Nepal is also affected by Corona Virus Disease (COVID-19) pandemic which is likely to last for several months. The Reverse Transcriptase-Polymerase Chain Reaction is the current gold standard diagnostic test. Chest X-ray or Computed Tomography scan is considered inappropriate according to most society recommendations for screening though are emerging as frontline diagnostic modalities in conjunction with clinical history and laboratory parameters.Multiple guidelines have been released by prominent radiological societies worldwide to facilitate preparedness of radiology department in the war against COVID-19. Based on these, the Nepal Radiologists’ Association has proposed its guidelines, endorsed by the Nepal Medical Council, practical in our context, with the aim to limit exposure to the infection while ensuring best use of imaging, protection of health care personnel and other patients and maintenance of uninterrupted radiology department operations.This review article aims to summarize the highlights from various guidelines focusing on role of chest X-ray and Computed Tomography including the indications, specific findings, reporting format and important differentials and also addresses the safety issues.

Introduction: Subpubic angle, an important parameter used for sex determination in the pelvis, is the angle between two inferior pubic rami below the symphysis pubis. This study was carried out to determine the subpubic angle among the individuals referred for pelvic and KUB radiographs in the department of Radiology and Imaging, Tribhuvan University, Teaching Hospital.Methods: Prospective cross-sectional study was done on 120 individuals. The subpubic angle was measured by drawing two tangent lines on the inferior border of the pubic rami. The subpubic angle of both sexes was measured. An independent sample t-test for equality of means was used to determine the difference between the two sexes regarding the subpubic angle. The correlation between the subpubic angle and the age of subjects was obtained using Pearson Correlation Coefficients in males and females.Results: The range of the subpubic angle in male was 82o to 122° and the mean was 104.72°±10.47°. In females, the range was 96o to 159° and the mean was 137.15°±11.92° with a significant statistical difference from the angle in male (p<0.05). The subpubic angle was not significantly correlated with age in males (r=0.029, p=0.824) whereas, in females, the correlation of subpubic angle with age was significant (r=-0.303, p=0.019).Conclusion: The mean subpubic angle was significantly wider in females than in males in this study. We found a weak negative correlation between subpubic angle and age in females whereas in the male there was no correlation between age and subpubic angle.

Introduction: CT guided biopsy is essential for histopathological diagnosis of suspicious lung nodule, which are not amenable for either bronchoscopic or sonography guided sampling. Methods: Twenty eight patients with suspicious lung nodules not amenable for bronchoscopic or sonography guided sampling who underwent CT guided lung biopsy with 18 G coaxial semiautomatic core biopsy needle in one year were retrospectively studied for diagnostic yield and complications. Results: Out of 28 patients, who underwent CT guided lung nodule biopsy, 18 were male and 10 were female. The age ranged from 22 to 80 years. Lesion size ranged from one cm to four cm and depth of lesion from pleura ranged from zero cm to five cm. Diagnostic yield of our core needle biopsy was 26(92.3%). Clinically significant complication was low. Massive pneumothorax which needed intercostal drainage was 7.14% (2 patients). Pulmonary hemorrhage manifesting as hemoptysis was seen in 14.3 %( 2 patients). No hemothorax or air embolism was noted in any of the patient. Conclusion: CT guided lung lesion biopsy with 18 G coaxial semi-automatic core biopsy needle is a safe procedure with good diagnostic yield and relatively low incidence of clinically significant complications.

Introduction: Pregnancy is one of the predisposing factors for carpal tunnel syndrome, which may manifest as swelling of the median nerve. The purpose of this study was to obtain the mean cross-sectional area of median nerve using ultrasound in pregnant females at carpal tunnel inlet and its variations with different trimesters. Methods: A total of 102 pregnant females at first, second and third trimesters were evaluated for median nerve with ultrasonography. Mean cross sectional area of median nerve was calculated in both hands by using two methods- direct and indirect. The study was conducted after obtaining ethical clearance from Institutional Review Board of Institute of Medicine, and after obtaining the written informed consent from the subjects. Convenience sampling technique was used. Data obtained were compiled and analyzed using SPSS. Results: The overall mean cross-sectional area was 6.84±1.09 mm2 using direct method and 7.09±1.19 mm2 using indirect method. The values obtained with indirect method were greater than that obtained with direct method. Mean cross-sectional area of the median nerve were higher at third trimester in both hands and by both direct and indirect methods. Conclusions: From the study conducted, the normal value of mean cross-sectional area of median nerve in pregnant females was established.

Introduction: Variation in Circle of Willis is a commonly encountered entity in patients undergoing computed tomography angiography, identification of which is crucial in the management of patients with vascular pathologies. The aim of the study was to find out the anatomical variations in the Circle of Willis in patients undergoing Computed Tomography cerebral angiography in a tertiary hospital in Nepal. Methods: This is a descriptive cross-sectional study involving 95 patients using convenient sampling techniques who were sent to the Department of Radiology and Imaging, Tribhuvan University Teaching hospital, for further evaluation of suspected vascular pathologies in the brain from April 2017 to September 2017. Ethical approval was taken from the Institutional Review Committee of the Institute of Medicine with reference number 326 (6-11-E). CT angiographic images of these patients were evaluated for the presence of variations in Circle of Willis, aneurysms, and other vascular pathologies. Data were analyzed using SPSS. Results: Among 95 subjects included in the study, the anatomical variations in the arteries of Circle of Willis was seen in 52 (54.7%) patients, hypoplastic posterior communicating artery being the most common variation 33 (34.7%). The aneurysm was seen in 22 (23.2%) of cases. Conclusions: CT Angiography is a commonly performed imaging modality for suspected cases of cerebral aneurysms and various other vascular pathologies. Multidetector computed tomography can effectively detect variations in arteries of Circle of Willis, recognition of which is crucial in operative management of vascular pathologies.