The ASEAN Journal of Radiology <p><strong>General Information</strong><br>The ASEAN Journal of Radiology (ASEAN-JR), an official journal of ASEAN association of Radiology (AAR), publishes original articles pertaining to the clinical imaging, therapy, and basic science of the radiology, radiation therapy, medical physics and related educational, socioeconomic and medicolegal issue in ASEAN regions and worldwide. The content of the ASEAN-JR is determined by the Editors.<br><br>ISSN: 0859-144X (Print)<br>ISSN: 2672-9393 (Online)</p> Foundation of Ophan and Rare Lung Disease (FORD) en-US The ASEAN Journal of Radiology 0859-144X <p><span class="fontstyle0"><strong>Disclosure Forms and Copyright Agreements</strong><br></span><span class="fontstyle2">All authors listed on the manuscript must complete both the electronic copyright agreement. (in the case of acceptance)</span></p> From The Editor Wiwatana Tanomkiat, M.D. ##submission.copyrightStatement## 2019-07-28 2019-07-28 20 1 3 3 Appropriateness of Pediatric CT Utilization in Clinical Practice <p><strong>Background: </strong>Justification of imaging investigations is important, particularly in pediatrics underwent investigation using a relatively higher radiation such as CT, due to the higher radiation sensitivity of children.</p> <p><strong>Objective: </strong>To assess the difference of viewpoints between pediatric physicians and pediatric radiologists on the appropriateness of pediatric CT utilization in a tertiary-care university hospital with limited MR capacity.</p> <p><strong>Methods:</strong> Pediatric medical records of head CT, chest CT, and abdominal CT were retrospectively reviewed in consecutive date of the examination until having 100 head CTs and 100 body CTs with complete clinical and imaging information. The physicians and the radiologists were asked to suggest the imaging modality of choice for each patient according to the given data, regardless of the hospital’s limitation. If the suggested modality of choice was not CT, the CT request would be considered as “inappropriate”. They additionally scored the CT appropriateness, firstly using individual judgement, and secondly using the ACR Appropriateness Criteria. Both scoring methods used the same rating scale from 1 to 9; score 1-3 was considered “inappropriate”.</p> <p><strong>Results:</strong> From the viewpoint of the physicians and radiologists, the number of inappropriate CT request was 20% and 54% according to “the modality of choice”, 2.5% and 17% according to “individual judgement”, 12% and 22% according to the “ACR Appropriateness Criteria”. The main difference was not from no indication for imaging but from the selected modality of imaging. The radiologists suggested 52% of head CTs and 64% of abdominal CTs could have been replaced by MRI if available.</p> <p><strong>Conclusion:</strong> There are ten-percent disagreement on appropriateness of pediatric CT request between physicians and the radiologists when using the same guidelines and considering the hospital limitation.</p> Panruethai Trinavarat, M.D. Nisanard Pisuchpen, M.D. Sasitorn Petcharunpaisan, M.D. Darintr Sosothikul, M.D. Jitladda Deerojanawong, M.D. Montida Veeravigrom, M.D. Jiraporn Amornfa, M.D. Paisarn Vejchapipat, M.D. Michael Riccabona, M.D. ##submission.copyrightStatement## 2019-07-28 2019-07-28 20 1 4 17 Barium granuloma in peritoneal cavity and right scrotal sac mimicking a germ cell tumor <p>Colonic perforation after barium enema is rare. We present a case of 6-month-old boy with palpable mass at left sided abdomen and right sided scrotum. Ultrasound and computed tomography (CT) showed calcified masses at Cul de sac and right scrotum with intraperitoneal fat infiltration mimicking germ cell tumor. Preexisting colonic wall injury or trauma and exposed to barium enema procedure can help to correct diagnosis and obviate unnecessary surgery.</p> SUPIKA KRITSANEEPAIBOON, M.D. Surasak Sangkhathat, M.D. Kanet Kanjanapradit, M.D. ##submission.copyrightStatement## 2019-07-28 2019-07-28 20 1 18 22 'X-ray gun' identifies sources of Song Dynasty porcelains from a shipwreck in the Java Sea Arthur Edward Brown, M.D., MPH ##submission.copyrightStatement## 2019-07-28 2019-07-28 20 1 23 27 MR lymphangiography in lymphedema <p>Lymphedema is a chronic disorder, defined as progressive and excessive accumulation of protein-rich fluid, inflammation and fibrosis in the interstitial space, resulting from impaired lymphatic drainage. It is vulnerable to misdiagnosis and has been badly reputed as an incurable disease. Nowadays, the lymphovenous anastomosis (LVA) is microsurgical technique for bypassing the obstructed segment of the lymphatic pathway into the venous system.<br> MR lymphangiography (MRL) is an advance imaging technique using 3D volumetric contrast-enhanced MR angiography with high temporal and spatial resolution, which can evaluate both anatomy and function of the lymphatic system. It is a quick less invasive imaging technique, which aids in diagnosis, preoperative evaluation and follow up.<br> For the experience and technical detail of MRL in PSU will be described in this article.</p> Sitthiphan Limphanudom, M.D. Piyatida Boonsin, M.D. ##submission.copyrightStatement## 2019-07-28 2019-07-28 20 1 28 34 Standard National High-Resolution Computed Tomography (HRCT) Protocol <p>Diffuse interstitial lung diseases (ILDs) include more than hundreds of diseases which have different causes or underlying, target groups, signs and symptoms, clinical courses, radiographic appearances, treatments, and prognosis. Among them, idiopathic pulmonary fibrosis (IPF) is the most fatal, with prognosis worse than many cancers. After decades of no specific treatment, new medications that may help slow the progression of the fibrosis have been introduced and approved in some countries. &nbsp;Similar to corticosteroid, anti-inflammatory and immunosuppressive drugs which are used to treat some ILDs; these antifibrotic medications could cause certain side effects. In contrast, the cost of treatment is much higher.</p> <p>To monitor ILDs in terms of incidence, demographic and geographic distributions, and life expectancy;&nbsp; T.S.T. is developing a national ILD database. To ensure that this data base will provide the most accurate information, diagnosis should be as much precise as possible.</p> <p>However, the diagnoses of most ILDs are multidisciplinary. With the facts that surgical lung biopsies are available in patients fewer than 20% in most countries<sup>1</sup>, HRCT plays important role in showing disease characters and extension. Certain HRCT patterns are accepted to replace surgical lung biopsies (SLB) in some diseases.</p> <p>Unfortunately typical diagnostic HRCT patterns to replace SLB are not possible in all cases; for example, only about half of usual interstitial pneumonia<sup>2</sup>. Initially, diagnosis could not be made in some cases whose HRCT patterns are not specific and other clinical information is not sufficient. Longitudinal study by following up HRCTs and adding subsequently exhibited clinical data, or even surgical lung biopsy, could eventually establish the diagnosis.&nbsp; These patients need a system that provide regular clinical and HRCT follow up, also the multidisciplinary team to evaluate those newly acquired clinical and radiographic information .</p> <p>As an important role in managing patients with ILDs, standard HRCT is required to ensure that the initial examination will provide sufficient radiographic information, both the initial and follow-up examinations could be compared,&nbsp; the interpretation of all examinations is reproducible, and it could be performed in most institutes.</p> <p>To develop national standard HRCT protocol; current situation of interstitial lung diseases in Thailand,the purpose to develop the protocol, and a probable draft of the standard protocol (made by the committee from RCRT) were presented to a panel consisted of thoracic radiologist experts from all parts of Thailand in a meeting held on 11 January 2019 by Foundation of Orphan and Rare Lung Disease (FORD) and Imaging Academic Outreach Center (iAOC). &nbsp;Knowledge sharing, benefits and disadvantages of the drafted protocol were discussed. Adjustment was done based on feasibility, coverage of all lung diseases, diagnostic accuracy, and radiation safety.</p> <p>The panel provided a standard protocol describing scan coverage, technique, collimation, rotation time, pitch, radiation dose, and reconstruction images. The standard protocol recommends a mandatory acquisition for the first HRCT and optional or additional ones for the follow-up or particular cases.</p> Nannapat Trisiripanit, M.D. Soraya Suntornsawat, M.D Worapan Phonkaew, M.D. ##submission.copyrightStatement## 2019-07-28 2019-07-28 20 1 35 39 Learning History Through Porcelains Supakorn Yuenyongwannchot ##submission.copyrightStatement## 2019-07-28 2019-07-28 20 1 40 44