding bin size was chosen 2ms. A simple program was developed for doing this

study in Microsoft Excel 2007.

Results and Observations: The following table presented the outcome of DFL for three median

nerves. The black line indicates the DFL pattern generated with about 200 data points. The other five

different colors (Blue, Brown, Green, Purple and Red) were used to represent the 5 DFL patterns by

choosing 40 data values randomly for five times from the 200 data values.

Nerve N1 Nerve N2 Nerve N3

DFL

Patterns

Discussions: Multiple DFL patterns with 40 data values were generated from a large number (about

200) of recorded F-latency values. The bin size was chosen 2ms. Several attempts were taken to

verify each of the patterns. The outcome of this study enhances our confidence to the use of DFL for

the diagnosis of the neuropathy with 40 data values.

Acknowledgement: Ministry of Science and Technology, Government of the People‘s Republic of

Bangladesh and International Science Program of Uppsala University, Sweden for part support.




84

LCD-7: Determination of Distribution of Conduction Velocity (DCV) from

measured Distribution of F-latency (DFL)

M Obaidur Rahman and K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka, Dhaka, Bangladesh E-mail: [email protected], [email protected]

Introduction: Distribution of Conduction Velocity (DCV) of nerve fibres in a peripheral nerve is

required for a proper diagnosis of neuropathy. In the previous work of our extended group at Dhaka

University, DCV of motor nerve fibres in a peripheral nerve trunk was shown to be an approximate

mirror image of Distribution of F-Latency (DFL), a new nerve conduction parameter conceived and

developed by that group as well. To obtain DFL, 30 to 40 consecutive F-latencies were obtained

through multiple stimulation of a peripheral nerve trunk. However, because of the inverse relationship

between latency and velocity, this mirror image is not exact, a small variation can be expected,

particularly when discrete bin sizes are used to obtain the frequency distribution. In the present work

it is intended to determine DCV from individual conduction velocity (CV) values that are obtained by

converting the corresponding individual F-latencies, obtained experimentally. The effect of bin size

for DCV in relationship to that in DFL will also be studied in order to go for an optimum value.

Methods: For experimental DFL, bin-size of F-latencies is usually taken as 2ms. Since latency is

inversely proportional to CV, if bin sizes for DCV are chosen to correspond to the constant F-latency

bins over the whole range, varied bin sizes for DCV will result, which is not a desired situation. A bin

size which gives a justified correspondence between the two distributions is necessary. Therefore, a

constant bin size of DCV was chosen based on the following parameters of the F-latency data for the

range of non-zero values: the average of the minimum and maximum, the weighted average, median

and mode. The correspondence between DFL and DCV was assessed visually from the plots for a

choice among these.

The bin-sizes for DFL were also varied between 0.5ms to 2ms although the distributions for the

smaller bin sizes may have variations that are not statistically significant for the limited number of

experimental events (30 to 40). This exercise would help choose an optimum value of a constant bin

size for DCV. A program in EXCEL was developed to perform the above studies.

Results: DCVs corresponding to DFLs were obtained for several subjects with or without neuropathy,

using different constant bin sizes chosen according to the methods suggested above. The plots were

compared and assessed visually to look for a reasonable correspondence. For different subjects

slightly different bin sizes for DCV appeared to be appropriate. The study on the several subjects gave

an indication of appropriate bin sizes which would help in further studies.

Conclusion: The present technique gives an acceptable DCV from measured F-latencies, which is a

parameter required for a proper diagnosis of neuropathy.

Acknowledgement: Ministry of Science and Technology, Government of the People‘s Republic of

Bangladesh and International Science Program of Uppsala University, Sweden for part support.




85

LCD-8: Development of an Electronic Stethoscope with Optimized

Frequency Response for Different Body Sounds

Ismat Ara Roksana and K Siddique-e Rabbani

Department of Biomedical Physics and Technology, University of Dhaka, Dhaka, Bangladesh

Introduction: Stethoscope is used for primary diagnosis of any disease. Medical stethoscope is used

for listening to body sounds. As acoustic stethoscopes are not reliable for noisy environment and

telemedicine electronic stethoscopes are used. Electronic stethoscope can amplify the sounds to aid

the user but it cannot be used for all the organs simultaneously as the frequency of all the organs are

not the same. The objective of this thesis was to make a modified stethoscope which can be used for

body organs like heart, lung and abdomen.

Methods: An electret microphone was used to convert the audio signal from the chest piece to

electrical signal. Then the signal was fed to the pre amplifier to amplify. The output of the pre

amplifier was added to the filters. The modified stethoscope had three different filters for three

different organs and the filter ranges are 10Hz-300 Hz, 300Hz- 700Hz and 700 Hz–3 KHz for heart,

lung and abdomen respectively. The ranges were obtained by analyzing body sounds from Littman

sound library using the software Audacity. A sound mixer was connected to the filter outputs and a

volume controller was added to every filter for the purpose of controlling the volume gain by the user.

The output of the mixer was then added to the headphone or headset with a transducer for converting

the electric signal to audio signal.

Results and Observations: Three inverted band

pass analog filters were used for the filtering of the sounds. The gains of the filters were drawn to a

graph with reference the frequency in log scale. From the collected data it was seen that the filters that

the mid bands were around 150 Hz, 400 Hz and 1 KHz for heart, lung and abdomen filters

respectively.

Discussions: The stethoscope had some problems with the gain control as the filters were overlapping

each other. There was some noise as the project was implemented on the breadboard. Proper shielding

can be helpful in reducing the noise to the minimal level. The stethoscope can be developed in future

by making it capable of storing data or by interfacing it to the computer so it can be used for the use

of telemedicine.

Figure 6: Chart for frequency versus gain of filters


86

LCD-9: Implementations of a system of transferring electronic stethoscope

sound over mobile phone call for live auscultation in Telemedicine

Maruf Ahmad1, Md. Kamrul Hussain


Department of Biomedical Physics and Technology, University of Dhaka, Dhaka, Bangladesh E-mail:

[email protected],

[email protected]

Introduction: Electronic stethoscope is being used in telemedicine for many years. But most of the

time, stethoscope sound is first recorded on computer then it is sent to the destination computer for

doctor‘s hearing. Because, real time auscultation wouldn‘t be possible for many reason – one of this is

most videoconferencing system and voice transfer protocol perform audio compression technique and

limit the passes of low frequency signal that reduce the quality of the heart sound [1]. With this

challenge, much research has so far been done for live auscultation in telemedicine. Here we represent

an easy and low cost solution for it.

Methods: The system consist of two main edges – i)

Patient end for sensing and transmitting stethoscope

sound ii) Doctor end for receiving and hearing the

sound [see figure-1]. The frequency range of the

human internal body sounds – mostly heard heart

sounds is between 20 Hz to 200 Hz and lung is

between 25 Hz to 1.5 KHz [2] and same output is

given by electronic stethoscope but audio frequency

range of mobile phone call is limited. For

narrowband the range is from 300 Hz to 3.4 KHz

and for wideband the range is from 50 Hz to 7 KHz [3]. Most of the telecom providers of our country

are using narrowband audio frequency range for voice call transmission. So, as most of the sounds of

electronic stethoscope are low frequencies which are unable to transfer over mobile phone call. To

overcome this, in the transmitting side, low frequency stethoscope signal is modulated with high

frequency carrier signal typically it is 2.5 KHz so that it meets the audio frequency limit of the mobile

phone call and in the receiver side, received signal is first gone through demodulation process for

extracting stethoscope signal. Patient end consists of i) electronics stethoscope with appropriate filters

ii) modulation using PLL iii) sender‘s mobile phone and doctors end consists of i) receiver‘s mobile

phone ii) demodulation using PLL iii) headphone for hearing sound.

Results: Initially we have tested the modulation and demodulation process over mobile phone call for

different input frequency range and found the result quite impressive. The figure-2 shows CH-1

(yellow) represents the shape of the output signal and CH-

2 (blue) represents shape of the input signal. Though

output signal is somewhat noisy, it is actually high

frequency carrier signal and would be further canceled by

using second order high pass filter.

Conclusion: As we found a satisfactory result from the

test, we, therefore, are expecting that overall system will

work successfully and will be able to transfer stethoscope

sound using mobile phone call and it would also be a low

cost solution for live auscultation in telemedicine.

Acknowledgement: International Science Program of

Uppsala University, Sweden for part support. References:

[1] http://www.thinklabs.com/#!telemedicine/c1q1a

[2] Ara, Ismat ―Development of an electronic stethoscope with optimized frequency response for different body

sound.‖ A Thesis submitted to Department of Biomedical Physics & Technology University of Dhaka. 2014.

[3] http://en.wikipedia.org/wiki/Wideband_audio



http://www.thinklabs.com/#!telemedicine/c1q1a

http://en.wikipedia.org/wiki/Wideband_audio


87

LCD-10: Investigation of X-ray Image Quality for Telemedicine

Susmita Afruz, M Abdul Kadir and K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka, Dhaka 1000 Bangladesh

Introduction: Because of being overpopulated and underprivileged, most of the people of third world

countries, especially the rural people are deprived of modern medical facilities. Telemedicine may be

an easier and cheaper way to disseminate healthcare facilities to the rural areas. Department of

Biomedical Physics and Technology, University of Dhaka has been working for the development of a

telemedicine system with integrated diagnostic equipment, mostly designed and fabricated locally. X-

ray imaging is widely used in disease diagnosis and for telemedicine; this image quality should be

excellent, as it is required to transfer the image to a distance through any medium. The present work

was taken to evaluate quality of such images.

Methods: X-rays attenuates exponentially with thickness while passing through a material. A wedge

shaped piece of aluminium was used for this study whose X-ray image was taken on a film at a

conventional clinic. It was assumed that the exposure on the film after passing the aluminum piece

would be exponential. A digital image of this X-ray film was created by photographing the X-ray

film, placed over the illuminated X-ray view box. It uses a reasonably high resolution webcam to take

picture of an X-ray film image illuminated using a conventional X-ray view-box. The piece of

aluminium provided a gradual change in the level of darkness of the image. The digital image was

analyzed using MATLAB software to study the variation of the level of darkness of the image with

the thickness of the piece of aluminium. Besides, the resolution of the image was also studied.

Results: The results of the analyses would provide a quantitative assessment of the quality of the

digital image captured using this device. This would be helpful in giving interpretations of the digital

image and also in improving the quality of the system in the future. Characteristics of the digital

image reasonably follow the characteristics of real X-ray film grayscale image. It also provides an

exponential relation between image pixel value and object thickness. This relation supports the

expected behavior based on basic principles. It can also provide information about granular object. In

this research work, X-ray image Quality was found good enough for diagnosis and for making any

medical decision.

Discussion: This research work explains the procedure as well as the result of X-ray image quality

investigation. X-ray image as well as the digitized image both can articulate sufficient information.

Theoretically, we accepted that pixel value is exponentially related to the distance and from the

experimental graph, we can also establish that. 14 vertically situated grooves indicated a continuous

thickness variation for which, we have found nearly a sinusoidal waveform that retain the particular

object information.

Figure: Pixel value Vs distance graph for horizontal thickness

difference.

Figure 1: Pixel value vs distance for vertical thickness difference.


88

LCD-11: Phaco-Emulsifcation Using Rotating Needles: A New Technique

Mohammad Abu Yousuf Talukder1 and Sirajum Monir

2

1 Medical College for Women & Hospital,

2 Department of Physics, Gofforgaon Govt. College

Introduction: Cataract is a leading cause of blindness which can be corrected by extracting

cataractous lens and by introducing PCIOL. Modern technique extraction of cataractous lens is phaco-

emulsification which is very expensive and can no longer be done if the patient attains the hyper –

matured stage of life cycle. To make the process safer, a new machine has been recommended. The

recommended new device is very simple in nature yet very effective in achieving the goal, and also

very cost effective for the vast number patients. The machine will work by rotating a special type of

needle (Yusuf‘s needle) which is made by incorporating 3-4 hypodermic needles. Material and method: The Machine has two parts namely BODY and the TUBE. The Body is again

divided into two parts. It houses the power sources and a small motor. The motor has a shaft enabling

the needle to rotate in circular motion at the speed of 700-1400 rpm. The base of the body there is a

contact switch to activate the circuit. The diameter of the tapered end of the tube is about 2 to 2.5mm,

so during the micro incision the tube bearing the needle will enter the anterior chamber of the eye ball

with only 2.5 to 3 mm incision. Three different tests have been carried out successfully which read as

under: with wood, with goats eye and with human crystalline lens in vitro. These tests were carried

out with a view to evaluating the performance of the referred machine in different medium.

Result: The first test is fitted for the penetration capacity which is seen satisfactory. The second test is

done to evaluate the efficiency of the machine which is again found to be very inspiring with no major

complication detected. While the last one is carried out with human crystalline lens in vitro in which

it is seen that in immature cases lens become jelly like substance very quickly , on the other hand in

matured and hyper matured cases lens become jelly like substance slowly and very slowly

respectively. So, that is to say that the lenses have been emulsified optimally as expected.

Discussion/Conclusion: The result thus obtained satisfies the ophthalmological standard, and by

following this new machine, a large number of people who are left with no treatment for want of

money in the poor countries like Bangladesh, can be brought under treatment in a very cost effective

way. It is to propose here that we may effectively start using the new device in rural areas with the

effective training process imparted to qualified ophthalmologists.


89

LCD-12: Low cost Dynamic Pedograph and customized shoe for diabetic

patients

MO Rahman and KS Rabbani

Department of Biomedical Physics and Technology, Dhaka University E-mail: [email protected], [email protected]

Introduction: Diabetic patients usually suffer from lack of nerve sensation, especi ally in the feet.

Therefore, their gait on standing and during walking may deviate from that of a normal person and points

of high pressure develop under the feet. However, due to neuropathy they do not feel any pain which

would have been felt had the nerve functions were alright. Later, ulcers form at these high pressure points;

gangrene and amputation of the leg follow suit. Therefore, a simple device to assess and measure the

pressure distribution under the feet would be very helpful in early detection of high pressure points.

Special insoles can then be prepared to spread the pressure away from the hot spots, thus saving the patient

from the eventual traumatic amputation, crippling the person for the entire life. Again, pressure points and

pattern may differ while standing and during walking, usually it is the latter which put the soles on greater

burden, and a dynamic pressure measurement during walking has more importance from a clinical point of

view.

Methods & Results: A low cost Dynamic Pedograph, including hardware and computer software, suitable

for the Third World was developed [2,3]. Giving due consideration of various factors, a Pedograph based

on an optical sensor was the choice of our group. The idea was borrowed from an earlier work in Sheffield,

UK [4]. Figure below on left shows an installed unit and printouts of foot pressure distribution.

After clinical evaluation of the patients an attempt was also made to provide them insoles

for customized shoes such that the pressure at the high pressure points are distributed over

a larger area, thus decreasing the localized pressure points. Initially a manual system was

developed which is cost effective and is suitable for countries like Bangladesh where cost

of labour is low. In this method firstly a grayscale printout of the foot pressure distribution,

as shown in Figure on right is placed over a 3 to 4 mm thick rubber sheet, which will be

used to make insoles of shoes. At the high pressure points, easily recognizable through the

density of the print, dents are made using a spherical grinding bit attached to a drilling machine. This

produces a final customized insole (furthest right photo) that can be used to make a customized shoe for

the individual patient.

Conclusion: In future, the insole may be prepared automatically using a CNC machine getting data

directly from the computerized Pedograph unit. A 3D printer may also be used to print out a customized

insole. Thus a low cost solution for foot problems of diabetic patients may be obtained through the

developed technology.

Acknowledgement:

Diabetic Hospital of Baqai Medical University, Karachi, Pakistan and Bangladesh Institute for Biomedical

Engineering & Appropriate Technology for funding for the first prototype of the Pedograph. References: 1. Tekscan, Inc. website (2010). [Online]. Available: http://www.tekscan.com/medical/system- matscan1.html

2. KS Rabbani, SMZ Ishraque, MS Islam, RM Rabbani, Improvisation of an optical pressure sensor based dynamic foot

pressure measurement system, Bangladesh Journal of Medical Physics, Vol. 4, No.1, 2011, p.51-58

3. WHO Compendium of Medical Devices for Low Resource Countries, 2011

4. C. I. Franks, R. P. Bens, and T. Duckworth, “Microprocessor based image processing system for dynamic foot pressure studies”, Med. and Biol. Engg. And Comput. Vol. 21, pp. 566 - 572, 1983.




90

LCD-13: A Study of Nuclear Detector Materials Using Thermal

Evaporation Method

K M A Hussain1, Z. H. Mahmood

2, S. M. Ishtiaque

3, T. Begum

4, J. Begum

1, F. A. Chowdhury

1,

T. Faruqe1 & S Ahmed

1

1Experimental Physics Division, Atomic Energy Centre, Dhaka

2Department of Electrical and Electronic Engineering, University of Dhaka,

3Department of Physics, University of Dhaka,

4Atomic Energy Centre, Dhaka.


Introduction: Patient dose optimization is a great challenge in the present medical field. Digital

sensors have shown importance in this challenge. CdTe have favorable physical characteristics for

medical applications which have been investigated in the 1980s.The material is considered to be one

of the most effective materials for the fabrication of X-ray and γ-ray detectors operating at room

temperature due to specific properties of high average atomic number, good charge-transport

properties, high resistivity, and relatively large band gap energy. However, new CdTe detector

designs are promising greater potential for the application of CdTe detectors to X-ray and γ-ray

applications. The present investigation is preparation and characterization of CdTe thin film

semiconductor with new deposition parameters.

Methods: The CdTe thin film was prepared by thermal evaporation method. A vacuum unit

(Edwards, E306A, UK) was used to prepare the films. The thickness of the CdTe thin film was

measured by a quartz crystal monitor Edward model FTM 5. The transmittance (T %) of the CdTe

films with wavelength of light incident on them were recorded using a dual-beam UV-VIS-NIR

recording spectrophotometer (Shimadzu, UV-3100, Japan) in the photon wavelength range from 300-

2500 nm. The absorption co-efficient and optical band gaps were found from the transmittance data.

Results and Observations: The figure-1 showed that the transmittance was varied with photon

wavelength of 400nm to 2500nm. It is observed that high transmittance (90.54%) in the visible region

is obtained for all films. The films of thickness 500 nm shows good interference pattern which

indicates better homogeneity and good quality of CdTe thin films. The X-ray diffraction analysis in

figure-2 shows that the (111) diffraction plane is localized at approximately 23.7º and the two weak

peaks are at approximately 39.3º and 46.6º match with the (220) and (311) diffraction plane of cubic

phase CdTe films which is in good agreement with the reported literature.

Figure 1: Optical transmittance and XRD spectra of CdTe thin films.

Conclusions: The CdTe thin film detector material is successfully deposited using thermal

evaporation method. The insitu technique shows digital thickness. The structural and optical

properties of vacuum evaporated CdTe thin films with varying film thickness (500-700 nm) were

investigated. The high transmittance showed all the films have high absorption coefficient above the

fundamental absorption edge. Each film shows a preferred orientation along (111) plane of cubic

phase, in addition two other prominent planes (220) & (311). The crystalline quality is observed at

optimum substrate temperature.

0

20

40

60

80

100

0 1000 2000 3000

Wave length (nm)

Tran

smitt

ance

(%)

500 nm600 nm700 nm



91

LCD-14: A PC based Data Acquisition System for Bio-medical

Instrumentation

A Al Amin, A Imtiaz Khan, AKM Bodiuzzaman, K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka, Dhaka, Bangladesh E-mail: [email protected], [email protected], [email protected], [email protected]

Introduction: Computer controlled data acquisition system is an essential part of biomedical

instrumentation. Most of the commercially available PC based Data Acquisition systems are of very

high cost, requires specific commercial software for data storage and analysis. Moreover if the data is

not stored in raw binary or known format, it is not possible for the user to use the data in other

software of their own choice. Therefore, a low cost, simple and open source PC based data acquisition

system for biomedical application would be very useful for instrument developers in the low resource

countries.

Methods: A low cost 8-bit Atmel AVR ATmega8 [Atmel

Corporation] microcontroller with integrated analog to digital

converter (ADC), four operational amplifiers, a MOSFET, a hand

wound high frequency toroidal transformer, an optocoupler, and a

few passive components are used for the hardware part. For

subject‘s safety and noise reduction an analog optical signal

isolator was designed and implemented [Rabbani et all, 2011].

The analog bioelectric signal from the human body is first

conditioned and fed to the non-isolated PC side through the

analogue isolation circuitry (Fig.1). Then the signal is

conditioned to meet the ADC input requirement and converted to digital values using the onboard 10-

bit ADC of the microcontroller. The digital data is then transferred to the PC through USB 1.1 low

speed HID Class interface [USBIF], implemented in the same microcontroller using firmware only

USB library V-USB [Objective Development Gmbh]. For powering the isolated circuitry in the

patient side, a medical grade isolated dc to dc converter is constructed which uses the non-isolated +5

volt supply available from the USB port of the PC. Therefore no external battery or power supply is

needed. The device was operated in two modes, Continuous conversion mode and Batch mode. The

former was for low frequencies up to a few hundred Hz, while the latter could work up to a few tens

of kHz. The software is a graphical user interface which allows viewing the bioelectrical signal in

selectable different time scale and can store data in raw binary format. It is developed using ‗JAVA‘

platform considering its operating system (OS) independent feature.

Results & Observation: A sinusoidal wave of 80 Hz is fed from a

signal generator to the data acquisition system and resulting PC

side software is shown in Figure-2. It is observed that the system

reproduces the signal very nicely in PC. Aliasing effect is seen

after 150 Hz and at 12 KHz and the system shows no significant

phase or amplitude change up to 100 Hz and 10 KHz for

continuous conversion and Batch mode respectively. The system is

used in ECG, EMG, NCV and FIM [Rabbani et al 1999] with

excellent satisfactory results.

Discussion: Most of the bioelectrical signals occur within the band

width of 0 to 10 KHz; therefore this system satisfies the biomedical instrumentation requirements.

The mode of operation is selected form PC, also sampling and data transfer is done simultaneously

and well synchronized, and thus form sampling to display has latency of approximately 10 ms, which

can be regarded as real time. This total system is open source and can be used conveniently in

research or development phase of biomedical instruments without need of extra isolated power source

and signal isolation circuitry.


Figure 1: Block Diagram of Data Acquisition System

Figure 2: GUI software of Data

Acquisition System






92

LCD-15: Development of user friendly software in Bangla for a PC based

rural health monitor with option for telemedicine

Ahamad Imtiaz Khan, Abdullah Al-Amin, Zihad Tarafdar, AKM Bodiuzzaman,

Ahmed Raihan Abir, M Obaidur Rahman, K Siddique-e Rabbani

Department of Biomedical Physics and Technology, University of Dhaka, Dhaka, Bangladesh. E-mail: [email protected], [email protected]

Introduction: Providing quality health service in rural areas is one of the major challenges for

developing countries like Bangladesh. Even if infrastructures are provided, retaining qualified medical

doctors in a village is almost impossible in the near future. The solution to this problem can be

Telemedicine, or ‗medicine at a distance‘. A doctor in a city anywhere in the world can advise a

patient at any remote village, if required communication channel is available. Bangladesh has a good

internet and mobile phone infrastructure spread almost all over the country which can be used to

advantage. Our department has already developed some basic diagnostic equipment the outputs of

which are all digitised and interfaced to a PC with the aim of integrating these facilities with the

telemedicine system. The present work takes care of the software aspect of the integrated telemedicine

system, and that in user friendly way, with some graphical user interface in Bangla, our local

language.

Methods: The diagnostic devices developed in our department to go with the telemedicine system

are: ECG, Respiration Monitor, X-ray viewer, Microscope, Colposcope and General purpose image

digitiser (a high quality webcam on a stand). To get information on temperature, blood pressure,

weight, height, etc., standard equipment are available at reasonably low cost and a rural technician can

type in the resulting values into the computer system.

In order to develop user friendly software for the whole system, firstly we developed necessary

software to acquire the data into a PC at the rural centre from the above mentioned equipment. For the

ECG equipment, which was developed in our laboratory from basics, we developed appropriate

software using Java programming language for data acquisition of all 12 lead signals in sequence,

display, signal processing and storage and for sending almost live data over internet. Outputs of

digital X-ray viewer, microscope and colposcope are images which were acquired using software for

the webcam used inside these devices. For transferring images we used our web application which we

developed for telemedicine.

We have developed a web based application for our telemedicine solution. The purpose of this

application is to maintain the whole system properly. It‘s like a hub of our telemedicine system.

Patient registration, request forwarding, prescription making with minimal mouse clicks, report

submission etc. can be done using this web based application. We used PHP and MySQL for

developing this application. The goal of our task was to make it user friendly and appropriate for

using in our rural areas. Graphical User Interface of both ECG software and web based application

was developed in both English and Bangla languages. Bangla will make it easier for the rural

operators to use it comfortably.

Results: The developed software appears to work well, as field tests were carried out in several

remote villages in Faridpur.

Discussion/Conclusion: The user friendly software, whether in English or Bangla, will enhance the

quality of diagnosis and the resulting treatment through telemedicine immensely.





93

LCD-16: Solar Water Pasteurizer and Rain Water Collector for provision

of safe drinking water in urban slums and rural areas

M Abu Yousuf 1, Rezwan bin Hussain


1

1Department of Biomedical Physics & Technology, University of Dhaka, Dhaka, Bangladesh

2University of Liberal Arts, Dhaka, Bangladesh


Introduction: Providing safe drinking water to rural people throughout the resource poor countries is still

a challenge. Our extended group at Dhaka University innovated a very low cost solar water Pasteuriser in

the eighties that can be made by people themselves using locally available materials like hay, bamboo tray,

transparent polythene bags and sheets. It uses well known ‗Green House Effect‘ to heat water to more than

600C which is needed to destroy all diarrhoeal germs as in Pasteurisation. In this design the UV ray in

sunshine also falls on the water and diarrhoeal germs were destroyed even at 45 to 500C. Hazardous

arsenic contamination is found in water form tube wells, but surface

water is free of arsenic. Therefore destroying diarrhoeal pathogens in

surface water using this Pasteuriser solves both the problems providing

safe drinking water. Besides, being domestic models, individual families

can maintain the device resulting in a sustained solution. Recently we

developed models more suited to the demands and taste of the urban

poor. Besides, it was designed to collect rainwater as well to make it

useful all the year round.

Methods: One model, a ground laid solar water Pasteuriser only, used

thick polystyrene foam blocks to make up a thermally insulated tray,

24‖x32‖ in area, as shown in the top figure. Its base is covered by a black

plastic sheet. A transparent polythene or polypropylene bag of size

24‖x36‖ is filled with about 10 litres of water and spread over the whole

of the inside base, to make a water depth of about 2 cm. The open side of

the bag rises over one of the edges. A rectangular frame made of

aluminium or uPVC pipes was covered on both sides by stretching

transparent PVC films. This frame was allowed to rest on the edges of the

plastic tray, thus providing two covered air gaps, each 2cm thick, on top

of the water bag for thermal insulation. This configured a low cost solar

flat plate water heater that employed ‗Green House Effect‘ as in the

previous design, but with improved insulation. It also allowed sun‘s UV

ray to reach the water layer.

A second table model was made which could perform both as a solar

water Pasteuriser and a clean rainwater collector, the collected water

being drinkable directly. For this the table top of a commercially

available folding table is used as a base, where the table top was chosen to have a black plastic finish.

Polystyrene foam was used to insulate the underside and the four sides of the table top, again to make a

tray. A small length of an aluminium tube was fixed at one of the sides to work as a drain pipe. When the

iron tube frame underneath is extended to mount it horizontally, as shown in the middle figure, it makes a

solar Pasteuriser in conjunction with a bag of water and rectangular frame covered by two transparent PVC

sheets as in the previous design. We provided a catch on the iron frame below to mount the table in a

slanting position as well, as shown in the bottom figure. With the bag and the top frame removed, this acts

as a rainwater collector. The cost was about US $20.

Results: The device could heat about 10 litres of water to about 900C under summer sun in Dhaka in about

two and a half hours. Only about an hour was needed to reach 600C. It would take slightly longer in winter.

Therefore, two or three harvests are possible making more than enough for a family. Amount of rainwater

that can be collected is about 4 litres for 10 mm rainfall.

Conclusion: This device can provide safe drinking water for urban slums as well as in rural areas. The

transparent bags would need occasional change but the main structure is expected to last for years. As

mentioned before, a family that owns it will maintain it providing a sustained solution.





94

LCD-17: Low Cost Technology for Inactivation of Diarrhoeal Pathogens in

Drinking Water Using Metals

*Sharmin Zaman1, Anowara Begum

1, Md. Latiful Bari


2

1Centre for Advanced Research in Sciences, Department of Microbiology,

University of Dhaka, Bangladesh, 2Department of Biomedical Physics and Technology, University of Dhaka, Dhaka, Bangladesh

Introduction: Technology for safe drinking water for rural areas of the low resource countries is still

a big challenge for the humankind. The present study was designed to develop a simple technology,

employing the bactericidal effect of metals that can be implemented by rural households. The research

was initiated by reports that brass door knobs in hospitals contained less germs than on single metal

knobs, which was supplemented by the knowledge of the ancient practice in rural Bangladesh of

leaving water in a brass or bronze pitcher overnight.

Methods: Three thick metallic sheets made of Copper, Zinc and Brass (alloy of copper and Zinc)

respectively were placed in three plastic (polythene) containers with base areas 11cm x 7cm each so

that the metallic sheets covered the entire base areas of the respective containers. Four hundred (400)

ml of contaminated water from a public pond was added to each container, covered with lids and left

undisturbed at room temperature. The microbial analysis of Total Viable Bacteria (TVB), Total

Coliform Bacteria (TCC) and E. coli was done taking small samples initially and then every 24 hours

up to six days of storage at room temperature. E. coli is considered as the indicator for diarrhoeal

pathogens. Therefore, if E.Coli is completely inactivated, the water is said to be safe for drinking.

Other remaining bacteria are usually harmless.

Results and Observations: In a typical experiment, the initial bacterial counts were, TVB: 1.67 x

103, TCC: 1.4 x 10

3 and E.Coli: 1.38 x 10

3. TVB count did not reduce significantly for any of the

metals used in this study during the 144 hours of study. Total coliform counts decreased to almost half

the original in the first 24 hours for all the three metals, but remained almost the same afterwards.

However, E.Coli was completely inactivated on treatment with copper for 24h, and remained so

afterwards. On the other hand, Brass and Zinc reduced E. coli population by almost half in the first 24

hours, but this remained almost constant throughout the rest of the measured period.

Discussion: The above results suggest that a simple copper sheet could be useful in inactivating

diarrhoeal pathogens, producing safe drinking water in 24 hours. Therefore, this could give rise to a

simple technology to obtain safe drinking water in the rural areas of the low resource countries.

However, it needs to be ascertained whether the amount of copper present in water is within the safe

limit, since regular use in larger amounts may lead to copper poisoning. A future study will try to

optimize the relationship of the volume of water to the exposed surface area of the copper sheet and

the time of treatment so that the diarrhoeal pathogens are inactivated to a safe level while keeping the

copper level within the safe limit too.


95

LCD-18: A Low Cost Mechanical Prosthetic Hand

Ehsan Alam Chowdhury, K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka. E-mail: [email protected], [email protected]

Introduction: Leg prostheses are available in Bangladesh from several sources but hand prostheses

are not. Those that are available are simply cosmetic, without any functional capability. The

department of Biomedical Physics & Technology of the University of Dhaka had developed a semi-

functional prosthetic hand for wrist amputees earlier as shown in the four photographs in the top row

of pictures. The hand of a mannequin was used for this purpose. The thumb was cut out and refitted

using a spring hinged mount. Normally the thumb kept closed but the user, who had an intact opposite

hand, could slip in a pen or other things to hold between the thumb and the forefinger. The subject

could write using this hand which is also shown in the picture. She could also type holding a pen with

the other end in front and could solder electronic circuits. This was a very successful design providing

both cosmetic purpose and some functionality. A similar hand was fitted to a rickshawpuller which is

shown in the bottom row of pictures. This comes out to be very cheap, about $US 30, which is

affordable to many in low resource countries like Bangladesh.

In the present work we intend to make the prosthesis body powered so that the user can open or close

the thumb through movement of the hands or the shoulder as shown in the right hand side photograph

in the bottom row. This picture is taken from the internet and such devices are available in the

advanced countries. However, these are not available in Bangladesh. Besides such body powered

prosthetic hands need individual customized fixing. in The

Methods: In the present work we tried to

develop the harness of the prosthetic hand using

belts and pads made of leather and woven

materials. The user would extend the shoulder

to open the thumb and when released will

automatically grip an object through the spring

mounted thumb as before. For transfer of power

to the hand we used brake cables of bicycles.

Results: When we tried to fix this prosthetic to

the girl who was given the prosthetic hand

earlier, we found that the extension provided by

her shoulder was not enough to pull the thumb open as she had a slim body. On the other hand

persons with a broad shoulder such as a grown up man could easily extend the thumb. Again the

harness needed is not liked by girls very much.

Discussion: The body powered prosthetic hand is a practical option mostly for grown up males. An

electrically driven prosthetic hand would be more suitable for girls and children.




96

LCD-19: A Low Cost Prosthetic Bionic Hand

Md. Nazimul Kadir, Md. Kamrul Hussain, Zubair Barkat, K Siddique-e Rabbani

Department of Biomedical Physics & Technology, University of Dhaka.


Introduction: The study reported here explored the design of the prosthetic bionic hand to be made

by department of Biomedical Physics and technology, University of Dhaka. Prosthetic Bionic hand

will be installed and used in least developed countries (LDCs),the purpose is to realize a functional

and user friendly system, suitable for diverse group of users, with a cost of less than 80€. The

proposed project aims to make available to the populations of developing countries at affordable cost.

Methods: The developed prosthesis is composed of a light plastic and aluminum structure with

opposing fingers. We have obtained the movement of the prosthesis with a geared stepper motor. The

control system we have created is based on microcontroller based simple electronic circuit that

doesn‘t use advanced technological solutions but cheaper and easier to find circuit components; in this

way we have tried to achieve the best compromise between performance, convenience and durability.

Results and Observations: The mechanical part of the prosthesis is composed by light aluminum

structures and powered by a geared stepper motor. Prosthesis total weight is 250 grams. The stepper

DC motor block includes steeper motor; its nominal supply voltage is 12V and absorbs a maximum

current of 800 mA.

Discussions: The future work includes specific speed testing for various application, multiple finger

control as well as inclusion of force sensor for identify object and improved gripping.


9 Inch



CLINICAL NEUROPHYSIOLOGY PAPERS


98

Invited Talk

ICN-1: Technical Aspect of Neuroradiology and their Clinical Evaluation

in Children Presenting with Seizures and Neurodevelopmental

Comorbidities

Rakshan Gocmen

Professor Neuroradiology, Hekatteppi University Hospital, Ankara, Turkey

Magnetic resonance imaging (MRI) is the main structural imaging in epilepsy. Using a dedicated

MRI-protocol for epilepsy, it is possible to detect and characterize an epileptogenic focus in the

majority of patients with focal seizures. Its detection is crucial for subsequent diagnostic and

therapeutic planning and, in the event of a negative MR, one must always consider the possibility of

increasing image quality. Resection of these lesions can lead to seizure freedom in many patients.

Using together structural MRI techniques and functional MRI modalities such as diffusion tensor

imaging, BOLD imaging, magnetic resonance spectroscopy and magnetic resonance perfusion are

key technology in the presurgical evaluation of patients with focal epilepsy. Task-related functional

MRI techniques can be used to estimate language networks and lateralization and memory networks,

and may therefore inform the presurgical planning process. Similarly, diffusion tensor imaging is

becoming widely used in research settings to image white matter pathways and provide an alternative

structural view of connections between brain regions.

CN-1: Recognizing Normal Electrophysiological Criteria and Deviation to

Dysfunction in Neonatal EEGs.

Naheed Nabi1, Biplob Banerjee, Selina H. Banu

1Dept of Clinical Neurophysiology, Comfort Diagnostic Center, Green Road Dhaka

Background: Electrical activities of neonatal brain remain in a rapid progression that needs a careful

evaluation. Only an experienced neurophysiologist can differentiate a cerebral dysfunction during

this maturation process. Neonatal seizures might be idiopathic or with severe structural,

neurometabolic or transient metabolic disorder. Routine or continuous EEG monitoring can confirm

the diagnosis, predict the underlying cause and helps the clinician for further management planning.

This study describe the variable EEG features in neonates presented with neonatal seizures.

Method: We have complied retrospectively 195 neonatal recordings from EEG lab of Comfort

Hospital and Central Hospital from June‘13 to December‘14. The clinical presentation, birth related

information and EEG findings were correlated.

Result: Among total 195 neonates there was male preponderance (65.12%). The majority had h/o full

term (88.2%) hospital delivery, about 60% delivered by caesarean section. Home delivery was

reported in 17.4 %. The common reasons for EEG advise was definite seizures (26.7%), jerky

movement (24.6%) and inconsolable crying (18.5%). The EEG findings were categorized as

epileptogenic discharges in (35.1%) , non-epileptic dysfunction or inappropriate activities for the age

in ( 5% ) and no abnormality in ( 53.3% ).

Conclusion: Neonatal EEG should be read carefully and maturational changes should not be confused

with epileptiform patterns. It is a very simple and useful tool for the early capture of electrical

dysfunction of growing brain.


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CN-2: Co-Relation of Neurodevelopmental Status, Seizures,

Electroencephalography and Neuroimaging Findings of Children having

Neurological Problem

A.Z.M. Mosiul Azam, Mustafa Mahbub

Department of Paediatric Neurosciences, Dhaka Shishu Hospital.

Introduction: Electroencephalography (EEG) test has been advised for the children who are seeking

medical advice for seizure. EEG is important for classification of seizure (sz) typed also for selecting

appropriate anti-epileptic drugs. To observe the co-relation between neurodevelopmental status,

EEG Features and Neuroimaging finding in the children with epilepsy Method: A retrospective analysis of 200 children, attended in the year 2012 at department of

Paediatric Neurosciences, Dhaka Shishu Hospital. Neurodevelopmental status, seizure types, EEG

and neuroimaging (CT scan of brain or MRI of brain) findings along with age, sex and other socio-

demographic state were recorded and statistical analysis was done.

Result: EEG test was normal in 50% children and 50% showed different changes e.g. epileptiform

discharges and background abnormalities. Those who were having normal EEG, 24% had history of

perinatal asphyxia, 60% had seizures, 32% had motor dysfunction, 40% had speech problem, 40%

had cognitive deficit and a minor percentage had hearing and visual problem. Fifty percent showed

abnormality in Neuroimaging.

In abnormal EEG group, 35% had history of perinatal asphyxia, 70% had seizures, 61% had motor

dysfunction, 52% had speech problem, 52% had cognitive deficit and 75% showed abnormality in

Neuroimaging.

Conclusion: For clinician to evaluate the neuro-developmental impairments and disabilities. EEG as

well as neuroimaging study have a significant role.

CN-3: Variation of Electroencephalographic (EEG) Pattern in Children

Diagnosed with West Syndrome Md. Shahjahan chowdhury

Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University

Dhaka, Bangladesh

Introduction: West syndrome (WS) is characterized by multiple seizures including central tonic,

myoclonic seizure and infantile spasms; global developmental delay or regression, and characteristic

EEG (electroencephalography) features. Early diagnosis and successful seizure control may halt

further developmental delay and regression. Seizure control and prognosis are best guided by EEG.

Hypsarrhythmic (HA) pattern is the most common feature in EEG. Elimination of hypsarrhythmic

pattern is a principal goal of therapy and a key outcome measure in clinical trials. After the initial

description of Gibbs and Gibbs, several variations of hypsarrhythmia have been described. To

describe the clinical profile and EEG patterns in children with clinical spasm.

Method: This is a retrospective type of study. Total 98 children having clinical spasm were included

in the study, attending Paediatric Neurology Unit, BSMMU during January 2013 to November 2014.

The EEG test findings were collected and correlated with clinical profile. Twenty one cases were

excluded from the study due to normal EEG.

Result: Out of 77 patients of HA, EEG showed episodes of voltage attenuation in 27(35.06%),

classical hypsarrythmia in 14(18.18%), hypsarrhythmia with suppression-burst pattern in

13(16.88 %), hypsarrhythmia with increased interhemispheric synchronization in 8(10.39%),

multifocal epileptic discharges in 7 (9.1%), hypsarrhythmia with a constant focus of abnormal

discharge in 5(6.5%), hypsarrhythmia with high voltage slow wave with little spike or sharp activity

in 3(3.9). Statistical analysis revealed that patients with perinatal asphyxia were more likely to have a

‗hypsarrythmia with voltage attenuation‘ pattern.


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Conclusion: These results indicate that interictal EEG of WS showed various patterns other than

classic hypsarrythmia. Moreover, some EEG patterns are related to specific underlying neurological

disorder.

CN-4: Role of EEG in Children with Febrile Seizures

Sahifa Nazia1, Selina H Banu

1, Monimul Haque

1Institute of Child Health & Shishu Shastho Foundation, Mirpur, Dhaka

Introduction: Febrile seizure is very common in our population for multiple reasons. There is a state

of confusion regarding the use of investigation tools particularly of Electroencephalography (EEG).

There is no national guideline about when to advise for EEG in such cases. This study describe the

EEG findings in children presented with complex febrile seizures. Identification of clinical factors,

which would help to develop a guide line for the clinicians.

Methods: A cross sectional study including children attending the inpatient and outpatient

department of the SSF hospital during November 2012 to April 2013. Children of age between 3

month to 5 years, with feature of complex febrile seizures (focal or secondarily generalized szs,

duration longer than 15 minute, multiple szs in 24 hours or more than one attack in one febrile

episode, transient neuro- deficit after the attack) were included. Children with simple febrile seizure,

suspected or diagnosed CNS infection, or preexisting major neurodeficits were excluded from the

study. All clinical and EEG findings were categorized and analised using the SPSS. Total number-

frequency and age at first seizure, family history of seizure or epilepsy, any history of hypoxic

ischemic encephalopathy were categorized and correlated with the EEG findings.

Result: About two third of the population were from middle and upper income families, 13% had

consanguineous parents and the majority were male child. Most of them were born at hospital

without any untoward history during peri-, and postnatal period. Mean age at 1st febrile seizure was

9.7 months, 77% had generalized tonic clonic seizure, 73% had two or more attacks in 24 hours.

About 47% had abnormality on their routine EEG test, of which 78.6% revealed definite epileptiform

discharges. The electro-clinical correlation was significant.

Conclusion: Our study supports the utility of performing EEG for the children presenting with

complex febrile seizures. Based on which further investigation, medical treatment and close

monitoring should be advised. However, further study with larger population is indicated.


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CN-5: Clinical Spectrum, Electrophysiologic Profile and Medical

Treatment of Children with Nonconvulsive Status Epilepticus

Kanij Fatema1, Md Mizanur Rahman

1Dept of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University

Introduction: Nonconvulsive status epilepticus(NCSE) is a term used to denote a range of conditions

in which electrographic seizure activity is prolonged and results in nonconvulsive clinical symptoms.

This study was done to describe the clinical spectrum, electroencephalographic (EEG) findings and

evaluate the efficacy of different therapeutic agents in children with NCSE.

Method: Clinical data of 33 patients with NCSE who attended the OPD and IPD of a tertiary care

centre were analyzed. All these patients had EEG before and after treatment. Treatment was given

between the period 2011 to 2014.

Result: Age range was 6 months to 14 year (mean 5.18 year), 25 were male and 8 were female. Thirty

two patients had prior seizure. Regarding development status, 48% had developmental delay, 22%

had normal development, 9% had regression and 21% had both developmental delay and regression.

The cases were previously diagnosed as epilepsy (29), cerebral palsy (9), developmental delay (5) and

behavioral disorder. EEG diagnosis was as follows: Electrical status epilepticus in slow wave sleep

(ESES) 16 (48.5%), Generalized NCSE 13(39%), Focal NCSE 3 (9%) and Lennox Gastout syndrome

1 patient.

Patients were treated with parenteral or oral drugs. Eighteen patients were treated with Midazolam

drip out of which 1 patient had complete remission in EEG, 6 had 80% remission, 5 had 50%

remission and 5 patients had minimal or no response. In one patient, drug was withdrawn due to side

effects. Thirteen patients was treated with methyl prednisolone bolus out of which 2 patients had

complete remission, 4 patients had 80% remission while 4 patients had 50% remission and 3 patients

showed no response. Other drugs used were sodium valproate, topiramate, phosphenytoin,

levetiracetum and clonazepam.

Conclusion: Pediatric NCSE is an entity with heterogeneous presentation. This study provides

clinical criteria which may guide for early EEG which is essential for diagnosis of NCSE. This study

also highlights the treatment protocol of NCSE which revealed that intravenous drugs were more

effective than oral antiepileptic drugs in remission.


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CN-6: Portable EEG Service and Epilepsy Camps to Reach the Unreached

Abu Saleh Musa1, Selina Husna Banu, Shipra Rani, Naila Z. Khan

1 Dept of Paediatrics, Gonoshashtho Medical College Hospital, Savar, Dhaka

Introduction: EEG is needed for diagnosis and prognostic evaluation of seizures,

neurodevelopmental disorders and encephalopathies; however, the service is only available in the

major cities while majority remain unreached. An outreach portable EEG service was introduced in

2008. Later prolonged EEG (pEEG) and emergency EEG (emEEG) for selected and critically ill

patients was added to the service. This study report the service outcomes and explore the usefulness of

the tool in reducing the epilepsy treatment gap.

Methods: We organized monthly epilepsy camp with a team of primary care physician, epileptologist,

technician, developmental therapist and a portable EEG machine at the community. Electro-clinical

correlation, management and cost-effectiveness was reviewed.

Results: Mean age of total 244 patients was 8.94 years, two third of the recordings were performed in

rural populations and in Child Development Centers within public hospitals across Bangladesh; the

rest were in-patients in wards or Intensive Care Units (ICUs) in hospitals within Dhaka city.

Clinical problems categorized as 1. Seizure disorder (SD) 37%, 2. Speech-communication- behavioral

disorders with suspected seizures (SCBD)(21%), 3. Non-seizure neurological disorders (NSD) (42%).

The EEGs revealed epileptiform discharges in 48%, features of encephalopathy in 31%, normal

activities in 21%. Epilepsy diagnosis was confirmed in 74%, 43% and 47% of SD, SCBD and NSD

group respectively. Outcome prediction was statistically significant among the ICU population.

Conclusion: Portable EEG is a cost-effective and useful tool for communities within low resource

settings to reduce the treatment gap. The tool has multiple uses at within hospital settings as well.

CN-7: Reporting the Multiple EEG Findings and Clinical Outcome in

Children with and Without Overt Seizure

Shanta Yesmeen1, Selina H Banu,

1Clinical Neurophysiology Lab, Central Hospital, Green Road, Dhaka

ABSTRACT

Introduction: Repeated routine EEG test is required in some situation for the diagnostic and

prognostic evaluation of seizure and related neurodevelopmental disorders, particularly in absence of

continuous monitoring facility. We have performed multiple EEGs on the same child after hospital

admission or as outpatient. Objective of this study was to review the electro-clinical outcome and

effect of multiple tests on the management plan.

Method: We studied clinical and EEG criteria of children having 3 and more records at the same

laboratory. Detail history of the seizure(s), related neurodevelopmental disorders and drug histories

were recorded during the EEG recording. Information collected during the first and last contacts were

categorized and compared. The prescribed drug list and other investigation findings if available were

also reviewed.

Result: Total 350 EEGs were performed in 74 children during January 2011 to November 2013, 30%

had more than five, 7% had >10 repeat tests. Main complaint were recorded as frequent seizure

attacks with comorbidity, seizures without comorbidity, and recent regression of functional quality

and behavioral change were recorded in 37%, 34% and 29% of the study population respectively. A

large population revealed no-significant electrographic change on the last EEGs, the possible reasons

will be discussed.

Conclusion: With increasing number of such cases in children, there should be special protocol at the

laboratory for those who would need frequent EEGs . The management should focus on finding and

address the underlying cause of uncontrolled seizures particularly in otherwise normal children. In

some specific cases close monitoring should be suggested while there should be EEG test without any

AED.


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CN-8: Dynamic Topographic Visualization and Quantification of a

Multichannel Surface EMG Grid Array 1Khondaker Mamun,

2Elizabeth Nguyen,

2Winston De Armas,

2Tom Chau

1Dept. of Computer Science & Engineering, United International University, Bangladesh

2Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada

Introduction: Low back pain (LBP) is a prevalent health problem for many people and is one of the

significant causes of disability. Muscle or myoelectric activity is measured by the action potentials

produced by motor units. Surface electromyography (sEMG) is a non invasive procedure used to

evaluate and record these muscle activities. The aim of this study is to develop a novel technique for

clinicians to use sEMG based method for diagnosing and making treatment plan for LBP, where

accurate information about areas of muscle contraction may be obtained in a non-invasive manner.

Methods: In this study, we recorded sEMG signals from a surface electrode array placed in the

lumbar region of the lower back to monitor muscle activities related to static and dynamic conditions.

The sEMG signals produced from the lower back were contaminated with artifacts such as

electrocardiogram (ECG), movement artifacts and/or other noise sources which required effective

filtering. We developed an integrated method to isolate information content related to muscle activity

from noisy sEMG signals. We also developed an algorithm to generate a dynamic topographical map

from the filtered sEMG signals to allow visualization of the lumbar myoelectric activity in a form that

is useful for clinical interpretation and assessment.

Results: The sEMG topographic pattern obtained for static and dynamic conditions from 10

participants showed that the approach is able to provide clinically useful information (e.g. muscle

intensity and spatial distribution) about the lumbar muscle activities.

Conclusion: The methods developed from this study may help to provide clinicians with a novel

means of diagnosing and treating LBP, such that sEMG topography will offer accurate information

about muscle contraction patterns in the lower back. The distribution and patterns of the lumbar

muscle activities may help to identify early signs of LBP and can offer insight into trunk stability of

clients with disability, such that the design of upper body supports can be improved upon.


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ICN-2: Establishing Low-Cost High-Quality Technology-Based Health

Services For Countries With Limited Resources – Our Experience

Naila Zaman Khan, MBBS, FCPS, PhD (London)

Professor and Head

Department of Pediatric Neuroscience

Bangladesh Institute of Child Health, Dhaka Shishu Hospital E-mail: [email protected]

Within health services increasing numbers of children and their families are presenting with acute and

acute-on-chronic neurological, neurodevelopmental, pervasive neurodevelopmental and mental health

disorders whose diagnosis and management require the availability of neurophysiological,

neuroradiological, biochemical and genetic laboratory services. This presentation will map the development of quality neurophysiological services in Bangladesh

over the last two decades, which has not only led to its availability within public hospitals across the

country, but also to the transfer of technology to other low and middle income countries (LAMICs).

The importance of multidisciplinary services and partnerships (between North-South and South-South

countries) for quicker transfer of technology will be discussed.

ICN-3: Advancement of Human Machine Interface for Rehabilitation

Engineering

Dr. Khondaker Abdullah Al Mamun

Associate Professor, Dept. of Computer Science and Engineering

Director, AIMS Lab

United International University,Dhaka, Bangladesh.

Email: [email protected]

The advancement in biomedical signal processing and machine learning has led us exploring the

human brain and developing assistive Human Machine Interface (HMI) as well as Brain Machine

Interface (BMI) for rehabilitation engineering. It created the opportunity to discover new

mechanisms and develop new devices for clinical and physical intervention that improves quality of

life for people with severe disabilities. The idea of assistive HMI is detection of patterns of

physiological signals and then transforms it into commands to operate assistive devices, such as

computer, wheelchair, or artificial limbs. When the development of assistive HMI system specifically

considers the pattern of neurophysiological activities of the brain, i.e. neural signals, it is

further categorised as BMI. BMI system not only identifies the pattern of neural signals but also it can

able to feed signals into the deep brain for neural modulation (i.e., bidirectional communication for

enabling Brain Machine Brain Interface (BMBI)). In addition to that, it will help us to understand the

neural circuit mechanisms and open up the possibilities to develop intelligent therapeutic

interventions. This talk will focus on recent advancement of different alternative modalities and

methods of HMI and BMI technology and its ranges of real life applications.




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ICN-4: Moya Moya disease: clinical features, pre- and post operative MRI

findings.

Sania Ahsan

Consultant Diagnostic and Investigational Radiology, Apollo Hospital, Dhaka, Bangladesh

Moyamoya disease is a vasculo-occlusive disease involving the circle of Willis, especially the

terminal ICA. It can be primary; sometimes familiar and known as moyamoya disease. Numerous

entities have been described which mimic the Radiologic appearance, in which case the term

moyamoya phenomenon, syndrome or pattern is used.

Moyamoya is not uncommon in Bangladesh. Moyamoya is a disease of children and young people,

with a bi-modal age distribution. The condition was initially described in Japanese patients.

Presentation is age dependent. Children presents with ischemic strokes and adult with hemorrhages.

MRI is the modality of choice for initial diagnosis of Moyamoya. Direct angiography is used only in

equivalent cases. CT angiogram with perfusion studies are used to see cerebrovascular reserve.

Pial synangiosis for treatment of Moyamoya disease is offered in Apollo Hospitals Dhaka. So far the

result has been satisfactory.


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ICN-5: Neurofeedback Brain Training (NFBT) Technology

Md Osman Gony

Founder Chairman, Institute of NeuroDevelopment & Research (INDR)

NeuroFeedback (NF) Brain Training is a relatively new treatment option for various

NeuroDevelopmental Disorders like Autism, ADHD etc. where normal development in respect of

brain function is impaired which may results in poor social communication, inappropriate behavior,

attention deficiency etc. NeuroFeedback, a specific form of biofeedback, is based on the idea that

human beings can consciously alter their brain function through training sessions in which they

attempt to change the signal generated by their brain and measured via some neurological feedback

mechanism. By so doing, participants increase cerebral blood flow to a specified region of the brain,

consequently increasing brain activity and performance on tasks involving that region of the brain.

There are mostly two types of popular NF technology in practice now a day. One is EEG NF and

another is HEG (Hemoencephalography) NF. Currently we are using HEG NF at Bangladesh to treat

special child and train their brain to function more optimally.

Hemoencephalography (HEG) was developed by Dr. Hershel Toomim, Near Infrared

Hemoencephalography (nirHEG) measures changes in the local oxygenation level of the blood.

Similar to fMRI, which uses changes in the magnetic properties of blood resulting from oxygenation

to form an image of brain activity, NIR utilizes the changes in blood translucence resulting from

oxygenation to generate a signal that can be consciously manipulated in NF sessions. At the most

basic level, nirHEG shines alternating red (660 nm) and near infra-red (850 nm) light on a specified

area of the brain, usually through the forehead. While the skull is largely translucent to these

wavelengths of light, blood is not. The red light is used as a probe, while the infrared light provides a

relatively stable baseline for comparison. Photoelectric cells in a spectrophotometer device worn on

the forehead measure the amount of each wavelength of light reflected by cerebral blood flow in the

activated cortical tissue and send the data to a computer, which then calculates the ratio of red to

infrared light and translates it into a visual signal of corresponding to oxygenation level on a graphical

interface the patient can see. The key nutrient monitored by NIR is oxygen. In NIR, as the ratio of

oxygenated hemoglobin (HbO2) to deoxygenated hemoglobin (Hb) increases, the blood becomes less

and less translucent and scatters more of the red light, instead of absorbing it. In contrast, the amount

of infrared light scattered by the blood is largely impermeable to changes in the oxygenation level of

hemoglobin.

HEG as NeuroFeedback: Using this above principal, HEG can be used to indirectly measure neural

activity based on neurovascular coupling. Neurovascular coupling is the mechanism by which

cerebral blood flow is matched to metabolic activity. When a region of the cortex is used in a specific

cognitive task, neuronal activity in that region increases, consequently increasing local metabolic rate.

To keep up with the nutritional and waste removal demands of a higher metabolic rate, cerebral blood

flow to the cortical area in use must increase proportionally. Along with the increase in flow,

hemoglobin molecules in the blood, which are responsible for the transport and transference of

oxygen to tissue throughout the body, must increase the amount of oxygen they deliver to the

activated region of the cortex, resulting in a greater local blood oxygenation level. This is also

referred to as the haemodynamic response.


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CN-9: Fetal MRI – Experiences in Apollo Hospitals Dhaka

Sania Ahsan

Apollo Hospitals Dhaka

Introduction: USG has been the main modality for evaluating disorders of fetus and pregnancy;

however, fetal MRI has been used effectively to evaluate fetal abnormalities since mid 90s.

Some of the limitations of the USG are:

1. It is operator and interpreter dependant.

2. Small field of view and limitation of USG resolution through soft tissue and bone.

Thus sensitivity of USG is reduced in obese patient, oligohydramnios, for assessment of fetal

intracranial abnormalities and multiple pregnancies.

Multiplanner imaging is easier with MR than USG. There is a large field of view which facilitates

proper visualization of large and complex anomalies and visualization of a lesion in context of the

entire body of the fetus. It can add valuable information of fetal hypoxia and twin-twin transfusion.

Materials & Methods: Fetal MRI was performed in Apollo Hospitals Dhaka using 1.5 T MRI

scanner, T2 single shot images were taken. The examination was followed by a detailed fetal USG in

AHD.

Results: We will present few interesting cases of fetal MRI done in AHD where there has been

significant difference between USG & MR findings. Cases of rare congenital conditions are included.

Conclusion: Fetal MR scanning usually takes about 30 minutes and can be performed any time

during pregnancy; but preferably in 2nd & 3rd trimester. Fetal MRI has no known adverse effect in

the fetus. It offers a global view of the fetus and congenital anomalies of the fetus can be assessed and

excluded with confidence.

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108

CN-10: Electrmyographic Finding (EMG) in the Children of Spinal

Muscular Atrophy

Mustafa Mahbub, Suraj Chandra Majumder, Mosiul Azam, Selina H. Banu, Naila Z Khan

Introduction: Spinal muscular atrophies (SMA) are the group of disorders, usually but not

invariably inherited as autosomal recessive characters and the basic lesion lies in the anterior horn

cells of the spinal cord. Neurophysiologic investigation ike nerve conduction study and

electromyography (NCV, EMG), may provide important information to come to the conclusive

diagnosis of SMA particulary in a situation where genetic tests are not available. The main objective

of this study is to distinguish between disorders of anterior horn cell, peripheral nerve, and muscle

and to relate neurophysiological abnormality to the clinical context.

Method: Total 11 children were admitted in the neuroscience department of Dhaka Shishu Hospital

from Feb 2010 to Sept. 2012. Consanginity, perinatal insult and important clinical features were

recorded. Serum CPK, EMG, NCV suggested for all and muscle biopsy for selected cases. EMG &

NCV was done in Bangladesh Protibondhi Foundation by trained person.

Result: EMG was performed in 8 of total 11 children. According to the findings of EMG, 4 (50%)

were suggestive of disease of motor neuron, 1 was myogenic disorder, 1 was neurogenic disorder, 2

were normal and 3 were either not done or not found.

Conclusion: In half of the cases EMG findings were in favor of the clinical diagnosis. So it is

necessary to supplement clinical examination by the study of electrical activity in nerve and muscle.

CN-11: Transfer of Technology: Experience in Providing a Short Course

Of Training and Doing EEG Recording in, Tanzania, Ghana and Cox’s

Bazar

Shipra Rani1, Shanta Yesmin

2, Selina H Banu

3

1Senior technologist Clinical Neurophysiology laboratory, Comfort Diagnostic Center, Dhaka

2Technologist Clincial neurophysiology laboratory, Central Hospital and Dhaka Shishu Hospital, Dhaka

3Clinical Neurophysiologist and Child Neurologist, Associate professor, ICH and SSF Hospital, Mirpur, Dhaka

Introduction: Electroencephalography (EEG) is highly sensitive technology. Long time training is

required on equipment and, accessory handling and recording technique, which is one to seven years.

This paper will discuss the experience of dispensing a short intense course and its outcome in recent

time.

Methods: This study was part of prospective neuro-cognitive evaluation study among the children

who had severe malaria eight years ago in Bangladesh, Tanzania and Ghana‖ A selected population

was supposed to have their EEG performed in site to explore any ongoing cerebral dysfunction

including seizure phenomena. According to study protocol, we organized intense training for

technicians and physicians of those particular places. The course included online preliminary training

for 3 months followed by hands on training in Dhaka for 2 wks. Same model of portable equipment

with similar accessories and technique of data collection was used for three countries. The equipment

setting with montages and calibration were done in Dhaka by our team. Experienced technologists

went in site to supervise and facilitate the activities within short period. The EEG data is in the

process of uploading and downloading through google drive and getting ready for re-reviewing in

Dhaka.

The data acquisition in site, transfer to reviewing site went quite smoothly with persistent and very

intense monitoring and involvement of the experienced neurophysiologists, physicists, computer

experts, equipment suppliers and the technologists in this country. We will discuss on the Cox/s

Bazar data.

Result: Targeted population was 226 in Cox‘s Bazar, 203 in Tanzania, 200 in Ghana. Performed

tests number was 222, 203 and 156 in Cox‘s Bazar, Tanzania and Ghana respectively. Among the

total 222, 219 are available for discussion from CB, 5 records had insufficient data and needed a

repeat test. The rest had good quality data for reviewing. The data were first reviewed by the newly

trained pediatricians or neurologists, and later re-reviewed by the experienced neurophysiologist.

About 90% of the records revealed normal recording for the age and state, 8% had epileptiform


109

discharges and 4% had non-specific background dysfunction. Those cases were selected for further

evaluation. The only disagreement found in the description of the ongoing background activities.

Conclusion: The short time training on this highly sensitive technique is possible, however, previous

experience i.e., pre-selection of the trainees is important. The trainer‘s experience and coordination

between the trainee and trainers and intense interest and monitoring is needed.

CN-12: Evaluation of The Prolonged EEG and Clinical Correlation in 35

Children

Rafiqa Humaira1, Abu Saleh Musa

2, Khadiza Rahman

3, S.H. Banu

4

Dept of Neuroscience, Bangladesh Institute of Child Health, Dhaka Shishu Hospital,Dhaka

Introduction: Standard routine EEG recording runs for 30 minutes with sleep-wake and other

activation process. Different protocol is practiced in our laboratory for different clinical problems.

Some children need longer sleep recording beyond the routine test period to explore apparently

undetectable cerebral dysfunction. The prolonged EEG (p-EEG) protocol is more effective for certain

cases.

This study targeted reporting the electro-clinical condition of children who had the p-EEG to evaluate

the technique in clinical practice.

Methods: Prolonged EEG (p-EEG) test was organized for selective cases. The cases were selected

based on the child‘s clinical history of 1. Paroxysmal event, or increasing behavioral disorders, and/or

Suspected paroxysmal cerebral dysfunction in ASD, 2. questionable seizure disorder with normal

routine test, 3. Poorly controlled seizures with previous tests showing no abnormality.

Electro-clinical correlation and the final diagnosis and management plan will be discussed.

Result: Since 2010 total 35 p-EEGs were performed, mean age at recording was 7.8 years St

deviation 3.97, clinical problems were behavioral- speech-communication disorders in 17(49%),

non-specific jerking, limb flickering in sleep, eye blinking, staring, transient speech loss, transient

excessive sweating, cyanotic spells with normal routine EEG (R-EEGs) in 14 (40%) and poorly

controlled epilepsy with normal R-EEGs in 4 (11%). Mean duration of EEG data collection was 55

minutes, maximum 3.25 hours. In EEG any form of cerebral dysfunction was identified in 23(66%),

normal in 34%. The electro-clinical correlation in all and change of the management plan in a few

cases will be discussed.

Conclusion: Specialized technique for selected population is very helpful and should be used for

successful management.

CN-13: Role of EEG in Children With Non-Seizure Clinical Problems: an

Electro-Clinical Correlation

Naheed Nabi, Biplob Banergee, Selina H. Banu Introduction: Clinical presentation of continuous or paroxysmal cerebral dysfunctions may be

variable involving single or multiple function domains of children. A large number of children with

non-seizure complaints are referred to the neurophysiology laboratory, for which we have a definite

protocol for data collection and reviewing. This study was performed to describe the cerebral

dysfunctions found in children presenting with non-seizure clinical problems.

Method: We retrospectively reviewed the electroencephalographic criteria and clinical problems of

the children referred for routine EEG during June‘13 to June‘14. Children with history of overt

seizure(s) or epilepsy were excluded. History related to pregnancy, birth and early developmental

milestone, ongoing medical or other therapy are usually kept during r-EEG. We categorized the

clinical problems in a) behavioral problem group, b) speech delay or regression, d) sleep related


110

problems (sleep walking, terror, abnormal posturing in sleep), e) somato-sensory problem and fainting

attack. EEG findings were categorized as 1. Epileptiform discharges (focal, multifocal or

generalized), 2. Feature of encephalopathy (generalized, diffused or localized slowing of background

activities, and normal study.

Result: Total 993 EEGs were performed during last 1 year, 263 cases fulfilled the study criteria.

Mean age of the population was 5.4 years. Behavioral, speech, sleep related problem, somato-sensory

and fainting attacks were reported in 54.8%, 18%, 6.8%, 14.4% and 6.1% respectively. Definite

epileptiform discharges were reported in 20% among the total study population and 1.1% had features

of encephallopathy. This study will discuss the electro-clinical correlation.

Conclusion: This study suggests that a careful, optimum EEG data collection and their analysis is

helpful and should be routinely practiced for management of non-seizure clinical problems in

children.

CN-14: Posterior slow waves on eye closure: are they precursors of

epileptiform discharges in certain cases?

Shanta Yesmin, Khaleda Akhter, Selina H Banu

Introduction: Appearance of alpha rhythmic activity over posterior region is the normal findings on

eye closure, which is blocked on eye opening. Unusual finding of very slow waves over the posterior

region produced by eye closure was studied previously. Objective of this study was to evaluate the

posterior slow waves on eye closure and compare with those having other dysfunction, i.e.,

epileptogenic discharges.

Methods: We reviewed the EEG findings of those children having posterior slow waves on eye

closure. The records were performed since 2008 till recently. Children who had febrile seizures only,

febrile seizure plus and febrile seizures with mild comorbidities were included in this study. Children

with definite epileptic seizures, and or with severe comorbidity were excluded. The presenting

complaints were reviewed and correlated with the EEG findings.

Result: Total 70 children were included, male predominance (63%), mean age on the day of

recording was 4.8 years, standard deviation 2.45. Clinical complains were recorded as only febrile

seizure in 13(18.6%), febrile seizure plus in 35(50%) febrile seizure and mild comorbidity in 9(12.9)

and non-seizure problems (behavioral disorder, speech communication problems) in 13(18.6%). In

addition to PSW on eye closure definite epileptogenic discharges were recorded in 27(38.6%). A

significant correlation was found among those with febrile seizure with or without other problem and

EEG showing epileptiform discharges or no discharges.

Conclusion: Posterior slow waves provoked by eye closure, although not proved as definite

abnormality, we propose to consider this finding as an important pre-epileptic indicator. Close

monitoring and repeat EEG should be advised in such cases.


111

CN-15: Video-EEG Data Analysis and Electro-Clinical Correlation

Abdus Salam

Department of Neurology, Shaheed Sheikh Abu Naser Specialized Hospital, Khulna

Introduction: Video-EEG is a very effective diagnostic tool for differentiation of seizure and pseudo-

seizure. Also this is helpful to classify various seizure types. In our institute this investigation has

been introduced since last February. The objective of this study is to evaluate the findings of Video-

EEGs, done over last 09 months since its introduction.

Method: This was a retrospective study. The electro-clinical information of the patients who had their

Video-EEGs performed in our laboratory were collected and reviewed. All patients from February,

2014 to October, 2014 were included in this study. Clinical diagnosis was made by taking the history

meticulously and doing clinical examination by the investigator. Video-EEGs were performed for

various durations, ranging from 30 minutes to 24 hours with a view to capture an event and classify it.

The seizures were classified following the International League against Epilepsy classification (ILAE

1989, 1993). The EEG findings were interpreted accordingly.

Result: Over last 09 months total 25 Video-EEGs have been done. The duration of these V-EEGs

were 30 minutes-24 hours. Age of the patients was 5 month-78 year. Male and female ratio was

12:13. In 14 cases clinical events could be captured. Various types of EEG pathology were found in

21 cases. The final diagnosis was, CPS-T(complex partial seizure-temporal) 7, PS (partial seizure)

with secondary generalization 4, IGE (idiopathic generalized epilepsy) 2, symptomatic generalized

epilepsy 3, childhood absence epilepsy 2, juvenile myoclonic epilepsy1, SSPE (subacute sclerosing

panencephalitis) 1, status epilepticus of Atypical Absence Seizure 1(Lennox Gastaut syndrome),

pseudo-seizure in 3 and seizure + pseudo-seizure 1. After analyzing the data it was seen that EEG was

positive in 96% cases in our study. In 56% cases it was possible to capture an event which provided

conclusive result of the presenting complain.

Conclusion: This result demands wide-spread use of Video-EEG in selected cases by trained experts

for the accurate diagnosis and classification of epilepsy and to differentiate seizures from pseudo-

seizures.

CN-16: Neuroradiology: a Mandatory Subspeciality for Clinicians

Mustafa Mahbub Department of Pediatric Neuroscience; Bangladesh Institute of Child Health (BICH), Dhaka Shishu

(Children‘s) Hospital (DSH), Dhaka E-mail: [email protected]

Introduction: Neuroimaging includes the use of various techniques to either directly or indirectly

image the structure, function/pharmacology of the nervous system. CT scan and MRI are the tool of

choice in the evaluation of brain pathology and particular attention is devoted to the role of diffusion-

weighted imaging and magnetic resonance spectroscopy. To observe the clinical diagnosis and

neuroimaging findings of children admitted with neurological problems is the main objective of this

study.

Materials and method: A retrospective analysis of 40 children from the records of the patients

admitted in the Child Neurology Unit, Dhaka Shishu Hospital during the period of November,2013

and December, 2014. Either CT scan or MRI of the brain was done in all 40 children.

Result : Neuroimaging finding showed encephalomalacia in 9, cortical atrophy in 8, demyelination

in 5 and normal finding in 4 children. Among these 40 children 12 was diagnosed as cerebral palsy of

different types, 9 was diagnosed as sequel of encephalitis , 7 diagnosed as seizure with developmental

delay and 4 as neurometabolic disorder.

Conclusion: Neuroimaging plays an important and growing role in the diagnosis and therapeutic

management of pediatric neurology disorders.



112

Invited Talk

ICN-6: Learning Kit for Children with Special Needs: The RGACD

Learning Kit

Kazi Tanvir Ahmmed1, Md Rabiul Hossain

2, Kazi Abu Zubair

2, Bhuiyan Muhammad

Muktashif Anwar2, Sopan Sarkar

2, A.M. Mahmud Chowdhury

2, Sakibul Azam

2,

Mahmood Ahmed Chowdhury3

Department of Applied Physics, Electronics and Communication Engineering, University of Chittagong,

Bangladesh.

Department of Applied Physics, Electronics and Communication Engineering, University of Chittagong

Professor, Department of Child health, Chattagram Ma O Shishu Hospital Medical College, Chittagong.

Background: We, the Research Group to Aid Child Development (RGACD), are working in the

vein of converging various sides of medical and physical sciences. Here, we present a Microcontroller

based learning system, which has been named ―The RGACD Learning Kit‖.

Methods: It is a Microcontroller and Infrared sensor based unique portable, a plug and play styled

learning tool mainly targeted towards children with special needs to aid their physical and mental

development. The kit is equipped with 3-D models of everyday objects and other common

surroundings. Based on the response of the user it will show various knowledgeable videos about the

objects on a connected screen or Personal Computer. The kit has been made to be highly

interactive by introducing two modes: a) Learning mode- where the user picks a random object

and learns about it. b) Teaching mode- Where the kit‘s system randomly generates an object‘s

name in the screen and prompts the user to pick it up. If the wrong one is picked up, it will

inform the user that it is wrong and if the user is right he/she will be applauded by the kit‘s

system and the corresponding video will start to run.

An advantage of this system is that the code architecture has been made in such a way that

videos can be added or replaced easily. It can be updated to suit any culture by replacing or

adding videos too. The learning kit currently features various categories such as animals, shapes

etc. The interface and the videos of the kit are developed specially considering children with

visual, speech and hearing impairment. The videos contain text which helps children with hearing

impairment to get a clear hold of the object shown. It also helps the children with speech

difficulties by increasing their vocabulary with related pictures. The interface is colorful with bigger

fonts. The videos are also colorful, clear and attractive to children. Children with Autism are visual

learners and this kit helps to increase their cognition as well as communication level. As the kit is

equipped with 3-D models of various objects it helps the development of fine and gross motors of

the children. The children with visual impairment get proper orientation with the shapes of

everyday object and surroundings without even seeing them properly by holding the 3-D model

of an object and by hearing the essential information given about the objects in the videos. The

learning kit‘s functions were deliberately made easy so that it can be easily accessible for

children of every kind and the two modes of the kit are developed for enhancing the

development of the child‘s mind.

Results & Observations: The kit was tested on both children with special needs and normal

children. The kit has been successful in the primary stages. Our primary survey on doctors,

therapists and psychologists shows highly positive reactions. We are working on to extend the

scope of the survey by including parents and take data from various categories of children. Then

we will measure the efficiency of the system by comparing the children‘s development of mind

before and after using the kit.

Conclusions: In countries like Bangladesh where schools for children with special needs are

scarce our kit is of great help for their development. This kit is being used in a child development

center by speech, vision and hearing therapists successfully by making their work easier than

before. The kit can be used in home as well as schools. Currently, the kit‘s interface and videos

are all in Bengali language and the contents are mostly part of Bangladeshi culture. The kit is

cheap in price and it is ideal for developing and underdeveloped countries.

Acknowledgement: We acknowledge the Child Development Center of Chittagong Ma O Shishu

Hospital for financing and co-operation with our work on the kit.


113

CN-17: Can Early Detection of Predictors of Poor Seizure Outcomes

Change the Course of Neurodevelopement?

Shayla Imam Kanta, Humaira Rafiqua Qaderi and Naila Z Khan

Introduction: In a previous study in Bangladesh Banu et al (2003) showed three factors, i.e., multiple

seizure types, cognitive deficits and abnormal EEGs, to be predictors of poor seizure remission.

Another study by Banu et al (2010) included motor disability as another clinical predictor. Both these

studies provide important indicators for multidisciplinary services as part of an epilepsy programme.

Objective of this study is to determine the early identification of known predictors of poor seizure

outcome influence the course of the seizures and of neurodevelopemental outcomes.

Methods: Children attending the Child Development Center, i.e., a multidisciplinary service, in

Dhaka Shishu Hospital < 2 years of age at first attendance to the Epilepsy Clinic between 2010-2012

with follow-up records including EEGs, were included. Initial seizure semiology, EEG findings,

neurodevelopemental profiles were compared with last follows up.

Results: Total 45 children were included. Among them 60% were male and 40% were female; 70%

had eventful birth history & 30% uneventful. EEG test revealed normal findings in 23.8%,

generalized epileptiform discharges with normal background 9.5%, multifocal epileptiform discharge

in 9.5%, focal epileptiform discharge in 38.1%, epilepticencephalopathy in 14.3%, encephalopathy in

4.8%. Seizure semiology was analysed in detail, neurodevelopemental deficits were graded in mild,

moderate and sever degrees and compared with the follow up records. Seizure criteria at the initial

and last follow up records were compared toeavaluate the poor predictive factors.

Conclusion: Identification of poor seizure outcome predictors at initial stage was helpful and

important for the immediate and long-term treatment plan in childhood epilepsy. Those with

poor predictor would need regular stimulation and follow up at the epilepsy clinic for better

neurodevelopemental outcome.


114

CN-18: NeuroFeedback Brain Training (NFBT) Technology for ADHD in

Bangladesh: Single Case Study

Md Osman Gony

Founder Chairman, Institute of NeuroDevelopment & Research (INDR)

A Case Study: Our study subject was a seven years old child with severe symptom of ADHD. We

used pretest post test design to conduct the study. We conducted 20 HEG NF sessions, 3 sessions a

week. Specific custom designed software was used to analyze and project real-time brain activity on

dual screen.

Most frequently observed symptoms (all scored 7) with him were angry, compulsive behavior,

confused thinking, hyperactive, impatient, impulsive and inattentive. After twenty session of NFBT,

his symptoms were scored as follows: Angry (1), Compulsive Behavior (1), Confused Thinking (2),

Hyperactive (2), Impatient (2), Impulsive (1), Inattentive (2). [Progress graph is shown below]

As we can see from our result, NFBT induced marked improvement on our subject's manifesting

behavior. Even though the child got 20 sessions, the result is persistent still now.

Conclusion: NeuroFeedback can be answer to many Child‘s learning disability due to

NeuroDevelopmental Disorders like Autism, ADHD, CP etc. by training their brain. At least we now

can say, we do have a tool to train their brain which we can monitor real time and see changes

objectively.


115

CN-19: Identification of Cognitive States based on Transcranial Doppler

Ultrasonography

Eshtiak Ahmed1, Ashraful Islam

1, Jie Lu

2, Khondaker A. Mamun

3

1Dept. Of CSE, Ahsanullah University of Science and Technology, Bangladesh,

2IBBME, University of Toronto, Canada,

3Dept. of CSE, United International University, Bangladesh

Introduction: Individuals, having cognitive awareness but severe motor disorders like muscular dystrophy

or spinal cord injuries face difficulties to communicate with their surroundings. In order to shorten this

communication gap, Brain-machine Interface (BMI) is an inspiring technique that allows the users to

communicate through their brain activities. Among the number of different modalities for BMI,

Transcranial Doppler Ultrasonography (TCD) has sparked great interest as a potential modality because it

is affordable and robust against environmental noises[1]. TCD is a non-invasive ultrasound technology that

can be able to identify the changes in cerebral blood flow velocity (CBFV) in the middle cerebral artery

(MCA) of human brain.

Methods: Five able-bodied participants with normal vision were recruited. A Multi-Dop X4 TCD unit and

dual 2 MHz ultrasonic transducers were placed over the left and right transtemporal windows to acquire

the blood flow velocity in the MCA. The probes were positioned over the transtemporal insonation

window with the established insonation procedure (Fig. 1) [2].

Fig. 1: Axial view of the ultrasound probe set Fig. 2: Visual cues for the activation (left)

at the transtemporal insonation window and the rest mental task (right)

Participants were asked to perform two tasks which are activation and rest task. For the activation task,

participants repetitively rehearsed the spelling of a word that visually cued while imagining writing it (Fig.

2). During the rest task, an hourglass was presented for visual tracking (Fig. 2). The CBFV was measured

and the Doppler spectra of blood flow were acquired. Total 44 features were extracted and among them 3

highly discriminative features were selected by Fisher Criterion. A Naïve Bayes classifier was evaluated

using selected features with 10-fold cross-validation for classification between rest and activation tasks.

Results: Classification results for identifying rest and activation tasks show an average accuracy,

specificity (rest) and sensitivity (activation) of 77.13± 1.5%, 74.75± 5.23% and 79.5± 4.63% respectively.

It is also noted that all participants attained more than 70% accuracy. The achieved results are very much

encouraging for further study and it also has scopes of substantial future improvements.

Conclusion: The accuracy achieved for identifying cognitive states using TCD is inspiring for future

studies. Also, the accuracies may increase as the participants get more familiar with experimental tasks and

instruments. The study can be cited as a success in differentiating activation and rest mental tasks in

human brain and opens doors to develop TCD based BMI for rehabilitations.

Acknowledgements: The authors are grateful to Prof. Tom Chau and PRISM lab for datasets and advices.

Reference: [1] A. J. B. Myrden, A. Kushki, E. Sejdić, A.-M. Guerguerian, and T. Chau, ―A brain-computer interface based

on bilateral transcranial Doppler ultrasound.,‖ PLoS One, vol. 6, no. 9, p. e24170, Jan. 2011.

[2] A. V Alexandrov, M. A. Sloan, L. K. S. Wong, C. Douville, A. Y. Razumovsky, W. J. Koroshetz, M. Kaps,

and C. H. Tegeler, ―Practice standards for transcranial Doppler ultrasound: part I--test performance.,‖ J.

Neuroimaging, vol. 17, no. 1, pp. 11–18, 2007.


116

CN-20: Fundamentals of PET-CT (Positron Emission Tomography-

Computed Tomography) and it’s Application in Oncology

Md. Mehedi Masud

Department of Nuclear Medicine, United Hospital Ltd., Dhaka.

Introduction: The purpose was to demonstrate fundamentals of PET-CT (Positron Emission

Tomography) and its application in Oncology. PET-CT imaging is an important sophisticated nuclear

medicine technique to reveal organ energy metabolism in vivo in human as to contribute in the

Oncology (recent clinical application). PET-CT with administration of certain radiopharmaceutical

drug (18

FDG, fluorodeoxyglucose) to cancer patients would reveal the extent of disease process and

therapeutic plan for Oncologists.

Method: 18

F, a widely used radioisotope with physical half-life of 110 min is made by several nuclear

reactions. The nuclear reaction of 18

O (p, n) 18

F is often used by using enriched 18

O water. Fluorinated

deoxyglucose (18

FDG), an analogue of glucose with 18

F at 2nd

position of it‘s benzene ring has been

established as a tracer for glucose metabolism. 18

FDG is trapped metabolically in cells after being

administered intravenously into the body, and can be substantially used for evaluating functional

anatomy in vivo. 18

FDG and PET-CT imaging is used in assessing malignant lesions and staging-

restaging for therapeutic plan by inducing analytical procedure. Different malignant lesions of soft

tissue, haematological and skeletal organs are investigated.

Result & Discussion: An example of 18

FDG and PET-CT application to malignant lymphoma patient

was shown cervical lymphadenopathy with severe involvement of musculoskeletal system from

whole-body imaging for appropriate therapeutic plan (both chemo-radiotherapy and interval therapy).

Conclusion: 18

FDG and PET-CT imaging is sophisticated nuclear medicine technique in assessing

oncological diagnosis, staging/restaging and therapy plan.

117

List of Presenters:

Name E-mail Address

Abir, Raihan [email protected]

Ahmad, Maruf [email protected]

Ahmed, Sayed Parvez [email protected]

Ahmed, Zisun [email protected]

Ahmmed, Kazi Tanvir

Ahsan, Sania [email protected]

Akhanda, Sabbir [email protected]

Akhter, Khaleda

Ali, Mohammad Hanif [email protected]

Anwar, Bhuiyan Md.Muktashif

Azam, Mosiul

Azam, Sakibul

Azim, Mohammad Anwar-Ul [email protected]

Bala, Mousumi [email protected]

Banergee, Biplob

Banu, Selina H. [email protected]

Barkat, Zubair [email protected]

Begum, A. [email protected]

Bhuiyan, Md Anisuzzman [email protected]

Chowdhury, A.M. Mahmud

Chowdhury, Ehsan Alam [email protected]

Chowdhury, Mahmud Ahmed

Dey, Hirak Kumar [email protected]

Gony, Md.Osman

Hassan, Mahmud [email protected]

Hernández, Erick [email protected]

Hossain, Md. Nahid [email protected]

Hossain, Md.Rabiul

Humaira, Rafiqa

Hussain, K M A [email protected]

Hussain, Md. Kamrul [email protected]

Hussain, Rezwan bin [email protected],

Islam, Ariful [email protected]

Islam, Shekh Md Mahmudul [email protected]

Kadir, Muhammad Abdul [email protected]

Kadir, Nazimul [email protected]

Kanta, Shayla Imam

Khan, Naila Z

Khan, R.K. [email protected]

Kiber, Md. Adnan [email protected]

Mahbub, Mustafa [email protected]

Mahbub, Zaid Bin [email protected]

118

Name E-mail Address

Majumder, Suraj Chandra

Malik, Sadiq R. [email protected]

Mamun, Khondaker Abdullah [email protected]

Masud, Md.Mehedi

Mollah, Abdus Satta [email protected]

Monika, A. N. [email protected]

Musa, Abu Saleh

Nabi, Naheed

Nahar, Meherun [email protected]

Nisa, Lutfun [email protected]

Qaderi, Humaira Rafiqua

Quadir, Kamila Afroj [email protected]

Rabbani, Khondkar [email protected]

Rahman, Khadiza

Rahman, M Obaidur [email protected]

Rahman, M.S. [email protected]

Rahman, Md. Shakilur [email protected]

Rana, Muhammad Masud [email protected]

Rani, Shipra

Roksana, Ismat Ara [email protected]

Roshid, Md. Harun Or [email protected]

Sabur, M.A. [email protected]

Salam, Abdus [email protected]

Salam, Abdus [email protected]

Sarker, Sopan

Shahidunnahar, Sumana [email protected]

Sharmin, M.N. [email protected]

Siraz, M.M.M. [email protected]

Sultana, Nasreen [email protected]

Talukder, Mohammad Abu Yousuf [email protected]

Uddin, Md. Jamal [email protected]

Yasmeen,Shanta

Yeasmin, Selina [email protected]

Yousuf, Abu [email protected]

Zerin, Tasnim [email protected]

Zubair, Kazi Abu

119

A Brief Introduction to the Organizing Bodies

Bangladesh Medical Physics Association (BMPA)

Website: <www.bmpaweb.org>

Understanding the importance of Medical Physics in the modern healthcare a conference was

organized at the Bangladesh University of Engineering & Technology (BUET) in 1996 at the

initiatives of Professor Gias Uddin Ahmed, then at BUET, Dr. Syed Reza Hussain Ex Director,

Institute of Nuclear Medicine, Bangladesh Atomic Energy Commission (BAEC), Dr. A Sattar Mollah

of BAEC, Dr. M A Hai, Ex. Director of National Cancer Hospital, and an expatriate Bangladeshi in

Germany, Dr. G A Zakaria. This initiative was supported by Professor Uri Quest and Professor Hover

from Heidelberg University, Germany, and through a resolution in a meeting held during that

Conference, Bangladesh Medical Physics Association (BMPA) was born. Professor Gias Uddin

Ahmed, presently Vice Chancellor of the Primeasia University, was elected the first President of

BMPA, and Dr. Sattar Mollah as the first General Secretary. Through this leadership, continuing till

2009, the executive committee organized several International Conferences and Seminars, published a

scientific Journal with the name ‗Bangladesh Journal of Medical Physics‘, and got BMPA recognized

as the representative National member of International Organisation of Medical Physics (IOMP) and

Asia-Oceania Federation of Organizations for Medical Physics (AFOMP). BMPA also actively

supported a proposal to the Government by the National Institute of Cancer Research & Hospital in

creating 64 posts of Medical Physicists in all major hospitals. However, this still remains to be

addressed. In 2010 a new Executive Committee was formed with Professor K Siddique-e Rabbani as

its President and he is still continuing, at the request of the members. This Committee has been

continuing publication of the journal each year since 2011, which has recently been made online and

open source. Through this conference, the Association hopes to go forward in the mission with which

it was initiated.

Bangladesh Clinical Neuroelectrophysiologist Society

(BCNEPS)

BCNEPS was registered on 23

rd November, 2009. It started its regular activities in 2006 with aim to

produce recognized, well formatted training protocol and to establish a platform for the experts, i.e.,

technologists, physicists, biotechnical engineers and the clinical neurophysiologists of the country.

Clinical neurophysiology includes a) EEG (electro encephalography), that measures cerebral electrical

activity and currently the only available clinical laboratory test of brain physiology, b) NCS (nerve

conduction study) and EMG (electromyography) that measures the electrical activities of peripheral

nerves and muscle action potentials and c) SEPs (sensory evoked potential) to test the integrity of the

sensory pathway.

Through our society we provide training to technicians, physicians and set up electrophysiology labs

in different health facilities. We have monthly teaching classes for the society members and we share

knowledge and recent advancements. Our society has trained technicians and physicians from other

countries. We arrange short workshops for young doctors.

120

Department of Biomedical Physics & Technology

University of Dhaka

Website: <www.bmpt.du.ac.bd>

This multidisciplinary post graduate department started its journey with Professor K Siddique-e

Rabbani joining as its first Chairperson on 3 November, 2008. This department, emphasizing R&D at

Ph.D. and M.Phil levels, stands on 30 years of work carried out by the group while in the Department

of Physics, the mother department. There, late Professor M Shamsul Islam initiated and organized

research and education programmes in Biophysics and Medical Physics, visualising their far reaching

importance in 1978. A ten-year academic link with Universities in UK under a British ODA

sponsorship later gave a significant boost to these activities.

About 80% of Global population living in the Third World is deprived of the benefits of modern

healthcare technology, and this failure forms the key motivation of this department‘s research

programmes. This group has already achieved significant innovations in several areas: i) A novel

Focused Impedance Method (FIM) with potential in the detection and diagnosis of disorders and

diseases. This idea has received international acclaim and Universities in UK and Korea have already

started working in FIM, ii) Distribution of F-latency (DFL), a new physiological parameter giving a

velocity profile of motor nerves, having potential in the detection and diagnosis of peripheral

neuropathy. Researchers in UK and Singapore have already started working on this innovation. iii)

Design and development of low cost medical instruments for dissemination in the Third World

including telemedicine, and finally iv) Destruction of diarrhoeal germs in water at low cost by solar

energy using simple and easily available materials, which also provides an indirect means of solving

the Arsenic problem.

The department takes in students from all branches of science, engineering and medicine for its PhD

and MPhil programmes, and has already created an excitement among young scientists. At present 9

students are working for PhD and 2 for MPhil degrees. The department has initiated Masters courses

recently. The third batch has recently started and 27 students joined, 12 for specialization in Medical

Physics and 15 in Biomedical Engineering. Of course only students with backgrounds in Physics,

Applied Physics, Electrical and Electronic Engineering, Mechatronics and Biomedical Physics and/or

Engineering are taken in for the Masters course.

Through creation of a research environment that targets the needs of the deprived human beings in the

low resource countries, the department has been able to attract talented young researchers and has

already made its name known in the international arena. The department has already started to deliver

the results of its research to real life and hopes to add newer devices and techniques with further

research activities.

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