mdrc 2019: a brief introduction 5 of health, ministry of...

Program & Abstract Book

Transcend Professionalism in Medical Imaging 1

List of contents Page

MDRC 2019: A brief Introduction 5

MDRC 2019: The Objectives 6

MDRC 2019: The People 7

MDRC 2019: Welcome Message from the Director General of Health, Ministry of Health Malaysia

8

MDRC 2019: Welcome Message from the Director of Allied

Health Sciences Division, Ministry of Health Malaysia 9

MDRC 2019: Welcome Message from the Advisor I of

Malaysian Diagnostic Radiographers Conference 2019 10

MDRC 2019: Welcome Message from the Advisor II of Malaysian Diagnostic Radiographers Conference 2019

11

MDRC 2019: Welcome Message from the Chairperson of

Malaysian Diagnostic Radiographers Conference 2019 12

MDRC 2019: Program Tentative 13

MDRC 2019: Keynote Address 18

MDRC 2019: Plenary Speakers 19

MDRC 2019: List of Abstracts 20

Oral Presentation

MDRC 2019-D01: To evaluate if breast size and composition contribute to pain among our mammogram patients.

Noorazreen Muhamad

Hospital Melaka

20

MDRC 2019-D02: Effective dose assessments of adult patient

undergo CT TAP using CT EXPO version 2.2. Marlia Hipni

Hospital Umum Sarawak

21

MDRC 2019-D03: Optimization of dose and image quality for computed radiography and digital radiography for chest, abdomen

and lumbar sacral in Pahang.

Zubir Ahmad Shazli

Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang

22

MDRC 2019-D04: Assessment of the necessity to combine head

and cervical spine computed tomography (CT) for patient with blunt trauma injury in Hospital Sultanah Nur Zahirah (HSNZ).

Md Nadzir Azmi Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu

23

MDRC 2019-D05: Radiation dose between dual x-ray

absorptiometry (DXA) and quantitative computerized tomography (QCT) scanning in osteoporosis: A phantom study.

Yusof Ghazali

Hospital Pulau Pinang

24



MDRC 2019-D06: Knowledge and awareness on screening

mammography in the early detection breast cancer amongst staff nurses at Tengku Ampuan Rahimah Hospital (HTAR), Klang.

Wan Hasmalia Bt Wan Mohd Kamal

Hospital Tengku Ampuan Rahimah, Klang, Selangor

25

MDRC 2019-D07: Age estimation of adults: Cranial suture

method by using 3D computed tomography of the head. Mohd Azzuddin Zakariah

Hospital Wanita & Kanak-Kanak Kuala Lumpur

26

MDRC 2019-D08: Effective dose: comparison between multi-slice computed tomography and biplane angiography on coronary

angiogram. Muhammad Aizwan Sha’rani

Hospital Sultanah Aminah, Johor Baharu, Johor

27

MDRC 2019-D09: Routine MR rectal vs MR defecogram. Norzarina Mohd Ali

Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan

28

MDRC 2019-D10: Diagnostic accuracy of lung cancer screening programme with low dose ct scan and dual energy chest x-ray at

Institut Kanser Negara: A preliminary finding. Zarina Ramli

Institut Kanser Negara, Putrajaya

29

MDRC 2019-D11: Image quality and radiation exposure of HRCT thorax with low dose technique: phantom study.

Mohd Aiman Azmardi Hospital Sultanah Bahiyah, Alor Setar, Kedah

30

MDRC 2019-D12: Awareness of radiation protection safety

among patients waiting for radiology examination in Hospital Putrajaya.

Mohd Azwan Mustafa

Hospital Putrajaya

31

MDRC 2019-D13: Diagnostic accuracy of 128-MDCT

angiography for evaluating cerebral aneurysm using digital

subtraction angiography (DSA) as the standard of reference. Mohammad Mudzakir Zainal Alam

University of Malaya Medical Centre, Kuala Lumpur

32

MDRC 2019-D14: Innovation culture in radiation protection at

Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan

Malaysia. Mohamad Norman Mohd Nordin

Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia

33

MDRC 2019-D15: Observation study on usage of coils and stent for aneurysm embolization under interventional radiology guided

Shaiful Asri Abdol Halim

Hospital Kuala Lumpur

34



MDRC 2019-D16: Contribute to hospital infection; is it from dirty X-Ray cassette?

Kamaruddin Karim HRPZ II, Kota Bharu, Kelantan

35

Poster Presentation

MDRC 2019-C01: Occupational stress level among the

diagnostic radiographers in Johor Vithyaine Arumugam

Hospital Sultanah Aminah ,Johor

36

MDRC 2019-C02: A preliminary study on opportunistic

quantification of bone mineral density using CT thorax for

osteoporosis screening: Relationship between Hounsfield unit and dual energy x-ray absorptiometry (DEXA) values.

Mohamad Farhan Mohamad Amin


37

MDRC 2019-C03: The correlation of the measurements of liver

SUV and SUL in contrast and non-contrast enhanced PET/CT 18F–FDG studies.

Nur Hafizah Mohad Azmi Hospital Kuala Lumpur, Kuala Lumpur

38

MDRC 2019-C04: Evaluation of practice and knowledge on

nosocomial infection among radiographer in Sabah Women and Children Hospital (SWACH).

Azizan Binti Azman

Hospital Wanita Dan Kanak Kanak Sabah, Kota Kinabalu, Sabah

39

MDRC 2019-C05: Change in health behaviors among cancer

surviving individual in follow up mammogram.

Clarice Lea Jaymess Hospital Wanita Dan Kanak Kanak Sabah, Kota Kinabalu, Sabah

39

MDRC 2019-C06: Diagnostic performance of triple-phase computed tomography in the evaluation of hepatocellular

carcinoma.

Mohd Hafizi Mahmud

Hospital Selayang, Selayang, Selangor

40

MDRC 2019-C07: The efficiency of sclerotherapy in the

treatment of craniofacial vascular malformations for pediatric patients

Muhammad Khuzaimi Ishak


41

MDRC 2019-C08: Clinical audit exposure factor for general

radiography at Radiology Unit, Specialist Clinic Ambulatory Care Centre (SCACC), Hospital Kuala Lumpur

Fazlishah Abd Wahab Hospital Kuala Lumpur

42



MDRC 2019-C09: A clinical audit of optics lens involvement In

CT head imaging for Siemens MSCT scanner In Radiology Department Hospital Kuala Lumpur

Nor Hisam Bin Muhammad Hospital Kuala Lumpur

43

MDRC 2019-C10: Reducing the waiting time for general

radiograph examinations at Radiology Unit, Specialist Clinic Ambulatory Care Centre (SCACC), Hospital Kuala Lumpur cycle 2.

Izwan Ismail Hospital Kuala Lumpur

44

MDRC 2019: The Acknowledgement 45

MBRC 2019: Sponsor page 47



Malaysian Diagnostic Radiographers Conference (MDRC 2019): A Brief Introduction

The Malaysian Diagnostic Radiographers Conference (MDRC) 2019 is an annual event organized by the radiographers for radiographers in Malaysia. The

conference aims to address the continuous mission of the Ministry of Health in championing a healthy nation by offering a platform for exchanging scientific

information and skills to the radiographers, educators, research scientists and related healthcare professionals in Malaysia.

Themed “Transcend Professionalism in Medical Imaging“, the Malaysian Diagnostic Radiographers Conference 2019 will offer some exciting highlights

such as the launching of the standard operating procedure (SOP) for Malaysian Diagnostic Radiographers.

, “Digital Imaging Evolutionary”, “Working together, better together: Radiologists and radiographers”, “Research in Medical Imaging”, and “Role of

radiographer as a manager” sessions where we will hear from key opinion leaders and experts as they share their expertise, breakthrough ideas and

initiatives that will bring about remarkable changes to radiographer’s profession in Malaysia and throughout the Asia-Pacific region.

The conference hopes to bring together a wide range of radiographers across nations for the advancement of knowledge in medical imaging field. The

Organizing Committee of Malaysian Diagnostic Radiographers Conference 2019

cordially invites you to join us by presenting scientific papers or being an active participant at the conference.

An interesting and enriching program awaits you!



MDRC 2019: The Objectives

The objective of this conference is to provide opportunities for intellectual and practical interaction between radiographers, educators, and research scientists

in the fields of medical imaging. It also aims to promote opportunities for delegates to establish network and collaboration among participants from other

institutions and countries.



MDRC 2019: The People

Patron Ms. Hjh Che Ruhani Che’ Jaafar

Advisor I

Ms. Chan Lai Kuan

Advisor II

Mr. Mazli Mohamad Zin

Chairperson Ms. Mary Oommen Kochummen

Vice Chairperson Ms. Maheran Che Ha’

Secretariat

Ms. Nur Hafizah Mohad Azmi (Organising Secretary)

Mr. Mohamad Farhan Mohamad Amin

Finance Committee Ms. Zaidah Maspin (Treasurer)

Ms. Zarina Ramli

Scientific/ Academic Committee

Assoc. Prof Dr. Akmal Sabarudin (Head) Assoc. Prof Dr. Hairil Rashmizal Abdul Razak

Mr. Mohd Hafizi Mahmud

Registration Committee

Ms. Fara Shuhaida Shafiee (Head)

Social Committee Mr. Abdul Malik Md Isa (Head)

Logistic Committee Mr. Azmi Murad Taha (Head)

Technical Committee

Mr. Mohd Imran Mohd (Head)



MDRC 2019: Welcome Message from the Director General of Health, Ministry of Health Malaysia

First and foremost, I wish to extend a warm welcome to all delegates of the first Malaysian Diagnostic Radiographers

Conference in Malaysia. With the theme "Transcend Professionalism in Medical Imaging", this inaugural event

aligns with the aspirations of the Ministry of Health

Malaysia to achieve better health for all through value-based research and development to support decision-

making and capacity building. The conference aims to provide radiographers knowledge-exchange and networking opportunities in

the field of medical imaging.

Special thanks to collaborators from the Malaysian Society of Radiographers,

academia and private sector who have worked hand in hand with the

Radiographer Profession Technical Committee, Ministry of Health. Through their infallible commitment, we are able to integrate works related to medical

imaging successfully. Moreover, we can further promote and advance our diagnostic radiography practice and education to be on par with current

international standards through a common shared platform.

Congratulations to the conference's Chairperson, Madam Mary Oommen A/P Kochummen and the secretariat for making this event a success. It is a

testament of excellent team effort and avails as a starting point for future collaborations among the related experts in the field. Of course, none of these

would have been successful without the participation of all the presenters and contributors. I would also like to thank them for giving their excellent support.

Hopefully, this will inspire us to further explore the field of research and

development in medical imaging to improve efficiency, quality, accessibility and equity in health care delivery.

Thank you,

DATUK DR. NOOR HISHAM BIN ABDULLAH

Director General of Health Ministry of Health Malaysia



MDRC 2019: Message from the Director of Allied Health Sciences Division, Ministry of Health Malaysia.

It gives me great pleasure to welcome all delegates and

presenters to attend the first Malaysian Diagnostic Radiographers Conference (MDRC) from August 24th-25th,

2019 in Everly Hotel Putrajaya, Malaysia.

MDRC is the best platform for knowledge sharing and

information update on medical imaging. The conference will provide a forum for radiographers to present cutting edge

research, gain knowledge from the expert in the field and learn about the

latest breakthroughs and technologies in medical imaging. Medical imaging represents a group of diagnostic radiographers and nuclear imaging

radiographers. It is importance of exploration through research for the development of the career in the future.

Ultimately, i would like to express our heartfelt gratitude to the chairman of this conference, Madam mary Oommen A/P Kochummen and to all the

secretariat for their contributions, and sacrifice to make this event successful.

Of course, none of these would have been successful without the participations of all the presenters and contributors. We would like to welcome you to

present your recent work in medical imaging and ideas in MDRC. I would also like to thank them, for giving their good support.

Thank you,

HAJAH CHE RUHANI CHE JA’AFAR Director of Allied Health Sciences Division,

Ministry of Health Malaysia



MDRC 2019: Welcome Message from the Advisor I of Malaysian Diagnostic Radiographers Conference 2019

It gives me great pleasure to offer my sincere congratulations to the organizing committees for the 1st Diagnostic

Radiographers Conference. As this is the 1st such conference

organized, I really commemorate the effort for all that are involved and for the one that mooted the idea.

The conference theme is well selected in view of the rapid advancement of medical imaging technology. As radiographers,

we should always be ready to continually develop our practices to be in tandem with the technology advancement. From conventional technology, we

move to digital technology and soon we are approaching the era of Artificial

Intelligent (AI). The transition requires radiographers to constantly upgrade and transcend our service of care and professionalism. This conference opens

a great avenue for our radiographers to share their experiences, exchange scientific knowledge and at the same time gain latest technology updates from

the various expert of the field.

With this conference, I sincerely hope that the participants will regain professional goal of providing quality imaging services and working constantly

towards reducing the radiation risks. I hope this conference will be used as a platform to share and discuss how diagnostic radiographers can progress into

the new frontiers of healthcare and where should we be heading for in the future. I wish the conference a great success and my best wishes to everyone.

Thank you,

CHAN LAI KUAN

Advisor MDRC 2019



MDRC 2019: Welcome Message from the Advisor II of Malaysian Diagnostic Radiographers Conference 2019

Greetings to all participants! First of all, I would like to

welcome all delegates and presenters to our 1st Malaysian Diagnostic Conference (MDRC). This is supposed to be the

start of a new conference for diagnostic radiographers and

allied health professionals to gather, sharing knowledge and cultivating new ideas thus the platform created by this

conference should be able to encourage them to perform well in their professions.

On behalf of the Malaysian Society of Radiographers (MSR),

we are very honoured to collaborate in this conference. MSR

has always support any members, committees or institution to organised seminars and conferences for the radiographers as such.

The theme of MDRC “Transcend Professionalism in Medical Imaging” portrays the needs and aspiration in the field of medical imaging to go further beyond

technologies and latest advancement in radiology. Selected papers were

carefully chosen to fulfil the conference slots which should be beneficial to all delegates. Hopefully this conference will be fruitful to all delegates and also for

their career development.

Last but not least, I would like to congratulate the conference chairperson, Madam Mary Oommen A/P Kochummen and all the committee members who

have been working so hard in order to make this conference a success. I hope

that this conference will become an annual event or at least a biennial event as this conference is a good platform for the diagnostic radiographers to gather

and share knowledge among each other. Thank you.

MAZLI BIN MOHAMAD ZIN

Advisor II

MDRC 2019



MDRC 2019: Welcome Message from the Chairperson of Malaysian

Diagnostic Radiographers Conference 2019

It is my great pleasure to welcome you all to the First

Malaysian Diagnostic Radiographers Conference (MDRC 2019) which takes place in the federal administrative centre

of Malaysia on August 24 – August 25, 2019. It has been a

real honour and privilege to serve as the Chairperson of the conference.

This, first conference is conducted by the Diagnostic Radiographers Technical Committee in collaboration with the Allied Health

Science Division (AHSD) and the Malaysian Society of Radiographers (MSR). MDRC 2019 has provided a professional venue for researchers and

practitioners to address the rich space of communications and networking

research and technology. This year, the program is held for two days of the main conference consists of a keynote presentation, 4 plenary speakers, 16

oral presentations, 10 poster presentations and 7 special presentations. The conference would not have been possible without the enthusiastic and hard

work of the secretariat and steering committee members of MDRC 2019 and

the Malaysian Radiographers Society. We also thank the exhibitors from Fujifilm, Philips, Guebert, WeAnsa, Delta Medisains, GE and EOS for their

contribution to this conference.

A conference of this size relies on the contributions of many volunteers, and

we would like to acknowledge the efforts of our academic members and referees and their invaluable help in the review process. Special thanks to the

Keynote Speaker, Mr. Naponpong from Thailand and all juries for sharing their

views on the presentations. We appreciate the support of our sponsors AHSD, National Head of Radiology Service and the MSR. We also thank Madam Chan

Lai Kuan and Mr. Mazli Mohamad Zin, advisors of the MDRC 2019 steering committee and Mr. Sawal Marsait, the President of MSR for their vision and

leadership. We look forward to an exciting two days of insightful presentations,

discussions, and sharing of technical ideas with colleagues from around the country.

We thank you for attending the conference and we hope that you enjoy your visit to Putrajaya.

Thank you,

MDM MARY OOMMEN KOCHUMMEN MDRC 2019 Chairperson



MDRC 2019: Program Tentative

Day 1 Saturday, 24th August 2019 : Plenary Session

Mesmera Ballroom

7:00- 8:15 Registration

Keynote Address

8:30-9:30

Transcend Professionalism in Medical Imaging

Dr. Napapong Pongnapang

Vice President of International Society of Radiographers and Radiological Technologists (Asia/Australasia Region)

Opening Ceremony

9:30-9:35 Doa Recitation Mr. Mohd Hafizi bin Mahmud

9:35 -9:45 Welcome Address Ms. Mary Oommen A/P Kochummen

(MDRC2019 Chairperson)

9:45-11:00

Opening Speech

YBrs. Hajah Che Ruhani Che Ja’afar

Director of Allied Health Sciences Division, Ministry of Health Malaysia

Launching Standard Operating Procedure for Malaysian Diagnostic Radiographers

Photography Session

Break (Booth and Poster Exhibition)

Plenary Sessions

11:00-11:30

Digital Imaging in Ministry of Health Hospital: Invaluable Experience

Mr. Haji Daud Bin Ismail

Senior Radiographer

11:30-12:00

Working Together Better Together: Radiologist and

Radiographer Dr. Sarawana Chelwan A/L Muniandy

Radiologist, Hospital Kuala Lumpur

12:00-12:30

Research in Medical Imaging

Assoc. Prof. Dr. Hairil Rashmizal Bin Abdul Razak

Senior Lecturer Faculty of Medicine and Health Sciences, Universiti Putra Malaysia



12:30-13:00

Beyond Radiography, How Far Can Radiographer Go?

Mr. Mahenthiran A/L Thanapal Chief Operating Officer Prince Court Medical Centre

13:00-14:00 Lunch

14:00-15:00

What is Allied Health Profession (AHP)? Act 774 and How it

Benefits The Profession Mr. Saravanakumar Maniam

Principal Assistant Director, Allied Health Division, Ministry of Health Malaysia

15:00-15:15 Malaysian Society of Radiographers- Past, present and future. Mr. Sawal Bin Marsait

President Malaysian Society of Radiographers

Special Paper Presentation

15:15-16:00

“ALARAY- Making a Ray of Difference Through Innovative Digital Technologies in Medical Imaging”

Mr. Phanesh Atmuri

Fujifilm

16:00 – 16:30 Update on Interconnected CT Solutions Ms. Ja-Young Kim

Guerbet

16:30-17:00 The New Wave In MRI Technology And Its Clinical Applications Mr. Hesham ElBehairy

Philips Medical

Paper Presentation

17:00-17:10

MDRC 2019-D01: To evaluate if breast size and composition contribute to pain among our mammogram patients

Ms. Noorazreen Muhamad

Hospital Melaka

17:10-17:20

MDRC 2019-D02: Effective dose assessments of adult

patient undergo CT TAP using CT EXPO version 2.2. Ms. Marlia Hipni

Hospital Umum Sarawak

17:20-17:30

MDRC 2019-D03: Optimization of dose and image quality for computed radiography and digital radiography for chest,

abdomen and lumbar sacral in Pahang. Mr. Zubir Ahmad Shazli

Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang.

17:30-17:40

MDRC 2019-D04: Assessment of the necessity to combine head and cervical spine computed tomography for patient with

blunt trauma injury in Hospital Sultanah Nur Zahirah Mr. Md Nadzir Azmi

Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu



17:40-17:50

MDRC 2019-D05: Radiation dose between dual x-ray absorptiometry (DXA) and quantitative computerized

tomography (QCT) scanning in osteoporosis: A phantom study

Mr. Yusof Ghazali Hospital Pulau Pinang

17:50-18:00

MDRC 2019-D06: Knowledge and awareness on screening mammography in the early detection of breast cancer among

staff nurses at Tengku Ampuan Rahimah Hospital (HTAR),

Klang. Mrs. Wan Hasmalia Bt Wan Mohd Kamal


18:00 Evening Tea

End of Day 1



Day 2

Sunday, 25th August 2019: Plenary Session Mesmera Ballroom


8:30-9:00

3D X-Ray Imaging

Mr. Antoine MOUSNIER EOS

Paper Presentation

9:00-9:10

MDRC 2019-D07: Age estimation of adults: cranial suture

method by using 3D computed tomography of the head Mr. Mohd Azzuddin Zakariah


9:10-9:20

MDRC 2019-D08: Effective dose: comparison between multi-slice computed tomography and biplane angiography on

coronary angiogram.

Mr. Muhammad Aizwan Sha’rani Hospital Sultanah Aminah, Johor Baharu, Johor

9:20-9:30 MDRC 2019-D09: Routine MR rectal vs MR defecogram Mr. Norzarina Mohd Ali

Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan


9:30-10:00

Cost Effective Digital Solution

Ms. Satvinder Kaur WeAnsa Solutions Sdn Bhd

10:00-10:15 Morning Tea Break

Paper Presentation

10:15-10:25

MDRC 2019-D10: Diagnostic accuracy of lung cancer screening programme with low dose CT scan and dual energy

chest x-ray at Institut Kanser Negara: A preliminary finding. Ms. Zarina Ramli

Institut Kanser Negara, Putrajaya

10:25-10:35

MDRC 2019-D11: Image quality and radiation exposure of

HRCT thorax with low dose technique: Phantom study

Mr. Mohd Aiman Azmardi Hospital Sultanah Bahiyah, Alor Setar, Kedah

10:35-10:45

MDRC 2019-D12: Awareness of radiation protection safety

among patients waiting for radiology examination in Hospital

Putrajaya Mr. Mohd Azwan Mustafa

Hospital Putrajaya



10:45-10:55

MDRC 2019-D13: Diagnostic accuracy of 128-MDCT angiography for evaluating cerebral aneurysm using digital

subtraction angiography (DSA) as the standard of reference

Mr. Mohammad Mudzakir Zainal Alam

University of Malaya Medical Centre, Kuala Lumpur.

10:55-11:05

MDRC 2019-D14: Innovation culture in radiation protection

at Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia.

Mr. Mohamad Norman Mohd Nordin Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia

11:05-11:15

MDRC 2019-D15: Observation study on usage of coils and stent for aneurysm embolization under interventional radiology

guided Mr. Shaiful Asri Abdol Halim

Angiography Unit, Department of Radiology, Hospital Kuala Lumpur

11:15-11:25

MDRC 2019-D16: Contribute to Hospital Infection: Is It from

Dirty X-Ray Cassette? Mr. Kamaruddin Karim

Radiology Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan


11:25-12:00 Dose Management Ms. Stephanie Tan Lee Kian

Delta Medisains

12:00-12.30 Advancement In CT Technology And Its Clinical Applications Mr. ManMohan Singh

GE Healthcare

12:30-13:00 e-poster presentation Prize Giving and Closing Ceremony

13:00 Lunch



MDRC2019: Keynote Address

Transcend Professionalism in Medical Imaging

Dr. Napapong Pongnapang

Vice President, Asia and Australasia The International of Radiographers and Radiological Technologists (ISRRT)

Abstract

Radiographers and Radiological Technologists worldwide are bound by

their national legislation on scope of practice, which reflects requirements of their education and training. Some countries still have no regulatory body to

enforce the scope of practice, resulting in a decrease in standards and quality in the profession and always a decrease of recognition. However, in advanced

radiographic communities, the advanced practice in various aspects of imaging

and radiation therapy has become more and more common. The introduction of advanced imaging and radiation therapy technology leads to the demand of

specialized group of radiographers and radiotherapists, who either gained experience on their job setting or through the standardized advance

professional training. Advance practice in medical imaging and radiation therapy has been established in numbers of advanced radiographic

communities such as in Europe, the America and Australia for quite sometimes.

However, scope of advanced practice is not harmonized but rather depends on the local needs, where the practice exists. The presentation will cover details

on background of Radiography and Radiological Technology education and training in different parts of the world, with focus on how transcend

professionalism and advanced practice have impact on the patient care and

service delivery.



MDRC 2019: Plenary speakers

Plenary 1: Digital Imaging

in Ministry of Health Hospitals: Invaluable

Experience

Mr. Hj. Daud Ismail

Senior Radiographer (Diagnostic)

Plenary 2: Working

Together Better Together: Radiologists and

Radiographers

Dr. Sarawana Chelwan

Muniandy

Senior Radiologist, Hospital Kuala Lumpur

Plenary 3: Research and

Innovation in Medical Imaging

Assoc. Professor Dr. Hairil Rashmizal Abdul Razak

Senior Lecturer

Faculty of Medicine and Health Sciences,

Universiti Putra Malaysia

Plenary 4: Beyond

Radiography, How Far Can Radiographer Go?

Mr. Mahenthiran Thanapal

Chief Operating Officer Prince Court Medical Centre

Plenary 5: Allied Health

Professions Act 2016 (Act 774)

Mr. Saravanakumar Maniam

Principal Assistant Director, Allied Health Division,

Ministry of Health Malaysia

Plenary 6: Malaysian

Society of Radiographers: Past, Present & Future

Mr. Sawal Bin Marsait

President, Malaysian Society of

Radiographers



MDRC 2019: The Abstracts

MDRC 2019-D01

To evaluate if breast size and composition contribute to pain

among our mammogram patients.

Muhamad, N.

Hospital Melaka, Melaka, Malaysia

Abstract Compression in mammography is crucial for image quality and to

reduce patient dose. This study aimed to evaluate the pain score

among mammographic patients in Hospital Melaka in relations with breast size and breast composition. Prospective study was done in May

2016 involving all patients came for screening and diagnostic mammogram in Hospital Melaka. The study was excluded mastectomy

patients and incomplete questionnaire. 91 patients aged from 39 to 80

came for mammography examinations were included in the study. Patients’ demographic and breast size information was obtained from

self- reported questionnaire. Whilst compression thickness and breast composition (density) were completed by mammographer. Visual

analog scale (VAS) was used to assess the pain score after mammogram. The data was analyzed statistically for correlation

between pain with breast size and composition. Only 3.3% of the

patients reported no pain at all during mammogram examination, whilst 83.5% experienced mild to moderate pain and the rest 13.2%

experienced mammogram examination as moderate to severe pain. However, there was no significant correlation between pain score and

patients’ breast size which is proved by p- value (0.163) more than

level of significant value (0.005). There was also no significant correlation between pain score and patients’ breast composition as p-

value (0.008). We observed that pain in mammogram is not related with both breast size and composition. By understanding the factors

contributing to breast pain in mammogram will improve patients’

satisfaction thus increase compliance among the patients for attending the examination in the future.



MDRC 2019-D02

Effective dose assessment of adult patients undergoes CT TAP using CT EXPO version 2.2

Hipni. M. Radiology Department, Hospital Umum Sarawak Abstract

Many studies have been done on Effective dose assessment and effects of the radiation to the human especially consideration on cancer risk.

For this reason, this study aims to compare the effective dose in adults’

patient undergoing for CT Thorax Abdomen and Pelvis examination using Siemens Somatom sensation 64 slices in Sarawak General

Hospital. The result will be compared to ICRP 103 standard. The effective dose was measured using the CT-EXPO v 2.2 (E) which

computer program based on the Monte Carlo method which

automatically calculated the effective dose and the mean dose HT per series of organs or tissues involved. The samples were taken for 50

adult patients which undergoing routine CT Thorax Abdomen and Pelvis in Sarawak General Hospital which is consists of 25 male patients and

25 female patients. The collected data was analyzed using SPSS version 23. The survey successfully sampled which consists of 50 adults’

patients undergo for routine CT Thorax Abdomen and Pelvis in Sarawak

General Hospital using Siemens Somatom Sensation 64 slices. The effective dose of adult patients for routine CT Abdomen was analyzed

by one sample T-Test which gathered that the mean value of effective dose is 13.21. The Paired Sample T Test was using to compare the

mean HT dose per series of the tissues or organs. The independent T

Test is using to analyze the assessment of the mean HT dose per series for tissues or organs. This study showed that the value of effective

dose is still acceptable refers to the ICRP 103 standard. The effective dose can be decreased if the attentions and practice to the

modifications of the seven user-controlled factors such as kV, effective

mAs, pitch factor, mAs, Collimation, Slice Width and Reconstruction Kernel used in scanning protocol. Besides that, scanner-inherent factors

and patients factors also need to be considered to optimal the quality of CT images and dose reduction technique. In future trend for

modification of scanning protocol in routine CT Thorax Abdomen and Pelvis can obtain the decrease results in effective dose and this is not

limit only for the Thorax Abdomen and Pelvis scanning but can apply to

the entire region of body scanning. The benefits from this study also can be applied to the modifications in pediatrics scanning protocol.



MDRC 2019-D03

Optimization of dose and image quality for computed radiography and digital radiography for chest, abdomen and

lumbar sacral in Pahang

Shazli, Z.A.1, S-F Moey2

1 Department of Radiology, Sultan Haji Ahmad Shah Hospital, Temerloh, Pahang, Malaysia. 2 Department of Diagnostic Imaging and Radiotherapy, Kulliyyah (Faculty) of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Pahang, Malaysia

Abstract

Optimization of dose in radiographic examinations is essential since the utilization of x-radiation have a related induced cancer risk. Thus, this

study was conducted with the aim to provide guidance to the

radiographers in ensuring best practises in producing radiographs with acceptable image quality whilst minimizing radiation dose. The study

comprised of three phases (pre, experimental and post-optimization phase). The first phase involved 90 respondents aged between 20 to

60 years and weighed between 60-80 kilograms that underwent abdomen, lumbar sacral and chest examinations. DAP meter and

CALDose_X 5.0 were utilized to estimate effective dose. The second

phase (experimental study) were utilized an anthropomorphic phantom and Leeds test object to compare image quality. Variation of technical

parameters was utilized to find the best parameters to be adapted to patient AP thickness in the post-optimization study. In the optimization

study, similar respondent’s characteristics were used as the pre-

optimization study but utilizing the best technical parameter from the experimental phase with the lowest ESD and acceptable image quality.

The image quality for pre and post-optimization were assessed by two radiologists. Inferential statistics indicated there were significant

differences (p<0.05) between image quality and radiation dose for

chest in HOSHAS and HTAA in the pre-optimization study. Wilcoxon signed-rank test reflected that there were significant differences in

image quality for pre and post-optimization study. The study also indicated that the ESD received by the patient for post-optimization

study to be lower than all published data and by radiation regulatory bodies.



MDRC 2019-D04

Assessment of the necessity to combine head and cervical spine computed tomography (ct) for patient with blunt trauma

injury in Hospital Sultanah Nur Zahirah (HSNZ)

Azmi, M.N.1; J John2 1Hospital Sultanah Nur Zahirah, Kuala Terengganu; 2Ministry of Health

Training Institution, Sungai Buloh

Abstract

Automatic combined scan may lead to increase the harmful radiation to adult patient which also increase the risk of cancer. The purpose of this

study was to assess the practice patterns and diagnostic evaluation of combining order of the head and cervical spine computed tomography

and decrease unnecessary CT scans to the patients with blunt trauma. We conducted this retrospective study of adult patients who underwent

for combined CT brain and cervical spine from 1 July until 31 December

2018. The radiologist’s report on CT scans and plain radiograph were reviewed to record the pattern of injuries. Clinical criteria in the valid

guidelines also have been assessed using an emergency trauma clerking sheet. Of the 3643 patients, 221 cases of combined order were

retrospectively analyzed. Cranial injury was found in 135 cases. Injury

of the cervical spine was diagnosed in 37 cases. The combined injuries were found in 25 cases. However, there is no association of injuries

between head to the cervical spine region. CT scan is valuable in patients who have major and moderate blunt injuries. However, for the

patient with minor blunt injury, clinical assessment and plain radiography may suffice. Our findings suggest that the current practice

of simultaneous paired head and cervical spine CT scan is not

necessary. To preserve unnecessary scan, valid guidelines are strongly needed to clinically detect patient that need a CT scan. Therefore, the

physician needs to request order efficiently based on the guidelines without missing important injuries.



MDRC 2019-D05

Radiation dose between dual x-ray absorptiometry (DXA) and quantitative computerized tomography (QCT) scanning in

osteoporosis: a phantom study.

Ghazali, Y. 1,2 and M. Z. Adenan 1 1 Fakulti Sains Kesihatan,Universiti Teknologi MARA (UiTM), Puncak Alam, 42300 Kuala Selangor, Selangor. 2 Jabatan Radiologi, Hospital Pulau Pinang

Abstract Bone mineral density (BMD) is one of the established tests to diagnose

osteoporosis patient by measuring the bone density at various skeletal

sites and enable a prediction of individual risk fracture. The two methods of non-invasive BMD assessment most widely used are Dual

Energy X-ray Absorptiometry (DXA) and Quantitative Computerized Tomography (QCT). Spine phantom, Hologic DXA Quality Control

Phantom was exposed in the DXA room from the beginning till

completion the scan with fixed parameters 100kVp and 245mAs.This step was repeated in CT scan room by using similar spine phantom

with fixed kVp and mAs. Dose was measured by using Kerma Xplus dosimeter. Data collected was analysed by using Statistical Package of

Social Science (SPSS) software version 23 for descriptive analysis and measures of differences. Effective dose of DXA was very small and safe

for patient undergo DXA scanner. It is about 0.027-0.031mSv if

compared to the natural background radiation with one to two days of exposing. For QCT, the effective dose is between 0.273-0.283mSv and

it is considered high for BMD test among osteoporosis patient. Radiation doses associated with DXA are very low. QCT techniques

deliver doses to spine phantom was 10 times higher compared with

DXA. Low-dose modalities are needed to reduce unnecessary radiation exposure and minimize associated health risks.



MDRC 2019-D06

Knowledge and awareness on screening mammography in the early detection breast cancer amongst staff nurses at Tengku

Ampuan Rahimah Hospital (HTAR), Klang

Kamal, W. H. W. M1, K. Vijayalakshmi1, P. T. Rajendran1, P. S. A.

Mawardi2

1 Jabatan Radiologi, Hospital Tengku Ampuan Rahimah,Jalan Langat, 41200 Klang, Selangor, Malaysia. 2 Kolej Sains Kesihatan Bersekutu Johor Bahru, Lot8173, Persiaran Kempas Bar,81200 Johor Bahru, Johor, Malaysia Abstract

The awareness and knowledge of cancer on seriousness, screening, and early detection can reduce the risk of cancer related death. We aim

to determine the knowledge and awareness on screening mammogram

among registered staff nurses in the early detection of the breast cancer, breast screening by mammogram, and the information source

obtain related the breast cancer and breast screening. Therefore, health information and communication on breast cancer screening and

awareness should be intensified to reach the nurses especially at Klang Hospital, (HTAR). Total of 100 participants registered staff nurses

selected randomly amongst the registered staff nurses in HTAR.

Questionnaires were distributed to the respondents. These questions were close-ended. Data collection started from October 2015 until

December 2015. The data was collected using a questionnaire which was developed based on various aspects of breast cancer such as

purpose of screening mammography, early detection and their source

of information about screening mammogram. Descriptive analysis was performed to acquire the frequency of the variables in this study. The

SPSS (statistical package for the social sciences) version 23.0 program was used for data compilation and statistical analysis. The accepted

level of significant was set 0.00 (p<0.05). For the inferential analysis,

the Chi-Square test was used to test the knowledge and awareness by age, race, marital status, years of services and family history. In this

study, we found high knowledge and awareness on screening mammography in the early detection of the breast cancer amongst

staff nurses at HTAR, Klang. Female health workers, as a member of the health care team, play an important role to create public awareness

on breast cancer and educate the masses on screening mammography.

The ultimate goal of screening mammography is to detect breast cancer at an early stage to reduce the mortality rate.



MDRC 2019-D07

Age estimation of adults: Cranial suture method by using 3D computed tomography of the head.

Zakariah, M.A. & M. Z. Adnan Centre of Medical Imaging Study, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor Branch, Puncak Alam Campus 42300 Bandar Puncak Alam, Selangor, Malaysia Abstract

This study is hoped to establish a determination of age based on

eсtocranial vault and eсtocranial lateral‑anterior suture closure that can be used in forensic cases to estimate age at death for unidentified

bodies.A retrospective study of age estimation of adults based on 3D CT head images using cranial suture closure method. Observations of

the eсtocranial cranial suture from 3D CT head images to give a score

for each location of eсtocranial suture one until ten․ The composite score from each location of eсtocranial suture were divided into two․

Composite score eсtocranial vault suture closure (CSV) were the total score of eсtocranial suture one until seven while composite score

eсtocranial lateral‑anterior suture closure (CSLA) were the total score of eсtocranial suture six until ten. There was strong correlation between

age and suture closure in which r=0․68, n=100, p=0․00 for CSV and

r=0․74, n=100, p=0․00 for CSLA․ The result shows that there was no significance difference in the CSV for female (M=14․5, SD=2․7) and

male (M=14․9, SD=1․9) conditions; t (98)= ‑0․91, p=0․36, while there was also no significance difference in the CSLA for female (M=11․8,

SD=1․9) and male (M=12․0, SD=1․6) conditions; t (98) = ‑0․57,

p=0․57․ There was no significant effect of different types of skulls on CSV at the p<0․05 level for the three conditions [F (2, 97) =0․64, p=0.

53], while there was no significant effect of different types of skulls on CSV at the p<0. 05 level for the three conditions [F (2, 97) =0․28,

p=0․76]. Suture closure can provide estimation of age in adult․

However, the age estimation was given in a wide age range. It is recommended to use this method in conjunction with other age

indicator for the better result․



MDRC 2019-D08

Effective dose: comparison between multi-slice computed tomography and biplane angiography on coronary angiogram.

Sha’rani, M. A. Jabatan Radiologi, Hospital Sultanah Aminah, Johor Baharu

Abstract Cardiovascular Diseases are trending worldwide causing concerns due to their high incidence especially coronary artery disease. Coronary angiography is remaining as the gold standard for diagnosis of coronary artery disease meanwhile advances in Multi Slice Computed Tomography (MSCT) technology resulted in a continuous quality improvement of noninvasive methods to detect CAD. However, there are many arguments regarding the radiation dose exposed by medical personnel and patients from these both modalities. A cross sectional study design selected, retrospective data was collected at Hospital Sultanah Aminah JB within two (2) months from May 2019 until June 2019 for patient that underwent coronary angiogram procedure for both modalities. Sample size calculation method by Krejcie & Morgan (1970) are used to determine the sample size. Total of 160 patient dose were collected in this study. Both techniques produce different doses of radiation to the patient. Previously, the amount of dose recorded was not shown in general. The estimation of effective dose is calculated by using standard reference value that are provided by International Committee Radiological Protection. The purpose of this study was to evaluate effective exposures (ED) recorded to patients

using Multi Slice Computer Tomography (MSCT) and Biplane Angiography (BA) and to see the association between ED and demographic factors in coronary angiogram. In this study,320 patients were participated and the data showed that 160 (50%) patients from MSCT and 160 (50%) patients from BA. Malay patients are 113 (35.16%), Chinese 103 (32.34%) and India 104 (32.5%). Comparisons between MSCT mean ED 6.88 mSv ± 1.48, for BA, mean ED 4.13 mSv ± 0.35. For MSCT male patients mean 4.52 ± 2.32, female patients mean 8.21 ± 0.85. While mean BA for male patients was 3.92 ± 0.48 and female was 5.81 ± 0.51. Mean BMI for normal for MSCT and BA is 7.98 ± 0.91 and 5.58 ± 0.45. While the mean BMI for overweight for MSCT and BA is 9.53 ± 0.53 and 6.06 ± 0.34. For BMI obesity for MSCT and BA is 9.97 ± 6.49 and 6.78 ± 0.32. Pearson coefficient test, r is 0.908 for MSCT and 0.734 for BA is a strong positive relationship and this value is significant (p <0.00). This r value

indicates a strong and significant positive relationship between BMI and ED r = 0.908 n = 320, p <0.00 and r = 0.734 n = 320, p <0.00. This study showed that the amount of dose resulting from using MSCT for coronary artery screening contributes more exposure effective to patients compare to BA. In addition, the selection of parameters, protocols, techniques, and operator skills play a major role in reducing dose to patients and health care workers.



MDRC 2019-D09

Routine magnetic resonance (MR) rectal vs MR defecogram

Zarina, M. A., S. Menaga, Z. Aniza

Hospital Tuanku Ja’afar, Seremban, Malaysia

Abstract Magnetic resonance rectal demonstrates the clearest images of the

tissues around the rectum, for identifying the extent of any disease. It makes very accurate images of diseases involving the rectum, which is

the lower part of the large bowel, near the anus. MRI scan of the

rectum is generally performed if other tests have detected a problem such as the presence of a cancer or other neoplasm. Meanwhile,

magnetic resonance defecography is a special type of MR imaging, where images are obtained at various stages of defecation. It produces

detailed images during a bowel movement and provides information

about the structure and function of the rectum and the pelvic floor, a network of muscles that stretches between the pubic bone and spine

and the abdominal organs it supports. For MR rectal, the patient is placed in the supine position with the knee elevated and intravenous

contrast is given if necessary during the scan. For MR defecography, sonographic gel is introduced into the rectum while patient lies in the

lateral decubitus position and patient’s cooperation is a major factor to

achieve excellent images. Explanation to patient during the preparatory phase is important, since defecating in the supine position could be

difficult for some patients. In MR rectal visualization of tumour extension can be determined. In MR defecography, visualization of

bowel movement in relation to pelvic floor during defecation will be

demonstrated. MR rectal should be used to analyse structural abnormalities, while dynamic images should be used to analyse

functional abnormalities.



MDRC 2019-D10

Diagnostic accuracy of Lung Cancer Screening Programme with Low Dose CT scan and Dual Energy Chest X-Ray at

Institut Kanser Negara: A Preliminary Finding.

Ramli, Z., N. A Rahim, Z. A Hamid, N. A Ngah, S.N M Mustafa1

Department of Radiology, Institut Kanser Negara, Jalan P9, Presint 7, 62250 Putrajaya, Wilayah Persekutuan Putrajaya , Malaysia.

Abstract

The exceptionally high smoking prevalence in Malaysia compelled us to

initiate an early lung cancer screening programme with low dose CT scan (LDCT). Malaysia is a largely public funded healthcare system,

hence more affordable screening tool using Dual Energy Chest X-ray (DEX) can be a reasonable alternative to screen lung cancer in the

community. This study aimed to determine the diagnostic accuracy of

DEX in detecting lung nodules. The aim of this study is to evaluate effective dose received by participants from Lung Cancer Screening

program in Institut Kanser Negara (IKN), Putrajaya. Subjects were recruited from the general population, mostly through posters and

flyers distributed to public spaces. Retrospective study was performed where all scanning acquisition protocols and dose information from

forty (40) participants were recorded and investigated. The screening

process involves two types of imaging technique, the Dual Energy Subtraction (DES) Chest X-ray and Low-Dose Computed Tomography

(LDCT) imaging technique. It was observed that the mean (±SD) value for DES (at 60 kV), DES (at 120 kV) and MSCT examinations were

0.006 ± 0.005 mSv, 0.018 ± 0.005 mSv and 1.558 ± 0.129 mSv,

respectively. In a whole, the total cumulative ED values for participants were ranged from 1.376 mSv to 1.986 mSv. Preliminary results suggest

that LDCT and DEX finding may be dependent on reader experience. It was summarized that both optimized techniques were useful for

screening needs and the ED value from this study were lower when

compared to other established reference.



MDRC 2019-D11

Image quality and radiation exposure of HRCT thorax with low dose technique: phantom study

Azmardi, M. A. University Teknologi Mara, Kuala Lumpur, Malaysia Sentosa Medical Center, Kuala Lumpur, Malaysia

Jabatan Radiologi, Hospital Sultanah Bahiyah, Alor Setar

Abstract

Since the introduction of the CT scan, it contributes high percentage of the accumulated dose in diagnostic imaging field. This trend is worried

as the effect of radiarion can’t be precisely estimate. The aim in this experimental study is to reduce the dose by decreasing kVp while attain

the minimum requirement of image quality. The attempt to replace the

current protocol need to be good evidence and objectively superior. The reduction in dose will benefit the patient and reduce the stochastic

effect. Phantom PBH-50 been scanned in 140kVp, 120kVp, 100kVp and 80kVp. The images been evaluated by the radiologist using the Visual

Grading Characteristic. The 120kVp and 100kVp pass all the minimum criteria in all 4 aspect of image quality. Even the dose reduction in

80kVp more than 80%, the total mean score for VGC method is less

than 12 which indicate that the image is not passing the minimum requirement for HRCT thorax image criteria. It can be concluded that

the 100kVp and 120kVp is recommended for the new reduction technique with 30% lower dose as compared to the standard protocol

(140kVp). This trend of reduction will benefit the patient and lower the

risk of the stochastic effect. Even the effect is considerably small as compared to the risk in deterministic effect, radiation need to be as low

as reasonable as been promoted by the ICRP.



MDRC 2019-D12

Awareness of radiation protection safety among patients waiting for radiology examination in Hospital Putrajaya.

Mustafa, M. A. Radiology Department, Hospital Putrajaya

Abstract

Aims of the study are to determine what level of patients’ awareness towards medical imaging, did clients receive enough information about

the radiation safety of radiological examination, and how far public

awareness towards radiation safety. A cross sectional survey was carried out of 428 patients in the Radiology Department Hospital

Putrajaya. A questionnaire which tested patients’ information about radiation, harmful effects and protection. A true sample size calculated

for this stated was 338, but only 300 questionnaires fully answered by

participant and the rest are dropout. The data will be captured using Microsoft excel 2010 and transferred to SPSS V 17.0 for data analysis.

The majority of the participant is from between age 21 years old to 35 years old (34%) and many of them finished secondary school (54.7%).

Most of them think that radiation might be harmful (76%), and they need an explanation before the procedure (100%). Moreover, they

want to know about any side effect of the procedure (83.3%). Due to

that, they believe that, pelvic area is the most sensitive area that need to be covered (71.3%) and ultrasound is the most safety procedures

for pregnant woman (99.3%). Education is the most important factor to raise awareness among patients about ionizing radiation and its

harmful effects.



MDRC 2019-D13

Diagnostic accuracy of 128-MDCT angiography for evaluating cerebral aneurysm using digital subtraction angiography (DSA)

as the standard of reference.

Alam, M. M, Z.1, L. K. Wee2, F. M. Sani3

1 University of Malaya Medical Centre, Kuala Lumpur, Malaysia 2 University of Malaya, Kuala Lumpur, Malaysia Abstract

To investigate diagnostic accuracy of 128 MDCTA of brain in detecting

cerebral aneurysm compare to DSA of cerebral that had been a gold standard in diagnose the aneurysm. This study also to find out the

percentage of aneurysms size below 4mm that are detected in both examinations in related to diagnose cerebral aneurysm. This is a

retrospective study where data of patient undergone both CTA of brain

and DSA of cerebral are collected. The data such as aneurysm size and location are analyzed from the report in both examinations. Data from

May 2015 until March 2016 are collected. The data is descriptive and inferential statistic acquired. The data are contributed in True Positive

(TP), True Negative (TN), False Negative (FN) and False Positive (FP). The positive predictive value (PPV) = 0.96 and negative predictive

value (NPV) = 0.3. The sensitivity results is 82% and it identified the

ability of MDCTA to detect aneurysms. The specificity result is 75%. Diagnostic accuracy of the study is 81%, and the significant results

prove the accuracy of MDCTA. A 128-MDCTA is an accurate imaging modality for detection and visualize cerebral aneurysm in range 3-4mm

and above. CT scan remind have limitation in specificity to choose as

primary imaging tool in diagnose cerebral aneurysms especially for aneurysm size less than 2mm.



MDRC 2019-D14

Innovation culture in radiation protection at Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia

Nordin, M. N. M. Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan Malaysia

Abstract

Culture on inventing radiation protection device at Radiology Department, Hospital Canselor Tuanku Mukhriz, Universiti Kebangsaan

Malaysia has started since 2004. It is started when the department

relies that radiation protection area has a lot of potential to be discover. The culture has also raised by the limitation and costly radiation

protection device in the market. A group of staff consist of 10 team members with multidisciplinary background are establish to look at

department problems. The group uses QC story technique in order to

solve department problems. A facilitator are assign to guide and assist the group to solve the problem in 6 to 8 month period. The group are

using brainstorming techniques to find the most critical problem to solve. Benchmarking and target settings has been set before a

problem-solving technique are used to solve the problem. Since 2004, 13 innovation projects has successfully completed by the department.

All target settings that has been set for all the projects has been

archive. The project that has been done by the group has been recognized by several specialist and organization. Innovation product

has also won several awards at national and international team excellence and innovation convention. In order to maintain the culture

in innovation at the organization, the management has use the 2R

concept (recognition and rewards). Innovating radiation protection device will help organization to save money. Innovation culture has

make the Radiology Department more productive and has create a healthy working environment.



MDRC 2019-D15

Observation study on usage of coils and stent for aneurysm embolization under interventional radiology guided

Halim, S. A. A., S. Sani, N. H. M.Azmi, and L. J. Him. Angiography Unit, Department of Radiology, Hospital Kuala Lumpur.

Abstract

To identify use of coils and stent during Angiography procedure for Aneurysm embolization. A sample of 33 cases (n=33) was collected

from January to June 2019. This is a retrospective study done in

Angiography Unit HKL. The data was collected from the system that emerge from the machine Shimadzu Crossover Angiography System

Trinas B12 and registration book. The data gathered in few categories that is Kerma Air Product (mGy.m2), total treatment cost (RM) and

lastly the amount of media contrast used (mL). The result is tabulated

based on procedure done either by using coil or stent. The number of sample, KAP, RM and amount of contrast during treatment procedure

performed by Coiling (n=12, 3. 9mGy.m2-34mGy.m2, 2-8 coils, 40mL-200mL) and stenting (n=11, 4. 2mGy.m2-3. 28mGy.m2, 1-2 stents,

50mL-300mL) respectively. There is 54% (n=18/33) of treatment procedure exceed the Malaysian Standard Dose Reference Level for

Cerebral angiography (8. 7mGy.m2). The total amount of expanses by

using coils is (RM8,100-RM41,200) cheaper than stents (RM30,000-RM70,821). The treatment by using coils or stent will depend on type

of aneurysm.



MDRC 2019-D16

Contribute to hospital infection; is it from dirty X-Ray cassette?

Karim, K., S. R. Hussin, Tasnim M., Norhazwani MY., M. Yusri MY., Azmir A.,

Radiology Department, HRPZ II, Kota Bharu, Kelantan.

Abstract

An X-Ray cassette is used to capture image during radiography examination. During examination the cassette is in direct contact with

the body of the patient. Because of this, it is easily contaminated with

body fluid such as sweat, blood, pus, sputum, saliva, mucus or remnants of Plastic of Paris (PoP). The situation becomes more critical

when performing an X-Ray examination in high-risk patients such as Carbapenem-resistant Enterobacteriaceae (CRE), Severe Acute

Respiratory Syndrome (SARS) and Influenza-like illness (ILI) which

increase the risk of cross-infection. The used X-ray cassette is usually cleaned manually using soap. No proper testing of hygiene status of

the cleansed cassette done. There is no standard operating procedures and poor awareness on the importance of clean or hygienic X-ray

cassette.CR Cleaner is a tool designed to ensure the surface of the cassette is clean entirely using disinfectant fluid. Cleanliness status of

cassette: 10 unit of used X-ray cassette are random selected. Surface

swabbing was done before and after cleaning done using a CR Cleaner. Swab sent to laboratory for culture and sensitivity study. The lab result

showed 9 out of 10 X-ray cassettes or 90% shows no growth of microorganism such as Acinetobacter sp and Enterobacter bacteria sp

which are capable of causing infection.CR Cleaner improve the hygiene

of X-Ray cassette when used routinely. Besides reducing risk of nosocomial infections, CR Cleaner also increase the efficiency of work

processes, save time, money and increase production.



MDRC 2019-C01

Occupational stress level among the diagnostic radiographers in Johor, Malaysia.

Arumugam, V.

Hospital Sultanah Aminah, Johor Baharu, Malaysia Abstract

Occupational stress has negative effects on both the organization and individuals employed by the organization. In the organization it can

result in high levels of absenteeism, reduced productivity and

compromised levels of patient care. Moreover, individuals affected by stress may suffer from raised levels of tension, mental fatigue,

insufficient sleep, anxiety, and anger. 300 radiographers were randomly chosen. Cross sectional survey using a validated questionnaire with

open ended question was utilized. Respondents were asked to answer

60 closed ended and four open ended questions. This research was carried by distributing the questionnaire. A total of 60 radiographers

were chosen for this research. Open-ended questions were analyzed using thematic analysis. Quantitative data was analyzed using the

Statistical Package for Social Sciences (SPSS) version 21.0. The significant causes of stress and the activities which help to minimize the

stress were found out from the results. Out of the radiographers, (6%)

were in low stress level, (77%) in moderate stress level, and (17%) were in high stress level. Some of the factors which showed significant

association with stress were high work load (25%), faulty equipment (20%), staff shortage (40%). In addition, long and strenuous shifts as

well as training of students were also found to be stressors. About 77%

of radiographers in Johor Bahru district were experiencing moderate level of stress. 17% of radiographers were in high level of stress and

6% were under low level of stress. Gender, marital status and age of the radiographers in this study did not show any significant association

to the stress level. Common factors that influenced the stress were

staff shortage, high work load, faulty equipment, strenuous shift, training the students, re-source inadequacy and administrative

pressures.



MDRC 2019-C02

A preliminary study on opportunistic quantification of bone mineral density using CT thorax for osteoporosis screening:

relationship between Hounsfield unit and dual x-ray energy

absorptiometry (DEXA) values.

Amin, M. F. M.1,2, W. M. W. Zakaria3,& N. Yahya1

1 Universiti Kebangsaan Malaysia Fakulti Sains Kesihatan Kampus Kuala Lumpur, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2Jabatan Radiologi, Hospital Tengku Ampuan Rahimah, Jalan Langat, 41200 Klang, Selangor, Malaysia. 3Jabatan Radiologi, Hospital Putrajaya, Jalan P9, Presint 7, 62250 Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia.

Abstract

Computed tomography (CT) for other diagnoses has the potential to be used as a tool for early detection of the bone density changes with no

additional procedure and radiation dose. We hypothesize that vertebral bone density as measured in Hounsfield Unit (HU) by CT is correlated

to t-score derived Dual Energy X-ray Absorptiometry (DEXA). In this preliminary study we aim to quantify the relationship between HUs

derived from thoracic body to DEXA’s t-score. Data were obtained

retrospectively for patients who underwent both CT thorax and DEXA in the year 2016 in Hospital Putrajaya. The duration for both studies must

not exceed one year to ensure comparability. From the image CT thorax, plot region of interest (ROI) to measure HU for thoracic body

T7 at three level, top, mid and bottom from which averages were

calculated. Correlations were calculated between HU value and t score using Pearson’s correlation. A total of 29 patients met the criteria.

There is a significant strong positive correlation between t-score and HU (r=0.878, p<0.01). Mean level of HU of less than 95 may indicate

osteoporosis and HU between 95-145 may indicate osteopenia. There is

good correlation of HU at T7 vertebral body and t-score at lumbar. We target to increase the number of sample and expand to other bones.



MDRC 2019-C03

The correlation of the measurements of liver SUV and SUL in contrast and non-contrast enhanced PET/CT 18F–FDG studies.

Azmi, N. H. M.1, F. F. A. Saad2,3, N. M. Noor3, S. Suppiah2,3 1 Hospital Kuala Lumpur, Kuala Lumpur, Ministry of Health Malaysia, Malaysia 2 Centre for Diagnostic Nuclear Imaging, UPM, Malaysia 3 Department of Imaging, Faculty of Medicine and Health Sciences, UPM, Malaysia

Abstract

Purpose: To measure the correlation between the measurements of Standard Uptake Value (SUV) and Standard Uptake Value Normalised

by Lean Body Mass (SUL) using the liver as a reference organ in

contrast and non-contrast enhanced PET/CT 18F–FDG Studies. Materials and methods: 453 images of PET/CT scans were analyzed

(272 were contrast enhanced scans and 181 were non-contrast enhanced scans). A volume of interest (VOI) of 30mm in diameter was

placed in the right liver lobe to measure the parameters. An analysis was performed with scatter plots, ANOVA and Pearson’s correlation.

Results and discussion: There was a significant positive correlation of

SUV, in both contrast and non-contrast enhanced scans, with BMI (P<0.001). Contrarily, there was no significant difference between SUL

and BMI (p>0.05) in both categories. Nevertheless when subgroup analysis was performed using one-way ANOVA, there was a significant

difference of SUL values among the three BMI groups. Other

independent variables that significantly influenced SUV included age (p=0.01), weight (p<0.001) as well as injected radioactivity dose and

uptake period (p<0.001). SUL was noted to be dependent on age, blood glucose level, the injected dose and uptake period in non-

contrast enhanced scans. Conclusion: SUL is reliable tool and more

consistent measurement compared to SUV in quantitative measurement for contrast-enhanced 18F–FDG PET/CT study. SUL will serve a better

surrogate marker for good measurement reproducibility, however caution needs to be exercised when interpreting in patients with

extremes of BMI range.



MDRC 2019-C04

Evaluation of practice and knowledge on nosocomial infection

among radiographer in Sabah Women and Children Hospital

(SWACH)

Azman, A.

Sabah Women and Children Hospital, Kota Kinabalu, Malaysia

Abstract

This study’s purpose is to evaluate the radiographers’ practices and knowledge on nosocomial infections in the radiology department of

Sabah women & children hospital (SWACH). The evaluation of the practice and knowledge of nosocomial infections will help the

radiographers to ascertain their level of knowledge and practices on nosocomial infections. Besides that, this study can also help the

infection control member in the Imaging Department that runs this

course to prepare future radiographer information. This study is a cross- sectional study of the radiographers’ knowledge level and

practices on nosocomial infections in the radiology department.

MDRC 2019-C05

Change in health behaviors among cancer surviving individual

in follow up mammogram.

Jaymess, C. L.

Hospital Wanita Dan Kanak Kanak Sabah, Kota Kinabalu, Sabah

Abstract

In increasing of cancer survivor’s population, the important of health status and quality of life of cancer survivors becomes even more

crucial. Statistically one in five women will be diagnosed with breast cancer on their lifetime. For example, of the 559 650 cancer deaths in

2006, approximately one third were attributable to tobacco use, and

additional one third attributable to poor diet, physical inactivity and obesity. Therefore, the purpose of this study is to compare the previous

and current health behaviors (before diagnosed as cancer) among cancers surviving individual in follow up mammography. It is also to

evaluate a healthy lifestyle and prevent recurrence in screening mammography for young cancer survivor, by the experience of the

cancer survivors. The objectives of this research study have been met

as they have been outlined. The current health behaviors of respondents changed to be healthier and improve their quality of life,

and they went for their routine mammogram and their outcome were BIRADS I and BIRADS II ACR Classification. There is no evidence of

recurrence in about two to five years after detected as breast cancer.



MDRC 2019-C06

Diagnostic performance of triple-phase computed tomography

in the evaluation of hepatocellular carcinoma.

Tarmizi, N. H. M.1, M. H. Mahmud1, F. S. Shafiee2

1 Centre of Medical Imaging, Faculty of Health Sciences, Universiti Teknologi MARA Selangor Puncak Alam Campus, Bandar Puncak Alam, Selangor, Malaysia 2 Department of Diagnostic Imaging, Hospital Selayang, Selayang, Selangor, Malaysia Abstract

The study aims to evaluate the diagnostic performance of triple- phase CT imaging of liver for the evaluation of hepatocellular carcinoma

(HCC) patients with cirrhosis and/or chronic liver disease. 39

radiological reports of patient who had undergone triple- phase contrast-enhanced CT liver study for suspected/known HCC from

January 2016 to December 2018 were reviewed. The findings were validated with serum alpha-fetoprotein (AFP) levels concentration to

confirm the malignancy of the HCC. The sensitivity, specificity,

likelihood ratios, predictive values and diagnostic accuracy of the triple-phase CT were determined using ROC curve analysis. The HU cut-off

value in triple-phase CT was further estimated for discrimination between benign (non-HCC nodule) and malignant (HCC nodule) hepatic

lesion. Positive results of 20 HCC lesions and negative results of 19 non-HCC lesions were observed. Triple-phase CT imaging has a

sensitivity and specificity of 85% and 94.7% (p <0.001), respectively

with 94.4% PPV and 85.7% NPV with the overall diagnostic accuracy of 89.7%. The cut-off values of 43 HU at arterial phase, 50.5 HU at portal

venous phase and 46 HU at delayed phase were proposed for discrimination between benign (non-HCC nodule) and malignant (HCC

nodule) hepatic lesion. Triple-phase CT with high accuracy is helpful for

the evaluation of hepatocellular carcinoma. It has indispensable role in characterizing and differentiating benign and malignant hepatic lesion,

hence this protocol could further improve the clinical management of patients with cirrhosis and/or chronic liver disease.



MDRC 2019 C-07

The efficiency of sclerotherapy in the treatment of craniofacial

vascular malformations for pediatric patients

Ishak, M. K.1,G. R. J. Durai2,Rahimah H3

1 Interventional Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia 2 Radiology Department, Women and Child Hospital Kuala Lumpur, Kuala Lumpur Malaysia Abstract Vascular malformations are a vast group of congenital malformations

that are present at birth. These malformations can cause pain, pressure, and cosmetic annoyance as well as downturn growth and

development in a child in the case of high flow. Sclerotherapy has

become an important tool in the treatment of vascular malformations. However, little is known about the success rate of the sclerotherapy. In

this study, the efficiency of sclerotherapy in the treatment of vascular anomalies was investigated retrospectively in 116 pediatric patients

treated in Hospital Kuala Lumpur between 2017 and 2019 in the mean age of 7 to 16 years old. Sodium Tetradecyl Sulphate (STS) is used as

sclerosants agent and Lipiodol is used as contrast agent. Out of 116

paediatric patients investigated, 100 patients had Lymphatic malformations and 16 patients were defined having Venous

Malformations. All 116 pediatric patients received adequate help to their symptoms solely from sclerotherapy. Sclerotherapy is an effective

method in the treatment of Vascular Malformations with a satisfactory

clinical response in patient symptoms.



MDRC 2019 C-08

Clinical audit exposure factor for general radiography at

Radiology Unit, Specialist Clinic Ambulatory Care Centre

(SCACC), Hospital Kuala Lumpur

Wahab, F. A., R. Mohd, N. H. M. Azmi and M. Mahmood. Radiology Unit, Department of Radiology, Kuala Lumpur Hospital, Ministry of Health Malaysia Abstract

General radiography in Radiology Unit SCACC is using general radiography unit and Computerized Radiography (CR) for producing x-

ray images. The radiographer performing general radiography will set the exposure factor ie. Combination of kVp and mAs according to

patient’s thickness, tissue composition and pathology. The radiographic

exposure parameters that are set for an examination should be selected with consideration of these variations. Then, the patient will be

exposed to the exposure factor given and images recorded in imaging plate (Photostimulable Storage Phosphors) in CR cassette. CR Cassette

will be insert into image reader and the digital images will be appeared in monitor. The image formation will be process into three steps 1.

Exposure Data Recognizer (EDR), 2. Pattern Recognizer for Irradiated

Exposure Field (PRIEF) and 3. Histogram analysis (“S” value and “L” value). The adjustment of contrast and density can be made within “S”

value and “L” value recommended by the vendor. In order to clarify how this is achieved, the clinical audit was performed. The important of

this clinical audit is to ensure radiography images produce by

Radiographer having diagnostic value. This clinical audit proposed exposure or technique chart based on exposure factor set up by

Radiographer within recommended exposure value referring to standard reading for ST imaging plates suggested by vendor. The 25%

and 15% rules are useful guidelines for exposure adaptation (2).

During clinical audit, the most general radiography images are found within recommended exposure value meaning that the radiographer

has good knowledge on exposure factor using CR system. Next, our recommendation is to continue the clinical audit of exposure factor in

cycle 2 with more data on extremities, spine and skull area.



MDRC 2019 C-09

A clinical audit of optics lens involvement In CT head imaging

for Siemens MSCT scanner In Radiology Department Hospital

Kuala Lumpur

Muhamad, N., F. Fandi, N. N. N. Kamarudin, K. A. Tey Department of Radiology Hospital Kuala Lumpur Abstract

CT Head examinations are the most common cases that have been

done in CT-Scan Unit. Therefore, it is very important for radiographer to follow good standard practice in CT Head examination that can

minimize radiation exposure to the optic lens. The aim of this studies was to minimize of the involvement and resulting radiation of the optic

lens during CT Head examination and want to check whether

radiographers use proper techniques during a CT-scan is carried out. The audit involves a retrospective study of all CT head examination that

have been done in July 2018. There are two radiation reduction strategies that can be done by radiographer such as correct positioning

of patient’s head and angling the gantry machine. One hundred and five patients have been scanned and the images been

analyzed. Only 45% (n=47) from the CT Head cases involve the optic

lens. Apart from it 30 cases involve both lens. The percentage shows high involvement of optic lens in the examination, it’s means the

radiographers not using adequate technique in positioning the patient’s head and angling the gantry machine to avoid optic lens involvement.

Re-audit should be done to overcome this problemin the future.



MDRC 2019 C-10

Reducing the waiting time for general radiograph examinations at Radiology Unit, Specialist Clinic Ambulatory

Care Centre (SCACC), Hospital Kuala Lumpur cycle 2.

Ismail, I., W. N. Amalina W. A. R., S. Afila C. S., Rozali M., F. A.

Wahab, N. H. M. Azmi. and M. Mahmood. Jabatan Radiologi, Hospital Kuala Lumpur

Abstract Waiting time for general radiograph examinations at SCACC Unit is one of the contributing reasons for long waiting time for clients to receive treatment in SCACC Specialist Clinics. In Cycle 1, the remedial action was taken by improving registration system by given number and room division according to examination parts and difficulty. After that, the client’s satisfaction survey was performed and the results tell us that 19% clients have waiting time more than 1 hour and 24% clients have categorized it as long wait. In cycle 2, we continue this study to investigate about new factor contribute in reducing waiting time. Waiting time was defined as time taken from the time clients were registered at registration counter, until clients receive the radiographic films. In Cycle 1, our department clients’ charter stated that the waiting time is within 45 minutes for at least 70%. In Cycle 2, we decided to increase our standard to achieve waiting time is within 45 minutes for at least 80%. Data

from all clients registered for general radiograph examinations, who qualified for the study, were collected using Queue Management System (QMS) during registration. The time patient register in Radiology Department and time the films were dispatched were documented in Radiology Registration System using Microsoft excel. In Cycle 1, the pilot study was performed in February 2017 to assess the problem with optimum achievable target for 70%. Data collection for post remedial study was performed from April to August 2018 (Cycle 1). In Cycle 2, present level of study was using data on August 2018 with increasing the optimum achievable target for 80%. The data was collected from January to June 2018 (Cycle 2). Then, the data collected was analyzed using Microsoft Excel and SPSS. In Cycle 2, the manual registration of patients was replaced by a simple computer program stationed at the reception area. The use of computer system can reduce documentation by collecting information needed for examination and get rid of unnecessary information and duplicate order. This will have the added advantage of simplifying retrieval of patient data when needed. The number of clients who received their radiographic films within 45 minutes improved, thus leading to better clients’ satisfaction and alleviating stress level for staff. The waiting time for performing general radiograph examinations for outpatients had improved by better planning from registration system, arrangement of staff and fast response to damaged equipment. To maintain and further improve the service given to clients in our general radiography Radiology Unit at SCACC.



MDRC 2019: The Acknowledgements

The Malaysian Diagnostic Radiographers Conference 2019 Committee

gratefullty acknowledges contributions from the following to the MDRC 2019 Conference:

SPONSORS



EXHIBITORS

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