Objective: To find out the optimal timeline for the safe disposal of radioactive wastes generated at the end of normal and anomalous productions of 18F-Fluorodeoxyglucose for positron emission tomography-computed tomography scans. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Aug to Dec 2020. Methodology: Wastes generated at the end of 18F-Fluorodeoxyglucose production were tested for residual radioactivity at 2, 12 and 24 hours after synthesis to ascertain the optimal timeline for discarding. The radiation dose at 5 cm from the surface of the container was also assessed. Results: Fifty productions were included in the study, of which 46(92%) were normal, and 4(8%) were anomalous productions. The mean activity at 2 and 24 hours after the end of synthesis was 4.102±0.831mCi and 0.0047±0.00116mCi, respectively, in normal productions and 45.125±2.332mCi and 0.005±0.00026mCi respectively in anomalous productions. The mean radiation dose at 5cm from the surface of the container at 2 and 24 hours after the end of synthesis was 8.2107±1.665mSv/h and 0.00000966±0.00000212mSv/h in normal productions and 90.32±4.66mSv/h and 0.00975±0.0005-mSv/h respectively in anomalous productions. Conclusion: The residual radioactivity in wastes was negligible 24 hours after the end of synthesis in both normal and anomalous productions. Radioactive wastes from 18F-Fluorodeoxyglucose production should, therefore, be conserved for at least 24 hours before their disposal to the environment.

Objective: To evaluate the patients' feedback for potential improvements in the patient management of PET-CT Department. Study Design: Cross-sectional survey. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi Pakistan, from Sep to Dec 2020. Methodology: A total of 350 participants were investigated in the study. Structured proforma was utilized for collecting patient feedback, and the ages ranged from 4 to 89 years. The collected data were arranged systematically to apply statistical tests using Microsoft excel. Results: Explicitly, 14(4%) patients communicated their reservations about further development in PET-CT scan practice. In this regard, 4(1.14%) patients suggested overall improvement in the department. Further, 4(1.14%) and 3(0.86%) patientss’ suggestions were towards staff behaviour and building of the department, respectively. Additionally, 2(0.57%) patients were not contented with the available prerequisite equipment, and 1(0.29%) patient suggested a reduction in scanning charges. Conclusion: More than 95% patients were satisfied with their experience. The studied data can be utilized to establish patient management protocols for similar PET-CT departments.

Objective: To determine the spectrum of diseases on F-18 FDG PET/CT imaging at the Armed Forces Institute of Radiology and Imaging, Rawalpindi. Study Design: Cross-sectional study. Place and Duration of the Study: PET/CT and Cyclotron Department, Armed Forces Institute of Radiology and Imaging,Rawalpindi Pakistan, from Jul 2019 to Mar 2021. Methodology: The patients were scanned for staging, restaging, interim/response assessment and relapse/recurrence purposes. In addition, the frequency of various cancers and types of scans were determined. Scanning has been performe using GE Health care MiDR PET-CT Scanner. Results: A total of 1573 patients were included in the study. Male patients were 927(58.93%), and female patients were 646(41.06%). The most common diseases encountered were lymphoma 623(39.6%), breast cancer 193(12.2%), lung cancer 12(7.6%), colorectal cancer 88(5.5%) and unknown primary 84(5.3%). Amongst lymphoma, Non-Hodgkin’s lymphoma was the most common 276(44.3%), followed by Hodgkin’s lymphoma 267(42.8%). Conclusion: F-18 FDG PET/CT hybrid imaging is an important modality and can significantly alter patient management plans. Lymphomas were the most common disease in our spectrum, followed by cancers of the breast, lungs, colon-rectum and unknown primary cases, which can be managed well by PET/CT’s routine utilization.

Introduction: High grade B-cell lymphoma and diffuse large B cell exhibiting myelocytoma (MYC) translocation with B-cell lymphoma 2 (BCL2) and/or B-cell lymphoma 6 (BCL6) re-arrangements, also known as double and triple hit lymphomas, are aggressive entities. World Health Organization update 2017 includes this cytogenetically defined category of “High grade B cell lymphoma with myelocytoma MYC and BCL2 and/or BCL6 rearrangements” as a distinct entity on their own. We present an interesting case of an obese patient presenting with a neck mass, suspected to be an aggressive thyroid carcinoma, which eventually turned out to be a high grade B-cell lymphoma. Case description: A 64 years-old male presented with complaints of neck pain for 10 weeks and a huge swelling in front of neck for 4 weeks. Respiratory system evaluation revealed cough, pleuritic pain and expectoration. Rest of the systemic review was unremarkable. Baseline reports showed hypothyroid status. Ultrasonography (USG) thyroid showed right upper pole Thyroid Imaging Reporting and Data Systems - 4 (TIRADS-4) nodule with bilateral cervical lymphadenopathy for which correlation with fine needle aspiration cytology (FNAC) was advised. Magnetic resonance imaging (MRI) films were submitted for review which showed overall features of locally invasive primary thyroid malignancy. Case was discussed in a multi-disciplinary team (MDT) meeting and suspicion arose of non-thyroidal origin of tumor. Patient underwent Positron emission tomography/computed tomography (PET/CT) as per MDT recommendations. PET/CT findings were highly suggestive of lymphomatous disease as opposed to thyroidal malignancy suspicion early on, which was confirmed on histopathology of cervical nodes. Practical implications: High grade B-cell lymphoma is an aggressive entity and can be very deceptive in its presentation, as evident from this case report. Functional imaging modalities such as Fluorodeoxyglucose (F-18 FDG) PET/CT can provide crucial assistance in unmasking a deceptive disease entity masquerading as some other, thus changing the management plan completely.